Data Analysis on Medical Service Utilization and Out-of-pocket Spending among Near-poor National Health Insurance Members in South Korea

Abstract

Background: The near poor, a low income population which is excluded from the Republic of Korea's Medical Aid (MA) program, experiences insufficient use of medical services and high out-of-pocket (OOP) spending due to insufficient coverage by the country's National Health Insurance (NHI). This study aims to examine medical utilization, OOP spending, and occurrence of catastrophic health expenditures (CHE) among the near poor compared to MA beneficiaries and other NHI members.Methods: A cross-sectional study was conducted drawing upon a nationally representative dataset based on the 2018 Korea Welfare Panel Study (KOWEPS). We classified people into MA beneficiaries, the near-poor population below 50% of the median income threshold, and other NHI members above the 50% median income threshold. Using propensity score matching between MA beneficiaries and the near poor and between the near-poor group and the group of those above the poverty line, this study examined medical utilization, OOP spending, and the occurrence of CHE among the study groups. Results: The findings suggest that MA beneficiaries make greater use of outpatient services compared to the near poor, but other uses of medical services were not significantly different among the study groups. However, OOP spending and occurrence of CHE were significantly higher in the near-poor group compared to the other two groups. Conclusion: We found that the near-poor group was the most vulnerable group in these terms among the Korean population. Health policy needs to take into account the vulnerability of the near-poor population.