Yoo Wanho, Jang Hyojin, Lee Min Ki, Kim Yeongdae, Jungmin Son, Jinmi Kim, Lee Kwangha
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Pusan National University Hospital, Busan, Korea.
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
Medicine (Baltimore). 2025 Sep 19;104(38):e44687. doi: 10.1097/MD.0000000000044687.
Patients with severe pneumonia requiring mechanical ventilation often face substantial clinical and financial burdens. In South Korea, the National Health Insurance benefit extension policy provides expanded coverage for individuals with specific disease categories. This study aimed to examine the association between this policy and long-term outcomes in ventilated patients with pneumonia using a nationwide cohort. We conducted a retrospective cohort study using data from the Korean National Health Insurance Service database. Adult patients admitted to the intensive care unit for pneumonia and treated with mechanical ventilation between January 2016 and December 2018 were included. Patients were categorized into 2 groups: those with benefit items under the health insurance benefit extension policy (n = 542) and those without such items (n = 557). The primary outcome was 1-year all-cause mortality. Secondary outcomes included medical expenditures, vasopressor and renal-replacement therapy use, and length of intensive care unit and hospital stay. Among the 1099 patients analyzed, those with benefit items showed no mortality benefit compared to those without benefit items (61.3% vs 62.5%, P = .722). In subgroup analysis, patients with benefit items related to cerebrovascular, cardiovascular, or rare diseases demonstrated significantly lower mortality (50.7%) than patients without benefit items. Multivariable Cox regression showed that the presence of these benefit items was associated with a reduced risk of 1-year mortality (hazard ratio, 0.712; 95% confidence interval, 0.611-0.857; P = .010). Patients with benefit items also showed increased use of medical resources and reduced out-of-pocket expenditures. In this nationwide retrospective cohort, the presence of health insurance benefit extension items was associated with lower 1-year mortality and greater utilization of medical resources among ventilated patients with pneumonia. These findings highlight potential implications of insurance policy design on outcomes in critically ill populations.
需要机械通气的重症肺炎患者往往面临巨大的临床和经济负担。在韩国，国民健康保险福利扩展政策为特定疾病类别的个人提供了扩大的保险范围。本研究旨在使用全国队列研究来检验该政策与肺炎通气患者长期预后之间的关联。我们使用韩国国民健康保险服务数据库的数据进行了一项回顾性队列研究。纳入了2016年1月至2018年12月期间因肺炎入住重症监护病房并接受机械通气治疗的成年患者。患者被分为两组：有健康保险福利扩展政策下福利项目的患者（n = 542）和没有此类项目的患者（n = 557）。主要结局是1年全因死亡率。次要结局包括医疗支出、血管活性药物和肾脏替代治疗的使用，以及重症监护病房和住院时间。在分析的1099例患者中，有福利项目的患者与没有福利项目的患者相比，没有死亡率获益（61.3%对62.5%，P = 0.722）。在亚组分析中，与脑血管、心血管或罕见疾病相关福利项目的患者死亡率显著低于没有福利项目的患者（50.7%）。多变量Cox回归显示，这些福利项目的存在与1年死亡率风险降低相关（风险比，0.712；95%置信区间，0.611 - 0.857；P = 0.010）。有福利项目的患者还显示出医疗资源使用增加和自付费用减少。在这项全国性回顾性队列研究中，健康保险福利扩展项目的存在与肺炎通气患者较低的1年死亡率和更高的医疗资源利用率相关。这些发现突出了保险政策设计对危重症人群结局的潜在影响。
