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Nationwide trends in stroke hospitalization over the past decade

Article information

J Korean Med Assoc. 2012;55(10):1014-1025
Publication date (electronic) : 2012 October 17
doi : https://doi.org/10.5124/jkma.2012.55.10.1014
Young Dae Kwon, MD1, Hyejung Chang, PhD2, Youn Jung Choi, PhD3, Sung Sang Yoon, MD4
1Department of Humanities and Social Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
2Department of Health Services Administration, Kyung Hee University School of Management, Seoul, Korea.
3Health Insurance Review & Assessment Service, Seoul, Korea.
4Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea.
Corresponding author: Sung Sang Yoon, hsyoon96@medimail.co.kr
Received 2012 August 31; Accepted 2012 September 11.

Abstract

Stroke is a major health problem in Korea. It is the second leading cause of death, and many stroke survivors are permanently disabled. Despite the high economic and social burden of stroke, little is known about utilization of health care services for sufficiently long follow-up periods. This study assessed nationwide patterns of hospitalization for inpatients with stroke from 2000 to 2010, using national health insurance claim data. Overall, during these 10 years, the number of stroke hospitalizations grew by a compound annual growth rate of 6.4%, and health care expenditures showed continued growth at a faster rate of 13.2%. These growth trends were also consistent in different types of hospitals as well as different stroke subtypes. However, the utilization patterns of inpatient services were different across hospital types, especially in lengths of hospital stay (LOS), health care expenditures, and proportions of stroke subtypes. Concerning the proportion of patients in different types of hospitals, there were sharp increases in the use of long-term care hospitals from 5% to 20% of all stroke patients while the proportion has decreased from 49% to 39% in general hospitals. The LOS was also different across hospital types: The longest average LOS of 49 days was shown in long-term care hospitals, while the tertiary hospitals showed the shortest LOS of 15. In conclusion, despite a continuing decline in stroke mortality due to improved survival, the burden of disease due to stroke is increasing. To manage this issue, monitoring the trends of health care expenditures in detail, as well as the incidence and mortality rates, would be useful. These efforts will result in understanding the factors contributing to the increasing burden and in identifying the efficient and effective utilization of limited health care resources.

Keywords: Stroke; Hospitalization; Trends

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Copyright © 2012 Korean Medical Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1

Figure 1

Utilization of inpatient services and age distribution by stroke type (unit: year). TIA, transient ischemic attack; SAH, subarachnoid hemorrhage; ICH, intracerebral hemorrhage.

Figure 2

Figure 2

Average length of stay of stroke inpatients by stroke type (unit: day). ICH, intracerebral hemorrhage; SAH, subarachnoid hemorrhage; TIA, transient ischemic attack.

Figure 3

Figure 3

Average total cost of stroke inpatients by stroke type (unit: 1 million Korean won). ICH, intracerebral hemorrhage; SAH, subarachnoid hemorrhage; TIA, transient ischemic attack.

Figure 4

Figure 4

Average length of stay of stroke inpatients by hospital level (unit: day).

Figure 5

Figure 5

Average total cost of stroke inpatients by hospital level (unit: 1 million Korean won).

Table 1

General characteristics of stroke admissions

Table 1

ICH, intracerebral hemorrhage; SAH, subarachnoid hemorrhage; TIA, transient ischemic attack; KRW, Korean won.

a)March to December, 2000.

b)January to June, 2010.

Table 2

Proportion of stroke type for inpatients by hospital level

Table 2

Values are presented as percent.

ICH, intracerebral hemorrhage; SAH, subarachnoid hemorrhage; TIA, transient ischemic attack.

Table 3

Mean of length of stay, cost per admission and daily cost of stroke inpatients

Table 3

LOS, length of stay; ICH, intracerebral hemorrhage; SAH, subarachnoid hemorrhage; TIA, transient ischemic attack; KRW, Korean won.