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Medical service utilization and out-of-pocket spending among near-poor National Health Insurance members in South Korea

Cited 3 time in Web of Science Cited 4 time in Scopus
Authors

Park, Sooyeol

Issue Date
2021-08-28
Publisher
BMC
Citation
BMC Health Services Research. 2021 Aug 28;21(1):886
Keywords
Medical utilizationOut-of-pocket spendingCatastrophic health expenditurePovertyRelative poverty
Abstract
Background
The public health care system in South Korea is a two-tiered system. The lowest-income population is covered by the Medical Aid program, and the remaining population is covered by the National Health Insurance. The near poor, a relatively low-income population which is excluded from South Koreas Medical Aid program due to exceeding the income threshold, experiences insufficient use of medical services and incurs high out-of-pocket expenses due to a lack of coverage under the countrys National Health Insurance (NHI) program. This study aims to examine medical utilization, out-of-pocket spending, and the occurrence of catastrophic health expenditures among the near-poor group compared to both Medical Aid beneficiaries and other (higher income) NHI members.


Methods
A cross-sectional study was conducted drawing upon a nationally representative dataset derived from the 2018 Korea Welfare Panel Study. The study classified people into three groups: Medical Aid beneficiaries; the near-poor population below 50 % of the median income threshold but still not qualifying for Medical Aid and thus enrolled in NHI; and NHI members above the threshold of 50 % of the median income. Using a generalized boosted model to estimate the propensity score weights between study groups, this study examined medical utilization, out-of-pocket spending, and the occurrence of catastrophic health expenditure among the study groups.


Results
The findings suggest that the utilization of medical services was not significantly different among the study groups. However, out-of-pocket spending and the occurrence of catastrophic health expenditure were significantly higher in the near-poor group compared to the other two groups.


Conclusions
The study found that the near-poor group was the most vulnerable among the Korean population because of their higher chance of incurring greater out-of-pocket spending and catastrophic health expenditures than is the case among the Medical Aid beneficiary and above-poverty line groups. Health policy needs to take the vulnerability of this near-poor population into account.
ISSN
1472-6963
Language
English
URI
https://hdl.handle.net/10371/174859
DOI
https://doi.org/10.1186/s12913-021-06881-8
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