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This study quantitatively analyzes the effects of employment patterns at the time of death of the elderly on the utilization of medical care before death using the cohort data from the National Health Insurance Corporation, controlling mortality to obtain more accurate results. Gender was coded as 0 for males and 1 for females, and average monthly household income was taken as a logarithm to approximate a normal distribution. Care cost at the end of life was defined as the sum of the national health insurance contributions and statutory self-contributions. To measure proximity to death, deceased elderly were divided by the period from last hospital visit to death (except any hospital visit at time of death). We distinguished regular workers, irregular workers, self-employed and employers, unpaid family workers, and unemployed. The data used in this study are sample cohort data from the National Health Insurance Corporation. We examined the relationships between variables through 4 models using negative binomial regression. The effects of employment status on health status were analyzed and adjusted for demographic characteristics, socioeconomic status, and proximity to death. As the dependent variable, medical expenses were taken for 1 year before death. In this study, care costs at end of life were higher when children were economically independent and when the respondent was more educated, had high economic level, and had high average monthly household income. In addition, employment security also had a significant impact on care cost at end of life: Irregular workers spent significantly less than regular workers. The fact that care cost at end of life is differentiated according to employment status suggests that individuals' health exists within a social context, which may also constrain it: There is a risk that people's health status will become determined by socioeconomic status.
This article was published in the following journal.
Name: Inquiry : a journal of medical care organization, provision and financing
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The personal cost of acute or chronic disease. The cost to the patient may be an economic, social, or psychological cost or personal loss to self, family, or immediate community. The cost of illness may be reflected in absenteeism, productivity, response to treatment, peace of mind, QUALITY OF LIFE, etc. It differs from HEALTH CARE COSTS, meaning the societal cost of providing services related to the delivery of health care, rather than personal impact on individuals.
A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. Cost effectiveness compares alternative ways to achieve a specific set of results.
Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.
A scheme which provides reimbursement for the health services rendered, generally by an institution, and which provides added financial rewards if certain conditions are met. Such a scheme is intended to promote and reward increased efficiency and cost containment, with better care, or at least without adverse effect on the quality of the care rendered.
A quality-of-life scale developed in the United States in 1972 as a measure of health status or dysfunction generated by a disease. It is a behaviorally based questionnaire for patients and addresses activities such as sleep and rest, mobility, recreation, home management, emotional behavior, social interaction, and the like. It measures the patient's perceived health status and is sensitive enough to detect changes or differences in health status occurring over time or between groups. (From Medical Care, vol.xix, no.8, August 1981, p.787-805)
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