• 보건행정학회지
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• 제33권3호
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• pp.363-369
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• 2023

The term "catastrophic health expenditure" means assessing the extent to which medical costs cause financial hardship for households. The aim of this research is to analyze the percentage of households that faced severe financial strain due to medical expenses from 2006 to 2021. This was achieved by utilizing data obtained from the National Survey of Tax and Benefit (NaSTaB), Korea Health Panel (KHP), and Households Income and Expenditure Survey (HIES). A trend analysis was conducted to examine the percentage of households that experienced catastrophic healthcare expenses. The households that experienced the catastrophic health expenditure was 2.49% in 2021 using the NaSTaB data. The trend analysis yielded a statistically significant result, indicating a decreasing trend (annual percent change [APC], -4.79; p<0.0001) in the proportion of households facing catastrophic health expenditures. Also, the results of the 2019 KHP and the 2021 HIES showed 1.09% and 2.44% for the households that experienced catastrophic health expenditure. The trend was increased according to the KHP (APC, 0.55; p=0.0004) and the HIES (APC, 7.04; p<0.0001). As a result, this study proposes that sustained attention and further interventions are necessary to ease the economic pressure caused by catastrophic health expenses, particularly for low-income households.

• 보건행정학회지
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• 제30권1호
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• pp.126-130
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• 2020

Catastrophic health expenditure refers to measure the level of the economic burden of households due to medical expenses. The purpose of this study was to examine the proportion of households that experienced catastrophic health expenditure between 2006 and 2018 using available data from the National Survey of Tax and Benefit (NaSTaB), Korea Health Panel (KHP), and Households Income and Expenditure Survey (HIES). Trend test was used to analyze the proportion of household with catastrophic healthcare expenditure. The households experienced the catastrophic health expenditure 2.08% in 2018 using the NaSTaB data. Trend analysis was significant with the decreasing trend (Annual Percentage Change [APC], -4.88; p<0.0001) in the proportion of households with the catastrophic health expenditure. On the other hand, the results of the HIES showed 2.92%, and KHP showed 2.48% of households experienced the catastrophic health expenditure in 2016. The trend was significantly increased in HIES (APC, 1.43; p<0.0001) and KHP (APC, 6.68; p<0.0001). Therefore, this suggests that further interventions to alleviate the burden of catastrophic health expenditure to the low-income group are needed.

• 보건행정학회지
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• 제31권1호
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• pp.140-144
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• 2021

Catastrophic health expenditure refers to measure the level of the economic burden of households due to medical expenses. The purpose of this study was to examine the proportion of households that experienced catastrophic health expenditure between 2006 and 2019 using available data from the National Survey of Tax and Benefit (NaSTaB), Korea Health Panel (KHP), and Households Income and Expenditure Survey (HIES). Trend test was used to analyze the proportion of households with catastrophic healthcare expenditure. The households experienced a catastrophic health expenditure of 2.44% in 2019 using the NaSTaB data. Trend analysis was significant with the decreasing trend (annual percentage change [APC], -4.49; p<0.0001) in the proportion of households with catastrophic health expenditure. Also, the results of the 2017 KHP and the 2016 HIES showed 2.20% and 2.92%. The trend was significantly increased in the KHP (APC, 1.79; p<0.0001) and the HIES (APC, 1.43; p<0.0001). Therefore, this study suggests that further public healthcare interventions to alleviate the burden of catastrophic health expenditure, especially for low-income households, are needed.

• 보건행정학회지
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• 제33권2호
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• pp.166-172
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• 2023

Background: To improve the support low-income individuals' medical expenses, it is necessary to think about ways to enhance the Catastrophic Health Expenditure Support Program. This study proposes expanding support criteria and changing the income standard. Methods: This study conducted simulations using national data from the National Health Insurance Service. Simulations performed for people who have used health services (n=172,764) in 2022 to confirm the Catastrophic Health Expenditure Support Program's size based on changes to the subject selection criteria. Results: As a result of the simulation with expanded criteria, the expected budget was estimated to increase between Korean won (KRW) 13.2 (11.5%) and 138.6 billion (37.4%), and the number of recipients increased between 41,979 (48.9%) and 150,317 (76.1%). The results of the simulation for the change in income criteria (applied to health insurance levels below the 50th percentile) estimated the expected budget to increase between KRW -8.9 (-7.8%) and 55.6 billion (15.0%) and the number of recipients to increase between -8,704 (-10.1%) and 41,693 (21.1%) compared to the current standard. Conclusion: The 2023 Catastrophic Health Expenditure Support Program's criteria were expanded as per the 20th Presidential Office's national agenda to alleviate the burden of medical expenses on the low-income class. In addition, The Catastrophic Health Expenditure Support Program needs to be integrated with other medical expense support policies in the mid- to long-term, and a foundation must be prepared to ensure the consistency of each system.

• 한국산학기술학회논문지
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• 제16권6호
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• pp.4067-4076
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• 2015

본 연구는 2008년~2011년 "한국의료패널" 원시자료를 이용하여 연간 가구 과부담 의료비 지출 추이와 과부담 의료비 발생에 영향을 미치는 요인을 알아보고자 하였다. 연도별 과부담 의료비 발생률 추이는 교차분석(correspondence analysis)을 실시하였고, 과부담 의료비 발생에 영향을 미치는 요인은 일반화 추정방정식(generalized estimating equation)을 이용하였다. 연간 과부담 의료비 발생률 추이는 10%, 15%, 20%, 30%, 40% 역치 수준에서 각각 평균 25.1%, 15.4%, 10.1%, 5.4%, 3.2%로 나타났다. 과부담 의료비 발생에 영향을 미치는 요인을 살펴본 결과, 연간 총가구소득이 낮을수록, 가구주의 교육수준이 낮을수록, 의료보장형태가 건강보험가입 가구일수록, 가구주가 장애가 있을수록, 가구주의 연령이 높아질수록, 총가구원 수가 적을수록, 가구원의 주관적 건강수준이 낮을수록, 가구당 만성질환 유병률이 높을수록 과부담 의료비 발생 확률이 높게 나타났다(p<0.05). 따라서 의료 접근성 향상을 위한 전반적인 보장성 확대를 위한 노력과 동시에 특히 의료비 부담이 큰 노인 가구, 만성질환 가구 등의 취약계층을 우선으로 고려하는 정책 마련이 필요하다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권6호
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• pp.2713-2717
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• 2014

Background: Cancer imposes significant economic challenges for individuals, families, and society. Households of cancer patients often experience income loss due to change in job status and/or excessive medical expenses. Thus, we examined whether changes in economic status for such households is affected by catastrophic health expenditures. Materials and Methods: We used the Korea Health Panel Survey (KHPS) Panel $1^{st}-4^{th}$ (2008-2011 subjects) data and extracted records from 211 out of 5,332 households in the database for this study. To identify factors associated with catastrophic health expenditures and, in particular, to examine the relationship between change in economic status and catastrophic health expenditures, we conducted a generalized linear model analysis. Results: Among 211 households with cancer patients, 84 (39.8%) experienced catastrophic health expenditures, while 127 (40.2%) did not show evidence of catastrophic medical costs. If a change in economic status results from a change in job status for head of household (job loss), these households are more likely to incur catastrophic health expenditure than households who have not experienced a change in job status (odds ratios (ORs)=2.17, 2.63, respectively). A comparison between households with a newly-diagnosed patient versus households with patients having lived with cancer for one or two years, showed the longer patients had cancer, the more likely their households incurred catastrophic medical costs (OR=1.78, 1.36, respectively). Conclusions: Change in economic status of households in which the cancer patient was the head of household was associated with a greater likelihood that the household would incur catastrophic health costs. It is imperative that the Korean government connect health and labor policies in order to develop economic programs to assist households with cancer patients.

• 보건행정학회지
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• 제21권2호
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• pp.159-178
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• 2011

Korea ranks high among the OECD member countries with a high out-of-pocket share. In 2006, the government implemented in full scale the policy of extending the health insurance benefit coverage. Included in the policy are lowering the out-of-pocket share of patients of serious case and expanding the medical bill ceiling system to mention just a few. This study proposes to confirm effectiveness of the benefit extension policy by identifying changes in 'out-of-pocket expenditure as a share of the ability to pay' and 'incidence rate of catastrophic health care expenditure' of each individual household as manifested before and after the benefit extension policy was implemented. The 1st and 3rd year data from the Korea Welfare Panel Study (KoWePS), conducted by the Korea Institute for Health and Social Affairs (KIHASA), were used for the analysis, where low-income households and ordinary households are sampled separately. While the absolute amount of 'out-of-pocket expenditure' occurred to the average household increased for the period 2005-2007, the 'out-of-pocket expenditure as a share of the ability to pay' decreased. At the same time, the share decreased in the case of low-income households and households with patients of chronic or serious case as contrasted with ordinary households. 'Incidence rates of catastrophic health care expenditure' of ordinary households for 2007 stood at 14.6%, 5.9% and 2.8% at the threshold of 10%, 20% and 30%, respectively. The rates decreased overall between 2005 and 2007, while those of low-income households with patients of serious case statistically significantly increased. An analysis of this study indicates that it is related with the medical bill ceiling system regardless of incomes introduced in 2007.

• 보건행정학회지
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• 제26권3호
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• pp.172-184
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• 2016

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.

• 보건행정학회지
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• 제28권4호
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• pp.369-377
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• 2018

Background: Catastrophic health expenditure (CHE) occurs when medical expenditure of a household passes over a certain ratio of household income. This research studied the effect of gender on CHE based on Korea Health Panel data. Methods: This study implemented binary logistic regression model to figure out whether gender affects CHE and how different gender groups show pattern of CHE process. With gender, age, marital status, income level, economic activity, membership of private insurance, existence of chronic disease, and self-rated health were included in the model. Results: Results showed that females faced CHE 1.5 times more than males (odds ratio, 1.241). Also, main determinants of CHE in female groups were marital status, while age and economic activity status were significant in male groups. Subgroup analysis displayed that married female under 35 years old are located in intersectionality of CHE including pregnancy and delivery, multiple health risk behaviors, mental stress, and relatively vulnerable social status due to lower income. Meanwhile, both gender above 50 years old faced remarkably high chance of CHE, which seems to be caused by complex health risk behaviors and chronic diseases. Conclusion: Such results implied not only that gender is an important determinant of CHE, but also other determinants of CHE differ according to gender, which suggests a necessity of gender-based CHE support and rescue policy.

• 한국콘텐츠학회논문지
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• 제22권1호
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• pp.484-492
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• 2022

본 연구는 베이비부머세대의 과부담 의료비에 미치는 요인을 파악하기 위하여 한국의료패널조사 2017년 원자료를 분석자료로 이용하여, 베이비부머세대 808명을 최종 분석대상으로 하였다. 분석은 빈도분석, 교차분석, 로지스틱 회귀분석을 실시하였고, 모든 검증은 p=.05를 유의수준으로 하였다. 베이비부머세대의 교육수준, 배우자 유무, 의료보장형태, 가구소득, 음주여부, 흡연여부, 주관적 건강상태, 외래진료여부, 입원진료여부가 통계적으로 유의한 차이가 있었다. 베이비부머세대의 평균 질환수는 8.14개 이었고, 남자 7.97개, 여자 8.99개 이었다. 외래 진료평균횟수는 16.81회 이었고, 남자 14.81회, 여자 26.89회 였다. 과부담 의료비 발생률 중 지불능력 40% 이상은 남자 15.3%, 여자 26.3% 였다. 과부담 의료비 지출에 미치는 영향 요인은 남자는 민간보험가입여부, 가구소득, 음주여부, 입원진료여부 이었고, 여자는 민간보험가입여부, 가구소득, 음주여부였다.