Impact of Health Insurance Type on Health Care Utilization in Patients with Acute Cerebral Infarction

ABSTRACT

BACKGROUND: Previous research has revealed that the type of health insurance significant impacts health-care utilization and patient health. The aim of this study was to describe and compare hospital service utilization and charges of inpatients with acute cerebral infarction among patients using two types of health insurance National Health Insurance (NHI) and Medical Aid (MA). METHODS: The demographic, clinical, health-service utilization, and payment data of 1600 patients were analyzed. The patients were admitted within 7 days after the onset of stroke symptoms. Two insurance groups were compared in terms of patient characteristics and hospital charges using the chi-square test or the t-test. The significance of the impact of the health-insurance type on health-care utilization was tested after controlling for other related factors, using regression models. RESULTS: At the time of admission, the patients' gender, age, and stroke subtype differed significantly between the two insurance groups, whereas there were no differences in risk factors, admission route, referral status, or severity. There were no significant differences in treatments, length of stay, and referral status during their hospital stay. The total hospital charges and daily charges were significantly higher for patients with NHI than for patients with MA. In particular, significant differences were found in the categories of room and board, injection, laboratory tests, and imaging studies. CONCLUSIONS: There were significant differences between NHI and MA in terms of patient demographic characteristics, health-care utilization, and inpatient charges. Patients with NHI had higher hospital charges, especially in the categories of room and board and imaging tests.