Korea Journal of Hospital Management (한국병원경영학회지)

Korean Society of Hospital Management (한국병원경영학회)
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Impact of Adjusted Out-of-Pocket Maximum Rules of Long-stay Admissions in Long-Term Care Hospitals

요양병원 장기입원에 대한 본인부담상한제 개편 영향 분석

  • Yeojeong Gu (Health Insurance Research Institute, National Health Insurance Service) ;
  • Seungji Lim (Health Insurance Research Institute, National Health Insurance Service)
  • 구여정 (국민건강보험공단 건강보험연구원) ;
  • 임승지 (국민건강보험공단 건강보험연구원)
  • Received : 2024.04.08
  • Accepted : 2024.05.30
  • Published : 2024.06.30
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Abstract

Purpose: This study aimed to determine the effect of adjusted out-of-pocket maximum rules in the 'differential co-payment ceiling', which means having a higher burden of co-payment, that expanded to the entire ceiling level in long-stay admission patients in long-term care hospitals(LTCH). Methodology: We used health insurance claim data between January 1, 2022, and December 31, 2022 received from the National Health Insurance Service. The study populations were inpatients in long-term care hospitals more than 1 days during the study period. We performed the difference in characteristics of the LTCH patient of the differential and general ceiling by the chi-square test. We estimated the change of the population, cost, and co-payments per person under the assumption of restructuring. Finding: Based on adjusted out-of-pocket maximum rules in 2023, it was expected that the number of benefits decreases at the high-income level while increasing at the low-income level. The burden of health expenditure after reimbursement of co-payment ceiling, is expected to increase by 65.1% in the highest medical necessity, whereas the low medical necessity would decreases compared to 2022. Practical Implications: The results demonstrate that the current out-of-pocket maximum rules do not reflect the needs of medical necessity. This study suggested the need to reflect the medical necessity in LTCH on the out-of-pocket maximum rules in the future.

Keywords

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