Association between health insurance benefit extension policy and long-term outcomes in ventilated pneumonia patients: Analysis of a nationwide dataset

Patients with severe pneumonia requiring mechanical ventilation often face substantial clinical and financial burdens. In South Korea, the National Health Insurance benefit extension policy provides expanded coverage for individuals with specific disease categories. This study aimed to examine the association between this policy and long-term outcomes in ventilated patients with pneumonia using a nationwide cohort. We conducted a retrospective cohort study using data from the Korean National Health Insurance Service database. Adult patients admitted to the intensive care unit for pneumonia and treated with mechanical ventilation between January 2016 and December 2018 were included. Patients were categorized into 2 groups: those with benefit items under the health insurance benefit extension policy (n = 542) and those without such items (n = 557). The primary outcome was 1-year all-cause mortality. Secondary outcomes included medical expenditures, vasopressor and renal-replacement therapy use, and length of intensive care unit and hospital stay. Among the 1099 patients analyzed, those with benefit items showed no mortality benefit compared to those without benefit items (61.3% vs 62.5%, P = .722). In subgroup analysis, patients with benefit items related to cerebrovascular, cardiovascular, or rare diseases demonstrated significantly lower mortality (50.7%) than patients without benefit items. Multivariable Cox regression showed that the presence of these benefit items was associated with a reduced risk of 1-year mortality (hazard ratio, 0.712; 95% confidence interval, 0.611-0.857; P = .010). Patients with benefit items also showed increased use of medical resources and reduced out-of-pocket expenditures. In this nationwide retrospective cohort, the presence of health insurance benefit extension items was associated with lower 1-year mortality and greater utilization of medical resources among ventilated patients with pneumonia. These findings highlight potential implications of insurance policy design on outcomes in critically ill populations.