Browse > Article
http://dx.doi.org/10.4332/KJHPA.2020.30.3.326

Effect of Coverage Expansion Policy for an Ultrasonography in the Upper Abdomen on Its Utilization: A Difference-in-Difference Mixed-Effects Model Analysis  

Son, Yena (Health Insurance Review & Assessment Service)
Lee, Yongjae (Department of Health Policy and Management, Yonsei University Graduate School of Public Health)
Nam, Chung-Mo (Department of Preventive Medicine, Yonsei University College of Medicine)
Kim, Gyu Ri (Department of Preventive Medicine, Yonsei University College of Medicine)
Chung, Woojin (Department of Health Policy and Management, Yonsei University Graduate School of Public Health)
Publication Information
Health Policy and Management / v.30, no.3, 2020 , pp. 326-334 More about this Journal
Abstract
Background: Korea has gradually expanded the coverage of medical care services in its national health insurance system. On April 1, 2018, it implemented a policy that expanded the coverage for an ultrasonography in the upper abdomen. In this study, we aimed to investigate the effect of the policy on the utilization of the ultrasonography in the upper abdomen in tertiary care hospitals. Methods: Using the dataset of the Health Insurance Review and Assessment Service, we explored changes in the utilization of the ultrasonography in the upper abdomen in tertiary care hospitals from July 1, 2017 to November 30, 2018 through the difference-in-difference (DID) mixed-effects-model method. Facility factor, equipment factor and personnel factors, type of hospital, the total amount of medical care expenses, and geographic region were considered as control variables. Results: On average, the utilization of the ultrasonography in the upper abdomen increased by 228% after the coverage expansion policy. However, the results of DID mixed-effects-model method analysis showed that the utilization increased by 73%. As for the number of beds, the utilization was higher with a group of 844-930, 931-1,217, and 1,218 or greater compared with a group of 843 or fewer, while the utilization of the number of ultrasonic devices was lower with a group of 45-49 compared with a group of 44 or fewer. The utilization decreased with the number of interns and the number of nurse assistants. Besides, relative to Seoul, the utilization was lower in the other metro-cities and provinces. Conclusion: The coverage expansion policy in the national health insurance system increased service utilization among people. Future research needs to investigate the degree to which such coverage expansion policy reduces the unmet medical care needs among the deprived in Korea.
Keywords
Health insurance coverage expansion; Upper abdomen; Uultrasonography; Difference-in-difference; Mixed model; Republic of Korea;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Kim SR. Study on the comparison of inpatients healthcare utilization between the Medicaid recipients and the insured [dissertation]. Seoul: Yonsei University; 2000.
2 Meyer BD. Natural and quasi-experiments in economics. J Bus Econ Stat 1995;13(2):151-161. DOI: https://doi.org/10.2307/1392369.   DOI
3 Callaway B. Sant'Anna PH. Difference-in-differences with multiple time periods [Internet]. Rochester (NY): SSRN; 2019 [cited 2020 May 2]. Available from: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3148250.
4 Curran-Everett D. Explorations in statistics: the log transformation. Adv Physiol Educ 2018;42(2):343-347. DOI: https://doi.org/10.1152/advan.00018.2018.   DOI
5 Yang BM. Health care economics. Paju: Nanam; 2015.
6 Halvorsen R, Palmquist R. The interpretation of dummy variables in semilogarithmic equations. Am Econ Rev 1980;70(3):474-475.
7 Chen L, Yip W, Chang MC, Lin HS, Lee SD, Chiu YL, et al. The effects of Taiwan's National Health Insurance on access and health status of the elderly. Health Econ 2007;16(3):223-242. DOI: https://doi.org/10.1002/hec.1160.   DOI
8 Phelps CE. Health economics. 5th ed. New York (NY): Routledge; 2016.
9 Shin Y, Kang HJ, Kim NS, Jeong YH, Kim DJ, Hwang DK. Improving the sustainability of healthcare delivery in line with NHI coverage enhancement. Sejong: Korea Institute for Health and Social Affairs; 2013.
10 Seo N, Yi O, Ahn S. Changes in medical cost composition by hospital size after the benefit coverage extending policy. Korean J Health Econ Policy 2019;25(4):93-118.
11 Oh Y. The distribution of the high price medical technologies in Korea and policy suggestions. Health Welf Policy Forum 2003;(78):62-76.
12 Doh S. Changes of medical utilizations and issues on health care policies. Health Welf Policy Forum 2005;(102):65-76.
13 Oh YH. Improvement plan and problems of medical human resource mobilization. Wonju: Health Insurance Review & Assessment Service; 2011.
14 Park IS, Lee DH. Analysis of actual condition of medical utilization by region using health insurance data: focus on cancer patients. Wonju: National Health Insurance Service; 2010.
15 Choi JK, Jeong HS. Impacts of the benefit extension policy on financial burden and catastrophic health care expenditure. Korean J Health Econ Policy 2012;18(4):1-19.
16 Huh SI, Kim CB. An evaluation of benefit extension strategies of the Korea National Health Insurance. Health Policy Manag 2009;19(3):142-165. DOI: https://doi.org/10.4332/KJHPA.2009.19.3.142.   DOI
17 Choi Y. The effects of expanding benefit coverage on medical care utilization of cardio-cerebrovascular disease inpatient [master's thesis]. Seoul: Korea University; 2009.