Journal List > J Korean Soc Hypertens > v.20(1) > 1089824

J Korean Soc Hypertens. 2014 Mar;20(1):8-20. Korean.
Published online March 31, 2014.  https://doi.org/10.5646/jksh.2014.20.1.8
Copyright © 2014. The Korean Society of Hypertension
Analysis for the Patterns of Medical Care Utilization during 19 Years (1990-2008) and Its Related Factors in Hypertensive Patients Using National Patient Survey in Korea
Nam Wook Hur, PhD, and Hyeon Chang Kim, PhD
Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author (Email: namwookhur@gmail.com )
Received February 10, 2014; Revised March 04, 2014; Accepted March 10, 2014.

Abstract

Background

To analyze the patterns of medical care utilization and its related factors in hypertensive patients during 19 years (1990-2008), utilizing national patient survey in Korea.

Methods

Using seven surveyed data, age-standardized medical care utilization increasing ratios for the inpatients and outpatients compared to the year of 1990 were calculated, respectively. Changes of medical facilities (%) of patients used in 1990, 1999, and 2008 were compared. For the outpatients, median length of stay and discharge mortality rate per 1,000 persons were calculated. Multivariate logistic regression methods were used to identify related factors of the resident patients and the comparison characteristics between hypertensives and the others of all subjects. Sample weights were used.

Results

The medical care utilization of hypertensives were increased for both inpatients and outpatients. However, the ratios were dramatically diminished after the standardization. Age-standardized ratios were 3.6 in outpatients and 5.9 in inpatients compared to 1990. For the outpatients, mainly used medical facilities were changed from general hospital to convalescent hospital. Also, median length of stay and discharge mortality rate were increased up to 5 times and 4 times compared to 1990. The odds of being resident patients were related with discharge as death and using oriental medical center convalescent hospital in 2008. Hypertensive patients were older than the others. Confined to hypertensive patients, member of National Health Insurance was more tend to be outpatients but less inpatients.

Conclusions

Aging population and long-term care Act were presumed as the main reason for the increasing of medical care utilization in 1990 to 2008.

Keywords: Hypertension; Utilization review; Health care surveys

Figures


Fig. 1
Comparison the ratios for the number of medical care users as hypertensives per day compared to the year of 1990 according to the age groups and standardization. Standardization using standard population in Korean in 2005. (A-D) Outpatients data by life cycle age groups from 1990 to 2008. (E-H) Inpatients data by life cycle age groups from 1990 to 2008.
Click for larger image


Fig. 2
Comparison the ratios for the number of medical care users per day as hypertensives compared to the year of 1990 according to the gender. All the p for trends are < 0.001. Standardization using standard population in Korea in 2005. (A) Outpatients men and (B) women data from 1990 to 2008. (C) Inpatients men and (D) women data from 1990 to 2008.
Click for larger image


Fig. 3
Changes of using type of medical facilities (%) by year of 1990, 1999, and 2008. (A) Total outpatients. (B) Confined to ≥ 65 years outpatients. (C) Total Inpatients. (D) Confined to ≥ 65 years inpatients.
Click for larger image

Tables


Table 1
Pre- and post-standardized number of hypertensive patients using medical care utilization per day
Click for larger image


Table 2
Median length of stay and mortality rate of inpatients
Click for larger image


Table 3
Factors for resident patients by year of 1994, 1999, and 2008
Click for larger image


Table 4
Major characteristics of hypertensive patients among total medical care utilization patients by year of 1990 1999, and 2008
Click for larger image

Notes

No potential conflict of interest relevant to this article was reported.

Appendix 1

Total subjects number of surveyed patients each year (including hypertensives)

References
1. Ried LD, Johnson RE, Brody KK, Vogt TM. Medical care utilization among older HMO members with and without hypertension. J Am Geriatr Soc 1995;43:222–229.
2. Ministry of Health and Welfare. 2008 National health statistics: 4th Korean National Health and Nutrition Survey (2008). 2009. pp. Seoul-Ministry of Health and Welfare.
3. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217–223.
4. Yoon SJ, Ha BM, Kim C. Measuring the burden of hypertension using DALY in Korea. Korean J Health Policy Adm 2001;11:89–101.
5. Health Insurance Review & Assessment Service. Statistical report. Seoul: Health Insurance Review & Assessment Service; 2010.
6. Kim SG, Kim S, Park W. Prevalence and management status of hypertension in Korea. J Korean Soc Hypertens 2006;12:7–15.
7. Doh SR. Transition of the change of medical utilization in Korea. Health Welf Issue Focus 2009;8:1–8.
8. Doh SR. Medical utilization of the aged: issues and policy tasks. Health Welf Policy Forum 2009;(157):66–79.
9. Ministry of Health and Welfare. 2008 National patient survey. Seoul: Ministry of Health and Welfare; 2009.
10. King DE, Ellis TM, Everett CJ, Mainous AG 3rd. Medication use for diabetes, hypertension, and hypercholesterolemia from 1988-1994 to 2001-2006. South Med J 2009;102:1127–1132.
11. Wu PH, Yang CY, Yao ZL, Lin WZ, Wu LW, Chang CC. Relationship of blood pressure control and hospitalization risk to medication adherence among patients with hypertension in Taiwan. Am J Hypertens 2010;23:155–160.
12. Kim JS, Lee HC, Yoo WS, Yoo UH. Mean blood pressure, prevalence and epidemiologic characteristics of hypertension among representative Korean adult population. J Korean Soc Hypertens 1998;4:89–98.
13. Lee YJ, Nam CM, Kim HC, Hur NW, Suh I. The association between obesity indices in adolescence and carotid intima-media thickness in young adults: Kangwha Study. J Prev Med Public Health 2008;41:107–114.
14. Choi DP, Lee JY, Ahn V, Kim HC. Association between pulse pressure and carotid intima-media thickness in healthy adolescents: Jangseong High School Study. J Korean Soc Hypertens 2012;18:29–37.
15. Song H, Jan S, Shin S. Patterns of medical care utilization behavior and related factors among hypertensive patients: follow-up study using the 2003-2007 Korean health insurance claims data. Korean J Health Educ Promot 2012;29:1–12.
16. Johnson RE, Ried LD, Vogt TM. Comparing health-related indicators of very old hypertensives and nonhypertensives in an HMO. J Aging Health 1994;6:535–548.
17. Park JK, Kim KS, Kim CB, Lee TY, Lee K, Lee DH, et al. The accuracy of ICD codes for cerebrovascular diseases in medical insurance claims. Korean J Prev Med 2000;33:76–82.