The Effect of Additional Private Health Insurance on Mortality in the Context of Universal Public Health Insurance

Abstract

(1) Background: Korea operates its national health insurance (NHI) system as a form of public health insurance, and is commonly regarded as having achieved universal health coverage (UHC). However, many Korean households register for additional private health insurance (PHI) programs. Typically, registration rates for PHI are higher for individuals with a higher socioeconomic status (SES). A difference in mortality between those with and without additional PHI would indicate that there are health inequalities within the Korean NHI system under UHC. Therefore, this study aimed to confirm whether additional PHI affects mortality under the Korean NHI system. (2) Methods: We conducted a longitudinal study using the Korean Longitudinal Study of Aging data from the first to the sixth wave. The analysis included 8743 participants, who were divided into two groups: those who only had NHI and those who had both NHI and PHI. Differences in mortality between the two groups were compared using the Cox proportional hazard regression. (3) Results: The group with both NHI and PHI had lower mortality than the group with only NHI (hazard ratio = 0.53, 95% confidence interval: 0.41, 0.9). (4) Conclusions: The results of this study reveal that there are health disparities according to SES and PHI within the Korean NHI system under UHC. Therefore, relevant government institutions and experts should further improve the NHI system to reduce health disparities.

Disparities in cause-specific mortality by health insurance type and premium: evidence from Korean NHIS-HEALS cohort study, 2002–2019

“…Previous Korean studies have shown that the SI group has lower outpatient medical utilization and higher unmet medical needs compared to the EI group [ 7 ]. Conversely, previous studies have shown that having private insurance in addition to the NHIS is associated with increased outpatient costs, inpatient utilization, and lower mortality, particularly among high-income individuals who are more likely to have private insurance [ 27 , 28 ]. According to these results, since Korea’s NHI covers only 64.5% of the total medical expenses (as of 2021), those with private insurance or high incomes may have access to expensive treatments, procedures, and preventive screenings not covered by public insurance, potentially lowering their mortality risk [ 29 ].…”