Factors influencing health care use by health insurance subscribers and medical aid beneficiaries: a study based on data from the Korea welfare panel study database

Kong, Na Young; Kim, Dong Hee

doi:10.1186/s12889-020-09073-x

Cited by 19 publications

(12 citation statements)

References 7 publications

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“…The effect of age is positive, but a lower chance of having health insurance coverage was found among respondents aged 25-59 years in Nigeria compared to those aged 15-24 (p < 0.05) in both models. This could agree with previous studies that reported that a substantial proportion of individuals are unwilling to contribute to health insurance premiums, as they do not attach any significance to it [29,30]. In South Africa, respondents aged 25-34 years, 35-44 years and 45-59 years were found to be 18%, 13% and 10% more likely to have health insurance coverage compared to the younger age group 15-24 (p < 0.05).…”

Section: Discussionsupporting

confidence: 91%

“…Moreover, South Africa's higher coverage may be ascribed to the coordinated and combined public and private health insurance scheme, ensuring risk pooling and increasing the confidence of potential subscribers or insurers in the health insurance system, hence encouraging them to subscribe [25,26]. Furthermore, the scheme is decidedly made to cover working individuals in government and private organizations, and non-working individuals can also have access to other lower medical aid plans, which makes it likely for all impoverished individuals to subscribe without paying other fees for the required annual premiums [29,46]. Financial contributions to the National Health Insurance Department (NHID) in South Africa are designed in such a manner that premium payments are graded according to people's wealth status and ability to pay; individuals with a higher income are made to pay higher premiums compared with those with a lower income.…”

Section: Discussionmentioning

confidence: 99%

“…Understanding these factors that impede the uptake of health insurance will assist policy makers and relevant stakeholders to institute new effective interventions that will improve health insurance coverage to alleviate disease burden in the population. While there is a dearth of empirical studies on the comparative cross-sectional survey of the causes impelling health insurance coverage in Nigeria and South Africa, studies conducted at an individual country level have revealed that socio-demographic factors such as education, age, wealth status, residence, economic activities, religion, health status, parity, sex of head of the household, exposure to media, perception and willingness to become health insurance subscribers significantly influence health insurance coverage [29,30]. To bridge the present gap in understanding the comparative cross-sectional survey for a multi-country study through empirical observations, we examined the prevalence and predictors of health insurance coverage in Nigeria and South Africa, using the two study countries' national demographic and health survey (DHS) data.…”

Section: Introduction/backgroundmentioning

confidence: 99%

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A Comparative Cross-Sectional Study of the Prevalence and Determinants of Health Insurance Coverage in Nigeria and South Africa: A Multi-Country Analysis of Demographic Health Surveys

Akokuwebe

Idemudia

2022

IJERPH

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Background: The core Universal Health Coverage (UHC) objectives are to ensure universal access to healthcare services by reducing all forms of inequalities. However, financial constraints are major barriers to accessing healthcare, especially in countries such as Nigeria and South Africa. The findings of this study may aid in informing and communicating health policy to increase financial access to healthcare and its utilization in South Africa and Nigeria. Nigeria-South Africa bilateral relations in terms of politics, economics and trade are demonstrated in the justification of the study setting selection. The objectives were to estimate the prevalence of health insurance coverage, and to explore the socio-demographic factors associated with health insurance in South Africa and Nigeria. Methods: This was a cross-sectional study using the 2018 Nigeria Demographic Health Survey and the 2016 South Africa Demographic Health Survey. The 2018 Nigeria Demographic Health Survey data on 55,132 individuals and the 2016 South Africa Demographic Health Survey on 12,142 individuals were used to investigate the prevalence of health insurance associated with socio-demographic factors. Percentages, frequencies, Chi-square and multivariate logistic regression were e mployed, with a significance level of p < 0.05. Results: About 2.8% of the Nigerian population and 13.3% of the South African population were insured (Nigeria: males—3.4%, females—2.7% vs. South Africa: males—13.9%, females—12.8%). The multivariate logistic regression analyses showed that higher education was significantly more likely to be associated with health insurance, independent of other socio-demographic factors in Nigeria (Model I: OR: 1.43; 95% CI: 0.34–1.54, p < 0.05; Model II: OR: 1.34; 95% CI: 0.28–1.42, p < 0.05) and in South Africa (Model I: OR: 1.33; 95% CI: 0.16–1.66, p < 0.05; Model II: OR: 1.76; 95% CI: 0.34–1.82, p < 0.05). Respondents with a higher wealth index and who were employed were independently associated with health insurance uptake in Nigeria and South Africa (p < 0.001). Females were more likely to be insured (p < 0.001) than males in both countries, and education had a significant impact on the likelihood of health insurance uptake in high wealth index households among both male and females in Nigeria and South Africa. Conclusion: Health insurance coverage was low in both countries and independently associated with socio-demographic factors such as education, wealth and employment. There is a need for continuous sensitization, educational health interventions and employment opportunities for citizens of both countries to participate in the uptake of wide health insurance coverage.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introduction/backgroundmentioning

confidence: 99%

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A Comparative Cross-Sectional Study of the Prevalence and Determinants of Health Insurance Coverage in Nigeria and South Africa: A Multi-Country Analysis of Demographic Health Surveys

Akokuwebe

Idemudia

2022

IJERPH

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“…This assumption is in agreement with the results reported by several other studies. Medical Aid beneficiaries were found to use more inpatient and outpatient services, incurred less out-of-pocket spending, and had a lower chance of experiencing catastrophic health expenditures compared to NHI members [ 39 ]. A study that defined the near poor as people not enrolled in Medical Aid but with an income less than 120 % of the minimum cost of living found that Medical Aid beneficiaries experienced significantly lower health care costs and proportion of out-of-pocket spending to income compared to the poor not enrolled in Medical Aid [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Medical service utilization and out-of-pocket spending among near-poor National Health Insurance members in South Korea

Park

2021

BMC Health Serv Res

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Background The public health care system in South Korea is a two-tiered system. The lowest-income population is covered by the Medical Aid program, and the remaining population is covered by the National Health Insurance. The near poor, a relatively low-income population which is excluded from South Korea’s Medical Aid program due to exceeding the income threshold, experiences insufficient use of medical services and incurs high out-of-pocket expenses due to a lack of coverage under the country’s National Health Insurance (NHI) program. This study aims to examine medical utilization, out-of-pocket spending, and the occurrence of catastrophic health expenditures among the near-poor group compared to both Medical Aid beneficiaries and other (higher income) NHI members. Methods A cross-sectional study was conducted drawing upon a nationally representative dataset derived from the 2018 Korea Welfare Panel Study. The study classified people into three groups: Medical Aid beneficiaries; the near-poor population below 50 % of the median income threshold but still not qualifying for Medical Aid and thus enrolled in NHI; and NHI members above the threshold of 50 % of the median income. Using a generalized boosted model to estimate the propensity score weights between study groups, this study examined medical utilization, out-of-pocket spending, and the occurrence of catastrophic health expenditure among the study groups. Results The findings suggest that the utilization of medical services was not significantly different among the study groups. However, out-of-pocket spending and the occurrence of catastrophic health expenditure were significantly higher in the near-poor group compared to the other two groups. Conclusions The study found that the near-poor group was the most vulnerable among the Korean population because of their higher chance of incurring greater out-of-pocket spending and catastrophic health expenditures than is the case among the Medical Aid beneficiary and above-poverty line groups. Health policy needs to take the vulnerability of this near-poor population into account.

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“…This assumption is in agreement with the results reported by several other studies. MA beneficiaries were found to use more inpatient and outpatient services, incurred less OOP spending, and had a lower chance of experiencing CHEs compared to NHI members [8,28]. A study which defined the near poor as people not enrolled in MA with income less than 120% of the minimum cost of living found that MA beneficiaries experienced significantly higher health care utilization in terms of both outpatient visits and inpatient visits, and lower health care costs and proportion of OOP spendings to income compared to the poor not enrolled in MA [15].…”

Section: Discussionmentioning

confidence: 99%

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

park

2020

Preprint

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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.

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Factors influencing health care use by health insurance subscribers and medical aid beneficiaries: a study based on data from the Korea welfare panel study database

Cited by 19 publications

References 7 publications

A Comparative Cross-Sectional Study of the Prevalence and Determinants of Health Insurance Coverage in Nigeria and South Africa: A Multi-Country Analysis of Demographic Health Surveys

A Comparative Cross-Sectional Study of the Prevalence and Determinants of Health Insurance Coverage in Nigeria and South Africa: A Multi-Country Analysis of Demographic Health Surveys

Medical service utilization and out-of-pocket spending among near-poor National Health Insurance members in South Korea

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

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