How public and private health insurance coverage mitigates catastrophic health expenditures in Republic of Korea

Abstract

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.

Inequality in the distribution of resources and health care in the poverty quintiles: Evidence from Peruvian comprehensive health insurance 2018-2019

“…For example, a study in Ghana found that individuals aged 56 to 65 and without employment were less likely to enroll in health insurance, with nearly half of participants paying for membership out of pocket [21]. Similarly, in Korea, a large number of households subscribed to private health insurance, but very few received reimbursements for medical costs or services [22]. These findings underscore the need for policies and interventions to address disparities in health insurance enrollment and coverage.…”

Medication utilisation trends during pregnancy and factors influencing adverse pregnancy outcomes in patients with rheumatoid arthritis

“…In Korea, the National Health Insurance (NHI) system covers 97% of the population, and the remaining population consists of Medical Aid recipients, as well as temporary or illegal residents. 17 The NHI database includes sociodemographic information, healthcare utilisation and national health examination results. 18 Using the NHI database, we extracted data on female patients with RA who claimed insurance between 2010 and 2020.…”

Association of Primary Care Physician Supply with Population Mortality in South Korea: A Pooled Cross-Sectional Analysis

“…However, a drawback of this approach is the lack of comprehensive care. In South Korea, 97% of the population is covered by the national health insurance scheme, and medical aid is provided to ensure medical access for the poor [ 3 ]. Under a fee-for-service reimbursement system, providers are encouraged to increase the volume and intensity of patient care rather than improve health outcomes [ 2 ].…”