Patterns of Medical Utilization in Children, Adolescents, and Young Adults With Life-Limiting Conditions in Korea: A Cohort Study Based on National Health Insurance Data

초록

Background: Children, adolescents, and young adults (CAYAs) with severe illnesses require intensive treatment, often relying on medical devices and advanced medical services. Modern medical technology has improved the lifespans of these patients. In addition, CAYAs represent a vulnerable group, resulting in a significant caregiving burden on the entire family.This study examined patterns of medical utilization following diagnosis of a life-limiting condition (LLC).Methods: We establish a cohort of 176,236 CAYAs who were first diagnosed with an LLC using National Health Insurance data between 2011 and 2013. Patients diagnosed with an LLC within the 3 years preceding this period and those who had died were excluded, and only those receiving care at a general medical hospital were included. In total, 25,410,411 claims for medical expenses, outpatient visits, and lengths of stay for medical utilization over the approximately 10 years up to 2020 were investigated (2.3% inpatients, 97.7% outpatients).Results: The average annual medical utilization per LLC patient among CAYAs following initial diagnosis included medical expenses of $1,163,16.8outpatientvisits,and18.7daysofadmission.Amonginpatients,cancerpatientsaveraged$5,340 for total medical expenses and 21.0 days of admission, while non-cancer patients averaged $3,013and18.1days,respectively.TheoverallaveragemedicalexpensesduringthefirstyearfollowingdiagnosisofanLLCwere$3,012, whereas for cancer patients they were $5,962. In addition, there was a sharp increase in total medical expenses as death approached, particularly in the last month of life, with a considerable proportion attributable to critical-care treatments.Conclusion: Our investigation into medical utilization by CAYAs with an LLC in Korea provides a foundation for healthcare policy development. Timely treatment at each stage and tailored policies that take into account the heterogeneity among diseases are of paramount importance.

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