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      • KCI등재

        과부담 의료비 지출이 빈곤화 및 빈곤 지속에 미치는 영향

        송은철,신영전,Song, Eun-Cheol,Shin, Young-Jeon 대한예방의학회 2010 예방의학회지 Vol.43 No.5

        Objectives: The low benefit coverage rate of South Korea's health security system has been continually pointed out. A low benefit coverage rate inevitably causes catastrophic health expenditure, which can be the cause of the transition to poverty and the persistence of poverty. This study was conducted to ascertain the effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea. Methods: To determine the degree of social mobility, this study was conducted among the 6311 households that participated in the South Korea Welfare Panel Study in both 2006 and 2008. The effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea was assessed via multiple logistic regression analysis. Results: The poverty rate in South Korea was 21.6% in 2006 and 20.0% in 2008. 25.1 - 7.3% of the households are facing catastrophic health expenditure. Catastrophic health expenditure was found to affect the transition to poverty even after adjusting for the characteristics of the household and the head of the household, at the threshold of 28% or above. Conclusions: 25.1% of the households in this study were found to be currently facing catastrophic health expenditure, and it was determined that catastrophic health expenditure is a cause of transition to poverty. This result shows that South Korea's health security system is not an effective social safety net. As such, to prevent catastrophic health expenditure and transition to poverty, the benefit coverage of South Korea's health security system needs to the strengthened.

      • KCI등재

        재난적 의료비 지출이 빈곤화 및 빈곤 지속에 미치는 영향: 복지패널 2007-2012년 자료 분석

        송은철 ( Eun Cheol Song ),신영전 ( Young Jeon Shin ) 한국보건행정학회 2014 보건행정학회지 Vol.24 No.3

        Background: The low benefit coverage rate of South Korea`s health security system causes catastrophic health expenditure. And catastrophic health expenditure can be the cause of the transition to and persistence of poverty. This study was conducted to ascertain the effect of catastrophic health expenditure on the transition to and persistence of poverty, using 6 years of the Korea Welfare Panel Study Data. Methods: This study was conducted among the 22,528 households that participated in the Korea Welfare Panel Study, 2007-2012. Catastrophic health expenditure was defined as equal to or exceeds thresholds (10%, 20%, 30%, and 40%) of household`s capacity to pay. The effect of catastrophic health expenditure on the transition to and persistence of poverty was ascertained via multivariate logistic regression. Results: Four-point-seven percent to 20.6% of the households are facing catastrophic health expenditure. Rates of the transition to (relative risk [RR], 18.6 to 30.2) and persistence of (RR, 74.8 to 76.0) poverty of households facing catastrophic health expenditure was higher than households not facing catastrophic health expenditure. Even after adjusting the characteristics of the household and the household head, catastrophic health expenditure was found to affect transition to (odds ratio [OR], 2.11 to 3.04) and persistence of (OR, 1.53 to 1.70) poverty. Conclusion: To prevent catastrophic health expenditure and transition to and persistence of poverty resulting from catastrophic health expenditure, the reinforcement of South Korea`s health security system including the benefit coverage enhancement is required.

      • KCI등재

        재난적 의료비 예방을 위한 포괄적 의료비 상한제: 비용 추계를 통한 적용 가능성을 중심으로

        송은철 ( Song Eun Cheol ),신영전 ( Shin Young Jeon ) 한국보건사회연구원 2015 保健社會硏究 Vol.35 No.2

        한국 건강보장제도의 낮은 보장성은 재난적 의료비의 원인이 되며, 재난적 의료비는 빈곤화의 원인이 될 수 있다. 재난적 의료비와 이로 인한 빈곤화를 예방하기 위한 정책이 필요하며, 그 정책의 하나인 포괄적 의료비 상한제의 적용 가능성을 검토하기 위해 연구를 진행하였다. 한국의료패널 2011년 자료를 이용하였으며, 재난적 의료비는 지불 능력에서 의료비가 차지하는 비율이 10~40% 이상 일 때로 정의하였다. 포괄적 의료비 상한제의 적용 단위를 설정하고, 그 기준을 소득 10분위별로 추정하였으며, 투입되는 추가 비용을 산출하였다. 5.9~23.7%의 가구가 재난적 의료비를 지출하고 있는 것으로 나타났다. 개인 및 가구 단위로 적용하는 경우 상한제의 효과가 가장 컸으며, 추정된 분위별 상한액은 재난적 의료비 기준이 10%인 경우는 0.0~285.0만원, 20%인 경우는 0.0~607.6만원, 30%인 경우는 0.0~1,095.2만원, 40%인 경우는 0.0~1,701.4만원이었다. 재난적 의료비 기준이 10%인 경우 15.9~26.3조원, 20%인 경우 11.9~19.7조원, 30%인 경우 9.3~15.4조원, 40%인 경우 7.8~12.8조원의 추가 비용이 필요한 것으로 추계되었다. 포괄적 의료비 상한제적용 시 재난적 의료비 발생률은 0.1~0.2%로 감소하며, 추가로 소요되는 비용은 전 국민이 한해 동안 민간의료보험료로 지출한 43.4조원의 18.0~60.6%로 나타났다. 포괄적 의료비 상한제 적용으로 건강보장제도의 보장성 강화와 함께 재난적 의료비의 예방이 가능할 것이다. The low benefit coverage rate of South Korea`s health security system can cause catastrophic health expenditure, and catastrophic health expenditure can be the cause of impoverishment. This study was conducted to ascertain the applicability of the comprehensive health expenditure ceiling system to prevent catastrophic health expenditure and impoverishment using cost estimation. The applicability was ascertained by analysis on data from the Korea Health Panel, 2011. Catastrophic health expenditure was defined as equal to or exceeding the thresholds (10%, 20%, 30%, and 40%) of the household`s capacity to pay. Ceiling limits of health expenditures were estimated by income groups, and the additional costs were also estimated. 5.9 - 23.7% of the households are facing catastrophic health expenditure. The estimated ceiling limits of the comprehensive health expenditure ceiling system were 0.0-2.9 (T/y≥10%), 0.0-6.1 (T/y≥20%), 0.0-11.0 (T/y≥30%), and 0.0- 17.0 million won (T/y≥40%). The estimated additional costs were 15.9-26.3 (T/y ≥10%), 11.9-19.7 (T/y≥20%), 9.3-15.4 (T/y≥30%), and 7.8-12.8 trillion won (T/y≥40%). The additional costs were estimated to 18.0 - 60.6% of total private health insurance premiums. There is a need for application of the comprehensive health expenditure ceiling system to prevent catastrophic health expenditure and impoverishment.

      • KCI등재

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