• Journal of Periodontal and Implant Science
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• v.26 no.3
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• pp.689-699
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• 1996

The purpose of this research is to determine elements affecting the out-of-pocket cost of woman. The sample consisted of 1907 women living Iksan city. The survey was conducted by means of questionnaires. The model used in the analysis of out-of-pocket cost was the Andersen-Newman model, while the analysis techniques used were stepwise multiple regression and path analysis. The number of independent variables used in the analysis was 28 in total, ie 19 predisposing components, 6 enabling components, and 3 need components. In this study, the amount of variance by the model was 17 percent. Number of restricted activity days caused by oral disease, perceived susceptibility of dental disease, having a regular dental care, dental treatment costs, education level and income were found to have significant major effects on out-of-pocket cost. Number of restricted activity days caused by oral disease was the most important variable affecting out-of-pocket cost of woman. Also out-of-pocket cost shows larger effect due to enabling components than frequency of dental utilization.

• Journal of Society of Preventive Korean Medicine
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• v.3 no.1
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• pp.67-82
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• 1999

This study was performed to investigate out-of-pocket money among medical expenses of an oriental medical university hospital by the use of internal data of an oriental hospital because medical insurance program data could not show us insuree's out-of-pocket money among medical expenses. The purpose of this study was to analyze out-of-pocket money among medical expenses of ambulatory and hospitalized patients. Under this purpose, We analyzed actual medical expenses data of 1389 out-patients and 858 in-patients of the oriental medical university hospital with 90 beds that could be approach to internal data from July 1, 1998 to March 31, 1999. The major findings are as follows : 1. In ambulatory patients, the cost share ratio of insuree & that of insurer was 90 : 10 respectly. 2. In hospitalized patients, the cost share ratio of insuree & that of insurer was 72 : 28 respectly.

• Environmental and Resource Economics Review
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• v.11 no.4
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• pp.659-687
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• 2002

This study used a discrete choice model to investigate an association between air pollution and hospital visits for acute respiratory symptoms with the national health interview survey conducted in 1998 in South Korea. The results showed that $NO_2$ and TSP were significantly related to hospital visits in a single-pollutant model, but when they were simultaneously considered, only $NO_2$ remained significant. It was estimated as $NO_2$ level increased by 10%(0.0027ppm) from 0.027ppm (the mean $NO_2$ level), hospital visits increase by 0.176%. This study also measured respondent's out-of-pocket expense and the time cost for commuting and waiting for the visit. We found that on the average, out-of-pocket expense is 5,600 won per hospital visit, but the total cost per hospital visit is measured at 33,440 won with time cost of commuting and waiting at 27,840 won. Time cost was over 63.6~83.3% of the total cost per hospital visit.

• Health Policy and Management
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• v.27 no.2
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• pp.139-148
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• 2017

Background: The purpose of this study is to investigate family caregivers' opinions about out-of-pocket payment for long-term care (LTC) facilities, and find the differences in the opinions for family caregivers of all different levels of income. Methods: We used the data of the study on out-of-pocket payment in national long-term care insurance, including 1,552 family caregivers with the elderly in long-term care facilities. Results: The average out-of-pocket payment per month was 511,635 Korean won and distributed from 230,750 to 1,365,570 Korean won. The amount of out-of-pocket payment might be affected by not co-payment but the cost of non-covered service. There were differences in them for family caregivers of all different levels of income. Opinions were surveyed about 5 issues. By levels of income, there were differences in their opinions about 3 issues, the financial burden on LTC, the necessity of reducing out-of-pocket payments, and to be willing to pay more for a high quality service. But there were not different opinions about the interruption of LTC service and staying with LTC facilities. Conclusion: These findings suggest that the range of out-of-pocket payment for LTC facility is wide and it can be a burden to lower income group. It should be to prepare the policies to ease the financial burden and support the appropriate LTC use.

• Health Policy and Management
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• v.33 no.4
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• pp.400-410
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• 2023

Background: As the government has recently been discussing the expansion of the disaster health expenses support project, we would like to confirm the characteristics of beneficiaries of the support project, particularly those of high-cost beneficiaries. Methods: Using the database of catastrophic health expenditure support project from 2019-2020, this study aims to confirm the characteristics of high-cost beneficiaries focusing on the overlap of the relieved out-of-pocket systems, known as the out-of-pocket ceiling system and the system for rare incurable diseases. Logistic regression analysis is used to examine this issue. Results: In order to analyze the factors influencing high-cost beneficiaries, five models were created and analyzed, including the status of duplicated beneficiaries for relieved out-of-pocket systems, sociodemographic and economic factors, and individual health status as sequential independent variables. All five models were statistically significant, of which economic factors had the greatest impact on the model's predictions. The main results indicated that those who benefited from multiple systems in duplicate were more likely to be high-cost beneficiaries, and there is a higher probability of incurring high health expenses among the underage. In addition, within the beneficiaries of catastrophic health expenditure support project, it was observed that higher health insurance premium percentiles are associated with a higher proportion of high-cost beneficiaries. Conclusion: This study examined the characteristics of high-cost beneficiaries by encompassing reimbursement and non-reimbursement. According to this study, it is expected to be used as basic data for setting priorities and improving the current criteria of catastrophic health expenditure support project, aiming to sequentially expand the program.

• Health Policy and Management
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• v.32 no.3
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• pp.282-292
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• 2022

Background: Aging societies face social problems of increased medical expenses for older adults due to increased geriatric diseases. This study aims to analyze the relationship between the state change of multiple chronic conditions (MCC) and out-of-pocket medical expenses in the elderly aged 60 or older. Methods: The 2014-2018 Korean Longitudinal Study of Aging data were used for 2,202 elderly people. Four status change groups were established according to the change in the number of chronic diseases. The association between the change of MCC and the out-of-pocket medical cost was analyzed using the generalized estimating equation model analysis. Results: The average out-of-pocket total medical costs were 1,384,900 won for participants with MCC and 542,700 won for those without MCC, which was a statistically significant difference (p<0.0001). Compared to the reference group (simple chronic disease, SCD→SCD), the change in multiple chronic conditions significantly increased the total out-of-pocket medical expenses in MCC→MCC and SCD→MCC groups (MCC→MCC: 𝛽=0.8260, p<0.0001; SCD→MCC: 𝛽=0.6607, p<0.0001). Conclusion: In this study, it was confirmed that the prevalence of MCC increased with age, and the out-of-pocket medical cost increased in the case of MCC. Continuity of treatment can be achieved for patients with MCC, and the system and management of treatment for MCC are required to receive appropriate treatment.

• Korea Journal of Hospital Management
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• v.22 no.4
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• pp.61-73
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• 2017

In the Health Insurance System of South Korea, patients must pay high out-of-pocket expenditures for the medical service by uninsured medical benefits. So, the government implemented a policy to relieve the burdens of patients by lowering the uninsured selective-medical treatment costs in August, 2014. This study investigate the policy effects of selective-medical treatment(SMT) on the medical service's usage and cost with severe lung cancer patients. The patients are selected in one university hospital(with 1,000 beds), between one year before and after policy implementation. The study find that the usages of outpatient(visit number) and inpatient (length of stay) are not changed by statistically significant. It means that there are no effect in medical service behavior between before and after the policy. In medical expenses, outpatients decreased in their out-of-pocket payments by policy, but total medical expenses and insured medical benefits is not changed, because of the increased another medical insurance fees. For inpatient, although the SMT costs are statistically significant decrease, the total out-of-pocket payments and insured medical expenses are not changed statistically significant. Those findings show that the political decision making about SMT made lowing the selective-medical expenses, but total insured cost and patient's out-of pocket money were not changed by the new increased medical insurance fees. It means that the policy about SMT gave no particular benefit for patients. So, it need another benefit plans to lower the medical expenses of severe lung cancer patients with a high medical service usage and much total medical expense.

• Health Policy and Management
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• v.22 no.3
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• pp.383-402
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• 2012

The purpose of this study is to investigate the factors affecting family caregiver financial burden of out-of pocket expenses for the nursing home service under Long-term Care Insurance System. We conducted a national cross-sectional descriptive survey from July to September 2010 to collect data based on the long-term care benefits cost specification. Total 1,016 family caregivers completed questionnaires. 185 subjects of total were excluded from the data analysis due to being answered by user(18 cases), or caregivers not to pay for services expenditures(122 cases), having a missing data on family caregivers characteristics(45 cases). Finally, 831 subjects were included in the study. The average financial burden was 3.18(${\pm}0.71$). We divided subjects into two groups by level of burden, high-burden group and low-burden group. In the result of the multiple logistic regression analysis, family caregiver financial burden was significantly higher in family caregivers with ages 40 to 49 compared to less than 40, lower educational level, unsatisfaction for long-term care service, high percentage(more than 50%) of cost-sharing and high total out-of pocket expenses(more than 300,000 won) for long-term care services. Also, Family caregivers who are spouse felt higher financial burden compared to son. This study is meaningful as the first attempt to measure family caregiver financial burden for long-term care service and to identify factors affecting the financial burden. Family caregivers felt financial burden of out-of pocket expenses for the nursing home service. The policy makers, the insurer, and the providers need to pay attention to ease family caregiver financial burden.

• Korea Journal of Hospital Management
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• v.26 no.3
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• pp.1-12
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• 2021

Purpose: This study aims to examine the effect of the copayment reduction policy on the health care utilization of patients under age 15 after the policy started in 2017. (이하는 아래 methodoloty로 이동) Methodology: Data on the ALOS, the average admission cost, and the out-of-pocket expenditure for patients under 15 years of age from 2015 to 2019 were obtained from the National Health Insurance database. Policy effects were measured by analyzing three dependent variables before and after policy: the average length of stay (ALOS), the average admission cost, and the out-of-pocket expenditure for patients under 15 years of age. The collected data were analyzed using the SAS package, and the analysis methods used in this study were the mean difference test and linear regression analysis. Findings: The study results reveal that, after the copayment reduction policy in the year 2017, the ALOS and the out-of-pocket expenditure were significantly decreased, but the average admission cost was significantly increased. Practical Implications: These results imply that the policy of copayment reduction for the patients under the age of 15 has contributed to mitigating the patients' financial burden with little concern about growing medical utilization.

• Korea Journal of Hospital Management
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• v.29 no.2
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• pp.37-47
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• 2024

Purpose: This study aimed to determine the effect of adjusted out-of-pocket maximum rules in the 'differential co-payment ceiling', which means having a higher burden of co-payment, that expanded to the entire ceiling level in long-stay admission patients in long-term care hospitals(LTCH). Methodology: We used health insurance claim data between January 1, 2022, and December 31, 2022 received from the National Health Insurance Service. The study populations were inpatients in long-term care hospitals more than 1 days during the study period. We performed the difference in characteristics of the LTCH patient of the differential and general ceiling by the chi-square test. We estimated the change of the population, cost, and co-payments per person under the assumption of restructuring. Finding: Based on adjusted out-of-pocket maximum rules in 2023, it was expected that the number of benefits decreases at the high-income level while increasing at the low-income level. The burden of health expenditure after reimbursement of co-payment ceiling, is expected to increase by 65.1% in the highest medical necessity, whereas the low medical necessity would decreases compared to 2022. Practical Implications: The results demonstrate that the current out-of-pocket maximum rules do not reflect the needs of medical necessity. This study suggested the need to reflect the medical necessity in LTCH on the out-of-pocket maximum rules in the future.