DOI QR코드

DOI QR Code

재난적 의료비 발생과 재발생이 빈곤화와 빈곤지속에 미치는 영향

The Effect of Occurrence and Reoccurrence of Catastrophic Health Expenditure on Transition to Poverty and Persistence of Poverty in South Korea

  • 김은경 (서울대학교 보건대학원) ;
  • 권순만 (서울대학교 보건대학원)
  • Kim, Eunkyoung (Graduate School of Public Health, Seoul National University) ;
  • Kwon, Soonman (Graduate School of Public Health, Seoul National University)
  • 투고 : 2016.08.19
  • 발행 : 2016.09.30

초록

Background: The objective of this study was to examine the effect of occurrence and reoccurrence of catastrophic health expenditure (CHE) on transition to poverty and persistence of poverty in South Korea. Methods: The data of the year 2008-2011 from the Korea Health Panel were used. CHE was defined as the share of total health expenditure in a household out of a household's total income at various threshold levels (more than 5%, 10%, 15%, and 20%). The effect of catastrophic expenditure on transition to poverty and persistence of poverty was analyzed through multivariate logistic regression. Results: The shares of households facing CHE at various threshold levels have increased gradually with 37.7%, 21%, 13.1%, and 9.5% in 2011. Households facing CHE were more likely to experience transition to poverty at thresholds level of more than 5% and 20% in 2010 set. Households facing CHE seemed to experience persistence of poverty, but it was not statistically significant. About 40% of households facing CHE in 2009 encountered another shock of CHE in 2010. Households without CHE seemed to experience more transition to poverty and persistence of poverty, but it was not statistically significant. For household with multiple CHE, those with medical aid were more likely to experience transition to poverty with statistical significance, but the statistical significance disappeared in case of persistence of poverty. Conclusion: The Korean health system needs to be improved to serve as a social security net for addressing transition to poverty and persistence of poverty due to facing CHE.

키워드

참고문헌

  1. United Nations. Open Working Group proposal for sustainable development goals [Internet]. New York (NY): United Nations; 2015 [cited 2016 Aug 5]. Available from: https://sustainabledevelopment.un.org/content/documents/1579SDGs%20Proposal.pdf.
  2. Tangcharoensathien V, Mills A, Palu T. Accelerating health equity: the key role of universal health coverage in the Sustainable Development Goals. BMC Med 2015;13:101. DOI: http://dx.doi.org/10.1186/s12916-015-0342-3.
  3. World Health Organization. The world health report: health systems financing: the path to universal coverage. Geneva: World Health Organization; 2010.
  4. Kwon S. Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage. Health Policy Plan 2009;24(1):63-71. DOI: http://dx.doi.org/10.1093/heapol/czn037.
  5. Jones R. Health care reform in Korea: OECD Economics Department Working Paper No.797. Paris: Organization for Economic Cooperation and Development Publishing; 2010.
  6. Organization for Economic Cooperation and Development. Health expenditure: OECD indicators. Paris: Organization for Economic Cooperation and Development Publishing; 2016.
  7. Van Doorslaer E, Masseria C. Income-related inequality in the use of medical care in 21 OECD countries. Paris: Organization for Economic Cooperation and Development Publishing; 2004.
  8. Kim E, Kwon S, Xu K. Has income-related inequity in health care utilization and expenditures been improved?: evidence from the Korean National Health and Nutrition Examination Survey of 2005 and 2010. J Prev Med Public Health 2013;46(5):237-248. DOI: http://dx.doi.org/10.3961/jpmph.2013.46.5.237.
  9. Van Doorslaer E, O'Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, et al. Catastrophic payments for health care in Asia. Health Econ 2007;16(11):1159-1184. https://doi.org/10.1002/hec.1209
  10. Lee HJ, Lee TJ. Factors associated with incidence and recurrence of household catastrophic health expenditure in South Korea. Korean Soc Secur Stud 2012;28(3):39-62.
  11. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. Lancet 2003;362(9378):111-117. DOI: http://dx.doi.org/10.1016/S0140-6736(03)13861-5.
  12. Woo KS, Shin YJ. The effect of catastrophic health expenditure on household economy: focusing on financial coping and poverty. Health Soc Welf Rev 2015;35(3):166-198. DOI: http://dx.doi.org/10.15709/hswr.2015.35.3.166.
  13. Wagstaff A, van Doorslaer E. Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998. Health Econ 2003;12(11):921-934. DOI: http://dx.doi.org/10.1002/hec.776.
  14. Flores G, Krishnakumar J, O'Donnell O, van Doorslaer E. Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty. Health Econ 2008;17(12):1393-1412. DOI: http://dx.doi.org/10.1002/hec.1338.
  15. Lee HJ. Determinants of household catastrophic health expenditure and impacts on poverty [dissertation]. Seoul: Seoul National University; 2015.
  16. Cheong C, Lee TJ. The factors influencing the occurrence and recurrence of catastrophic health expenditure among households in Seoul. Korean J Health Policy Adm 2012;2(2):275-296. DOI: http://dx.doi.org/10.4332/kjhpa.2012.22.2.275.
  17. Song EC, Shin YJ. The effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea. J Prev Med Public Health 2010;43(5):423-435. DOI: http://dx.doi.org/10.3961/jpmph.2010.43.5.423.
  18. Song EC, Shin YJ. The effect of catastrophic health expenditure on the transition and persistence of poverty in South Korea: analysis of the Korea Welfare Panel Study data, 2007-2012. Korean J Health Policy Adm 2014;24(3):242-253. DOI: http://dx.doi.org/10.4332/kjhpa.2014.24.3.242.
  19. Sohn SI, Shin YJ, Kim CY. Factors influencing household catastrophic health expenditure of the poor. Health Soc Welf Rev 2010;30(1):92-110. DOI: http://dx.doi.org/10.15709/hswr.2010.30.1.92.
  20. Lee TJ, Yang BM, Kwon S, Oh JW, Lee SH. Equity in the expenditures of health care services. Korean J Health Econ Rev 2003;9(2):25-33.
  21. Alam K, Mahal A. Economic impacts of health shocks on households in low and middle income countries: a review of the literature. Global Health 2014;10:21. DOI: http://dx.doi.org/10.1186/1744-8603-10-21.
  22. Shin HW, Shin YS, Hwang DK. The effects of catastrophic health expenditure on poverty. Sejong: Korea Institute for Health and Social Affairs; 2010.
  23. Korean National Health Insurance Corporation, Korea Institute for Health and Social Affairs. Manual for the Korean Health Panel. Seoul: Korean National Health Insurance Corporation; 2015.
  24. Seo NK, Ahn SZ, Kang TU, Hwang YH. The study of estimating household catastrophic health expenditure using Korea Health Panel data. Korean J Health Econ Policy 2015;21(1):79-102.
  25. Korea Institute for Health and Social Affairs. Poverty statistics year book. Sejong: Korea Institute for Health and Social Affairs; 2015.
  26. Organization for Economic Cooperation and Development. In it together: why less inequality benefits all. Paris: Organization for Economic Cooperation and Development Publishing; 2015.