Journal of Preventive Medicine and Public Health

  • 제50권6호
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  • Pages.393-400
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  • 2017
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  • 1975-8375(pISSN)
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  • 2233-4521(eISSN)
대한예방의학회 (The Korean Society for Preventive Medicine)
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Has the Copayment Ceiling Improved Financial Protection in the Korean National Health Insurance System? Evidence From the 2009 Policy Change

  • Lee, Tae-Jin (Department of Public Health Science, Graduate School of Public Health, Seoul National University) ;
  • Cheong, Chelim (Institute of Health and Environment, Graduate School of Public Health, Seoul National University)
  • 투고 : 2017.09.23
  • 심사 : 2017.11.09
  • 발행 : 2017.11.30
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초록

Objectives: To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a "copayment ceiling," which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients' income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups. Methods: This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics. Results: The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients. Conclusions: The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.

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참고문헌

  1. Evans DB, Etienne C. Health systems financing and the path to universal coverage. Bull World Health Organ 2010;88(6):402. https://doi.org/10.2471/BLT.10.078741
  2. 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. https://doi.org/10.1093/heapol/czn037
  3. James CD, Hanson K, McPake B, Balabanova D, Gwatkin D, Hopwood I, et al. To retain or remove user fees?: reflections on the current debate in low- and middle-income countries. Appl Health Econ Health Policy 2006;5(3):137-153. https://doi.org/10.2165/00148365-200605030-00001
  4. Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health Aff (Millwood) 2007;26(4):972-983. https://doi.org/10.1377/hlthaff.26.4.972
  5. Galarraga O, Sosa-Rubi SG, Salinas-Rodriguez A, Sesma-Vazquez S. Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico. Eur J Health Econ 2010;11(5):437-447. https://doi.org/10.1007/s10198-009-0180-3
  6. Somkotra T, Lagrada LP. Payments for health care and its effect on catastrophe and impoverishment: experience from the transition to Universal Coverage in Thailand. Soc Sci Med 2008;67(12):2027-2035. https://doi.org/10.1016/j.socscimed.2008.09.047
  7. Spaan E, Mathijssen J, Tromp N, McBain F, ten Have A, Baltus sen R. The impact of health insurance in Africa and Asia: a systematic review. Bull World Health Organ 2012;90(9):685-692. https://doi.org/10.2471/BLT.12.102301
  8. Yardim MS, Cilingiroglu N, Yardim N. Financial protection in health in Turkey: the effects of the Health Transformation Programme. Health Policy Plan 2014;29(2):177-192. https://doi.org/10.1093/heapol/czt002
  9. Xu K, Evans DB, Kadama P, Nabyonga J, Ogwal PO, Nabukhonzo P, et al. Understanding the impact of eliminating user fees: utilization and catastrophic health expenditures in Uganda. Soc Sci Med 2006;62(4):866-876. https://doi.org/10.1016/j.socscimed.2005.07.004
  10. Meng Q, Xu L, Zhang Y, Qian J, Cai M, Xin Y, et al. Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study. Lancet 2012; 379(9818):805-814. https://doi.org/10.1016/S0140-6736(12)60278-5
  11. Shahrawat R, Rao KD. Insured yet vulnerable: out-of-pocket payments and India's poor. Health Policy Plan 2012;27(3):213-221. https://doi.org/10.1093/heapol/czr029
  12. 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. https://doi.org/10.1002/hec.776
  13. Jang SM. Development of indicators for assessing anti-hypertensive drugs. Seoul: Health Insurance Review and Assessment Service; 2008, p. 25-26 (Korean).
  14. National Health Insurance Service. Survey on patients' out-of-pocket payment in the national health insurance 2009. Seoul: National Health Insurance Service; 2010, p. 56, 114 (Korean).
  15. National Health Insurance Service. Survey on patients' out-of-pocket payment in the national health insurance 2011. Seoul: National Health Insurance Service; 2012, p. 31,48 (Korean).
  16. Yun HS. Effects of private insurance on medical expenditure. KDI J Econ Policy 2008;30(2): 99-128 (Korean). https://doi.org/10.23895/kdijep.2008.30.2.99
  17. Kang SW, You CH, Oh EH, Kwon YD. The impact of having private health insurance on healthcare utilization with controlling for endogeneity. Korean J Health Econ Policy 2010;16(1): 139-159 (Korean).