• Health Policy and Management
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• v.13 no.4
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• pp.48-65
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• 2003

Detailed analyses of total health expenditure and its sub­categories are essential for the evidence­based health policy(EBHP). These analyses, again, should be based on timely and reliable data that are comparable across countries. The System of Health Accounts (SHA), published by the OECD in 2000, provides an integrated system of comprehensive and internationally comparable accounts. The author has implemented the SHA manual into Korean situation, and examined overall expenditure estimate and its basic functional breakdown following the manual. This study explains how pharmaceutical expenditure is estimated. The results are, then, analyzed particularly from the international perspective. Both administrative data in Statistical Yearbooks (National Health Insurance, Medical Aid, Industrial Accident Compensation Insurance) and survey data on Health and Nutrition are used for the estimation. Per capita pharmaceutical expenditure in Korea (183 US$ PPPs) was far less than the OECD average (308 US$ PPPs) in 2001, but pharmaceutical expenditure share in total health expenditure (20.3％) was higher than the average (16.7％). This can be explained by the fact that there is a statistically significant correlation between pharmaceutical expenditure share and per capita GDP of each country. Korean people follow the tendency of relatively low­income countries to spend less than OECD average for health care, but follow again their tendency to spend more on drugs than on other health care services. In consideration of results and analysis as above, per capita pharmaceutical expenditure in Korea is expected to grow in the future, but the growth rate of the pharmaceutical expenditure is expected to be less than that of overall health expenditure.

• Health Policy and Management
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• v.32 no.1
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• pp.107-112
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• 2022

Catastrophic healthcare expenditure refers to out-of-pocket spending for healthcare exceeding a certain proportion of a household's income and can lead to subsequent impoverishment. The aim of this study was to investigate the proportion of South Korean households that experienced catastrophic healthcare expenditure between 2006 and 2020 using available data from the National Survey of Tax and Benefit (NaSTaB), Korea Health Panel (KHP), and Households Income and Expenditure Survey (HIES). Trend test was used to analyze the proportion of household with catastrophic healthcare expenditure. In the NaSTaB 2020 data, households who experienced catastrophic health expenditure was 1.73%. Trend analysis was significant with the decreasing trend (annual percentage change [APC], -5.55; p<0.0001) in the proportion of households with the catastrophic health expenditure. Also, in the 2018 KHP and the 2016 HIES, households who experienced catastrophic health expenditure was 2.21% and 2.92% respectively. In contrast, the trend was significantly increased in the KHP (APC, 0.55; p<0.0001) and the HIES (APC, 1.43; p<0.0001). Therefore, the findings suggest the need to strengthen public health care financial support and monitor catastrophic healthcare expenditures, especially for low-income group.

• Health Policy and Management
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• v.33 no.2
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• pp.166-172
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• 2023

Background: To improve the support low-income individuals' medical expenses, it is necessary to think about ways to enhance the Catastrophic Health Expenditure Support Program. This study proposes expanding support criteria and changing the income standard. Methods: This study conducted simulations using national data from the National Health Insurance Service. Simulations performed for people who have used health services (n=172,764) in 2022 to confirm the Catastrophic Health Expenditure Support Program's size based on changes to the subject selection criteria. Results: As a result of the simulation with expanded criteria, the expected budget was estimated to increase between Korean won (KRW) 13.2 (11.5%) and 138.6 billion (37.4%), and the number of recipients increased between 41,979 (48.9%) and 150,317 (76.1%). The results of the simulation for the change in income criteria (applied to health insurance levels below the 50th percentile) estimated the expected budget to increase between KRW -8.9 (-7.8%) and 55.6 billion (15.0%) and the number of recipients to increase between -8,704 (-10.1%) and 41,693 (21.1%) compared to the current standard. Conclusion: The 2023 Catastrophic Health Expenditure Support Program's criteria were expanded as per the 20th Presidential Office's national agenda to alleviate the burden of medical expenses on the low-income class. In addition, The Catastrophic Health Expenditure Support Program needs to be integrated with other medical expense support policies in the mid- to long-term, and a foundation must be prepared to ensure the consistency of each system.

• Health Policy and Management
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• v.19 no.4
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• pp.53-65
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• 2009

Purpose: This study was conducted to identify the prenatal heath care utilization and expenditure among pregnant women. Method: This was a 5-month follow-up study using a stratified sampling and the data were drawn from the "nationwide claim database of Korean National Health Insurance Corporation". Result: This study found that pregnant women were first diagnosed with pregnancy when they were 7.1 weeks pregnant, received 12.7 times of prenatal examinations and 10.6 times of ultrasonogram. It was revealed that 67.5% of the subjects continued to receive prenatal care at the same medical institutions from the diagnosis of pregnancy to the delivery. The study also showed that the total expenditure of prenatal care per pregnant woman was 700,000 Korean Won (KRW) on average and the insurance coverage rate stood at only 20%. Pregnant women living in metropolitan area spent more on prenatal healthcare expenditure than those who living in medium-sized city or rural area. Conclusion: The results of this study implies that the government needs to provide pregnant women with continuous support by increasing health insurance coverage for prenatal care. Especially, it is considered to provide more support to the pregnant women residing in medically underserved areas.

• Health Policy and Management
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• v.27 no.1
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• pp.84-87
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• 2017

Catastrophic healthcare expenditure refers to out-of-pocket spending for healthcare exceeding a certain proportion of a household's income and can lead to subsequent impoverishment. The aim of this study was to investigate the proportion of South Korean households that experienced catastrophic healthcare expenditure between 2006 and 2015 using available data from the Korea Health Panel, National Survey of Tax and Benefit, and Household Income and Expenditure Survey. Frequencies and trend tests were conducted to analyze the proportion of households with catastrophic healthcare expenditure. Subgroup analysis was performed based on income level. The results of the Household Income and Expenditure Survey revealed that around 2.88% of households experienced catastrophic healthcare expenditure in 2015 and that this proportion was highest in the low income group. Results also showed a statistically significant increasing trend in the number of households with catastrophic healthcare expenditure (annual percentage change= 0.92%, p-value < 0.0001). Therefore, the findings infer a need to strengthen public health care financing and to particularly monitor catastrophic healthcare expenditure in the low income group.

• Health Policy and Management
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• v.18 no.3
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• pp.110-127
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• 2008

Expenditures on pharmaceuticals of different concepts were estimated and their functional, financing and providers' breakdowns were examined in line with the OECD's System of Health Accounts (SHA) manual. This study also shows the way such estimates are made. The results are then analyzed particularly from the international perspective. Data from both Household Survey by the National Statistical Office and the National Health and Nutritional Survey by the Ministry of Health and Welfare of Korea were used to estimate pharmaceutical expenditures that. are financed by out-of-pocket payments of the household, while national health insurance data etc. were used for estimation of pharmaceutical expenditures that are financed by public funding sources. The 'per capita expenditure on pharmaceutical/medical non-durables' in Korea stood at 380 US$ PPPs, less than the OECD average of 443 US$ PPPs in 2006, but its share of the per capita health expenditure of 25.9% noticeably outnumbered the OECD average of 17.1%, due partly to low per capita health expenditure as a denominator of the ratio. This indicates that Koreans tend to spend less on health care than an OECD average, while tending to spend more on pharmaceuticals than on other health care services, much like the pattern found in relatively low income countries. An international pharmaceuticals pricing mechanism is most likely responsible for such a tendency. In addition, it is to be noted that the percentage comes down to 21.0%, when expenditures on both medical non-durables and herbal medicine, which is locally quite popular among the elderly, have been excluded.

• Health Policy and Management
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• v.33 no.3
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• pp.363-369
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• 2023

The term "catastrophic health expenditure" means assessing the extent to which medical costs cause financial hardship for households. The aim of this research is to analyze the percentage of households that faced severe financial strain due to medical expenses from 2006 to 2021. This was achieved by utilizing data obtained from the National Survey of Tax and Benefit (NaSTaB), Korea Health Panel (KHP), and Households Income and Expenditure Survey (HIES). A trend analysis was conducted to examine the percentage of households that experienced catastrophic healthcare expenses. The households that experienced the catastrophic health expenditure was 2.49% in 2021 using the NaSTaB data. The trend analysis yielded a statistically significant result, indicating a decreasing trend (annual percent change [APC], -4.79; p<0.0001) in the proportion of households facing catastrophic health expenditures. Also, the results of the 2019 KHP and the 2021 HIES showed 1.09% and 2.44% for the households that experienced catastrophic health expenditure. The trend was increased according to the KHP (APC, 0.55; p=0.0004) and the HIES (APC, 7.04; p<0.0001). As a result, this study proposes that sustained attention and further interventions are necessary to ease the economic pressure caused by catastrophic health expenses, particularly for low-income households.

• Health Policy and Management
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• v.30 no.4
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• pp.467-478
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• 2020

Background: The purpose of this study is to explain the factors influencing the incurrence of catastrophic health expenditure of national health insurance households using panel data observed over a long period. Methods: The study targeted 3,652 households who had no censoring during the 11-year survey period (2007-2017) and householders whose insurance type was consistently maintained as national health insurance. Generalized estimating equations were adopted to identify factors affecting the occurrence of catastrophic health expenditure at 20%, 30%, and 40% threshold levels. A subgroup analysis was conducted by categorizing groups depending on the existence of the elderly in the household. Results: For the last 11 years, the incidence of catastrophic health expenditure in the households without the elderly decreased slightly at all threshold levels, but the households with the elderly seemed to be increased. At baseline, household type showed a statistically significant relationship with all other variables. The results of generalized estimating equations analyses show that household income was not significant at all threshold levels in the households without elderly. On the other hand, in the households with the elderly, the 2nd (odds ratio [OR], 1.33-2.05) and 3rd quintile groups (OR, 1.25-2.55) were more likely to have catastrophic health expenditure compared to the 1st quintile of household income group. Conclusion: As the amount of health expenditures relative to the ability to pay is increasing in households with the elderly, the application of an intervention followed by consistent monitoring is needed. This study found that there were differences in influencing factors according to the presence of the elderly in the households. In particular, in households with the elderly, interesting results have been drawn regarding the occurrence of catastrophic health expenditure in the near-poor, so additional research is required.

• 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.

• Health Policy and Management
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• v.17 no.3
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• pp.50-67
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• 2007

This study investigated income elasticity of household health expenditures and differences by income level from 1998 through 2003. Data from Korean Labor and Income Panel Study was used for empirical analyses. To estimate the income effects on health expenditure, the two-part model was employed: a logistic regression for any health expenditure-first part-and a Ordinary Least Square regression for health expenditure conditional on any spending-second part. To estimate income elasticity, both health expenditure and income were log transformed in the second part. In addition, the random effects(RE) model was used for a longitudinal panel which was continuously followed from 1998 through 2003 to estimate income effects on health expenditures controlling for within and between unobservable household characteristics. Furthermore, difference in income effects on health expenditure across income level was investigated. Although income slightly increased odds of any health expenditure, there was not no table differences across income level. Income significantly increased health expenditures during study period(overall income elasticity: about 0.2) and the highest 20% income group presented higher income elasticity than the lowest 20% income group.