• Journal of Preventive Medicine and Public Health
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• v.55 no.4
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• pp.379-388
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• 2022

Objectives: Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households. Methods: This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP. Results: Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively. Conclusions: In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.

• Journal of Preventive Medicine and Public Health
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• v.30 no.2 s.57
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• pp.437-461
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• 1997

Because of a significant improvement in the economic situation and development of scientific techniques in Korea during the last 30 years, the life expectancy of the Korean people has lengthened considerably and as a result, the number of the elderly has markedly increased. Such an increase of the number of aged population brought about many social, economic, and medical problems which were never seriously considered before. This study was conducted to assess the trend of medical care utilization and medical expenditure of the elderly. The data of each patient in the study were taken from computer database maintained for administrative purpose by the Korea Medical Insurance Corporation. The study population was 132,670 who were 60 years old or more and registered in Korean Medical Insurance Corporation from 1989 to 1993. The study subjects were predominantly female(56.3%) and 10,000-20,000 Won premium group(50.6%). The following are summaries of findings : The total increase of the number of inpatient cases was 40.5% from 1989 through 1993. The average annual increase was 3.7% in inpatient medical expenditures per case, 4.4% in inpatient medical expenditures per day and 0.08% in length of stay per case from 1989 through 1993. Cataract was the most prevalent disease of 10 leading frequent diseases in all ages from 1989 through 1993. The case mix in 1993 compared to 1989 revealed that cataract and ischemic cerebral disease were increased whereas essential hypertension and pulmonary tuberculosis were decreased . The average annual increase of medical expenditures was 3.8% in general hospitals, 6.3% in hospitals and 2.4% in clinics. From 1989 through 1993, medical expenditures used by high-cost patients accounted for about 14% to 20% of all expenditures for inpatient care, while they represented less than 2.5% of the elderly population. Time series analysis revealed that total medical expenditures and doctor's fee for inpatient will be progressively increased whereas drug expenditures for inpatient will be decreased. And there will be no change in length of stay. Based on the above results, the factors increasing medical cost and utilization should be identified and the method of cost containment for the elderly health care should be developed systematically.

• Journal of Preventive Medicine and Public Health
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• v.24 no.4 s.36
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• pp.485-495
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• 1991

This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discouraging the use of tertiary care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131 (3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care utilization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.

• Journal of The Korean Society of Integrative Medicine
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• v.7 no.2
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• pp.111-119
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• 2019

Purpose : The aim of this study was to investigate patterns of medical use among juveniles and adolescents, including for chronic disease, in Korea. The study sought to do the following: (a) investigate the extent to which chronic diseases account for medical expenditures, (b) investigate and the socio-demographic characteristics associated with medical use, and (c) identify the differences in medical use between juveniles and adolescents. Methods : We used data from the 2015 Korean Health Panel and selected 12 variables. The socio-demographic characteristics investigated included, growth period (juvenile, adolescents), gender, family income, national basic livelihood act status, disability registration, and degree of disability. There were five medical factors that were considered: emergency room use, hospitalization use, hospital outpatient use, chronic disease, and medical expenditure. Data were analyzed using stepwise multiple and logistic regression. Results : The prevalence of chronic disability in juveniles and adolescents was 31.1 % and 1 %, respectively. The factors affecting medical expenditures included hospitalization use, hospital outpatient use, family income, disability, gender, chronic disease, and emergency room use ($R^2=.160$, p<.05). For national basic livelihood act recipients, the probability of having chronic disease was about 1.6 times higher (OR=1.597, 95 % CI=1.092-2.335, p=.016), compared with non-national basic livelihood act recipients. People with disabilities were 6.6 times more likely than those without disabilities to suffer from chronic disease (OR =6.571, 95 % CI=2.776-15.556, p<.001). Hospital outpatient user was 2.3 times higher than non-user (OR=2.260, 95 % CI=1.702-3.001, p<.001). Juveniles had a 1.7 times and 6.2 times higher likelihood of emergency rooms user (OR=1.654, 95 % CI=1.270-2.155, p<.001), and hospital outpatient user than adolescents (OR=6.208, 95 % CI=4.443-8.676, p<.001). Conclusion : The findings of this study suggest that health care services for juveniles is needed to manage chronic diseases that have an effect on medical expenditures.

• Journal of Preventive Medicine and Public Health
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• v.28 no.1 s.49
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• pp.207-223
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• 1995

A new medical delivery system which regulated outpatient department(OPD) use from tertiary care hospitals was adopted in 1989. Under the new system, patients using tertiary care hospital OPD without referral slip from clinics or hospitals could not get any insurance benefit for the services received from the tertiary care hospital. This study was conducted to evaluate the Patient Referral System(PRS) with respect to health care expenditures and utilization. Two data sets were used in this study. One was monthly data set(from January 1986 to December 1992) from the Annual Report of Korea Medical Insurance Corporation(KMIC). The other was monthly joint data set composed of personal data of which 10% were selected randomly with their utilization data of KMIC from January 1988 to December 1992. The data were analyzed by time-series intervention model of SAS-ETS. The results of this study were as follows: 1. There was no statistically significant changes in per capita expenditures following PRS. 2. Utilization episodes per capita was increased statistically significantly after implementation of PRS. The use of clinics and hospitals increased significantly, whereas in tertiary care hospitals the use decreased significantly immediately after implementation of PRS and increased afterwards. 3. Follow-up visits per episode were decreased statistically significantly after implementation of PRS. The decrease of follow-up visits per episode were remarkable in clinics and hospitals, whereas in tertiary care hospitals it was increased significantly after implementation of PRS. 4. There was no statistically significant changes in prescribing days per episode following PRS. Futhermore, clinics and hospitals showed a statistically significant decrease in prescribing days per episode, whereas in tertiary care hospital it showed statistically significant increase after implementation of PRS. 5. Except high income class, the use of tertiary care hospitals showed statistically significant decrease after implementation of PRS. The degree of decrease in the use of tertiary care hospitals was inversely proportional to income. These results suggest that the PRS policy was not efficient because per capita expenditures did not decrease, and was not effective because utilization episodes per capita, follow-up visits per episode. and prescribing days per episode were not predictable and failed to show proper utilization. It was somewhat positive that utilization episodes per capita were decreased temporarily in tertiary care hospitals. And PRS policy was not appropriate because utilization episodes per capita was different among income groups. In conclusion, the PRS should be revised for initial goal attainment of cost containment and proper health care utilization.

• Health Policy and Management
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• v.34 no.1
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• pp.87-93
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• 2024

Background: In recent years, studies have shown conflicting results regarding the benefits of dietary supplements in reducing healthcare expenditures. This study aimed to address this inconsistency by examining the association between supplement consumption and health expenditures using nationally representative data from the Korea Health Panel Survey (2019-2020). Methods: A 1:1 matched case-control dataset was established using propensity score matching technique based on supplement consumption. Then, total annual healthcare expenditures were compared between the two groups. In addition, a multivariate regression analysis (Proc Surveyreg) was performed to determine the association between the supplement consumption and medical costs. Results: The supplement user group spent about 1.72 million Korean won, while the non-user group spent about 1.43 million Korean won on medical services (p=0.0186). The results of multivariate regression showed that the costs were approximately 26.15% higher in the user group than in the non-user group (p=0.0004). Conclusion: Contrary to the previous studies that have shown the benefits of supplement use in reducing healthcare costs, this study showed that those who consistently consumed supplements spent more on medical services. This can be interpreted in the same context as previous studies suggesting that dietary supplement intake is a healthy behavior for managing one's health. However, we caution against drawing firm conclusions due to data limitations. Further analysis using patient-level epidemiologic data is needed.

• Research in Community and Public Health Nursing
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• v.27 no.3
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• pp.272-283
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• 2016

Purpose: This is a comparative study using secondary data from the Korean national long term care (LTC) insurance. Methods: Visiting nursing (VN) service users (n=666) and non-users (n=4,375) were extracted and compared in terms of medical expenditures, length of hospitalization, and annual number of ambulatory care visits to investigate effects of VN services in LTC. Results: Total health care expenditures were compared between the two groups and it was found that VN service users spent about $ 1700 than non-users for their medical costs between 2009 and 2011. The average length of in-hospital stay for VN service users was 19.4 days shorter than that of non-users. However, using VN services did not significantly influence the annual number of ambulatory care visits. Conclusion: The study has found that VN services are effective ways of providing community-based LTC services. We recommend LTC policy makers to further utilize VN services to deliver cost effective health care services.

• Journal of Preventive Medicine and Public Health
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• v.24 no.2 s.34
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• pp.211-220
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• 1991

Finances of health insurance can be explained by factors determining benefit expense and premium collection. This study was conducted to analyze factors contributing to the financial status of rural health Insurance. Nationwide 134 health insurance associations except the six pilot project counties were analyzed and obtained the followings. 1. In univariate analysis, statistically significant variables that explain 1) outpatient benefit expenditures include public health center utilization, proportion of pregnant women. premium and collection rate of premium 2) inpatient benefit expenditures include public health center utilization, Proportion of old age, proportion of pregnant women, premium and collection rate of premium 3) profits include public health center utilization, proportion of old age, proportion of pregnant women and collection rate of premium. 2. In multiple regression analysis, statistically significant determinants in 1) outpatient benefit include premium and public health utilization 2) inpatient benefit include premium 3) profit include public health center utilization, premium and collection rate of premium.

• Korean Journal of Community Nutrition
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• v.7 no.6
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• pp.863-871
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• 2002

To compare the costs incurred by infant feeding between mothers who breastfed their infants and those who fed them infant formula, a questionnaire survey was carried out to 136 mothers living in Seoul, Cheongju and Chungju who breastfed and 199 mothers who formula-fed their infants. The cost of formula-feeding was estimated based on the expenditures for formula and feeding apparatus, and the time needed to wash bottles and prepare formula. The cost of breastfeeding was estimated based on the expenditures for food for the additional nutritional intake of these mothers. The mean cost of formula-feeding was ￦ 1,870,125 during the first year of the baby＇s life. The food cost for the additional nutritional intake of the breastfeeding mothers was ￦ 203.004 per year. The extra medical cost for respiratory illnesses in the formula-fed group compared to the breastfed group was W 62,920 because the formula-fed infants required medical attention for respiratory illnesses more often than the breast-fed infants. Therefore, breastfeeding could save ￦ 1,730,041 during the first year of an infant＇s life. We may have underestimated the cost savings from breastfeeding because we did not take into account the potentially decreased costs of fertility control and the health benefits for mothers. as well as the decreased usage of water and gas. Analyses showed that breastfeeding is not only nutritionally advantageous, but also economically advantageous for families and society.

• Korea Journal of Hospital Management
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• v.23 no.3
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• pp.28-38
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• 2018

Purpose: To evaluate the medical expenditures for prostate cancer patients, including out-of-pocket costs, and compared the costs between androgen deprivation therapy and radical prostatectomy treatment. Methodology: This study combined clinical data from 357 prostate cancer patients from the Smart Prostate Cancer Database and the medical expenditure data from the claims and cost databases. We used the independent two-sample t-tests to compare androgen deprivation therapy and radical prostatectomy. Multivariable logistic regression analysis was conducted to identify determining factors for androgen deprivation therapy and radical prostatectomy treatments. Findings: The medical costs of androgen deprivation therapy treatment were much lower than radical prostatectomy treatment at the one year and remained lower until the fourth-year. However, after four years, the accumulated medical expenditures of androgen deprivation therapy become significantly higher than radical prostatectomy treatment. Patients with a higher cancer stage and older age had higher chances of being treated using androgen deprivation therapy treatment than radical prostatectomy treatment. Practical Implications: Our results show that early detection of cancer reduces the treatment cost for both patients and insurance payers. It also demonstrates that cost comparisons should be conducted over long periods of time in order to most accurately assess the costs.