• Health Policy and Management
• /
• v.15 no.1
• /
• pp.30-56
• /
• 2005

This paper used two threshold approaches to measure the equity in urban households' out-of-pocket payments for health care from 1997 to 2002, which developed by Wagstaff and van Doorslaer. One approach used catastrophic health expenditure, which means that payments exceed a 'pre-specified proportion' of total consumption expenditures or ability to pay and the other used impoverishment that they did not drive households into poverty. Indicies for 'catastrophic expenditure' captured intensity as well as its incidence and also the degree of which catastrophic payments occur disproportionately among poor households. Measure of poverty impact also captured both intensity and incidence. The methods applied with data on out-of-pocket payments from the Urban Household Expenditure Survey Incidence and intensity of catastrophic payments - both in terms of total household consumption as well as ability to pay - increased between 1997 and 2002, and that both incidence and intensity of 'catastrophic expenditure' became less concentrated among the poor, but more concentrated in 2001 than in 1997. The incidence and intensity of the poverty impact of out-of-pocket payments increased between 1997 and 2002. Health security system may not have provided financial protection against catastrophic health expenditure to low-income households, because of high user fee policy not considering income level. The policies alleviating catastrophic health payments among the poor need to be more developed, and two threshold approaches further evaluated on our policy context.

• Health Policy and Management
• /
• v.2 no.1
• /
• pp.167-203
• /
• 1992

The effects of regional health insurance on access to ambulatory care are examined in this paper. Access is measured as use-disability ratios. The data are collected in a household interview survey at Hwachon county before and after the introduction of regional health insurance. Before the introduction of regional health insurance, low-income class has less contacts with physicians than high-income class. This disparity in accessibility among economic classes is reduced with the health insurance coverage, but not removed, even after adjusting for health need.

• Health Policy and Management
• /
• v.22 no.1
• /
• pp.85-108
• /
• 2012

One of the ways to achieve the principle of equal access for equal needs, availability and geographical accessibility of health care resources regardless of resident sites is important. The purpose of this paper is to measure socioeconomic inequities in distribution of health care resources among regions in the Republic of Korea (hereafter Korea). Data were extracted from regional statistics of National Health Insurance, Community Health Survey, Korea Social Science Data Archive, and Korean Statistical Information Services at the same period of 2009. The dependent variables were the number of health workforce and health care facilities in each region. The proxy indicator of regional socioeconomic status was local tax per person. To identify whether inequalities among regions, we examined the concentration index(CI) and indirectly standardized CI by controlling each region's demographics and need factors. Total observations were 232 districts in nationwide, and we analyzed separately Seoul(25 districts) and non-Seoul areas(207 districts). The standardized CI values of health care resources were positive(favoring the rich region) across the nation in almost all kinds of resources. Especially the number of specialist, dentist, dental clinics, clinics, oriental medical clinics, pharmacists, and pharmacies were statistically significantly favoring the rich region. But the CI for the number of long-term care hospitals, public health centers were negative(favoring the poor region). The tendency of CI presenting positive values were increased in Seoul area. But in the case of non-Seoul, the CI indexes were nearly zero. The results suggest that except the Seoul area, little regional socioeconomic-related inequalities were observed in the distribution of health care resources in Korea.

• Health Policy and Management
• /
• v.29 no.3
• /
• pp.288-302
• /
• 2019

Background: The one-person households (OPH) are rapidly increasing and vulnerable to socioeconomic and health problems. Because it is predicted to be inequitable to health care utilization, we would like to find out about the equity of health care utilization of the OPH by comparison with the multi-person households (MPH). Methods: This study followed the theoretical framework of Wagstaff and van Doorslaer (2000), O'Donnell and his colleagues (2008), where the horizontal inequity index is the difference between the concentration indices of actual health care utilization and health care needs. This study employed the 9th Korea Health Panel survey, and a total of 10,807 cases were analyzed. Health care needs were measured by age, sex, subjective health status, chronic disease count, Charlson's Comorbidity Index, limitation of activities, and disability. Results: Compared with the MPH, there were pro-poor inequities in hospitalization, emergency utilization, hospitalization out-of-pocket payments, and pro-rich inequities in outpatient out-of-pocket payments for the OPH. The decomposition of the concentration index revealed that chronic disease count made the largest contribution to socioeconomic inequality in outpatient utilization. Age, health insurance, economic activities, and subjective health status also proved more important contributors to inequality. The variables contributing to the hospitalization and emergency utilization inequity were age, education, Charlson's Comorbidity Index, marital status, and income. Conclusion: Because the OPH was more vulnerable to health problems than the MPH and there were pro-poor inequities in medical utilization, hospitalization, and emergency costs, it is necessary to develop a policy that can correct and improve the portion of high contribution to medical utilization of the OPH.

• Health Policy and Management
• /
• v.6 no.1
• /
• pp.110-143
• /
• 1996

The purpose of this study is to assess the extent of inequality in health outcomes and the distribution of health services according to health need under National Health Insurance System in Korea. For the empirical analysis, data were collected through an interview survey during one month of October, 1994. Interview were conducted with a total of 10, 875 of the employees and the self-employed selected through cluster, systematic sampling. The major findings of this research are as follows: 1. The analysis of the differentials in morbidity rates by socio-economic group showed that health inequality in the pro-higher groups existed in all self-reported morbidity indicators. 2. The findings of the conventional use measures showed that the lower socio-economic groups had more ambulatory and inpatient services than the higher groups. In contrast to the level of the medical care utilization, however, the higher socio-economic groups were more likely to use the high-quality source of care in terms of their treatment place compared to the lower groups. 3. By using the need-based use measures, the results were different from each use-disability ration indicator. Using the use-disability ration measured by physician visits per 100 restricted-activity days in the population, it was found that there was no evidence favoring the higher socio-economic groups. In contrast, the use-disability ration based on physician visits per a chronic patient in one year displayed that there was remarkable relative difference by income group as well as the evidence of the pro-higher income groups. 4. The results of logistic regression analysis and two-stage estimation method indicated that although the utilization is significantly affected by type and duration of insurance coverage, the use or nonuse of service and the volume of physician care consumed is determined by health need and demographic characteristics rater than economic status. In sum, these findings suggest that physician service is equitably distributed according to health need under national health insurance system in Korea. As there were some evidences of inequality including the differential in physician visits of chronic patients by income group, however, the government should strengthen the activities to guarantee the equity of health services utilization.

• The Korean Journal of Health Service Management
• /
• v.9 no.2
• /
• pp.1-12
• /
• 2015

The objective of this study was to verify the effects of brand equity of small & medium hospitals on trust and relationship commitment and mediation effect of trust in the relation between brand equity and relationship commitment. For testing reliability and validity of the measurement tool, Cronbach's ${\alpha}$ and confirmatory factor analysis was used, respectively. A structural equation model was applied for verifying the study model suggested. Out of 450 questionnaires distributed, 439 was returned. On the study results, brand image and perceived quality positively determined trust of customers for small & medium hospitals. Customers' trust also has a positive effect on relationship commitment. Brand awareness positively influence the levels of relationship commitment. Moreover, a mediation effect was identified. Customers' trust mediated the effects of brand image and perceived quality on relationship commitment of hospitals customers. On conclusions, relationship commitment was determined, either directly or indirectly, by brand image and perceived quality, while trust mediated the their relationship. Thus, hospitals management may use the concepts of brand equity and trust as a key success factor of their business purposes.

• Health Policy and Management
• /
• v.18 no.4
• /
• pp.185-206
• /
• 2008

The National Health Insurance (NHI) has been the main body of health care system in Korea for the last 30 years since the NHI was founded. However, the inefficient management and strong regulations of the NHI have hindered the development of health care industry. The establishment of the MB government, whose interest lies on economic growth rather than equity, is expected to help the health care services gain a momentum. The essential measures that can step up public health care services overall are the following: the introduction of competition within NHI, the activation of private health care insurance, and the allowance of for-profit hospital. The private-public mix with market mechanism would level up the health care service for the public.

• Journal of Korean Academy of Nursing Administration
• /
• v.17 no.2
• /
• pp.180-188
• /
• 2011

Purpose: This study was done to evaluate the operating status of community-based home health center for revitalization of the centers. Method: In this study performance data including organization plan and service utilization plan were evaluated according process theory. Target of evaluation was the community-based home health care center. Results: The vulnerable part of the organization was the information system and financial resources. The home health center introduced PDA (Personal Digital Assistants) in 2005, however home health care nurses did not make full use of it. This service received full support from Seoul city and local government and there were no other sources of income. The vulnerable part of service utilization was service expansion and standardization due to vulnerability of organizational aspects. Conclusions: The home health care center provides high quality services to underprivileged people. In the future, these services should be provided with equity for continuous health care for this population.

• 대한예방의학회:학술대회논문집
• /
• 1995.10a
• /
• pp.175-176
• /
• 1995

• Health Policy and Management
• /
• v.16 no.4
• /
• pp.86-111
• /
• 2006

Either ways of understanding health care as a commodity or public work are at opposite ends of health care spectrum. These two rival conceptions reflected by viewpoint(ideology) would lead to different directions in policy-making for health care reform. The purpose of this study is to access the value differences of experts' policy views about health care issues by analyzing the extent of consensus among experts in the field of health care. Using primary data obtained through a mail survey of 558 experts in the field of health care, we analyzed the differences of experts' opinions about characteristics of health care market, policy issues and values Gdeology). The study represents from 50-50 split analysis, entropy index, and factor analysis that the wide spread disagreements over health policy, which is a major barriers to effective policy-making, could be caused by the ideological perception differences among experts. This implies that, if values play an important role in policy-making, we should identify the differences in value and seek ways to balance among the diverse values such as efficiency, equity, freedom, and security. For this, the policy issues debated on differences in values should be reconciled for narrowing gaps of experts' perceptions through various ways.