• Health Policy and Management
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• v.7 no.2
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• pp.109-146
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• 1997

This study explores the feasibility of activating private health insurance in Korea. The rationale for expanding private supplementary health insurance can be found in many cases of health care reforms in the European countries. Private health insurance can not only relieve the financial distress of the government health insurance programs but also offer the medical institutions incentives to improve the quality of medical care. In Korea there is no supplementary health insurance that reimburses for various kinds of diseases based on a well designed fee schedule. Recently, the cancer insurance is the best seller in the health related insurance market. As observed in the U. S. case, the cancer insurance which pays the predetermined amount (indemnity coverage) regardless of the medical charges incurred to the patient is limited in its coverage for the insured. To provide better protection against catastrophic diseases, the government should give insurance companies incentives to develop health insurance products that cover multiple diseases rather than a single disease. Consumers can hardly understand and compare complex insurance products. To resolve the information asymmetries, the government should publish a consumer report that compare various health insurance products in a user friendly way. In the long run, insurance companies will plan to sell health insurance products that charge risk related premium only when insurers accumulate the underwriting know-hows, the government shares data on various health statistics including claims and demographics, and risk pool for high risk patients is well established and subsidized by the government.

• The Korean Journal of Health Service Management
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• v.5 no.4
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• pp.177-192
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• 2011

The arguments exist that private health insurance(PHI) policy holders tend to use the health care services more than non-policy holders due to their little out-of-pocket spending, resulting in the adverse effects on the finances of National Health Insurance. This study aims to increase the objective understanding of the issue and to draw a direction of further research, by reviewing the articles, reports and statistics which examined the effects of purchasing PHI policies on health care utilization. Significant differences in healthcare utilization, except for the very partial increase of utilization in outpatient settings, have been not found. The similar trends of the results have existed in a few previous studies which tried to control the endogeneity of medical use and health insurance with latent variables which affect the decision on medical use and health insurance. However, we can not exclude the potential change of healthcare utilization patterns because the portion of the insured of indemnity PHI is becoming rapidly larger in the market. For further research, we should try to obtain the objective information of subjects' past medical history, health status, health related behavior, and income affecting purchase of PHI and utilization of healthcare services. And the efforts of controlling the endogeneity of medical use and health insurance with latent variables which affect the decision on medical use and health insurance, are very considerable.

• The Journal of the Korea Contents Association
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• v.22 no.1
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• pp.601-610
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• 2022

Although the number of people insured by private health insurance in Korea is steadily increasing, the household burden or the status of multiple purchasing for private health insurance has not been addressed. In this study, data of the 2011-2018 Korea Health Panel Survey was used to examine the purchasing trend of Korean households' private health insurance. Households with more than three private health insurance per household member were defined as the 'poly-purchases'. The logit model was applied to analyze factors associated with poly-purchase of private health insurance using 2018 cross-sectional data. From 2011 to 2018, the number of insurances purchased by Korean households increased (4.0 to 4.6), the number of insurances per capita increased (1.3 to 1.6), and the proportion of the poly-purchasing households increased (5.2% to 10.8%). As a result of logit analysis, the probability of poly-purchasing was increased when the household head was a woman, with a high level of education and income, and when the job of the household head was a service or sales. Poly-purchasing was less likely when the family was subsidized with Medical Aids and suffered with more chronic diseases. The results of this study serve basic evidence for establishing policies regarding private health insurance, such as establishing the relationship between public and private insurance.

• Health Policy and Management
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• v.29 no.2
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• pp.184-194
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• 2019

Background: The extent of coverage rate of the public health insurance is still insufficient to meet healthcare needs. Private health insurance (PHI) plays a role to supplement coverage level of national health insurance in Korea. It is expected that reduce unmet need healthcare. This study was aimed to identify relationship between PHI type and the unmet healthcare need and its associated factors. Methods: Data were obtained from the 2014 Korea Health Panel Survey using nationally representative sample was analyzed. Respondents were 8,667 who were adults over 20 years covered by PHI but have not changed their contract. According to the enrollment form, PHI was classified into three types: fixed-benefit, indemnity, and mixed-type. To identify factors associated with unmet needs, multiple logistic regression conducted using the Andersen model factors, which are predisposing factors, enabling factors, and need factors. Results: Our analysis found that subjects who had PHI with mixed-type were less likely to experience unmet health care needs compared than those who did not have it (odds ratio, 0.80; 95% confidence interval, 0.66-0.98). As a result of analyzing what affected their unmet healthcare needs, the significant factors associated with unmet medical need were gender, marital status, residence in a metropolitan area, low household income, economic activity participation, self-employed insured, physically disabled, low subjective health status, and health-risk factors such as current smoking and drinking. Conclusion: The results of this study suggest that having PHI may reduce experience of unmet healthcare needs. Findings unmet healthcare needs factors according to various subjects may be useful in consideration of setting policies for improving accessibility to healthcare in Korea.

• Health Policy and Management
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• v.17 no.2
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• pp.1-17
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• 2007

Limited coverage for health care services of National Health Insurance(NHI) in Korea has been ongoing policy issue but additional NHI financing through raising contribution or taxes in order to improve coverage faces substantial obstacles. Private health insurance(PHI) is often considered as an alternative financing source to improve coverage. Recent reform that attempted to stretch the role of PHI allowed life insurance companies to provide complementary PHI, indemnity plan which will pay for uncovered services by NHI and out-of-pocket spending for covered services. Although complementary PHI may relieve financial burden of patients, it may significantly raise NHI spending as well as total health expenditure since little out-of-pocket spending may increase utilization of health care. So far, there has not been enough discussion about concerns of potential adverse effect resulting from extended role of PHI. This study investigated potential increase of NHI spending followed by extension of complementary PHI through sensitivity analysis. The amount of NHI spending for services that would be covered by complementary PHI was calculated using 2005 NHI statistics and expected complementary PHI enrollment rate by age and sex. Expected utilization increases were obtained based on price elasticities$(-0.2{\sim}-0.5)$ from previous studies and expected coverage rate$(50{\sim}80%)$ of complementary PHI and then converted to monetary figures. Because coverage rate of complementary PHI has not been determined yet, we employed the sensitivity analysis using coverage rate of $50{\sim}80%$. Findings demonstrate that additional spending for health care services is expected to be $426{\sim}1,702$ billion won, corresponding amount payed by NHI $298{\sim}1,192$ billion won. In conclusion, since complementary PHI may raise NHI spending significantly, there should be an agreement whether this additional cost would be accountable and acceptable in our society. Potential inefficiency resulting from extended role of complementary PHI should be considered since public and private financing do not operate in isolation and there should be more discussion on proper role of PHI in Korea.

• Health Policy and Management
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• v.31 no.4
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• pp.387-398
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• 2021

Moon Jae-in Care can be seen as a 2.0 version of Roh Moo-Hyun Care. Just as Roh Care failed to achieve its coverage rate goal and 30% share of public beds, Moon Care also failed to achieve its expected goal. The reason is that it followed Roh Care's failed strategy. Failure to control non-covered services has led to a long way to achieve a 70% coverage rate and induced the expansion of voluntary indemnity insurance, resulting in increased public burden. The universal coverage of non-covered services caused an immediate backlash from doctors. And Moon government also failed to control the private insurance market. The expansion of publicly owned beds has not become realized and has not obtained public support. Above all, it failed to overcome the resistance of doctors and failed to obtain consent from budget power groups in the cabinet for public investment. It was also insufficient to win the support of civic groups. Communication with interested groups failed and the role of private health care providers was neglected. The next government should also continue to strengthen health care coverage, but it should prioritize preventing medical poor and create a consensus with both medical providers and consumers for the control of non-covered services. Ahead of the super-aged society, the establishment of linkage between medical services and long-term care and visiting health care or welfare services is an important task. All public and private provisions and resources should be utilized in the view of a comprehensive public health perspective, and public investment should be input in sectors where public medical institutions can perform more effective functions. The next government, which will be launched in 2022, should design a new paradigm for health care in the face of a period of transformation, such as the coming super-aged society in 2026 and the Fourth Industrial Revolution, and recognize that the capabilities of the health care system represent the nation's overall capacity.

• Korean Security Journal
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• no.32
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• pp.151-176
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• 2012

Government organizations (including police, prosecutor, and Financial Supervisory Service) and programs to uncover or prevent from insurance crime are not well developed. However, insurance crime are increasing among not only private insurances such as life insurance, indemnity insurance, and auto insurance but also public insurances including national health insurance and industrial accident compensation insurance. The damages of crimes are serious in both economical and ethical perspectives. Insurance crime deteriorates a current account of insurance companies and the leakages due to insurance fraud worsen loss ratio. Consequently, insurance crime increases customers' costs of insurance. For this reason, insurance companies stated to establish Special Investigation Unit(SIU) to detect insurance crime and fraud by themselves. However, organizational and operational efficiencies are limited. The purpose of this study is to examine the relationship between work environment factors, perception of insurance crime and job satisfaction among Special Investigation Units. Therefore, this study investigated the perception of work environments of Special Investigation Units. In addition, this study examined how their work environments and general perception of insurance crime influence their job satisfaction. In order test the purpose of this study, reliability test, exploratory factor analysis(EFA), multiple regression were employed. The results of this study suggested that clarity of insurance company, distress/difficulty of resolve, compensation, perception of work pressure are statistically significant on jab satisfaction among Special Investigation Unit in South Korea. This exploratory study expected to contribute to understanding of Special Investigation Unit, and their insurance crime prevention system. The results from this analysis will be examined in light of previous findings and policy implications discussed.