Effect of national health insurance benefit extension policy on long-term outcomes of ventilated patients with pneumonia: a nationwide cohort study

The purpose of this study was to evaluate the relationship between 1-year mortality and health insurance benefit extension policy items in severe pneumonia patients requiring mechanical ventilation using a South Korean nationwide cohort. This study was conducted using the Korean National Health Insurance database. A total of 1,099 patients (542 patients in the health insurance benefit item group and 557 patients in the control group) were included. The primary outcome was 1-year mortality. Among patients with health insurance benefit extension policy items, 203 patients (37.5%) were diagnosed with hemato-oncological disease, who were categorized as group A, and 339 patients (62.5%) were diagnosed with cerebrovascular, cardiovascular, or rare diseases, who were categorized as group B. Group B had lower 1-year mortality (50.7% vs. 62.5%, P < 0.001), higher total medical expenditure (median: 31,543 vs. 18,132 U.S. dollars [USD], P < 0.001), and lower out-of-pocket medical expenditure (median: 2,835 vs. 3,318 USD, P < 0.001) than the control group. Cox regression analysis revealed that group B benefit items were associated with lower 1-year mortality (hazard ratio, 0.697; 95% confidence interval, 0.580–0.836; P < 0.001). The results suggest that the health insurance benefit extension policy was associated with use of more medical resources and lower 1-year mortality.