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

Abstract

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.

The cascade of care for latent tuberculosis infection in congregate settings: A national cohort analysis, Korea, 2017–2018

“…This was then categorised into four groups: low (1st to 5th ventiles), lower-middle (6th to 10th), upper-middle (11th to 15th) and high (16th to 20th). Medical Aid beneficiaries ( 26 ) who do not pay a premium, were added to the lowest income tier. Place of residence was categorised into: rural area, small to medium-sized city, and metropolitan city.…”

“…income level, place of residence, comorbidities, treatment centre, and initial treatment regimen. Income level was divided into 20th percentiles based on the amount of the national health insurance premium paid, ranging from the first (the lowest 5%) to 20th (the highest 5%) ventiles (25). This was then categorised into four groups: low (1st to 5th ventiles), lower-middle (6th to 10th), upper-middle (11th to 15th) and high (16th to 20th).…”

Comparison of catastrophic out-of-pocket medical expenditure among older adults in the United States and South Korea: what affects the apparent difference?

“…The incidence of households’ catastrophic out-of-pocket medical expenditures is observed all across the countries; however, low to middle-income countries show a higher incidence compared to high-income countries [ 21 , 22 ]. Although the World Health Organization defines catastrophic out-of-pocket medical expenditures as out-of-pocket spending that exceeds 40% percent of a household’s “non-subsistence” income, studies often use varying percentages of income from 5% to 40% [ 15 , 22 ]. In this study, we effectively used a 25% threshold as recommended in previous literature [ 9 , 23 ].…”

“…Even though older adults ages 65 and over in both countries are covered by national health insurance, the South Korean national health insurance system is not very generous relative to other counties with universal national health insurance, offering more limited benefits and higher cost-sharing [ 13 , 14 ]. Recent research has raised specific concerns about high out-of-pocket medical spending among poor and near-poor households in South Korea [ 15 , 16 ]. Thus, at least in principle, South Korean older adults would seem to have more exposure to catastrophic out-of-pocket medical spending than their American counterparts.…”

Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea

“…In particular, guaranteeing equal access without discrimination or exclusion of specific groups is important. However, the National Health Insurance system in South Korea (2)(3)(4)(5) creates a barrier to health care access including vaccination. In Korea, majority of the population (97%) are covered by the National Health Insurance Services, while the most disadvantaged are covered by the Medical Aid Program.…”