The Relationship between Unmet Healthcare Needs Due to Financial Reasons and the Experience of Catastrophic Health Expenditures

강정희,김철웅 한국지역사회간호학회 2021 지역사회간호학회지 Vol.32 No.1

Purpose: The purpose of this study is to investigate the association between unmet healthcare needs due to financial reasons and catastrophic health expenditures. Methods: This study used secondary data from the 2014~2015 Korean Health Panel survey. The subjects of this study were 21,495 people aged 20 or older, and of them, there were 16,227 people aged 20 to 64 and 5,268 people aged 65 or older, which were surveyed between 2014 and 2015. The association between unmet healthcare needs due to financial reasons and catastrophic health expenditures was analyzed through logistic regression. Results: In 2015, 1.7% of people aged 20~64 years and 7.9% of those aged 65 or older experienced unmet healthcare needs due to financial reasons. In the 20~64 age group, people who repeatedly experienced catastrophic health expenditures (=10%,=20%) were less likely to experience unmet healthcare needs due to financial reasons than those who did not experience catastrophic health expenditures for two years (OR=0.50, OR=0.41). However, in the 65-or-older group, people who repeatedly experienced catastrophic health expenditures (=20%) were more likely to experience unmet healthcare needs due to financial reasons than those who did not experience catastrophic health expenditures for two years (OR=1.68). Conclusion: A greater percentage of the elderly repeatedly faced both catastrophic health expenditures and unmet healthcare needs due to financial reasons compared to the non-elderly.

의료비 지출이 소득불평등에 미치는 영향

송은철,김창엽,신영전 한국보건행정학회 2010 보건행정학회지 Vol.20 No.3

The degree of income inequality deepened by health care expenditure was useful in assessing the health security level. This exploratory study was conducted to provide a basic evidence to prove the necessity of reinforcement the benefit coverage of South Korea’s health security systems. Data from the Household Income and Expenditure Survey of Korea and Luxembourg Income Study were used. Income inequality indices before and after deduction of health care expenditure were computed, and the degree of the increase in the indices was compared among 13 countries. The degree of decrease against the effect of income inequality reduction policies by health care expenditure was determined. The relationships between the national characteristics and the increase in income inequality were examined. In South Korea, all income inequality indices increased after deducting health care expenditure, but the difference was not high compared to the mean of 13 countries. However, the degree of decrease against the effect of income inequality reduction policies by health care expenditure was high,compared to the mean of 13 countries. The proportion of public sector spending on health care proved to be statistically significant with the increase of income inequality indices (p<0.05). In the context of the continuous increase in health care expenditure, if benefit coverage of health security systems is not reinforced, income inequality will all the more increase due to health care expenditure. In the establishment of the policies for reinforcement of the benefit coverage,income inequality after deduction of health care expenditure should be continuously monitored.

의료보장성이 주관적 건강상태의 변화에 미치는 영향: 차상위계층과 상위중산층 비교

김진현 ( Jinhyun Kim ) 한국보건행정학회 2016 보건행정학회지 Vol.26 No.4

Background: This study aims to analyze the impact of levels of health care coverage on the trajectory of self-rated health, comparing the near-poor which tends to be excluded in traditional health care systems with the upper middle class. Methods: The study participants were 3,687 people who sincerely responded questions regarding health care expenditures, unmet medical needs, and self-rated health in the Korea Health Panel data in 2009-2012. Results: The higher health care expenditures and the presence of unmet medical needs were significantly associated with the lower level of self-rated health. However, both factors did not significantly predict the steeper decline in the self-rated health. The results from multiple group analyses showed that health care expenditures and unmet medical needs had greater impact on the near-poor compared to their higher income counterparts. Conclusion: Public health care coverages need to be enhanced as well as reducing health care expenditures and unmet medical needs.

당뇨 환자의 운동실천에 따른 건강행태, 의료이용 및 의료비용 비교

차지은,윤순녕 한국지역사회간호학회 2015 지역사회간호학회지 Vol.26 No.1

Purpose: The purpose of this study was to compare the use of health services and health expenditures betweennon-exercise and exercise groups of diabetic patients and among three groups divided according to exerciseintensity. Methods: Data were obtained from the Korean Health Panel Survey of 2011. The participants of thisstudy were 864 diabetic patients who did exercise (walk, moderate exercise, or vigorous exercise) or not. Datawere subsequently analyzed using the SPSS 21 Program. Results: The exercise group showed higher percentagesof medication compliance, non-smokers, and regular diet than the non-exercise group. The hospitalizationpercentage, the number of outpatient hospital visits, and health expenditures were higher in the non-exercisegroup than in the exercise group. There was no difference among the three groups divided according to exerciseintensity in the use of health services and health expenditures. Conclusion: These results show that exercise isa way to reduce diabetic patients’ use of health services and their health expenditures.

국민의료비 결정요인분석

최병호 ( Byong Ho Tchoe ),남상호 ( Sang Ho Nam ),신윤정 ( Yoon Jung Shin ) 한국보건행정학회 2004 보건행정학회지 Vol.14 No.2

This study estimates the determinants of national health expenditures of OECD countries using panel regression method. The data used are OECD Health Data(2003) covering 33 countries and from 1970 to 2001. This study shows several important different results compared to the previous studies. Further this study estimates the determinants of Korean case using data from 1977 to 2000, and compare with the results of OECD panel. The main findings are as follows. The income elasticity of health expenditures is estimated below 1.0, but is shown above 1.0 when the different health systems of each country are controlled. The women`s labor participation influences strongly positive effect on the health expenditures. The diffusion of new technologies is positively related with the increasing expense. The increasing government expenditures have a tendency not to contain health expenses, but to increase expenses. The expansion of public health insurance holders is containing the expenses, and the increasing number of doctors is pushing expenditures. This implies the health expenditures are influenced more by the induced demand of providers rather than the moral hazard of patients. However, the above result is opposite in Korean case. The existence of primary care doctors affects slightly up warding rather than containing expenditures. Finally the determinants are seriously depending upon which factors are included in the model and which statistical model is chosen. Therefore it must be cautious to interpret the results of statistical model.

Trends in Scale and Structure of Korea’s Health Expenditure over Last Three Decades (1980-2009): Financing, Functions and Providers

정형선,Jeong-Woo Shin 대한의학회 2012 Journal of Korean medical science Vol.27 No.-

This paper introduces statistics related to the size and composition of Korea’s total health expenditure. The figures produced were tailored to the OECD’s system of health accounts. Korea’s total health expenditure in 2009 was estimated at 73.7 trillion won (US$ 57.7billion). The annual per capita health expenditure was equivalent to US$ PPP 1,879. Korea’s total health expenditure as a share of gross domestic product was 6.9% in 2009,far below the OECD average of 9.5%. Korea’s public financing share of total health expenditure increased rapidly from less than 50% before 2000 to 58.2% in 2009. However,despite this growth, Korea’s share remained the fourth lowest among OECD countries that had an average public share of 71.5%. Inpatient, outpatient, and pharmaceutical care accounted for 32.1%, 33.0%, and 23.7% of current health expenditure in 2009,respectively. A total of 41.1% of current health expenditure went to hospitals, 28.1% to providers of ambulatory healthcare (15.9% on doctor’s clinics), and 17.9% to pharmacies. More investment in the translation of national health account data into policy-relevant information is suggested for future progress.

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.

OECD의 개념에 따른 우리나라 약제비의 국제 비교

정형선 ( Hyoung Sun Jeong ) 한국보건행정학회 2003 보건행정학회지 Vol.13 No.4

Detailed analyses of total health expenditure and its sub-categories are essential for the evidence-based 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 low-income 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.

OECD국가에서 총 의료비 및 정부지출 의료비와경제성장의 Granger Causality: 2000~2012

변진옥 ( Jin Ok Byeon ),이현복 ( Hyun Boc Lee ) 한국사회보장학회 2014 사회보장연구 Vol.30 No.1

The purpose of this study is to identify whether and the extent to which total health expenditure and (or) government health expenditure has granger causality in OECD countries after economic crisis. This study analyze the data including GDP, total health expenditure, government health expenditure, health expenditure per capita, government health expenditure per capita from 2000 to 2012 of each OECD countries and investigates the Granger-causality relationship between GDP and the other variables. The results show the positive(+) bidirectional Granger-causality not only between GDP and total health expenditure but also GDP and the variables relating governmental health expenditure. A VAR test verifies that governmental health expenditure compared to the total health expenditure has been long-term impact on the GDP. Therefore total health spending as well as the share of government affects directly or indirectly to national economic growth with the possibility of both to enforce the labor productivity and to help accumulating human capital.

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.