Equity of health care financing in South Korea: 1990–2016

Lee, Tae-Jin; Hwang, Inuk; Kim, Hea-Lim

doi:10.1186/s12913-021-07308-0

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…Such improvements were in part due to better access to high-quality healthcare; National Health Insurance (NHI) was enacted in 1963 and coverage extended to the majority of the population by 1989 3 . It is now characterized as universal population coverage with a single-payer system since 2000 4 . However, the rate of decline in TB incidence slowed during the 2000s such that the incidence of TB was similar in 2001 and 2011, at 96.3 cases per 100,000, and 100.8 cases per 100,000 population, respectively 5 .…”

Section: Introductionmentioning

confidence: 99%

Hidden loss to follow-up among tuberculosis patients managed by public–private mix institutions in South Korea

Kim

Park

Min

et al. 2022

Sci Rep

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In South Korea, public–private mix (PPM) was launched in 2011. This retrospective cohort study sought to determine the rate of loss to follow-up (LTFU) among drug-susceptible tuberculosis (DS-TB) patients in all nationwide PPM institutions, and the risk factors for LTFU. National notification data for DS-TB patients diagnosed between August 2011 and July 2014 in PPM institutions were analysed. Determination of LTFU included detection of instances where patients were transferred out, but when they did not attend at other TB centres in the following two months. Univariable and multivariable competing risk models were used to determine risk factors for LTFU. 73,046 patients with 78,485 records were enrolled. Nominally, 3426 (4.4%) of records were LTFU. However, after linking the multiple records in each patient, the percentage of LTFU was 12.3% (9004/73,046). Risk factors for LTFU were: being foreign-born (3.13 (95% CI 2.77–3.53)), prior LTFU (2.31 (2.06–2.59)) and greater distance between the patient’s home and the TB centre (4.27 (4.03–4.53)). ‘Transfer-out’ was a risk factor in patients managed by treatment centres close to home (1.65 (1.49–1.83)), but protective for those attending centres further (0.77 (0.66–0.89)) or far-away (0.52 (0.46–0.59)) from home. By considering the complete picture of a patient’s interactions with healthcare, we identified a much higher level of LTFU than previously documented. This has implications for how outcomes of treatment are reported and argues for a joined-up national approach for the management and surveillance of TB patients, in nations with similar healthcare systems.

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Section: Introductionmentioning

confidence: 99%

Hidden loss to follow-up among tuberculosis patients managed by public–private mix institutions in South Korea

Kim

Park

Min

et al. 2022

Sci Rep

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“…Taking the Republic of Korea as an example, their overall healthcare financing system was regressive, not only for OOP payments, but also for its National Health Insurance and private health insurance scheme. This was due to high OOP payments made by their population regardless of their socioeconomic status as copayments for healthcare services that are not covered under either national and private health insurance, such as for expensive oncological medications and diagnostics [36]. The same scenario can be seen in other developed European countries, such as Austria, in which the OOP healthcare payments were regressive.…”

Section: Discussionmentioning

confidence: 93%

Equity in Out-of-Pocket Payments for Healthcare Services: Evidence from Malaysia

Baharin

Juni

Manaf

2022

IJERPH

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Background: Out-of-pocket (OOP) payments are an inequitable mechanism for health financing as their high share of total health expenditures poses a risk of catastrophic healthcare expenditures. This study aimed to assess the distribution and progressivity of OOP payments made by Malaysian households for various group of healthcare services. Methods: This study utilized data from the Malaysian Household Expenditure Survey (HES) between 2014 and 2015, which involved 14,473 households. Distribution and progressivity of OOP payments were measured through their proportion of household consumption, a concentration curves plot and the Kakwani Progressivity Index (KPI). Results: The mean proportion of Malaysian OOP payments for healthcare of household consumption was 1.65%. The proportion increased across households’ consumption quintiles, from 1.03% made by the poorest 20% to 1.86% by the richest 20%. The OOP payments in Malaysia were progressive with a positive KPI of 0.0910. The OOP payments made for hospital-based services were the most progressive (KPI 0.1756), followed by medical products, appliances and equipment (KPI 0.1192), pharmaceuticals (0.0925) and outpatient-based services (KPI 0.0394) as the least progressive. Conclusions: Overall, the OOP payments for healthcare services in Malaysia were progressive and equitable as they were more concentrated among the richer households.

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“…In another country within the region, South Korea, a developed high-income country, a survey-based study based on household data from 1990 to 2016 emphasizes the significance of the healthcare insurance system and its impact on fair distribution of financial burden [28]. The study revealed a weak regressivity in OOP expenditures, which may not affect individuals with low incomes in terms of access to doctors or outpatient services.…”

Section: Discussionmentioning

confidence: 99%

“…In South Korea, the high-income country of this region, Tae-Jin Lee et al (2021) conducted a study to assess the vertical equity of healthcare financing over a considerable timeframe between 1990 and 2016 [28]. Their findings revealed that direct tax was the most progressive mode of healthcare financing, while OOP payments were consistently weakly regressive.…”

Section: East Asiamentioning

confidence: 99%

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Inequalities in Out-of-Pocket Health Expenditure Measured Using Financing Incidence Analysis (FIA): A Systematic Review

Shaltynov,

Jamedinova,

Semenova

et al. 2024

Healthcare

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Government efforts and reforms in health financing systems in various countries are aimed at achieving universal health coverage. Household spending on healthcare plays a very important role in achieving this goal. The aim of this systematic review was to assess out-of-pocket health expenditure inequalities measured by the FIA across different territories, in the context of achieving UHC by 2030. A comprehensive systematic search was conducted in the PubMed, Scopus, and Web of Science databases to identify original quantitative and mixed-method studies published in the English language between 2016 and 2022. A total of 336 articles were initially identified, and after the screening process, 15 articles were included in the systematic review, following the removal of duplicates and articles not meeting the inclusion criteria. Despite the overall regressivity, insurance systems have generally improved population coverage and reduced inequality in out-of-pocket health expenditures among the employed population, but regional studies highlight the importance of examining the situation at a micro level. The results of the study provide further evidence supporting the notion that healthcare financing systems relying less on public funding and direct tax financing and more on private payments are associated with a higher prevalence of catastrophic health expenditures and demonstrate a more regressive pattern in terms of healthcare financing, highlighting the need for policy interventions to address these inequities. Governments face significant challenges in achieving universal health coverage due to inequalities experienced by financially vulnerable populations, including high out-of-pocket payments for pharmaceutical goods, informal charges, and regional disparities in healthcare financing administration.

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Equity of health care financing in South Korea: 1990–2016

Cited by 5 publications

References 16 publications

Hidden loss to follow-up among tuberculosis patients managed by public–private mix institutions in South Korea

Hidden loss to follow-up among tuberculosis patients managed by public–private mix institutions in South Korea

Equity in Out-of-Pocket Payments for Healthcare Services: Evidence from Malaysia

Inequalities in Out-of-Pocket Health Expenditure Measured Using Financing Incidence Analysis (FIA): A Systematic Review

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