• Asian Pacific Journal of Cancer Prevention
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• v.14 no.11
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• pp.6985-6989
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• 2013

Background: This study aimed to examine out-of-pocket expenditure for cancer treatments of hospitalized patients and to analyze changing patterns over time. Materials and Methods: This study examined data of all cancer patients receiving inpatient care from two tertiary hospitals from January 2003 to December 2010. Medical expenditures per admission were calculated and classified into those covered and uncovered by the Korean National Health Insurance (NHI) and co-payment. Results: The medical expenditure per admission increased slowly from 3,455 thousand Korean won (KRW) to 4,068 thousand KRW. While expenditures covered by the NHI have increased annually, co-payments have generally decreased. The out-of-pocket expenditure ratio, which means the proportion of uncovered expenditure and co-payment among total medical expenditure dropped sharply from 2005 to 2007 and was maintained at a similar level after 2007. Medical expenditures, NHI coverage, and the out-of-pocket expenditure ratio differed across cancer types. Conclusions: It is necessary to continually monitor the expenditure of uncovered services by the NHI, and to provide policies to reduce this economic burden. In addition, an individual approach considering cancer type-specific characteristics and medical utilization should be provided.

• Health Policy and Management
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• v.15 no.1
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• pp.30-56
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• 2005

This paper used two threshold approaches to measure the equity in urban households' out-of-pocket payments for health care from 1997 to 2002, which developed by Wagstaff and van Doorslaer. One approach used catastrophic health expenditure, which means that payments exceed a 'pre-specified proportion' of total consumption expenditures or ability to pay and the other used impoverishment that they did not drive households into poverty. Indicies for 'catastrophic expenditure' captured intensity as well as its incidence and also the degree of which catastrophic payments occur disproportionately among poor households. Measure of poverty impact also captured both intensity and incidence. The methods applied with data on out-of-pocket payments from the Urban Household Expenditure Survey Incidence and intensity of catastrophic payments - both in terms of total household consumption as well as ability to pay - increased between 1997 and 2002, and that both incidence and intensity of 'catastrophic expenditure' became less concentrated among the poor, but more concentrated in 2001 than in 1997. The incidence and intensity of the poverty impact of out-of-pocket payments increased between 1997 and 2002. Health security system may not have provided financial protection against catastrophic health expenditure to low-income households, because of high user fee policy not considering income level. The policies alleviating catastrophic health payments among the poor need to be more developed, and two threshold approaches further evaluated on our policy context.

• Health Policy and Management
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• v.21 no.2
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• pp.159-178
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• 2011

Korea ranks high among the OECD member countries with a high out-of-pocket share. In 2006, the government implemented in full scale the policy of extending the health insurance benefit coverage. Included in the policy are lowering the out-of-pocket share of patients of serious case and expanding the medical bill ceiling system to mention just a few. This study proposes to confirm effectiveness of the benefit extension policy by identifying changes in 'out-of-pocket expenditure as a share of the ability to pay' and 'incidence rate of catastrophic health care expenditure' of each individual household as manifested before and after the benefit extension policy was implemented. The 1st and 3rd year data from the Korea Welfare Panel Study (KoWePS), conducted by the Korea Institute for Health and Social Affairs (KIHASA), were used for the analysis, where low-income households and ordinary households are sampled separately. While the absolute amount of 'out-of-pocket expenditure' occurred to the average household increased for the period 2005-2007, the 'out-of-pocket expenditure as a share of the ability to pay' decreased. At the same time, the share decreased in the case of low-income households and households with patients of chronic or serious case as contrasted with ordinary households. 'Incidence rates of catastrophic health care expenditure' of ordinary households for 2007 stood at 14.6%, 5.9% and 2.8% at the threshold of 10%, 20% and 30%, respectively. The rates decreased overall between 2005 and 2007, while those of low-income households with patients of serious case statistically significantly increased. An analysis of this study indicates that it is related with the medical bill ceiling system regardless of incomes introduced in 2007.

• The Journal of Korean Medicine
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• v.25 no.1
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• pp.142-151
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• 2004

Objectives : To document the use and out-of-pocket expenditure of complementary and alternative medicine(CAM) in Korean adult population. Methods : Nationwide, random-sampled, and population-weighted telephone survey was conducted. The sample size of respondents was 1,000(age over 18). The respondents were asked about their use, out-of pocket expenditure of CAM in the past 12 months. SAS 8.0 statistic package was used for checking the relevance between each variables by performing $x^2-test$ and variance evaluation. Results : In 2001, 64.0% of people experienced more than one alternative therapy and the beneficiary took therapy average figure of 2.07. Alternative therapies were generally used for health promotion(73.7%) rather than curing the disease(26.3%). The most common therapies included Medication(30.2%), Physical-therapy(21.9%) health implements(20.8%), herb medication(19.2%), diet therapy(14.3%) etc. Average annual out-of-pocket expenditure was ￡<192,186. Use varied according to age, living province, income, and education, while cost expenditure did according to sex, health condition, income, education. Conclusions : The use of CAM in Korea is very large and the expenditure for them is 22.6% of national medical expenditure. It shows great need of political and academic approach.

• Journal of the Korean Home Economics Association
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• v.39 no.3
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• pp.93-105
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• 2001

The purpose of this study was to examine the factors associated with health insurance expenditures of the employed in the US. The data were from the 1994 Consumer Expenditure Surrey and the sample selected was admits aged 18 to 64 who were either a single head of household or part of a married couple. Results of Tobit regression indicated that age, education, and occupation of household head, region of residence, number of earners, homeownership(as a proxy for wealth), total expenditure(as a proxy for income), health care expenditures(as a proxy for health status) are significantly related to out-of-pocket health insurance expenditures by the employed.

• Journal of Preventive Medicine and Public Health
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• v.32 no.4
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• pp.546-555
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• 1999

Objectives : To determine the prevalence, pattern. and out-of-pocket expenditure of complementary and alternative medicine (CAM) utilization in Korean adult population. Methods : We conducted a representative telephone survey of 2,042 persons aged 18 or older. Data about any health problem, details of their use of medical doctors(MDs) offices/hospitals/pharmacies services and CAM during the preceding 12 months were collected with structured questionnaire. Results : The utilization rate of CAM among Korean adults was 29% in one year. A total of 231 kinds of CAM was identified from this survey. Annual out-of-pocket expenditure associated with CAM use in 1998 amounted to ${\xi}{\S}1.88$ billion and was comparable to 40.8% of out-of-pocket expenditure paid for MDs offices/hospitals/pharmacies services. Among those(N=424) who paid for both MDs offices/hospitals/pharmacies services an d CAM, 35.8% paid more for CAM. CAM gave more satisfaction than western medicine to those who had experience of both types of therapy. About half of CAM users were willing to recommend CAM to others. Disclosure rate to physician among CAM users was not high(40.6%). Conclusion : CAM became a popular source of health care in Korea, Korean spent a substantial amount of out-of-pocket money on CAM without any public control. Because CAM use is likely to be increased rapidly through lay referral system, health policy makers and health professionals should pay more attention to CAM for making appropriate utilization of CAM.

• 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.29 no.3
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• pp.342-356
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• 2019

Background: The objectives of the study are to find out the effect of the implementing reform in three Central Asian countries, identify its impact on health status and health care delivery systems. This study address to identify strong and weak points of the health systems and provide a recommendation for further health care organization. Methods: A comparative analysis was conducted to evaluate the effects of implemented policy on health care system efficiency and equity. Secondary data were collected on selected health indicators using information from the World Health Organization Global Health Expenditure Database, European Health Information Platform, and World Bank Open Data. Results: In terms of population status, countries achieved relatively good results. Infant mortality and under-5 mortality rate decreased in all countries; also, life expectancy increased, and it was more than 70 years. Regulations of the health systems are still highly centralized, and the Ministry of Health is the main organ responsible for national health policy developing and implementation. Among the three countries, only Kyrgyzstan was successful in introducing a national health system. Distribution of health expenditure between public expenditure and out-of-pocket payments was decreased, and out-of-pocket payments were less the 50% of total health expenditure in all countries, in 2014. Conclusion: After independent, all three countries implemented a certain number of the policy reform, mostly it was directed to move away from the old the Soviet system. Subsequent reform should be focused on evidence-based decision making and strengthening of primary health care in terms of new public health concepts.

• Health Policy and Management
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• v.8 no.1
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• pp.183-202
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• 1998

This study is to investigate patient's choice of health care and the demand for Korean traditional medicine care in rural areas in 1995. It tried to evaluate the effect of out-of-pocket expenditure, travel time, and waiting time on improving care-seeking and substituting clinical medicine for pharmacy care and Korean traditional medicine care in rural areas. The statistical model of this study is conditional logit to estimate effects of choice-specific and individual-specific characteristics on the choice of type of services. This study used, as explanatory variables, average out-of-pocket payment, travel time, and waiting time of services required to use the services. The model was empirically tested using data from 1995 Korean National Health Survery. The results showed that rural Koreans responded to out-of pocket payment and travel time. Increases of out-of-pocket payment and travel time decreased the probability to choose care in rural Korea. Rural Koreans were more likely to seek care than others with low out-of-pocket payment and travel time. The probability of choosing Korean traditional medicine were higher among the members of the households with higher education level and older persons, while they were lower in the households with large family than others compared with the probabilities of choosing public health facilities. The result of this study implies that policy on use of health care in rural Korea can be focused in managing travel time and out-of-pocket payment.

• Korea Journal of Hospital Management
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• v.19 no.4
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• pp.57-68
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• 2014

Since the introduction of National Health Insurance(NHI) in 1977, it has grown rapidly and contributed to extend patient's access to the health care services. However, limited coverage for health care services of NHI has been ongoing challenge and private health insurance(PHI) has been rising as an alternative source of enhancing coverage and saving out-of-pocket(OOP) expenditure for patients. In this study, after controlling for socio-demographic, economic, health related variables, we identified the patients' healthcare utilization and subsequent OOP expenditure depending on their PHI enrollment and their enrollment types(fixed benefit, indemnity, fixed benefit plus indemnity). Data were collected from the 2010 Korean Health Panel. The unit of analysis was a member of household(n=13,324). Of the 13,324 cases, 70.7% of patients held PHI, in detail, fixed benefit(47.0%), indemnity(3.6%), fixed benefit plus indemnity(20.1%). Major findings showd that patients who enrolled in PHI used more outpatient services(outpatient visit, number of physician visit, number of examination) and spent more OOP expenditure than non-PHI patients. There were also differences of healthcare utilization and OOP expenditure among the types of PHI. In addition, PHI patients used more inpatient services(inpatient use, number of hospitalization, LOS), but there was no significant difference between PHI and non-PHI patients with regard to the OOP expenditure. Thus, we could not find any distinct relationship between the types of PHI and patients' tertiary hospital use. Policy-makers should need careful political deliberation for monitoring the effect of PHI on health care utilization and subsequent expenditure not only to improve patients' coverage but also to save their OOP expenditures.