중,고령자의 민간의료보험 가입 여부의 결정 요인

유기봉 ( Ki Bong Yoo ),조우현 ( Woo Hyun Cho ),이민지 ( Min Jee Lee ),권정아 ( Jeoung A Kwon ),박은철 ( Eun Cheol Park ) 한국병원경영학회 2012 병원경영학회지 Vol.17 No.3

Objectives : The coverage of Korean National Health Insurance is limited to basic level. Korean government encourages private health insurance for covering medical securities. So, many studies examined the determinants of purchasing private health insurance. However, 11% of Korean population is older than 65 in 2011. Considering the elderly is important to establish a health policy. The aim of this study is to examine factors determining the purchase of private health insurance among middle-aged and elderly Korean adults. Methods : We used the second Korean Longitudinal Study of Ageing (KLoSA), selected 8,688 sample of the aged 47 or older for the analysis. KLoSA collected information on demographic characteristics, income, health- related factors. KLoSA data include in the number of outpatient, inpatient, oriental hospital visit, dental clinic visit for two years. Logistic regression was used to examine the relationship between the determinants of purchasing private health insurance and the factors which include age, gender, education, residential district, marital status, smoking, drinking, physical exercise, economic activity status, national health insurance type, income, the number of chronic disease, and the number of outpatient, inpatient, oriental hospital visit, dental clinic visit for two years. Results : People who were older, did not live in a city, had higher IADL, currently drunk alcohol, did exercise regularly and had chronic diseases more than three were inclined not to purchase private health insurance. Females, the married, well-educated, past & currently smokers, the employed, high income earners, national health insurers, metropolitan citizens and someone who got high MMSE were more likely to purchase private health insurance. The more people experienced outpatients, inpatients, dental clinics and Chinese medicine clinics, the more private health insurance was purchased. The elderly people over 75 had more private health insurance than the aged 65-74. The strongest factors for private health insurance is gender, and economic status such as income. Conclusion : In this study, we found healthy-high income people were more likely to purchase private health insurance. In contrast, unhealthy-low income and older people did not. The economic factors were strongly related with private health insurance in aged over 75. These mean inequality exists in the using private health insurance. Therefore, the government should consider vulnerable social group before expanding private health insurance.

민간의료보험 활성화에 대한 입원환자의 인식 및 태도에 미치는 영향 -서울시내 일개 종합병원을 대상으로-

윤수진 ( Soo Jin Yoon ),김성주 ( Seong Ju Kim ),유승흠 ( Seung Hum Yu ),오현주 ( Hyohn Joo Oh ) 한국병원경영학회 2008 병원경영학회지 Vol.13 No.1

This research is aimed at analyzing and understanding the perception and attitudes of inpatients in a general hospital in Seoul towards the activation of private health insurance. Survey was conducted against 231 inpatients, results of which were analyzed in the methods of frequency analysis, chi square test, and logistic regression. The results are summarized as follows; First, better-educated population who finished college education at least, higher-income population, and people who had more knowledge about private health insurance showed more perception about activation of private health insurance. Second, better-educated population who finished college education at least, higher-income population, those who are insured in existing private insurance, oncological patients, and people who had more knowledge about private health insurance showed more positive attitude towards private health insurance paying for actual damages, long-term care insurance, and income security insurance. Third, age and education were the factors affecting perception about activation of private health insurance. The older the age is, perception was 1.035 times positive towards activation of private health insurance, and those who finished college education or above showed 3.148 times positive perception towards the same. Forth, surgical patients showed 1.087 times more positive attitude towards private health insurance paying for actual damages than internal medicine patients, while oncological patients showed 2.314 times more positive attitude than internal medicine patients. Further, understanding on the activation of private health insurance was 6.014 times higher in the higher understanding group than in the lower understanding group. Intention to use long-term care insurance was 2.692 times stronger in the male group than in the female group, and 3.616 times stronger in the oncological patients group than in internal medicine patients group. Further, understanding on the activation of private health insurance was 3.881 times deeper in the higher understanding group than in the lower understanding group. Intention to use income security insurance was 3.185 times stronger in those who have academic background of under the high school than those over the college, and 4.175 times higher in the group those whose monthly average income is over 4 million won than those under 4 million won. Also, intention to use income security insurance was 4.323 times higher in the group those who are insured by existing private insurances than those who are not insured by those insurances and it was 5.234 times higher in the group of oncological patients than in the group of internal medicine patients. Further, intention to use income security insurance was 3.559 times higher in the group those who thought that out-of-pocket money of the National Health Insurance is too much to bear than those it is quite endurable. Understanding on the activation of private health insurance was 4.875 times deeper in the higher understanding group than in the lower understanding group. There were some suggestions could be made based on the results of this research. First, reinforced publicity and education is needed for the low-educated or low-income group, as there are gaps in the understanding on the activation of private health insurance depending on the degree of education and income. Second, government should prepare administrative complementary measures to solve the problem of adverse selection by the consumer which is foreseen when private health insurances are activated. Third, government should suggest the desirable course of development of private health insurance items to ensure efficient use of enormous fund of private insurance market for health security of the people. Further, institutional complementary measures are needed to convert existing cancer insurances or specific disease insurances to private health insurances paying for actual damages guaranteeing against

장년층과 고령층의 민간의료보험 가입과 보험료 지출에 영향을 미치는 요인

차경욱 한국FP학회 2022 Financial Planning Review Vol.15 No.1

This study identifies the factors related to the purchase of private health insurance by late middle-aged adults (50 to 64 years old) and the elderly (65 years and older), who are close to each other in the life cycle stages, but show the greatest difference in private health insurance subscription rates. This study compares the characteristics of late middle-aged adults and the elderly with regard to national health insurance coverage and private health insurance. For each group, socioeconomic and health-related characteristics are compared based on whether people purchase private health insurance or not. And this study identifies factors that determine the decision to purchase and the amount of premium of private health insurance. Data from the 2019 Korean Retirement and Income Study were used, and 2,941 late middle-aged adults and 4,303 elderly people were analyzed. The findings of this study are as follows. For both groups, females and those who had higher education were more likely to purchase private health insurance. Both groups exhibited an inverted U-shape for the probability of signing up for private health insurance, which increases with age and decreases after a specific age. For the elderly, insurance premiums decreased as they increased in age. For both groups, household income had a positive effect on purchases of private health insurance and the amount of insurance premiums. For late middle-aged adults, total assets and debts held had a positive effect on purchasing private health insurance. For the elderly, physical and mental health had a positive effect on private health insurance purchases, but it was not significant for late middle-aged adults. For both groups, chronic diseases affected both the purchase of private health insurance and the amount of premiums. 본 연구에서는 생애주기 단계상 인접해 있지만, 민간의료보험 가입률에서는 가장 큰차이를 보이는 장년층(50∼64세)과 고령층(65세 이상)의 민간의료보험 가입 관련 요인들을 분석하였다. 즉 장년층과 고령층의 국민건강보험 가입특성, 민간의료보험 가입특성을파악하고, 장년층과 고령층 각 집단의 사회경제적 특성, 국민건강보험 가입특성, 건강관련 특성에 따라 민간의료보험 가입여부를 비교하였다. 또한 장년층과 고령층 각 집단의민간의료보험 가입여부와 보험료 지출액 규모에 영향을 미치는 요인을 파악하고 이를비교하였다. 국민노후보장패널조사 제 8차년도(2019년) 자료를 활용하였고, 장년층 2,941명과 고령층 4,303명을 분석 대상으로 하였다. 본 연구의 주요 결과는 다음과 같다. 첫째, 장년층과 고령층 모두 여성, 교육수준이 높을수록 민간의료보험에 가입할 가능성이 높았고, 장년층은 배우자 있는 경우에 민간의료보험 가입 확률이 높았다. 둘째, 장년층과 고령층 모두 연령이 증가할수록 민간의료보험가입 가능성이 증가하다가 일정 연령이 되면 감소하는 역U자형 패턴을 보여주었고, 고령층은 연령이 증가할수록 보험료 지출액이 감소했다. 셋째, 가계소득은 장년층과 고령층 모두에서 민간의료보험 가입여부와 보험료 지출액에 정(+)의 영향을 미쳤다. 장년층에서는 총자산과 부채보유가 민간의료보험가입에 정(+)의 영향을 미친 반면, 고령층에서는 부채보유만 유의한 영향을 미쳤다. 넷째, 장년층과 고령층 모두 국민건강보험 직장가입자, 지역가입자가 민간의료보험에도 가입할 확률이 높았고, 장년층 직장가입자는 보험료 지출액도 많았다. 다섯째, 고령층에서는 신체적, 정신적 건강상태가 민간의료보험가입에 정(+)의 영향을 미친 반면, 장년층에서는 유의하지 않았다. 그러나 만성질환이있는 경우, 장년층과 고령층 모두 민간의료보험 가입 가능성이 높았고, 고령층에서는 보험료 지출도 많았다.

민간의료보험의 선택에 영향을 미치는 요인 : 민간의료보험 활성화에 대한 함의

윤태호,황인경,손혜숙,고광욱,정백근 한국보건행정학회 2005 보건행정학회지 Vol.15 No.4

Since the introduction of mandatory health insurance in 1977, the Korean national health insurance(KNHI) has grown rapidly. In 2004, about 96.9% of the total population are covered by the KNHI and the remaining 3.1% by the Medical Aid program. Despite national health insurance system in Korea, private health insurance market has grown rapidly. In 2004, the size of the private health insurance market was estimated at 6,568 billion won. The purpose of this study is to identify the factors that determine the purchasing decisions of supplementary private health insurance under mandatory national health insurance system in Korea. The data from 2004 Busan Health Survey were analysed for the purpose. The variables in this study are demographic factors, health status and health behavioral factors, health care systemic factors, and socioeconomic factors. For statistical analyse, we used logistic regression. The Findings show that female, economically active age group(especially 35-49 years), persons with better health status or experience of health screening test are more likely to purchase private health insurance. And higher household income and expenditure, higher education level are more associated with the increased probabilities of private health insurance purchases. This results imply that the expanding of private health insurance market could widen the gap between the have and have-not in terms of equal health care accessibility.

민간의료보험의 역할 설정 방안에 관한 연구

정두채,문승권 남서울대학교보건의료개발연구소 2005 보건복지 연구 논집 Vol.2 No.1

The purpose of this paper is how to set rational role of private health insurance system in Korea. The present national health insurance system(NHI) has some in covering people's need of medical care services. Moreover, the health insurance industry monopolized by NHI led to the unbalanced supply of medical resources and made social costs. Supplementary private health insurance can be a solution of problems in the NHI System. First, private health insurance will be activated more efficiently than NHI. Second, it will provide various packages of insurance service which individuals want based on quality-premium relations. Third, the private sector will improve the health industry to be more sufficient and will reduce health care cost with the higher satisfaction. The basic change of health insurance system suggested by this paper are as follows. First, the health insurance system should be changed to a diversified and multi-pillar system including private health insurance. Second, the private health insurance should cover the coinsurance fee as a supplementary to NHI. Third, the increase of medical costs would be controlled by private health insurance. Fourth, private health insurance would activate and diversify medical care needs. Fifth, intensification of guarantee should follow by reverse selection of private health insurance and decrease of insurance premium.

Interactions between public and private health insurance under moral hazard

석승훈 ( S. Hun Seog ),홍지민 ( Jimin Hong ) 한국리스크관리학회 2023 리스크 管理硏究 Vol.34 No.4

본 연구는 공적의료보험 가입이 의무적으로 요구되고 도덕적 해이가 존재할 때 민간의료보험의 도입이 공적의료보험(이하 공보험)의 효율성에 어떤 영향을 미치는지 살펴본다. 그 결과 첫째, 모든 개인이 민영의료보험 (이하 사보험)에 가입하는 경우(차선의 경우) 소비자 후생은 사보험이 없을 때, 즉 공보험만이 존재하는 경우와 동일하지만, 공보험의 부보율은 사보험이 없을 때보다 낮아진다. 둘째, 일부의 개인만이 사보험에 가입하는 경우 사보험에 가입하는 개인의 비율에 따라 다음 두 가지 경우가 성립한다. (ⅰ) 그 비율이 임계치 이상이면 공보험자가 도덕적 해이를 통제하고 공보험과 사보험의 부보율 범위는 차선의 경우와 동일해진다. (ⅱ) 비율이 임계값보다 작으면 공보험자가 도덕적 해이를 허용한다. 공보험의 경우 보험료가 계리적으로 불리하고 사보험이 없는 경우보다 부보율이 증가한다. (ⅰ)과 (ⅱ) 모두에서 사보험에 가입하지 않은 개인의 소비자 후생은 악화되고, 사보험에 가입한 개인의 후생은 차선의 경우와 같거나 감소한다. 이러한 결과는 건강보험제도의 지속가능한 발전을 위해 공보험과 사보험의 상호작용을 고려하여 도덕적 해이를 적절히 통제할 필요가 있음을 보여준다. This study examines how the introduction of private health insurance affects the efficiency of mandatory public health insurance in the presence of moral hazard. First, if all individuals purchase private health insurance (the second-best case), consumer welfare is the same as that in the absence of private insurance, whereas the coverage of public insurance is less than that in the absence of private insurance. Second, if some individuals purchase private health insurance, the following two cases are possible, depending on the proportion of individuals who purchase private insurance: (ⅰ) If the proportion is greater than or equal to a threshold, the public insurer controls their moral hazard, and the coverage of public and private insurance is the same as in the second-best case. (ⅱ) If the proportion is less than the threshold, the public insurer allows their moral hazard. For public insurance, insurance premium is actuarially unfavorable, and the coverage is higher than that of no private insurance. In both (ⅰ) and (ⅱ), the consumer welfare of the individuals who do not purchase private insurance is deteriorated, and the welfare for the individuals who purchase private insurance is at best equal to or less than in the second-best case. These results show that moral hazard needs to be properly controlled by considering the interaction between public and private insurance for the sustainable development of health insurance systems.

민간의료보험 가입이 의료이용에 미치는 영향

윤희숙 한국개발연구원 2008 KDI Journal of Economic Policy (KDI JEP) Vol.30 No.2

Nearly all Koreans are insured through National Health Insurance(NHI). While NHI coverage is nearly universal, it is not complete. Coverage is largely limited to minimal level of hospital and physician expenses, and copayments are required in each case. As a result, Korea's public insurance system covers roughly 50% of overall individual health expenditures, and the remaining 50% consists of copayments for basic services, spending on services that are either not covered or poorly covered by the public system. In response to these gaps in the public system, 64% of the Korean population has supplemental private health insurance. Expansion of private health insurance raises negative externality issue. Like public financing schemes in other countries, the Korean system imposes cost-sharing on patients as a strategy for controlling utilization. Because most insurance policies reimburse patients for their out-of-pocket payments, supplemental insurance is likely to negate the impact of the policy, raising both total and public sector health spending. So far, most empirical analysis of supplemental health insurance to date has focused on the US Medigap programme. It is found that those with supplements apparently consume more health care. Two reasons for higher health care consumption by those with supplements suggest themselves. One is the moral hazard effect: by eliminating copayments and deductibles, supplements reduce the marginal price of care and induce additional consumption. The other explanation is that supplements are purchased by those who anticipate high health expenditures - adverse effect. The main issue addressed has been the separation of the moral hazard effect from the adverse selection one. The general conclusion is that the evidence on adverse selection based on observable variables is mixed. This article investigates the extent to which private supplementary insurance affect use of health care services by public health insurance enrollees, using Korean administrative data and private supplements related data collected through all relevant private insurance companies. I applied a multivariate two-part model to analyze the effects of various types of supplements on the likelihood and level of public health insurance spending and estimated marginal effects of supplements. Separate models were estimated for inpatients and outpatients in public insurance spending. The first part of the model estimated the likelihood of positive spending using probit regression, and the second part estimated the log of spending for those with positive spending. Use of a detailed information of individuals' public health insurance from administration data and of private insurance status from insurance companies made it possible to control for health status, the types of supplemental insurance owned by theses individuals, and other factors that explain spending variations across supplemental insurance categories in isolating the effects of supplemental insurance. Data from 2004 to 2006 were used, and this study found that private insurance increased the probability of a physician visit by less than 1 percent and a hospital admission by about 1 percent. However, supplemental insurance was not found to be associated with a bigger health care service utilization. Two-part models of health care utilization and expenditures showed that those without supplemental insurance had higher inpatient and outpatient expenditures than those with supplements, even after controlling for observable differences. 민간보험은 공적보험과 보완적인 관계를 형성함에도 불구하고 우리나라의 민간보험은 소득계층에 따른 접근성 차이로 인한 사회적 불평등, 도덕적 해이로 인한 공적보험 재정악화 등의 우려를 낳고 있다. 그러나 이에 관한 실증적 분석은 그간 이루어지지 못하여 정책적인 방향을 정립하는 데 장애가 되어 왔다. 본 연구는 건강보험공단, 심사평가원, 민간보험사, 행정자치부 주민등록세대정보 등의 관련 정보를 종합하여 이에 대한 실증분석을 시도했다. 그 결과, 우리나라의 민간보험 가입률은 전 국민의 64%에 달하고 있으며, 고소득층과 저소득층 간에 민간보험 가입률의 차이가 나타나지 않았다. 이는 공적보험의 보장성이 미흡한 상황에서 저소득층 역시 갑작스런 의료지출에 대비하고 있으며, 민간보험이 의료접근성의 계층화를 초래하지 않고 있다는 것을 시사한다. 또한 민간보험 가입자는 평균적으로 미가입자에 비해 의료이용량이 높지 않았으며, Two- Part Model을 통해 다양한 변수를 통제했을 경우에도 동일한 결과가 나타났다. 연령대에 따른 차이로 미루어 이러한 결과는 노동시장과 연관된 한시적인 성격일 것으로 추측되나, 현재로서는 민간보험 가입에 따른 도덕적 해이가 강하게 나타나고 있다는 근거는 발견되지 않았다.

공공 및 민영의료보험의 비급여 관리정책에 대한 국가별 비교

김하윤,장종원 한국보건행정학회 2022 보건행정학회지 Vol.32 No.2

In the process of promoting policies to strengthen health insurance coverage, the relationship between public health insurance andprivate health insurance, along with the management of non-benefit, is also emphasized as a policy issue. First, the concept andscope of non-benefit were comparatively analyzed by country. Second, the interaction between the public and private healthinsurance was classified as ‘large or small,’ and the government’s regulation and management policy on private health insurance wasclassified as ‘strong or weak.’ Korea has relatively smaller benefits covered by public health insurance, higher copayment expenses,and more areas and scope of non-benefits. In countries where the interaction between public and private health insurance is small,private health insurance-related policies are weak. And in countries with large interactions had public-private partnerships and thegovernment’s management policies were also strong. On the other hand, Korea has a large interaction, but the actual structure ofcooperation between public and private insurance and management policies were weak. Because the non-benefit sector in Korea isrelatively wide, it is difficult to manage compared to other countries where the concept of non-benefit is limited. In addition, thehealth authorities rarely perform the role of supervision over private health insurance, and they have so few linkages and cooperationfor public-private insurance. Therefore, practical policy enforcement is necessary to achieve the easing of the burden of nationalmedical expenses through linkage and cooperation of public-private health insurance with reference to relevant other countries’cases.

경제적 요인이 민간의료보험 가입변동과 치과의료이용에 미치는 영향

김선미 ( Sunmi Kim ),신호성 ( Hosung Shin ) 대한예방치과·구강보건학회 2015 大韓口腔保健學會誌 Vol.39 No.3

Objectives: The study aimed to examine and derive policy implications from the contribution of private health insurance towards the effectiveness and equity of dental care utilization. Methods: The study used 2010-2011 Korea Health Panel data. We applied a two-stage probit least square (2SPLS) analysis method to 10,577 people who were aged 20 years and over and had outpatient health care utilization. Under the assumption that high demanders for dental outpatient health services try to subscribe and hold private health insurance, the study focuses on the changes in income and private health insurance status. Results: The results of the descriptive statistics indicated that the number of employed enrolled in private health insurance increased as age decreased and income increased. Two-year consecutive nonenrollment of private health insurance was highest in the groups aged 65 years or above, those that had completed primary school or below, and those that belonged to the top income bracket. The highest rates of continued enrollment in private health insurance were observed in the top fifth income group (highest quintile) and those with a college degree. Income was observed to have an effect on private health insurance enrollment status and the frequency of dental care services used. The results of the analysis indicated that changes in private health insurance status did not affect the frequency of dental care services used, but the frequency of dental care services used had a significantly positive effect on continued enrollment in private health insurance. Conclusions: To secure the right of health for citizens, it is necessary to establish measures that emphasize equity and strengthen benefit coverage of health insurance. Moreover, regulatory policies that support the low-income population are required.

민간의료보험, 공보험과의 공진화: 최근 20년간 우리나라의 민간의료보험 연구 동향

강성욱 ( Sungwook Kang ),권영대 ( Young Dae Kwon ),최지헌 ( Ji-heon Choi ),유창훈 ( Chang Hoon You ) 한국보건경제정책학회(구 한국보건경제학회) 2017 보건경제와 정책연구 Vol.23 No.3

우리나라 보건의료연구의 주요 주제 중 하나인 민간의료보험에 대하여 지난 20년간 관련연구가 상당히 축적되었고, 이에 대한 비판적 고찰을 통해 향후 연구에 대한 방향 제시가 필요한 시점이다. 본 연구는 지난 20년간 발표된 민간의료보험 연구 논문을 시기 및 주제별로, 연구 대상자 및 분석방법별로, 주요 계량분석 결과별로 정리·분석하였다. 분석 대상 논문을 추출하기 위해 국내 학술문헌 데이터베이스인 한국학술정보(KISS)와 한국교육학술정보원(RISS)에서 민간의료보험 관련 검색어 8개를 이용하여 1995년부터 2016년까지 발표된 문헌 370편을 1차로 선정하였고, 이 중 연구보고서, 학회발표 원고 등을 제외한 학술지 게재 논문 126편을 최종 분석 대상으로 선정하였다. 시기별로 보면, 1995년부터 초기 10년간은 민간의료보험 관련 정책연구가 주로 수행되었는데, 비급여에 대한 민간의료보험의 재정적 역할과 민간의료보험의 적용 모델(보완형, 대체형 등)에 관한 연구가 주를 이루었다. 2005년부터는 정책연구에서 제기된 문제, 즉, 민간의료보험가입자의 특성과 의료 이용 증가, 공보험과 민간의료보험 간의 상호 연관성 등을 검증하는 계량적인 연구가 진행되었다. 후기 계량연구에서는 노령화패널과 한국의료패널 등 전국단위의 표본조사 자료나 민간보험사의 가입 자료와 국민건강보험공단의 급여 이용 자료를 연계한 자료를 이용하였다. 전자의 자료는 보험 가입과 의료 이용 정보의 신뢰성에 제한점이 있었고, 후자는 연구 대상자의 다양한 인구·사회적 특성을 분석할 수 없다는 한계가 있었다. 연구에 적용된 분석모형으로는 보험 가입 연구에서는 주로 로짓모형을, 의료 이용 연구에서는 two-part 모형을 많은 연구자가 적용하였다. 특히, 보험 가입으로 인한 의료 이용 증가를 규명하는 인과관계분석에서는 도구변수를 활용하거나 결합모형 및 성향매칭분석 방법을 적용하여 보험 가입의 내생성 문제를 극복하고자 하였다. 후기 계량연구의 주요 연구 결과를 살펴보면, 교육수준이 높을수록, 도시에 거주할수록, 소득수준이 높을수록, 중년층일수록 민간의료보험에 더 많이 가입하는 것을 알 수 있다. 보험가입자의 인구·사회적 특성만을 고려하면, 역선택(adverse selection)보다는 순선택(favorable selection)이 이루어지고 있다고 말할 수 있다. 보험 가입자와 비가입자의 의료 이용 차이는 정액형 민간의료보험이 대부분인 초기 연구에서는 외래서비스 이용에서만 주로 보고되었지만, 실손형 민간의료보험이 확대된 후기의 여러 연구에서는 외래 및 입원서비스 모두에서 가입자와 비가입자 간 의료 이용 차이가 보고되었다. 공보험의 보장성이 큰 폭으로 확대되지 않고, 동시에 민간의료보험 시장의 규모가 점점 확대된다면, 민간의료보험으로 인한 계층별의료 접근성 차이가 더욱 심화될 것을 예측할 수 있다. 향후 연구로서 민간의료보험으로 인한 의료 이용 증가분을 비급여와 급여서비스로 구분한 분석, 민간의료보험으로 인한 의료전달체계의 왜곡, 공급자의 도덕적 해이, 보험사의 위험군 선택, 그리고 민간의료보험의 보험료 및 시장 규모 분석 연구를 제안한다. The purpose of this study was to analyze the research papers published in the last 20 years about the private health insurance by period and subject, used data and analysis methods, and empirical results (126 papers). The results of this study are as follows: The higher the level of education, the higher the level of income, the higher the income level, the higher the probability of middle age, the more the private health insurance subscription. Considering only the population and social characteristics of the insured, it can be said that favorable selection is performed rather than adverse selection. The difference between the insurance subscriber and the non-subscriber medical use is mainly reported in the outpatient service use in the initial study where the flat type private health insurance was mostly used. However, in the latter study, differences in the outpatient and inpatient service use were reported. If the coverage of public insurance does not expand significantly and at the same time the size of the private health insurance industry grows, it is predicted that the difference of access to medical care among various social and economic classes due to private health insurance will be further intensified. Future research should include research on segregating increased health care utilization from private health insurance into uninsured and insured services by public health insurance, research on effects of private health insurance on health care delivery system, research on moral hazard of suppliers, and a study of premiums and market size of private health insurance.