• The Korean Journal of Health Service Management
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• v.14 no.1
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• pp.147-159
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• 2020

Objectives: This study is the human factors and disease factors of the copayment system for the elderly (>65 years old) and to identify does the current status and characteristics of the applied elderly and conducted to provide basic data. Methods: Sample cohort data from the National Health Insurance Corporation database, from the years 2012-2015, were analyzed of 21,772 elderly people over the copayment ceiling. Results: The ratio of those who exceeded the copayment ceiling system rose sharply from progressive rates of 3.39% in 2012, 3.69% in 2013 and 5.03% in 2014, to rates of 37.13% from 2013. Factors identified that affect the instances of being over the copayment ceiling were: age, income group, region, severity, disability, sickness distribution, inpatient days, and outpatient days. Conclusions: The reorganization of the copayment ceiling system in 2014 favored low-income families of the elderly, but in 2015, the proportion of elderly was low (only 5.78%). The government's policies needs to change to allow for the amount of the deductible upper limit for low- and middle- income groups to be further subdivided in order for the elderly to receive more deductibles.

• Journal of Preventive Medicine and Public Health
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• v.50 no.6
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• pp.393-400
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• 2017

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.