• Journal of Preventive Medicine and Public Health
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• v.40 no.3
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• pp.227-232
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• 2007

Objectives : The purpose of this study was to determine the population-attributable risk (PAR) and estimate the total medical expenditure of the Korean National Health Insurance (KNHI) due to smoking. Methods : We used data from the Korean Cancer Prevention Study of 1,178,138 Koreans aged 30 to 95. These data were available from 1992 to 2003 and covered a long-term follow-up period among the Korean population. Results : The total medical expenditure of KNHI related to smoking increased by 27% from $324.9 million in 1999 to $413.7 million in 2003. By specific diseases, smoking-attributable KNHI medical expenditure was the highest for lung cancer ($74.2 million), followed by stroke ($65.3 million), COPD ($50.1 million), CHO ($49 million) and stomach cancer ($30 million). A total of 1.3 million KNHI patients were suffering from smoking-related diseases in 2003. We predicted rises in total KNHI medical expenditure related to smoking to $675.1 million (63% increase compared with that of 2003) and in the total number of KNHI patients suffering from smoking-related diseases to about 2.6million (an approximate 100% increase compared with those in 2003) in 2015. Conclusions : We found a substantial economic burden related to the high smoking prevalence in South Korea.

• Journal of Family Resource Management and Policy Review
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• v.23 no.1
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• pp.17-34
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• 2019

Older women who live alone are among society's most vulnerable people, since they experience increased risk of multiple chronic diseases and have limited financial protection. This can lead older women living alone to catastrophic health expenditure(CHE), which is defined as a healthcare expenditure that exceeds a certain portion of a household's ability to pay. Using the Korean Longitudinal Study of Ageing(KLoSA), this study investigated the incidence of CHE among older women living alone and identified the factors related to this incidence. Applying health expenditure thresholds of 10%, 20%, 30% and 40% of ability to pay, the proportions of those with CHE were 41.3%, 22.9%, 14.6%, and 9.4%, respectively. Logistic regression models were used to identify factors related to CHE incidence, which include demographics, income, the number of chronic diseases, perceived health status, and health insurance type. The results show that the health care safety net in South Korea is insufficient for older women living alone. The findings can guide policymakers in improving healthcare and welfare policies to protect people from catastrophic payments. Particularly, welfare policies should be established for poor non-recipients who are not included within the benefits scope of the National Basic Livelihood Security System due to the unrealistic criteria of income recognition and family support obligation.

• Health Policy and Management
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• v.28 no.4
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• pp.378-391
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• 2018

Background: People who were born in different years, that is, different birth cohorts, grow in varying socio-historical and dynamic contexts, which result in differences in social dispositions and physical abilities. Methods: This study used age-period-cohort analysis method to establish explanatory models on healthcare expenditure in Korea reflecting birth cohort factor using intrinsic estimator. Based on these models, we tried to investigate the effects of ageing population on future healthcare expenditure through simulation by scenarios. Results: Coefficient of cohort effect was not as high as that of age effect, but greater than that of period effect. The cohort effect can be interpreted to show 'healthy ageing' phenomenon. Healthy ageing effect shows annual average decrease of -1.74% to 1.57% in healthcare expenditure. Controlling age, period, and birth cohort effects, pure demographic effect of population ageing due to increase in life expectancy shows annual average increase of 1.61%-1.80% in healthcare expenditure. Conclusion: First, since the influence of population factor itself on healthcare expenditure increase is not as big as expected. Second, 'healthy ageing effect' suggests that there is a need of paradigm shift to prevention centered-healthcare services. Third, forecasting of health expenditure needs to reflect social change factors by considering birth cohort effect.

• Journal of Society of Preventive Korean Medicine
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• v.19 no.3
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• pp.57-66
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• 2015

Objective : Private health insurance coverage in Korean medicine has been reduced since October 2009 for preventing unnecessary utilization. The aim of this study is to identify how private health insurance coverage reduction affects on the Korean medicine utilization. Method : We analyzed the Korea Health Panel data from 2008 to 2012. Panel negative binominal regression model was used to analyze the relationship between private health insurance coverage reduction and utilization of outpatient service. Panel tobit regression analysis was used to identify the relationship between private health insurance coverage reduction and health expenditure of outpatient service. Results : Private health insurance coverage reduction significantly dropped both utilization and health expenditure of outpatient service by 9%, 9.22% respectively. In addition, therapeutic utilization significantly decreased up to 10%. Conclusion : Private health insurance coverage reduction seems to have an effect to reduce both utilization and the health expenditure of Korean medicine outpatient service. This effect was more noticeable in the therapeutic utilization. Thus, more elaborate policy will be needed to prevent unnecessary utilization of Korean medicine.

• Korean Journal of Social Welfare
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• v.64 no.3
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• pp.51-77
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• 2012

This study examines the scale of occurrence of Catastrophic Health Expenditure, and identifies the factors influencing Catastrophic Health Expenditure among disabled elderly households. Catastrophic Health Expenditure is defined by when the households' health care spending out of ability to pay exceeds 10%, 20%, 30%, and 40%. This study used the 2008, 2009, and 2010 surveys of the Panel Survey of Employment for the Disabled(PSED) to explore how gender, age, spouse, the level of education, the degree of disability, the type of disability, disability duration, subjective health status, chronic disease, the number of household members, the proportion of disabled households, the proportion of working households, the proportion of aged households, the type of poverty, household income, net asset, determine Catastrophic Health Expenditure among disabled elderly households. The study examines the frequency of Catastrophic Health Expenditure with 726 households, and conducted the panel logit model. The empirical results show that Catastrophic Health Expenditures are significantly related to age, spouse, the type of disability, subjective health status, chronic disease, the number of households, the proportion of disabled households, the proportion of aged households, the type of poverty. This study showed that the health care safety net in South Korea was insufficient for disabled elderly households and that a policy should be established in ordered to protect disabled elderly households from occurrence of Catastrophic Health Expenditure.

• Health Policy and Management
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• v.26 no.1
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• pp.63-70
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• 2016

Background: Selective health benefit was introduced for decreasing economic burden of patients. Medical devices with economic uncertainty have been covered as selective health benefit by National Health Insurance since December 2013. We aimed to analyze impact of selective health benefit to medical expenditure and provider behavior focused on electrosurgery (ultrasonic shears, electrothermal bipolar vessel sealers) for gastric cancer patients covered since December 2014. Methods: We used the National Health Insurance claims data of 2,698 patients underwent gastric cancer surgery between August 2014 and March 2015. Medical cost and patient sharing per inpatient day were analyzed to verify that covering electrosurgery increased medical expenditure and changed provider behavior from open surgery to endoscopic or laparoscopic surgery. Additionally, we analyzed the claim rate of medical device or goods relating gastric endoscopic and laparoscopic surgery. Results: Medical cost and patient sharing per inpatient day were increased after covering electosurgery as selective health benefit (39,724/1,421 won). However, there were no medical expenditure increases after adjusting claim of electosurgery and patient sharing was decreased 1,057 won especially. The coverage of selective health benefit did not increase the claim rate of medical device or goods related endoscopic or laparoscopic surgery, either. Conclusion: Covering electosurgery decreased patient economic burden and did not change of provider behavior. Expanding selective health benefit is needed to decrease economic burden of severe patients. Further study should evaluate the long term effect with accumulated data.

• Health Policy and Management
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• v.26 no.2
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• pp.95-106
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• 2016

A new manual of System of Health Accounts (SHA) 2011, was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. This offers more complete coverage than the previous version, SHA 1.0, within the functional classification in areas such as prevention and a precise approach for tracking financing in the health care sector using the new classification of financing schemes. This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 1970-2014 constructed according to the SHA2011. Data sources for public financing include budget and settlement documents of the government, various statistics from the National Health Insurance, and others. In the case of private financing, an estimation of total revenue by provider groups is made from the Economic Census data and the household income and expenditure survey, Korean healthcare panel study, etc. are used to allocate those totals into functional classifications. CHE was 105 trillion won in 2014, which accounts for 7.1% of Korea's gross domestic product. It was a big increase of 7.7 trillion won, 7.9%, from the previous year. Public share (government and compulsory schemes) accounting for 56.5% of the CHE in 2014 was still much lower than the OECD average of about 73%. With these estimates, it is possible to compare health expenditures of Korea and other countries better. Awareness and appreciation of the need and gains from applying SHA2011 for the health expenditure classification are expected to increase as OECD health expenditure figures get more frequently quoted among health policy makers.

• Health Policy and Management
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• v.11 no.3
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• pp.46-70
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• 2001

Medical Aid expenditure Increased rapidly at a higher rate than that of Medical Insurance during the period 1992-1999. To establish an effective cost containment strategy, knowledge of the cause and the nature of the increase of Medical Aid expenditure is required. The purpose of this study was to analyze increasing rates of Medical Aid expenditure by the components of medical expenses. Data were collected using the Medical Aid Statistical Yearbook during the period of 1992-1999. The major findings were as follows: 1. The annual mean increasing rate of Medical Aid expenditure between 1992 and 1999 was 22.8%, which exceeding that of Medical Insurance expenditure (17.5%) between 1992 and 1999. Since 1998, Medical Aid expenditure increased even more rapidly than in previous years, with the increase in number of Medical Aid beneficiaries. 2. Of Medical Aid expenditure, that of inpatient and outpatient annually increased 24.2% and 22.8% respectively and that of type 1 and type 2 increased annually 28.8% (outpatient) ∼29.9% (inpatient), 14.3% (outpatient) ∼ 15.5% (inpatient). Therefore, Medical Aid expenditure of inpatient and type 1 led the increase of Medical Aid expenditure. 3. Between 1992 and 1997, the frequencies of utilization per beneficiary and the charges per case positively contributed to the increase of Medical Aid expenditure while the number of beneficiaries contributed negatively, but since 1998, the number of beneficiaries increased and positively contributed to the increase of Medical Aid expenditure. 4. According to the analysis of the charges per case, the increase of the price index led to the increase of the charges per case but the days of medication and service intensity also contributed to the increase of the charges per case variably by year. Considering the above findings, factors associated with the Medical Aid system affected the increase of Medical Aid expenditure in addition to the general factors of the increase in medical expenditure. In conclusion, it appears that a more intensive cost containment strategy is required to control rapidly increasing Medical Aid expenditure. For this, more precise analysis and development of policy considering the effect of the number of beneficiaries and the increase of price index is needed.

• Health Policy and Management
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• v.18 no.4
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• pp.23-48
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• 2008

Although the universal health insurance, National Health Insurance (NHI), have improved access to health care and financial burden of health care costs for Koreans, limited coverage of the NHI leads to high out-of-pocket payment for health care. This study examines financial burden of household health expenditures by income level. Data from the Urban Household Expenditure Survey from 1985 through 2005 is analyzed and household expenditure is used as a proxy measure for income. Health expenditures include spending for inpatient care, ambulatory care and pharmaceuticals. If a household spends health expenditure above 40% of household consumption except for foods, that is defined as catastrophic health expenditure. Access to health care for the lowest income group had been improved for two decades relative to other income groups as well as in absolute term. However, both financial burden of health expenditures and the proportion of households that experienced catastrophic health expenditure had been increased in the lowest income group. Study findings have several policy implications. First, in terms of financial burden of health expenditures. the differences among income groups decreased until 2000 but it was worsen in 2005. This suggests that recent policies for extending NHI coverage are not enough to improve the disparity by income level. Second, a differential catastrophic coverage by income level would be an effective strategy that relieves financial burden for low income group. Third, since the catastrophic coverage is applied to only covered services by the NHI, additional strategy for uncovered services should be considered.

• Health Policy and Management
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• v.18 no.3
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• pp.90-109
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• 2008

Government has extended the benefit coverage and reduced out-of-pocket (OOP) payment for cancer patients in 2005. This paper intends to examine the impact of the above policy on the equity in health care utilization. This paper analyzed the national health insurance data and compared the health care utilization of cancer patients before and after the policy change for people with 10 different income levels. For the equity in health care utilization, we examined the change in concentration index (CI) for visit days, inpatient days, and health expenditure. In the case of outpatient care, CI of visit days and health expenditure were positive(favoring the rich) in both regional and employee health insurance members and both 'before' and 'after' the policy change. CI values rarely changed after the policy change, and the policy change seems to have little impact on the equity of outpatient care utilization except expenditure of regional subscriber. In the case of inpatient care, CI of inpatient days was negative and CI of health expenditure was positive in both regional and work subscriber and both 'before' and 'after' the policy change. After the policy change, CI of inpatient expenditure in both groups of members decreased. CI of inpatient days changed in the direction favoring the poor in regional insurance members, but it rarely changed in employee insurance members. These results suggest that the policy of reducing OOP payment has a positive impact and reduced the inequity particularly in the utilization of inpatient care of cancer patients.