This study examined the effects of healthcare inequality on personal health. It aimed to determine how health insurance type and income level influence catastrophic health expenditure and unmet healthcare needs among South Koreans. Unbalanced Korean Health Panel data from 2011 to 2015, including 33,374 adults, were used. A time-trend and panel regression analysis were performed. The first to identify changes in the main variables and, the second, mediating effects of unmet healthcare needs and catastrophic health expenditure on the relationship between health insurance type, income level, and health status. The independent variables were: high-, middle-, low-income employee insured, high-, middle-, low-income self-employed insured, and medical aid. The dependent variable was health status, and the mediators were unmet needs and catastrophic health expenditure. The medical aid beneficiaries and low-income self-employed insured groups demonstrated a higher probability of reporting poor health status than the high-income, insured group (15.6%, 2.2%, and 2.3%, respectively). Participants who experienced unmet healthcare needs or catastrophic health expenditure were 10.7% and 5.6% higher probability of reporting poor health, respectively (Sobel test: p < 0.001). National policy reforms could improve healthcare equality by integrating insurance premiums based on income among private-sector employees and self-employed individuals within the health insurance network.

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This study investigates whether self-employed beneficiaries experience greater difficulties in accessing dental care than insured employees based on their income level. This analysis uses 2011–2015 data from the Korea Health Panel, a population-based and nationally representative sample, covering 7083 participants aged 18 years and older. We measured barriers to dental access based on unmet needs or the inability to receive necessary dental care owing to the past year’s economic burdens. The type of health insurance and household income are considered independent variables. We applied multiple panel logistic regressions and two-panel logistic regression models with a fixed-effects approach to analyze the data. Self-employed beneficiaries were 1.16 times (95% confidence interval (CI) = 1.08–1.24) more likely to experience unmet dental needs than were insured employees. Insured employees and self-employed beneficiaries belonging to the lowest income bracket were 1.76 times (95% CI = 1.53–2.03) and 2.33 times (95% CI = 1.89–2.87) more likely to have unmet needs than those in the highest income bracket. Self-employed beneficiaries were 1.31 times (95% CI = 1.21–1.43) more likely to experience unmet dental needs caused by economic burdens than are insured employees. Insured employees of the lowest income quintile were 4.15 times (95% CI = 3.41–5.05) more likely to experience unmet needs caused by economic burdens, while the odds ratio for self-employed beneficiaries was 5.47 (95% CI = 4.05–7.39). Our findings indicate gaps in unmet dental needs between self-employed beneficiaries and insured employees. The government should adopt strategies to reduce unmet needs among marginalized groups and redefine the role of national health insurance.

Objectives This study aimed to analyse and compare the influence of National Health Insurance and Medical Aid coverage on the persistency of unmet dental care needs in South Korea. Methods This study was based on a longitudinal sample of 4461 adults aged 19 years and older who participated in the South Korea Health Panel from 2011 to 2014, using weights to make the data nationally representative. Propensity score matching was used to adjust the demographic, socioeconomic and health status information of National Health Insurance and Medical Aid groups. Panel logistic regression analyses were conducted to examine the association between health insurance type and unmet dental needs for three consecutive years. Results The odds of the lowest income group reporting unmet dental care needs compared with the highest income group was 6.75 (confidence interval 5.94−7.67), which reduced to 4.19 (confidence interval 3.76−4.67) in the models including health insurance schemes. Additionally, Medical Aid recipients (odds ratio 2.49; 95% confidence interval 2.18−2.48) were more likely to have unmet needs than those covered by National Health Insurance. Conclusions The dental care needs of Medical Aid beneficiaries were not being met, unlike those of the National Health Insurance beneficiaries. Such evidence suggests that increasing health insurance coverage to include several essential dental services would improve the accessibility of dental care services for Medical Aid beneficiaries.

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