Changes in Health Care Utilization and Medical Expenditures among the Visually Disabled

Abstract

Purpose: To identify changes in medical expenditures and health care utilization before and after visual impairment onset, then analyze differences according to visual impairment severity.Methods: Patients aged ≥ 18 years who were registered as visually disabled from 2005 to 2013 were selected using the database from the registry of the disabled and the National Health Insurance Service. The observation period of 3 years before and after the registration was divided into 6-month units (12 points of interest). At each point of interest, medical cost, number of outpatient visits, and length of hospital stay (LOS) were analyzed. The control group was obtained through 1:10 stratification randomization to match sex and age; individuals in the control group were then selected via 1:1 propensity score matching for the premium quantile and residential area.Results: In total, 131,434 patients with visual disability and the same number of non-visually impaired controls were included. Compared with non-disabled individuals, the mean medical cost and number of outpatient visits were higher for patients with visual disability (1.9- and 1.4-fold, respectively, <i>p</i> < 0.001); the LOS was also 3.5 days longer (<i>p</i> < 0.001). The mean medical cost and number of outpatient visits were greater in severely visually disabled patients than in mildly disabled patients (1.6- and 0.5-fold, respectively, <i>p</i> < 0.001); the LOS was also 12 days longer in severely disabled patients (<i>p</i> < 0.001). From 18 months before disability registration, medical costs and LOS increased according to the presence and severity of visual disability; the number of outpatient visits increased uniformly, regardless of disability and severity.Conclusions: More severe cases of visual impairment are associated with greater health care utilization and expenditures. Policy intervention is necessary to ensure that patients receive appropriate treatment and steady health care by reducing the burden of medical expenditures.