Kim Sun Jung, Park Eun-Cheol, Kim Tae Hyun, Yoo Ji Won, Lee Sang Gyu
Department of Health Administration, Namseoul University, Cheonan, Korea.
Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea.; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2015 May;56(3):853-61. doi: 10.3349/ymj.2015.56.3.853.
This study compared in-hospital mortality within 30 days of admission, lengths of stay, and inpatient charges among patients with heart failure admitted to public and private hospitals in South Korea.
We obtained health insurance claims data for all heart failure inpatients nationwide between November 1, 2011 and May 31, 2012. These data were then matched with hospital-level data, and multi-level regression models were examined. A total of 8406 patients from 253 hospitals, including 31 public hospitals, were analyzed.
The in-hospital mortality rate within 30 days of admission was 0.92% greater and the mean length of stay was 1.94 days longer at public hospitals than at private hospitals (mortality: 5.18% and 4.26%, respectively; LOS: 12.08 and 10.14 days, respectively). The inpatient charges were 11.4% lower per case and 24.5% lower per day at public hospitals than at private hospitals. After adjusting for patient- and hospital-level confounders, public hospitals had a 1.62-fold higher in-hospital mortality rate, a 16.5% longer length of stay, and an 11.7% higher inpatient charge per case than private hospitals, although the charges of private hospitals were greater in univariate analysis.
We recommend that government agencies and policy makers continue to monitor quality of care, lengths of stay in the hospital, and expenditures according to type of hospital ownership to improve healthcare outcomes and reduce spending.
本研究比较了韩国公立和私立医院收治的心力衰竭患者入院后30天内的院内死亡率、住院时间和住院费用。
我们获取了2011年11月1日至2012年5月31日期间全国所有心力衰竭住院患者的医疗保险理赔数据。然后将这些数据与医院层面的数据进行匹配，并检验多级回归模型。共分析了来自253家医院的8406例患者，其中包括31家公立医院。
公立医院入院后30天内的院内死亡率比私立医院高0.92%，平均住院时间比私立医院长1.94天（死亡率分别为5.18%和4.26%；住院时间分别为12.08天和10.14天）。公立医院的每例住院费用比私立医院低11.4%，每天的费用低24.5%。在对患者和医院层面的混杂因素进行调整后，尽管在单因素分析中私立医院的费用更高，但公立医院的院内死亡率比私立医院高1.62倍，住院时间长16.5%，每例住院费用高11.7%。
我们建议政府机构和政策制定者继续根据医院所有制类型监测医疗质量、住院时间和支出，以改善医疗结果并减少开支。
