DOI: https://doi.org/10.21203/rs.3.rs-113779/v1
Background: The near poor, a low income population which is excluded from the Republic of Korea's Medical Aid (MA) program, experiences insufficient use of medical services and high out-of-pocket (OOP) spending due to insufficient coverage by the country's National Health Insurance (NHI). This study aims to examine medical utilization, OOP spending, and occurrence of catastrophic health expenditures (CHE) among the near poor compared to MA beneficiaries and other NHI members.
Methods: A cross-sectional study was conducted drawing upon a nationally representative dataset based on the 2018 Korea Welfare Panel Study (KOWEPS). We classified people into MA beneficiaries, the near-poor population below 50% of the median income threshold, and other NHI members above the 50% median income threshold. Using propensity score matching between MA beneficiaries and the near poor and between the near-poor group and the group of those above the poverty line, this study examined medical utilization, OOP spending, and the occurrence of CHE among the study groups.
Results: The findings suggest that MA beneficiaries make greater use of outpatient services compared to the near poor, but other uses of medical services were not significantly different among the study groups. However, OOP spending and occurrence of CHE were significantly higher in the near-poor group compared to the other two groups.
Conclusion: We found that the near-poor group was the most vulnerable group in these terms among the Korean population. Health policy needs to take into account the vulnerability of the near-poor population.
Due to technical limitations, full-text HTML conversion of this manuscript could not be completed. However, the manuscript can be downloaded and accessed as a PDF.
|
Medical Aid beneficiaries |
Near-poor group |
Above-poverty-line group |
Total |
|||||
|
Frequency |
Relative frequency (%) |
Frequency |
Relative frequency (%) |
Frequency |
Relative frequency (%) |
Frequency |
Relative frequency (%) |
|
|
N |
616 |
5.48 |
2,153 |
19.16 |
8,466 |
75.35 |
11,235 |
|
|
Categorical variables |
|
|
|
|
|
|
|
|
|
Female |
384 |
62.34 |
1,394 |
64.75 |
4,588 |
54.19 |
6,366 |
56.66 |
|
Married |
164 |
26.62 |
1,150 |
53.41 |
5,554 |
65.60 |
6,868 |
61.13 |
|
Education |
|
|
|
|
|
|
|
|
|
no diploma |
110 |
17.86 |
493 |
22.90 |
245 |
2.89 |
848 |
7.55 |
|
below high school diploma |
328 |
53.25 |
1,221 |
56.71 |
2,021 |
23.87 |
3,570 |
31.78 |
|
high school diploma |
129 |
20.94 |
303 |
14.07 |
2,665 |
31.48 |
3,097 |
27.57 |
|
above high school diploma |
49 |
7.95 |
136 |
6.32 |
3,535 |
41.76 |
3,720 |
33.11 |
|
Occupation |
|
|
|
|
|
|
|
|
|
permanent employee |
2 |
0.32 |
15 |
0.70 |
2,319 |
27.39 |
2,336 |
20.79 |
|
temporary employee |
52 |
8.44 |
309 |
14.35 |
1,891 |
22.34 |
2,252 |
20.04 |
|
employer, self-employed, unpaid family worker |
11 |
1.79 |
302 |
14.03 |
1,161 |
13.71 |
1,474 |
13.12 |
|
unemployed, economically inactive |
551 |
89.54 |
1,527 |
70.92 |
3,095 |
36.56 |
5,173 |
46.04 |
|
Reporting bad health |
358 |
58.12 |
1,025 |
47.61 |
1,227 |
14.49 |
2,610 |
23.23 |
|
Chronic disease patient |
527 |
85.55 |
1,820 |
84.53 |
3,971 |
46.91 |
6,318 |
56.23 |
|
Disabled |
115 |
18.67 |
170 |
7.90 |
265 |
3.13 |
550 |
4.90 |
|
Private insurance subscription |
123 |
19.97 |
468 |
21.74 |
6,499 |
76.77 |
7,090 |
63.11 |
|
Depression |
276 |
44.81 |
649 |
30.14 |
782 |
9.24 |
1,707 |
15.19 |
|
Continuous variables |
|
|
|
|
|
|
|
|
|
Age |
66.21 (mean) |
16.60 (SD) |
72.27 (mean) |
13.02 (SD) |
50.27 (mean) |
17.65 (SD) |
55.30 (mean) |
19.02 (SD) |
|
Annual income |
1,105.13 (mean) |
377.402 (SD) |
979.25 (mean) |
638.31 (SD) |
3,759.28 (mean) |
2,530.93 (SD) |
3,081.01 (mean) |
2,513.95 (SD) |
|
Matching variable |
Before matching |
After matching |
||||
|
Medical Aid group |
Near-poor group |
p> [t] |
Medical Aid group |
Near-poor group |
p> [t] |
|
|
Near-poor and Medical aid |
|
|
|
|
|
|
|
N |
516 |
1949 |
|
507 |
915 |
|
|
Categorical variables |
|
|
|
|
|
|
|
Female |
62.34 |
64.75 |
0.272 |
63.31 |
60.04 |
0.285 |
|
Married |
26.62 |
53.41 |
0.000 |
26.62 |
24.50 |
0.440 |
|
Education |
|
|
|
|
|
|
|
below high school diploma |
53.35 |
56.71 |
0.127 |
52.46 |
51.49 |
0.758 |
|
high school diploma |
20.94 |
14.07 |
0.000 |
21.69 |
22.12 |
0.869 |
|
above high school diploma |
7.96 |
6.31 |
0.151 |
8.67 |
9.82 |
0.528 |
|
Occupation |
|
|
|
|
|
|
|
temporary employee |
4.44 |
14.35 |
0.000 |
9.07 |
9.08 |
0.993 |
|
employer, self-employed, unpaid family worker |
1.79 |
14.03 |
0.000 |
1.77 |
202 |
0.774 |
|
unemployed, economically inactive |
89.44 |
70.92 |
0.000 |
88.75 |
88.19 |
0.781 |
|
Reporting bad health |
58.11 |
47.60 |
0.000 |
55.81 |
54.61 |
0.701 |
|
Chronic disease patient |
88.55 |
84.53 |
0.535 |
85.6 |
84.13 |
0.516 |
|
Disabled |
22.28 |
8.71 |
0.000 |
21.30 |
19.44 |
0.463 |
|
Private insurance subscription |
19.96 |
21.73 |
0.345 |
20.51 |
21.84 |
0.604 |
|
Depression |
44.8 |
30.14 |
0.000 |
44.37 |
45.48 |
0.725 |
|
Continuous variables |
|
|
|
|
|
|
|
Annual income (ten thousand won) |
1105.1 |
979.26 |
0.000 |
1078.4 |
1063.8 |
0.563 |
|
Age |
65.22 |
72.28 |
0.000 |
65.43 |
65.02 |
0.718 |
|
Near-poor and above-poverty-line groups |
|
|
|
|
|
|
|
N |
915 |
8151 |
|
910 |
1482 |
|
|
Categorical variables |
|
|
|
|
|
|
|
Female |
66.88 |
54.19 |
0.000 |
67.25 |
65.94 |
0.554 |
|
Married |
36.28 |
65.60 |
0.000 |
36.48 |
38.29 |
0.424 |
|
Education |
|
|
|
|
|
|
|
below high school diploma |
56.72 |
23.87 |
0.000 |
56.70 |
57.77 |
0.644 |
|
high school diploma |
15.19 |
31.47 |
0.000 |
15.27 |
15.77 |
0.767 |
|
above high school diploma |
6.88 |
41.75 |
0.000 |
6.92 |
6.31 |
0.604 |
|
Occupation |
|
|
|
|
|
|
|
temporary employee |
11.69 |
22.33 |
0.000 |
11.75 |
11.97 |
0.885 |
|
employer, self-employed, unpaid family worker |
3.82 |
13.71 |
0.000 |
3.84 |
3.57 |
0.757 |
|
unemployed, economically inactive |
84.04 |
36.55 |
0.000 |
83.95 |
83.81 |
0.937 |
|
Reporting bad health |
53.88 |
14.49 |
0.000 |
53.62 |
55.22 |
0.495 |
|
Chronic disease patient with |
86.12 |
46.90 |
0.000 |
86.04 |
87.77 |
0.274 |
|
Disabled |
13.33 |
3.25 |
0.000 |
12.96 |
12.65 |
0.843 |
|
Private insurance subscription |
19.34 |
76.76 |
0.000 |
19.45 |
18.40 |
0.570 |
|
Depression |
39.12 |
9.23 |
0.000 |
38.79 |
36.82 |
0.387 |
|
Continuous variables |
|
|
|
|
|
|
|
Age |
70.36 |
50.27 |
0.000 |
70.32 |
71.11 |
0.275 |
|
Nearest neighbor matching with replacement, 1:4 ratio, caliper: 0.01 Matched sample of near-poor group in Medical Aid and near-poor matching is the same as unmatched sample of near-poor in near-poor and above-poverty-line group matching Annual income variable was excluded in matching with near-poor and above-poverty-line group to secure sufficient sample size and to estimate the effect of being near-poor |
||||||
|
Matching variable |
Outpatient visits |
Hospital visits |
Hospitalized days |
Hospitalized days per visit |
||||||||||
|
Negative binominal |
Poisson |
Logit |
Poisson |
Logit |
Poisson |
Logit |
||||||||
|
SE |
SE |
SE |
SE |
SE |
SE |
SE |
||||||||
|
Medical Aid |
0.30*** |
0.07 |
0.20 |
0.25 |
0.37 |
0.299 |
-0.36* |
0.19 |
0.14 |
0.163 |
-0.20 |
0.218 |
0.14 |
0.163 |
|
Female |
0.40*** |
0.08 |
-0.21 |
0.30 |
-0.13 |
0.34 |
-0.69** |
0.25 |
0.02 |
0.202 |
-0.85*** |
0.216 |
0.02 |
0.203 |
|
Age |
0.10** |
0.00 |
-0.05*** |
0.01 |
-0.05*** |
0.12 |
-0.02** |
0.011 |
-0.01** |
0.007 |
-0.00 |
0.010 |
-0.01** |
0.007 |
|
Married |
-0.06 |
0.08 |
-0.37 |
0.34 |
-0.37 |
0.393 |
-0.22 |
0.255 |
-0.02 |
0.187 |
-0.30 |
0.262 |
-0.27 |
0.187 |
|
Education |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
below high school diploma |
0.21** |
0.08 |
0.53 |
0.36 |
0.28 |
0.485 |
-0.13 |
0.193 |
-0.15 |
0.214 |
-0.33 |
0.231 |
-0.15 |
0.214 |
|
high school diploma |
0.28** |
0.12 |
-0.16 |
0.30 |
-0.72 |
0.578 |
-0.07 |
0.321 |
-0.42 |
0.311 |
-0.15 |
0.318 |
-0.42 |
0.311 |
|
above high school diploma |
0.09 |
0.22 |
-0.89* |
0.49 |
-1.78* |
1.006 |
0.20 |
0.481 |
-0.78* |
0.467 |
0.56 |
0.460 |
-0.78* |
0.466 |
|
Occupation |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
temporary employee |
-0.37* |
0.22 |
-3.84*** |
1.10 |
-1.72 |
2.295 |
-1.22* |
0.708 |
1.84* |
1.088 |
-0.75 |
.668 |
1.90* |
1.090 |
|
employer, self-employed, unpaid family worker |
-0.48* |
0.29 |
-1.52** |
0.68 |
-0.87 |
1.527 |
0.05 |
0.496 |
0.52 |
1.153 |
0.01** |
0.528 |
0.55 |
1.158 |
|
unemployed, economically inactive |
-0.43** |
0.21 |
-1.91** |
0.75 |
-1.38 |
1.529 |
0.45 |
0.473 |
0.42 |
1.016 |
0.55 |
0.476 |
0.45 |
1.021 |
|
Annual income (ten thousand won) |
0.12 |
0.09 |
-0.28 |
0.22 |
-0.17 |
0.452 |
0.29 |
0.155 |
-0.05 |
0.216 |
0.04 |
0.241 |
-0.05 |
0.216 |
|
Reporting bad health |
0.34*** |
0.08 |
1.35*** |
0.37 |
0.01 |
0.581 |
0.71** |
0.325 |
-1.06*** |
0.197 |
-0.67** |
0.278 |
-1.06*** |
0.197 |
|
Chronic disease patient |
1.55*** |
0.13 |
1.75** |
0.55 |
1.78 |
1.380 |
1.54** |
0.594 |
0.04 |
0.316 |
1.06* |
0.595 |
0.02 |
0.315 |
|
Disabled |
0.08 |
0.10 |
-0.08 |
0.31 |
0.15 |
0.384 |
0.05 |
0.226 |
0.18 |
0.218 |
-0.02 |
0.292 |
0.18 |
0.218 |
|
Private insurance subscription |
-0.00 |
0.10 |
-0.11 |
0.68 |
-0.62 |
0.611 |
-0.87** |
0.324 |
-0.34 |
0.224 |
-0.58** |
0.287 |
-0.33 |
0.224 |
|
Depression |
0.16** |
0.07 |
0.52* |
0.30 |
0.13 |
0.377 |
0.28 |
0.189 |
-0.15 |
0.166 |
0.08 |
0.217 |
-0.16 |
0.165 |
|
*** p < 0.001 ** p < 0.05 * p <0.1 |
||||||||||||||
|
OOP spending |
CHE (40%) |
CHE (20%) |
||||
|
Log-link GLM |
Logit |
Logit |
||||
|
SE |
SE |
SE |
||||
|
Medical Aid |
-1.33*** |
0.092 |
-2.27*** |
0.289 |
-1.78*** |
0.169 |
|
Female |
-0.04 |
0.107 |
0.10 |
0.301 |
0.02 |
0.186 |
|
Age |
-0.01 |
0.005 |
0.00 |
0.012 |
0.01 |
0.007 |
|
Married |
0.52*** |
0.100 |
0.41* |
0.232 |
0.84*** |
0.169 |
|
Education |
|
|
|
|
|
|
|
below high school diploma |
0.02 |
0.140 |
-0.07 |
0.251 |
0.05 |
0.200 |
|
high school diploma |
0.04 |
0.203 |
-0.48 |
0.418 |
-0.23 |
0.295 |
|
above high school diploma |
-0.10 |
0.241 |
-0.30 |
0.630 |
0.42 |
0.421 |
|
Occupation |
|
|
|
|
|
|
|
temporary employee |
-0.57 |
0.403 |
-2.60** |
1.228 |
-2.22* |
1.148 |
|
employer, self-employed, unpaid family worker |
-1.11** |
0.439 |
-2.24* |
1.319 |
-2.51** |
1.190 |
|
unemployed, economically inactive |
-0.34 |
0.401 |
-1.54 |
1.202 |
-1.40 |
1.124 |
|
Annual income (ten thousand won) |
0.36** |
0.144 |
-0.35* |
0.196 |
-0.72 |
0.161 |
|
Reporting bad health |
0.60*** |
0.103 |
0.97*** |
0.246 |
0.94*** |
0.173 |
|
Chronic disease patient |
0.25 |
0.160 |
0.61 |
0.469 |
0.35 |
0.307 |
|
Disabled |
-0.15 |
0.131 |
0.18 |
0.280 |
0.00 |
0.213 |
|
Private insurance subscription |
0.35** |
0.137 |
0.35 |
0.312 |
0.06 |
0.228 |
|
Depression |
0.18* |
0.094 |
0.37* |
0.216 |
0.20 |
0.163 |
|
*** p < 0.001 ** p < 0.05 * p <0.1 |
||||||
|
Matching variable |
Outpatient visits |
Hospital visits |
Hospitalized days |
Hospitalized days per visit |
||||||||||
|
Negative binominal |
Poisson |
Logit |
Poisson |
Logit |
Poisson |
Logit |
||||||||
|
SE |
SE |
SE |
SE |
SE |
SE |
SE |
||||||||
|
Medical Aid |
0.01 |
0.053 |
-0.10 |
0.214 |
0.24 |
0.331 |
0.23* |
0.134 |
0.21* |
0.121 |
0.20 |
0.161 |
0.21* |
0.121 |
|
Female |
0.39*** |
0.061 |
-0.38 |
0.319 |
-0.47 |
0.406 |
-0.26 |
0.194 |
-0.03 |
0.154 |
-0.31* |
0.185 |
-0.03 |
0.154 |
|
Age |
0.01*** |
0.002 |
-0.02** |
-0.010 |
-0.04** |
0.014 |
-0.00 |
0.006 |
-0.01* |
0.005 |
0.00 |
0.007 |
-0.01* |
0.005 |
|
Married |
-0.08 |
0.053 |
-0.18 |
0.260 |
0.17 |
0.336 |
-0.23 |
0.152 |
0.21 |
0.137 |
-0.24 |
0.160 |
0.21 |
0.137 |
|
Education |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
below high school diploma |
0.09 |
0.071 |
0.26 |
0.273 |
0.09 |
0.488 |
-0.07 |
0.159 |
-0.17 |
0.171 |
-0.27 |
0.179 |
-0.17 |
0.171 |
|
high school diploma |
0.01 |
0.097 |
0.21 |
0.443 |
-0.08 |
0.805 |
0.15 |
0.256 |
-0.23 |
0.240 |
-0.16 |
0.281 |
-0.23 |
0.240 |
|
above high school diploma |
0.00 |
0.154 |
--0.02 |
0.551 |
-0.48 |
1.006 |
-0.15 |
0.426 |
-0.26 |
0.308 |
-0.17 |
0.544 |
-0.26 |
0.308 |
|
Occupation |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
temporary employee |
0.14 |
0.309 |
-0.57 |
0.674 |
1.19 |
1.048 |
-0.12 |
0.487 |
1.16** |
0.721 |
-0.18 |
0.513 |
1.68** |
0.722 |
|
employer, self-employed, unpaid family worker |
0.14 |
0.315 |
-0.47 |
0.604 |
0.58 |
0.991 |
0.21 |
0.473 |
1.09 |
0.745 |
-0.05 |
0.465 |
1.09 |
0.745 |
|
unemployed, economically inactive |
0.01 |
0.307 |
-0.46 |
0.588 |
0.22 |
0.963 |
0.52 |
0.423 |
0.90 |
0.698 |
0.50 |
0.458 |
0.90 |
0.698 |
|
Reporting bad health |
0.32*** |
0.057 |
1.03*** |
0.223 |
-0.11 |
0.377 |
0.85*** |
0.145 |
-0.97*** |
0.142 |
0.74*** |
0.154 |
-0.97*** |
0.142 |
|
Chronic disease patient |
1.06*** |
0.119 |
0.87** |
0.383 |
0.70 |
0.628 |
0.74** |
0.259 |
-0.18 |
0.240 |
0.46* |
0.256 |
-0.19 |
0.240 |
|
Disabled |
0.16* |
0.090 |
-0.22 |
0.254 |
-0.54 |
0.421 |
0.15 |
0.190 |
-0.18 |
0.183 |
0.21 |
0.233 |
-0.18 |
0.183 |
|
Private insurance subscription |
0.03** |
0.070 |
-0.74** |
0.342 |
-1.52** |
0.755 |
-0.36* |
0.204 |
-0.31* |
0.159 |
-0.15 |
0.198 |
-0.31* |
0.159 |
|
Depression |
-0.16 |
0.057 |
0.46** |
0.224 |
0.07 |
0.351 |
0.28** |
0.145 |
-0.32** |
0.130 |
0.07 |
0.165 |
-0.32** |
0.130 |
|
*** p < 0.001 ** p < 0.05 * p <0.1 |
||||||||||||||
|
OOP spending |
CHE (40%) |
CHE (20%) |
||||
|
Log-link GLM |
Logit |
Logit |
||||
|
SE |
SE |
SE |
||||
|
Near-poor |
-0.56*** |
0.056 |
0.75*** |
0.147 |
0.87*** |
0.111 |
|
Female |
0.06 |
0.070 |
-0.02 |
0.193 |
-0.01 |
0.136 |
|
Age |
0.00 |
0.002 |
0.00 |
0.006 |
0.01** |
0.005 |
|
Married |
0.42*** |
0.062 |
0.04 |
0.155 |
0.46*** |
0.118 |
|
Education |
|
|
|
|
|
|
|
below high school diploma |
-0.06 |
0.083 |
0.05 |
0.197 |
0.05 |
0.161 |
|
high school diploma |
0.01 |
0.121 |
-0.34 |
0.299 |
-0.11 |
0.227 |
|
above high school diploma |
0.08 |
0.137 |
-0.03 |
0.386 |
0.23 |
0.299 |
|
Occupation |
|
|
|
|
|
|
|
temporary employee |
-0.52** |
0.261 |
-2.30*** |
0.820 |
-0.89 |
0.803 |
|
employer, self-employed, unpaid family worker |
-0.47* |
0.274 |
-2.06** |
0.882 |
-0.77 |
0.826 |
|
unemployed, economically inactive |
-0.24 |
0.260 |
-1.41* |
0.791 |
-0.30 |
0.789 |
|
Reporting bad health |
0.24*** |
0.070 |
0.85*** |
0.161 |
0.72*** |
0.125 |
|
Chronic disease patient with |
0.15 |
0.146 |
0.29 |
0.320 |
0.35* |
0.209 |
|
Disabled |
0.19* |
0.107 |
0.37* |
0.207 |
0.12 |
0.174 |
|
Private insurance subscription |
0.11 |
0.074 |
-0.22 |
0.199 |
-0.01 |
0.151 |
|
Depression |
0.28*** |
0.069 |
0.07 |
0.157 |
0.30** |
0.125 |
|
*** p < 0.001 ** p < 0.05 * p <0.1 |
||||||