Background The private health insurance (PHI) market in Republic of Korea has instituted indemnity insurance plans that provide partial reimbursements for some medical services or costs that are not covered by the National Health Insurance (NHI). To date, no study has estimated the extent to which PHI coverage lowers the economic burden of households’ access to health care. The current study aims to evaluate the design of Korea’s PHI system in terms of coverage using a catastrophic health expenditure (CHE) indicator and compare it with NHI. Methods This study determined the difference between the number of households that were subscribed to PHI and those that received reimbursements from PHI. Additionally, it compared the effects of reduced CHE by NHI benefits with PHI reimbursements. Furthermore, it compared PHI reimbursements based on income class. Finally, it analyzed the contribution of NHI and PHI to CHE reduction through a two-part model with hierarchical regression. Results The results indicated that of the 5644 households examined, 3769 subscribed to PHI, but only 246 households received reimbursements. Notably, NHI reduced CHE incidence by 15.17%, whereas PHI only reduced CHE by 1.22%. The NHI scheme indicated reduced inequality as it provided more benefits to the low-income class for their used medical services, whereas PHI paid more reimbursements to the high-income class. Accordingly, NHI coverage has protected households from CHE and improved equality to some extent; however, PHI coverage has had a relatively low effect on relieving CHE and has increased inequality. Conclusions The indemnity health insurance plans of PHI companies in Korea only cover partial medical costs or services, and so, most patients do not receive reimbursements. Thus, Korea’s PHI system needs to improve to provide benefits to patients more generously and alleviate their financial burden.

Background Catastrophic health expenditure (CHE) represents out-of-pocket payment as a share of household income. Most previous studies have focused on incidence aspects when assessing health policy effects. However, because CHE incidence is a binary variable, the effect of the health policy could not accurately be evaluated. On the contrary, the intensity of CHE is a continuous variable that can yield completely different results from previous studies. This study reassesses the coverage expansion plan for four serious diseases using the intensity of CHE in Korea. Methods We used the Korea Health Panel Study from 2013 to 2015 to conduct the analysis. The study population is households with chronic diseases patients. We divided the population into two groups: the policy beneficiary group, i.e., households with a patient of any of the four serious diseases, and the non-beneficiary group. A difference-in-difference model was employed to compare the variation in the intensity and incidence of CHE between the two groups. We defined the incidence of CHE as when the ratio of out-of-pocket medical expenses to household income is more than a threshold of 10%, and the intensity of CHE is the height of the ratio subtracting the threshold 10%. Results The increased rate of CHE intensity in households with four serious diseases was lower than that in households with other chronic diseases. The interaction term, which represents the effect of the policy, has a significant impact on the intensity but not on the incidence of CHE. Conclusions CHE indicators should be applied differently according to the purpose of policy evaluation. The incidence of CHE should be used as the final achievement indicator, and the intensity of CHE should be used as the process indicator. Furthermore, because CHE has an inherent characteristic that is measured by the ratio of household income to medical expenses, to lower this, a differential out-of-pocket maximum policy for each income class is more appropriate than a policy for strengthening the coverage for specific diseases.

Background: Korea has instituted a private health insurance (PHI) scheme that covers the remaining expenses uncovered by the National Health Insurance (NHI). No study has yet estimated the extent to which PHI coverage lowers the economic burden of household access to health care. The current study intends to evaluate the design of Korea's PHI system in terms of coverage using a catastrophic health expenditure (CHE) indicator and compare it with NHI. Methods: This study determined the difference between the number of households subscribed to PHI and the number of households that paid benefits. Also, it compared the effects of reduced CHE through NHI benefits with those of PHI. Furthermore, it compared PHI benefit rates by income class. Finally, it analyzed the benefit contribution of NHI and PHI to CHE reduction through a two-part model with hierarchical regression. Results: Results indicated that of the 5,644 households studied, 3,769 subscribed to PHI, but only 246 households received benefits. The NHI reduced CHE incidence by 15.17%, whereas PHI only reduced CHE by 1.22%. The NHI scheme indicated reduced inequality as it provided more benefits to the low-income class, whereas the PHI paid more to the high-income class. The NHI coverage has protected households from CHE and improved equality to some extent; however, PHI coverage has had little effect on relieving CHE and has deteriorated equality. Conclusions: Korean private insurance companies, which are mostly subsidiaries of for-profit conglomerates, only pay for pre-contracted diseases, therefore, most patients do not receive benefits. Thus, Korea's private insurance system needs to improve to provide benefits to patients more generously and alleviate the financial burden of medical use.

Background Patients’ perception of receiving overtreatment can cause distrust in medical services. Unlike outpatients, inpatients are highly likely to receive many medical services without fully understanding their medical situation. This information asymmetry could prompt inpatients to perceive treatment as excessive. This study tested the hypothesis that there are systematic patterns in inpatients’ perceptions of overtreatment. Methods We examined determinant factors of inpatients’ perception of overtreatment in a cross-sectional design that used data from the 2017 Korean Health Panel (KHP), a nationally representative survey. For sensitivity analysis, the concept of overtreatment was analyzed by dividing it into a broad meaning (any overtreatment) and a narrow meaning (strict overtreatment). We performed chi-square for descriptive statistics, and multivariate logistic regression with sampling weights employing Andersen’s behavioral model. Results There were 1,742 inpatients from the KHP data set that were included in the analysis. Among them, 347 (19.9%) reported any overtreatment and 77 (4.42%) reported strict overtreatment. Furthermore, we found that the inpatient’s perception of overtreatment was associated with gender, marital status, income level, chronic disease, subjective health status, health recovery, and general tertiary hospital. Conclusion Medical institutions should understand factors that contribute to inpatients’ perception of overtreatment to mitigate patients’ complaints due to information asymmetry. Moreover, based on the result of this study, government agencies, such as the Health Insurance Review and Assessment Service, should create policy-based controls and evaluate overtreatment behavior of the medical providers and intervene in the miscommunication between patients and providers.

Background: Korea has instituted a private health insurance (PHI) scheme that covers the remaining expenses uncovered by the National Health Insurance (NHI). No study has yet estimated the extent to which PHI coverage lowers the economic burden of household access to health care. The current study intends to evaluate the design of Korea's PHI system in terms of coverage using a catastrophic health expenditure (CHE) indicator and compare it with NHI. Methods: This study determined the difference between the number of households subscribed to PHI and the number of households that paid benefits. Also, it compared the effects of reduced CHE through NHI benefits with those of PHI. Furthermore, it compared PHI benefit rates by income class. Finally, it analyzed the benefit contribution of NHI and PHI to CHE reduction through a two-part model with hierarchical regression. Results: Results indicated that of the 5,644 households studied, 3,769 subscribed to PHI, but only 246 households received benefits. The NHI reduced CHE incidence by 15.17%, whereas PHI only reduced CHE by 1.22%. The NHI scheme indicated reduced inequality as it provided more benefits to the low-income class, whereas the PHI paid more to the high-income class. The NHI coverage has protected households from CHE and improved equality to some extent; however, PHI coverage has had little effect on relieving CHE and has deteriorated equality. Conclusions: Korean private insurance companies, which are mostly subsidiaries of for-profit conglomerates, only pay for pre-contracted diseases, therefore, most patients do not receive benefits. Thus, Korea's private insurance system needs to improve to provide benefits to patients more generously and alleviate the financial burden of medical use.