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Lee, Weon-Young; Shaw, Ian (2014)
Publisher: MDPI
Journal: International Journal of Environmental Research and Public Health
Languages: English
Types: Article
Subjects: health care utilization, R, Medicine, social health insurance, equity, catastrophic health expenditure, out-of-pocket payments, Article
The global financial crisis of 2008 has led to the reinforcement of patient cost sharing in health care policy. This study aimed to explore the impact of direct out-of pocket payments (OOPs) on health care utilization and the resulting financial burden across income groups under the South Korean National Health Insurance (NHI) program with universal population coverage. We used the fourth Korean National Health and Nutrition Examination Survey (KNHNES-IV) and the Korean Household Income and Expenditure Survey (KHIES) of 2007, 2008 and 2009. The Horizontal Inequity Index (HIwv) and the average unit OOPs were used to measure income-related inequity in the quantitative and qualitative aspects of health care utilization, respectively. For financial burden, the incidence rates of catastrophic health expenditure (CHE) were compared across income groups. For outpatient and hospital visits, there was neither pro-poor or pro-rich inequality. The average unit OOPs of the poorest quintile was approximately 75% and 60% of each counterpart in the richest quintile in the outpatient and inpatient services. For the CHE threshold of 40%, the incidence rates were 5.7%, 1.67%, 0.72%, 0.33% and 0.27% in quintiles I (the poorest quintile), II, III, IV and V, respectively. Substantial OOPs under the NHI are disadvantageous, particularly for the lowest income group in terms of health care quality and financial burden.
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    • 1. Busse, R.; Schlette, S. Health Policy Developments Issue 7/8. In Focus on Prevention, Health and Aging, New Health Professions; Verlag Bertelsmann Stiftung: Gütersloh, German, 2007; pp. 71-94.
    • 2. World Health Organization. What is Universal Coverage? Available online: http://www.who.int/ health_financing/universal_coverage_definition/en/ (accessed on 18 May 2014).
    • 3. The World Health Report 2008: Primary Health Care-Now More than Ever; World Health Orgainzation: Geneva, Switzerland, 2008; Chapter 2, pp. 23-40.
    • 4. The World Health Report: Health Systems Financing: The Path to Universal Coverage; World Health Organization: Geneva, Switzerland, 2010; Chapter 1, pp. 1-17.
    • 5. Savedoff, W.D.; de Frerranti, D.; Smith, A.L.; Fan, V. Political and economic aspects of the transition to universal health coverage. Lancet 2012, 380, 924-932.
    • 6. Mills, A. Literature Review of Health Systems Knowledge Network: Strategies to Achieve Universal Coverage: Are There Lessons from Middle Income Countries. Available online: http://www.who.int/social_determinants/resources/csdh_media/universal_coverage_2007_en.pdf (accessed on 13 February 2014).
    • 7. United Nations Millennium Project. A Practical Plan to Achieve the Millennium Development Goals; The United Nations: New York, NY, USA, 2005; Chapter 5, p. 66.
    • 8. Feldstein, M.S. The welfare loss of excess health insurance. J. Polit. Econ. 1973, 81, 251-280.
    • 9. Aron-Dine, A.; Einav, L.; Finkelstein, A. The RAND health insurance experiment, three decades later. J. Econ. Perspect. 2013, 27, 197-222.
    • 10. Maldovsky, P.; Srivastava, D.; Cylus, J.; Karanikolos, M.; Evetovits, T.; Thomson, S.; Mckee, M. Health Policy Responses to the Finacial Crisis in Europe. Available online: http://www.euro.who.int/ en/what-we-do/data-and-evidence/evidenceinformed-policymaking/publications/2012/health-poli cy-responses-to-the-financial-crisis-in-europe (accessed on 13 January 2014).
    • 11. Carrin, G.; James, C. Social health insurance: Key factors affecting the transition towards univesal coverage. Int. Soc. Secur. Rev. 2005, 58, 45-64.
    • 12. OECD Health Data 2012; OECD: Paris, France, 2012.
    • 13. National Health Insurance Corporation & Health Insurance Review Agency. 2012 Natioinal Health Insurance Statistical Yearbook; National Health Insurance Corporation: Seoul, South Korea, 2013.
    • 14. Survey of Out-of-Pocket Payment of Patients in 2011; National Health Insurance Corporation: Seoul, South Korea, 2013; pp. 55-56.
    • 15. Income-Related Inequality in the Use of Medical Care in 21 OECD Countries; Van Doorslaer, E., Masseria, C., Eds.; OECD: Paris, France, 2004; pp. 8-12.
    • 16. Wagstaff, A.; van Doorslaer, E. Measuring and testing for inequity in the delivery of health care. J. Hum. Resour. 2000, 35, 716-733.
    • 17. Wagstaff, A.; van Doorslaer, E. Catastrophe and impoverishement in paying for health care: With applications to Vietnam 1993-1998. Health Economics 2003, 12, 921-934.
    • 18. Devaux, M.; de Looper, M. Income-Related Inequalities in Health Service Utilisation in 19 OECD Countries, 2008-2009. Available online: http://dx.doi.org/10.1787/5k95xd6stnxt-en (accessed on 6 May 2014).
    • 19. Barraza-Lloréns, M.; Panopoulou, G.; Díaz, B.Y. Income-related inequalities and inequities in health and health care utilization in Mexico, 2000-2006. Pan Amer. J. Public Health 2013, 3, 122-130.
    • 20. Lu, J.R.; Leung, G.M.; Kwon, S.; Tin, Y.K.K.; van Doorslaer, E.; O'Donell, O. Horizontal equity in health care utilization evidence from three high-income Asian economies. Soc. Sci. Med. 2007, 64, 199-212.
    • 21. Salinas, J.J.; Snih, A.S.; Markides, K.; Ray, L.A.; Angel, R.J. The rural-urban divide: Health service utilization among older Mexicans in Mexico. J. Rural Health 2010, 26, 333-341.
    • 22. Schoen, C.; Osborn, R.; Squires, D.; Doty, M.M.; Pierson, R.; Applebaum, S. How health insurance design affects access to care and costs by income, in eleven countries. Health Affair. 2010, 29, 2323-2333.
    • 23. Kim, C.W.; Lee, S.Y.; Hong, S.C. Equity in utilization of cancer inpatient services by income classes. Health Policy 2005, 72, 187-200.
    • 24. Yoon, T.H.; Lee, S.Y.; Kim, C.W.; Kim, S.Y.; Jeong, B.G.; Park, H.K. Inequalities in medical care utilization by South Korean cancer patients according to income: A retrospective cohort study. Int. J. Health Serv. 2011, 41, 51-66.
    • 25. Friesner, D.; Rosenman, R. The relationship between service intensity and the quality of health care: An exploratory data analysis. Health Serv. Manage. Res. 2005, 18, 41-52.
    • 26. Hussey, P.S.; Wertheimer, S.; Mehrotra, A. The association between health care quality and cost. Ann. Intern. Med. 2013,158, 27-34.
    • 27. Jones, R.S. Health care reform in Korea. Economics Department Working Papers, 797; OECD: Paris, France; pp. 25-26.
    • 28. Xu, K.; Jeon, H.S.; Saksena, P.; Shin, J.W.; Mathauer, I.; Evans, D. Financial Risk Protection of Nation Health Insurance in the Republic of Korea: 1995-2007. Available online: http://www.who.int/ healthsystems/topics/ financing/healthreport/23RepKorXU.pdf (accessed on 10 May 2014).
    • 29. James, C.D.; Hanson, K.; Mcpake, B.; Balabanova, D.; Gwatkin, D.; Hopwood, I.; Xu, K. To retain or remove user fees? Reflections on the current debate in low- and middle-income countries. Appl. Health Econ. Health Policy 2006, 5, 137-153.
    • 30. Orem, J.N.; Mugisha, F.; Kirunga, C.; Macq, J.; Criel, B. Abolition of user fees: The Uganda paradox. Health Policy Plann. 2011, 26, 41-56.
    • 31. Chan, M. Opening Remarks at a WHO/World Bamk Ministerial-Level Meeting on Univeral Health Coverage, 2013. Available online: http://www.who.int/dg/speeches/2013/universal health coverage/en/ (accessed on 5 May 2014).
    • 32. Kakwani, N.; van Doorslaer, E.; Wagstaff, A. Socio-economic inequalities in health: Measurement, computation and statistical inference. J. Econ. 1997, 77, 87-104.
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