• 보건행정학회지
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• 제5권2호
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• pp.155-172
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• 1995

This study is an empirical analysis on the equity in the delivery of heatlh care under the Korean Medical Insurance Corporation System. The purposes of this study are to find out effects of income on the health care utiliztion and measure the income-related inequity in the distribution of health care. This study was carried out based on the fact that the health insurance program has been organized to achieve the equity objective, "equal treatment for equal needs". Of 41, 828 insured persons who had been diagnosed in the 1993 Health Screening Test and utilifzation data from 1, January 1993 through 31, December 1993 were derived from the Benefit Managment File. Inequity was measured by means of I) share approach, ii) standardization concentration curve approach, iii) inequity index, iv) test for inequity. The major findings were as follows : 1. The expenditure shares of the top two quintile groups exceeded their morbidity shares, whereas the opposite was true of the bottom three quintile groups, Which showed a positive HI$_{LG}$ inequity index, suggesting the presence of some inequity favoring the rich group. 2. Compared with other residential areas, the rural area showed the highest positive HI$_{LG}$ irrespective of need indicatior applied. 3. Standardized expenditure concentration indices adjusted by age, gender and need structure were also found to be positive, and therefore still indicated that there has been inequity favoring the rich after the standardization. 4. The Loglikelihood Ratio (LR) test for the statistical significance of income-related inequity of medical care utilization was carried out using the logistic regression model. The resulting loglikelihood ratio test statistic value was 176, which did exceed the 0.5 percent critical value of the chi-square distribution with 28 degrees of freedom, which is 50.993. Therefore, the null hypothesis of no income-related inequity of medical care utilization was rejected at the 99.5 percent confidence level. 5. The Regression based F-test has been carried out for analyzing the income-related inequity of medical expenditure in terms of age, gender, morbidity indicators as explanary variables. The hypothesis of the absence of income-relate inequity was rejected for all need indicators at the 95% confidence level.nce level.

• Journal of Preventive Medicine and Public Health
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• 제46권5호
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• pp.237-248
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• 2013

Objectives: The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea. Methods: We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners. Results: The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010. Conclusions: We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.

• 보건행정학회지
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• 제29권3호
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• pp.288-302
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• 2019

Background: The one-person households (OPH) are rapidly increasing and vulnerable to socioeconomic and health problems. Because it is predicted to be inequitable to health care utilization, we would like to find out about the equity of health care utilization of the OPH by comparison with the multi-person households (MPH). Methods: This study followed the theoretical framework of Wagstaff and van Doorslaer (2000), O'Donnell and his colleagues (2008), where the horizontal inequity index is the difference between the concentration indices of actual health care utilization and health care needs. This study employed the 9th Korea Health Panel survey, and a total of 10,807 cases were analyzed. Health care needs were measured by age, sex, subjective health status, chronic disease count, Charlson's Comorbidity Index, limitation of activities, and disability. Results: Compared with the MPH, there were pro-poor inequities in hospitalization, emergency utilization, hospitalization out-of-pocket payments, and pro-rich inequities in outpatient out-of-pocket payments for the OPH. The decomposition of the concentration index revealed that chronic disease count made the largest contribution to socioeconomic inequality in outpatient utilization. Age, health insurance, economic activities, and subjective health status also proved more important contributors to inequality. The variables contributing to the hospitalization and emergency utilization inequity were age, education, Charlson's Comorbidity Index, marital status, and income. Conclusion: Because the OPH was more vulnerable to health problems than the MPH and there were pro-poor inequities in medical utilization, hospitalization, and emergency costs, it is necessary to develop a policy that can correct and improve the portion of high contribution to medical utilization of the OPH.

• 한국안광학회지
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• 제16권2호
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• pp.209-217
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• 2011

목적: 본 연구는 노인의 가구 소득과 눈 건강과의 관계를 확인함으로써 노인의 눈 건강 불평등 정도를 알아보고, 향후 저소득층 노인의 삶의 질 향상을 위한 안보건 정책 수립의 기초자료를 제공하고자 한다. 방법: 국민건강영양조사(2009) 데이터를 이용하여 만 65세 이상의 노인 1,668명을 대상으로 가구 소득에 따른 눈 건강 관련요인(시력, 백내장 유무, 군날개 유무, 안압, 망막이상소견, 나이관련 황반변성, 당뇨망막병증, 근시, 원시, 난시, 부동시 유병률)을 t-test 및 ${\chi}^2$ 검정하였다. 결과: 자동굴절계검사의 굴절이상도와 안압은 저소득군이 낮았고, 나안시력과 교정시력은 0.1~0.5 미만에서 저소득군이 높았고, 원시는 고소득군에서 높았다. 백내장과 최대교정시력 0.8미만인 사람의 백내장 유병여부는 저소득군에서 더 높게 발생하였고, 흡연, 음주, 직업, 교육수준과 유의한 관계가 있었다. 결론: 노인의 가구 소득에 따른 눈 건강 불평등이 존재함을 알 수 있었고, 특히 백내장은 삶의 질과 밀접한 관계가 있는 안질환으로 저소득층 노인의 눈 건강 불평등 해소를 위한 안보건 정책이 필요할 것으로 사료된다.

• Journal of Preventive Medicine and Public Health
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• 제43권1호
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• pp.50-61
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• 2010

Objectives: The study is investigated socioeconomic variations in self-rated health status and contribution of health behavioral factors in Korea. Methods: A nationally representative sample (2,800 men and 3,230 women aged 20-64 years) from the 2005 Korea National Health and Nutrition Surveys was analyzed using logistic regression. Results: Self-rated health was lower among lower socioeconomic groups compared with higher socioeconomic groups, with gender being irrelevant. This association was attenuated when health behavioral and socio-demographic factors were adjusted. When each health behavioral factor was considered separately, mediators such as smoking in men, and stress or exercise in women explained a large part of the decreased socioeconomic health inequalities. Conclusions: In Korea, subjective health inequalities arise from different socioeconomic status, but this difference is decreased by health behavioral factors. Therefore, socioeconomic inequity in self-rated health status can be corrected more effectively by promotional health behaviors.

• 보건행정학회지
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• 제26권4호
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• pp.256-264
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• 2016

Equity-focused public health policy has solid theoretical and practical basis, in addition to ethical one. In the Republic of Korea (hereafter Korea), however, equity in health has not had a high priority in policy goals, regardless of policy areas and particular actors or approaches. Equitable health has been only a minor concern in most public health issues and their decision-making. Generic public health policies are needed to reduce inequity in health, but the importance of a firm basis for sound policy-making cannot be overemphasized. Health equity should be 'mainstreamed' in all public health policies. Potential approaches include intersectoral collaboration, health impact assessment, and 'Health in All Policies.' Public policy agendas for equitable health cannot be formulated without measurement and recognition of the problem. Korea is still suffering from the lack of reliable information on the current status of health inequity, resulting in a relatively weak awareness of the problem among both the general public and policy-makers. More information is needed to increase recognition and awareness that will increase intervention and actions. The absence of decision-making and actions should not be justified even by the lack of information on determinants and pathways of health inequities. Generic plausible solutions can often work in the real world according to political and social commitment. I have discussed several aspects of public health policy from the perspective of health equity, focusing on current status and plausible explanation. Policy process, agenda setting in particular, is highlighted and theories and concepts are presented along with analysis and description of current situation.

• 보건행정학회지
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• 제4권1호
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• pp.77-106
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• 1994

This study attempts to evaluate the beneficial equity and operational efficiency of the three Korean medical insurance programmes and thereby suggest directions for their policy improvement. Concepts of the equity and effciency were reviewed to develop indicators for comparative analysis. For the analysis, statistical and financial accounting data for 1991, issued by the National Federation of Medical Insurance and the Korea Medical Insurance Corporation, on the operational status and performances of the programmes, were collected and rearranged to be suited to the purpose of the study. The analysis reveals that beneficial inequity exists between self-employed and employee programs. and that operational inefficiency is prominent in both programms for self-employeds and for Government employees and private school teachers. In order to improve the beneficial inequity of the self-employed program, it is suggested that policies be formulated and implimented toward increasing the program revenue through increasing subsidies from the Government, and through inter- program finance adiustment. For the operational inefficiency of the two programs, it is judged that, toghether with the administrative support and control from the Government and the insurance society bodies, self- efforts be initiated to improve the internal mangement styles and systems of the insurance societies. Finally, from the viewpoint of the structural efficiency, expansion of the preventive insurance benefits by the insurance soceties is recommended both for beneficial equity and operational efficiency.

• 한국융합학회논문지
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• 제12권5호
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• pp.405-413
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• 2021

본 연구는 간호학생을 대상으로 빈곤과 건강 관련성에 대한 인식 및 빈곤에 대한 태도를 파악하기 위해 시도하였다. 본 연구는 일 대학 간호학생 198명을 대상으로 표준화된 설문지를 활용하여 조사한 후 SPSS ver. 22.0을 이용하여 분석하였다. 연구결과 간호학생은 빈곤에 대한 간호교육의 중요성을 인식하고 있으며 임상실습, 봉사 등 비교과 프로그램을 통한 간호교육이 필요함도 인식하였다. 간호학생은 빈곤과 건강에 악순환에 대해 인식하고 있었으나 빈곤층 건강 행태에 대한 인식은 부족하였다. 빈곤에 대한 태도는 사회구조적 책임 보다 개인적 요인으로 인식하고 있는 경향이 있었고, 연령, 경제적 수준, 정치적 성향과 임상실습 여부에 따른 점수 차이가 있었다. 결론적으로 빈곤층 건강불평등 옹호를 위한 역량있는 간호사 배출을 위해서는 다학문적 융합 임상실습 교육 이외 및 봉사 활동 등 프로그램 개발이 필요할 것이다.

• 보건행정학회지
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• 제32권1호
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• pp.53-62
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• 2022

Background: This study was designed to examine regional proportions for people who experienced unmet health care needs due to reduced mobility or unhealthiness and factors associated with experience of unmet health care needs by them. Methods: A total of 11,620 people were retrieved from the Korea Health Panel data (2014-2018). Regional proportions for people who experienced unmet health care needs due to reduced mobility or unhealthiness were estimated using cross-sectional weights and the factors associated with them were analyzed using generalized estimating equation. Results: The number of people who experienced unmet health care needs due to reduced mobility or unhealthiness was estimated as 278,083 in 2018. Women, the aged (65+), below elementary school, single as marital status, low income, bad self-rated health, people with disabilities, and long-term insurance beneficiaries were statistically significantly associated with experience of unmet health care needs due to reduced mobility or unhealthiness. Conclusion: Given high and dispersed demand for visiting health care, government need to expand the infrastructure and finance to facilitate visiting health care.

• 보건의료산업학회지
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• 제8권2호
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• pp.115-125
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• 2014

This study tries to investigate inequity in supplementary private health insurance insured in terms of the analysis of insurance insured general characteristics and to analyze the influence of supplementary private health insurance on their admission and their outpatient medical utilization behavior. As a result of the analysis of the general characteristics of supplementary private health insurances insured, it has turned out that men, persons at low ages, people with a spouse and chronic diseases, and persons with a high income have applied such insurances more. We can also tell that low-income classes have difficulty in applying private health insurances as people in the fifth income quintile have applied such insurances about 9 times as much as those in the first income quintile. The analysis of supplementary private health insurance insured health care utilization behavior has revealed that both male and female insured aged less than 55 and without chronic diseases have increases the number of their use of health care, their patient charge, and their medical cost per visit.