How public and private health insurance coverage mitigates catastrophic health expenditures in South Korea

doi:10.21203/rs.3.rs-1548535/v1

Download PDF

Research Article

How public and private health insurance coverage mitigates catastrophic health expenditures in South Korea

https://doi.org/10.21203/rs.3.rs-1548535/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this older preprint version

Read the latest preprint version →

Background: Korea has instituted a private health insurance (PHI) scheme that covers the remaining expenses uncovered by the National Health Insurance (NHI). No study has yet estimated the extent to which PHI coverage lowers the economic burden of household access to health care. The current study intends to evaluate the design of Korea's PHI system in terms of coverage using a catastrophic health expenditure (CHE) indicator and compare it with NHI.

Methods: This study determined the difference between the number of households subscribed to PHI and the number of households that paid benefits. Also, it compared the effects of reduced CHE through NHI benefits with those of PHI. Furthermore, it compared PHI benefit rates by income class. Finally, it analyzed the benefit contribution of NHI and PHI to CHE reduction through a two-part model with hierarchical regression.

Results: Results indicated that of the 5,644 households studied, 3,769 subscribed to PHI, but only 246 households received benefits. The NHI reduced CHE incidence by 15.17%, whereas PHI only reduced CHE by 1.22%. The NHI scheme indicated reduced inequality as it provided more benefits to the low-income class, whereas the PHI paid more to the high-income class. The NHI coverage has protected households from CHE and improved equality to some extent; however, PHI coverage has had little effect on relieving CHE and has deteriorated equality.

Conclusions: Korean private insurance companies, which are mostly subsidiaries of for-profit conglomerates, only pay for pre-contracted diseases, therefore, most patients do not receive benefits. Thus, Korea's private insurance system needs to improve to provide benefits to patients more generously and alleviate the financial burden of medical use.

Private health insurance

National health insurance

Insurance coverage

Korea

Catastrophic health expenditure

Table 1. General characteristics of samples

Variables			N (%)
Variables			Total	Insured in private health insurance	Paid benefits
Characteristics of householders	Gender	Men	4,305 (76.28)	3,051 (80.95)	193 (78.46)
	Gender	Women	1,339 (23.72)	718 (19.05)	53 (21.54)
	Age	< 29	187 (3.31)	90 (2.39)	13 (5.28)
		30~39	676 (11.98)	454 (12.05)	52 (21.14)
		40~49	1,166 (20.66)	761 (20.19)	83 (33.74)
		50~64	1,727 (30.6)	1,013 (26.88)	93 (37.80)
		> 65	1,888 (33.45)	1,451 (38.5)	5 (2.03)
	Education	Higher than college	1,703 (30.17)	1,123 (29.8)	114 (46.34)
		High school	2,185 (38.71)	1,487 (39.45)	92 (37.4)
		Less than middle school	1,756 (31.11)	1,159 (30.75)	40 (16.26)
	Marital status	Married	3,929 (69.61)	2,856 (75.78)	186 (75.61)
	Marital status	Single	1,715 (30.39)	913 (24.22)	60 (24.39)
	Job type	Employee	2,430 (43.05)	1,507 (39.98)	157 (63.82)
		Employer/self-Employed	1,356 (24.03)	896 (23.77)	61 (24.80)
		Unemployed	1,858 (32.92)	1,366 (36.24)	28 (11.38)
Characteristics of households	Income level	5^th (rich)	1,128 (19.99)	741 (19.66)	75 (30.49)
		4^th	1,128 (19.99)	724 (19.21)	61 (24.8)
		3^rd	1,129 (20.00)	695 (18.44)	71 (28.86)
		2^nd	1,129 (20.00)	760 (20.16)	33 (13.41)
		1^st (poor)	1,130 (20.00)	849 (22.53)	6 (2.44)
	Private health insurance	No	1,875 (33.22)	-	-
	Private health insurance	Yes	3,769 (66.78)	3,769 (66.78)	-
	Type of national health insurance	Employee	3,731 (66.11)	2,465 (65.40)	172 (69.92)
		Self-employed	1,481 (26.24)	971 (25.76)	70 (28.46)
		Medical Aid	432 (7.65)	333 (8.84)	4 (1.63)
	Presence of disabled	No	5,037 (89.25)	3,322 (88.14)	235 (95.53)
	Presence of disabled	Yes	607 (10.75)	447 (11.86)	11 (4.47)
	Presence of four major diseases	No	4,259 (75.46)	2,762 (73.28)	210 (85.37)
	Presence of four major diseases	Yes	1,385 (24.54)	1,007 (26.72)	36 (14.63)
	Number. of chronic diseases (mean, S.D.)		0.567, 0.678	0.610, 0.701	0.610, 0.701
Number of samples			5,644	3,769	246

* The Pearson chi² test between paid benefit and other characteristics results p < 0.05.

Table 2. National health insurance benefits, out-of-pocket expenses, and private health insurance benefits by income quintile

Income quartile	National health insurance benefits (dollar)			Out-of-pocket expenses (dollar)			Private health insurance benefits (dollar)
	n	Mean	S.D.	n	Mean	S.D.	n	Mean	S.D.
1^st (poor)	1,096	2,375.82	4,541.33	1,096	1,209.17	1,694.55	6	1,351.0	1,755.47
2^nd	1,113	2,463.50	4,362.19	1,113	1,627.60	2,106.19	33	762.11	666.34
3^rd	1,106	1,925.73	3,407.04	1,106	1,566.22	1,931.47	71	864.78	1,827.95
4^th	1,098	1,644.84	3,044.78	1,098	1,657.88	2,062.06	61	851.90	1,696.51
5^th(rich)	1,103	1,707.51	3,559.46	1,103	1,710.57	2,150.51	75	3,643.41	9,508.58
Total	5,516	2,024.12	3,839.85	5,516	1,554.74	2,003.41	246	1,706.84	5,545.17

Exchange rate: 1dollar = Korean Won 1,146.9 (2021.08.10)

Table 3. Summary results of incidence and the positive gap of catastrophic health expenditure based on out-of-pocket expenses, total healthcare payment, and private health care payments

	Based on out-of-pocket expenses			Based on total health care payment				National health insurance coverage
Threshold	10%	20%	40%		10%	20%	40%		10%	20%	40%
Incidence measures	19.26%	8.03%	2.43%		34.43%	19.95%	9.53%		15.17%	11.92%	7.10%
Intensity measures	2.76%	1.52%	0.62%		10.83%	8.23%	5.48%		8.06%	6.70%	4.86%
Intensity measures	14.39%	19.14	26.17%		31.51%	41.38%	57.84%		23.46%	33.71%	51.29%
	Based on out-of-pocket expenses			Based on private health care payment				Private health insurance coverage
Incidence measures	19.26%	8.03%	2.43%		20.48%	8.65%	2.73%		1.22%	0.62%	0.30%
Intensity measures	2.76%	1.52%	0.62%		3.05%	1.73%	0.73%		0.28%	0.20%	0.11%
Intensity measures	14.39%	19.14%	26.17%		14.94%	20.15%	27.62%		1.39%	2.38%	4.30%

Note: is incidence, is positive gap, is mean positive gap of catastrophic health expenditure using out-of-pocket payments; is incidence, is positive gap, is mean positive gap of catastrophic health expenditure using total healthcare payment rather than out-of-pocket payments; is incidence, is positive gap, is mean positive gap of catastrophic health expenditure using private healthcare payments; is incidence, is positive gap, is mean positive gap of national health insurance coverage, is incidence, is positive gap, is mean positive gap of private health insurance coverage.

Table 4. Coverage effects of national health insurance and private health insurance on catastrophic health expenditure (hierarchical regression analysis)

		Model 1				Model 2				Model 3
		Incidence		Positive gap		Incidence		Positive gap		Incidence		Positive gap
		OR	S.E.	f.	S.E.	OR	S.E.		S.E.	OR	S.E.		S.E.
Private Health Insurance coverage ()		-	-	-	-	-	-	-	-	1.467^*	0.252	0.068^**	0.022
National Health Insurance coverage ()		-	-	-	-	16.743^***	1.762	0.936^***	0.009	16.728^***	1.769	0.933^***	0.009
Gender (Male)	Female	1.018	0.138	-0.054	0.115	1.053	0.230	0.041	0.045	1.045	0.228	0.034	0.045
Age (< 29)	30–39	0.611	0.159	0.119	0.286	0.841	0.313	-0.088	0.113	0.830	0.309	-0.087	0.113
	40–49	0.754	0.184	0.132	0.260	1.031	0.360	0.008	0.102	1.015	0.355	0.004	0.102
	50–64	0.987	0.241	0.036	0.256	1.433	0.504	0.014	0.101	1.427	0.502	0.024	0.101
	> 65	1.231	0.313	0.106	0.262	1.542	0.574	0.004	0.103	1.541	0.573	0.017	0.103
Education level	High school	1.485^***	0.166	0.215^*	0.101	1.025	0.171	0.006	0.040	1.024	0.171	0.009	0.040
(> college)	< middle school	1.089	0.111	0.111	0.100	0.914	0.134	0.001	0.039	0.917	0.134	-0.001	0.039
Marital status (married)	Single	0.629^***	0.082	-0.023	0.111	0.742	0.155	-0.075	0.043	0.741	0.155	-0.073	0.043
Job type (employee)	Employer/self-employed	1.202	0.119	0.207^*	0.088	1.024	0.153	0.005	0.035	1.020	0.153	0.001	0.035
Job type (employee)	Unemployed	1.455^***	0.141	0.286^***	0.082	1.159	0.175	0.018	0.032	1.155	0.175	0.017	0.032
Income level (rich)*	Quintile 4	2.034^***	0.298	0.013	0.171	1.866^***	0.378	0.114	0.067	1.893^**	0.384	0.126	0.067
	Quintile 3	4.187^***	0.586	0.136	0.159	3.196^***	0.628	0.102	0.063	3.238^***	0.637	0.114	0.063
	Quintile 2	9.299^***	1.329	0.524^***	0.157	4.709^***	0.975	0.205^***	0.062	4.771^***	0.991	0.215^***	0.062
	Quintile 1 (poor)	17.057^***	2.740	0.848^***	0.163	6.392^***	1.558	0.283^***	0.064	6.489^***	1.585	0.293^***	0.064
Private health insurance (no)	Yes	1.159	0.104	-0.057	0.067	1.105	0.161	0.027	0.026	1.100	0.160	0.023	0.026
Type of national health insurance (employee)	Self-employed	0.935	0.077	-0.116	0.067	0.939	0.119	0.004	0.026	0.941	0.119	0.002	0.026
Type of national health insurance (employee)	Medical Aid	0.645^***	0.081	0.073	0.093	0.635^*	0.141	-0.188^***	0.037	0.639	0.141	-0.186^***	0.037
Disabled (no)	Yes	1.007	0.105	0.121	0.077	0.863	0.154	-0.017	0.031	0.861	0.154	-0.017	0.030
Four major diseases (no)	Yes	2.848^***	0.225	0.386^***	0.058	1.609^***	0.202	0.001	0.023	1.591^***	0.200	-0.001	0.023
Number of chronic diseases		1.618^***	0.121	0.061	0.065	1.354^**	0.158	-0.012	0.025	1.365^**	0.160	-0.008	0.025
Constants		0.045^***	0.012	1.561^***	0.282	0.022^***	0.008	0.254^*	0.112	0.226^***	0.008	0.237^*	0.112
Model fits		0.2708^***		0.144^***		0.6437^***		0.866^***		0.6443^***		0.866^***

*p < .05; **p < .01; ***p < .001

No competing interests reported.

Download PDF

Version 1

posted

You are reading this older preprint version

Read the latest preprint version →

How public and private health insurance coverage mitigates catastrophic health expenditures in South Korea

Archived Versions:

Version 1

Abstract

Figures

Full Text

Tables

Additional Declarations

Archived Versions:

Version 1