• 보건의료산업학회지
• /
• 제6권4호
• /
• pp.143-152
• /
• 2012

This study analyzes Korea health panel data (2008) (beta version 1.2) of Korea Institute for Health and Social Affairs, and National Health Insurance Corporation to figure out determinants of healthcare expenditure. In result of Multiple Logistic Analysis, in-patents felt burden on the medical expenditure were 70.0%. As to the patients' payment of medical expenditure, patients over 65 years old had 4.765 times higher than those under 14 years, disabled patients 2.778 than non-disabled patients, chronic patients 1.632 times than non-chronic patients, patients belonging to 12 million won ~ 46 million won and under 12 million won in family income had 1.680 times and 2.168 times respectively than patients with over 46 million won, patients in professional recuperation facility 1.546 times than patients in hospital, patients in private medical institutions 1.700 times than patients in national and public medical institutions, patients using upper grade rooms 1.701 times than patients in non-upper grade rooms. As a health care safety net mechanism to protect people from medical expenditure burden, there is the patients' payment ceiling in the National Health Insurance System. Thus, in order to facilitate the patient's payment ceiling, it is required that the level of ceiling is to be specified according to the income level, and self-payment items is to be included.

• 보건행정학회지
• /
• 제26권1호
• /
• pp.63-70
• /
• 2016

Background: Selective health benefit was introduced for decreasing economic burden of patients. Medical devices with economic uncertainty have been covered as selective health benefit by National Health Insurance since December 2013. We aimed to analyze impact of selective health benefit to medical expenditure and provider behavior focused on electrosurgery (ultrasonic shears, electrothermal bipolar vessel sealers) for gastric cancer patients covered since December 2014. Methods: We used the National Health Insurance claims data of 2,698 patients underwent gastric cancer surgery between August 2014 and March 2015. Medical cost and patient sharing per inpatient day were analyzed to verify that covering electrosurgery increased medical expenditure and changed provider behavior from open surgery to endoscopic or laparoscopic surgery. Additionally, we analyzed the claim rate of medical device or goods relating gastric endoscopic and laparoscopic surgery. Results: Medical cost and patient sharing per inpatient day were increased after covering electosurgery as selective health benefit (39,724/1,421 won). However, there were no medical expenditure increases after adjusting claim of electosurgery and patient sharing was decreased 1,057 won especially. The coverage of selective health benefit did not increase the claim rate of medical device or goods related endoscopic or laparoscopic surgery, either. Conclusion: Covering electosurgery decreased patient economic burden and did not change of provider behavior. Expanding selective health benefit is needed to decrease economic burden of severe patients. Further study should evaluate the long term effect with accumulated data.

• Asian Pacific Journal of Cancer Prevention
• /
• 제14권11호
• /
• pp.6985-6989
• /
• 2013

Background: This study aimed to examine out-of-pocket expenditure for cancer treatments of hospitalized patients and to analyze changing patterns over time. Materials and Methods: This study examined data of all cancer patients receiving inpatient care from two tertiary hospitals from January 2003 to December 2010. Medical expenditures per admission were calculated and classified into those covered and uncovered by the Korean National Health Insurance (NHI) and co-payment. Results: The medical expenditure per admission increased slowly from 3,455 thousand Korean won (KRW) to 4,068 thousand KRW. While expenditures covered by the NHI have increased annually, co-payments have generally decreased. The out-of-pocket expenditure ratio, which means the proportion of uncovered expenditure and co-payment among total medical expenditure dropped sharply from 2005 to 2007 and was maintained at a similar level after 2007. Medical expenditures, NHI coverage, and the out-of-pocket expenditure ratio differed across cancer types. Conclusions: It is necessary to continually monitor the expenditure of uncovered services by the NHI, and to provide policies to reduce this economic burden. In addition, an individual approach considering cancer type-specific characteristics and medical utilization should be provided.

• 보건행정학회지
• /
• 제30권1호
• /
• pp.126-130
• /
• 2020

Catastrophic health expenditure refers to measure the level of the economic burden of households due to medical expenses. The purpose of this study was to examine the proportion of households that experienced catastrophic health expenditure between 2006 and 2018 using available data from the National Survey of Tax and Benefit (NaSTaB), Korea Health Panel (KHP), and Households Income and Expenditure Survey (HIES). Trend test was used to analyze the proportion of household with catastrophic healthcare expenditure. The households experienced the catastrophic health expenditure 2.08% in 2018 using the NaSTaB data. Trend analysis was significant with the decreasing trend (Annual Percentage Change [APC], -4.88; p<0.0001) in the proportion of households with the catastrophic health expenditure. On the other hand, the results of the HIES showed 2.92%, and KHP showed 2.48% of households experienced the catastrophic health expenditure in 2016. The trend was significantly increased in HIES (APC, 1.43; p<0.0001) and KHP (APC, 6.68; p<0.0001). Therefore, this suggests that further interventions to alleviate the burden of catastrophic health expenditure to the low-income group are needed.

• 보건행정학회지
• /
• 제31권1호
• /
• pp.140-144
• /
• 2021

Catastrophic health expenditure refers to measure the level of the economic burden of households due to medical expenses. The purpose of this study was to examine the proportion of households that experienced catastrophic health expenditure between 2006 and 2019 using available data from the National Survey of Tax and Benefit (NaSTaB), Korea Health Panel (KHP), and Households Income and Expenditure Survey (HIES). Trend test was used to analyze the proportion of households with catastrophic healthcare expenditure. The households experienced a catastrophic health expenditure of 2.44% in 2019 using the NaSTaB data. Trend analysis was significant with the decreasing trend (annual percentage change [APC], -4.49; p<0.0001) in the proportion of households with catastrophic health expenditure. Also, the results of the 2017 KHP and the 2016 HIES showed 2.20% and 2.92%. The trend was significantly increased in the KHP (APC, 1.79; p<0.0001) and the HIES (APC, 1.43; p<0.0001). Therefore, this study suggests that further public healthcare interventions to alleviate the burden of catastrophic health expenditure, especially for low-income households, are needed.

• 한국임상약학회지
• /
• 제22권3호
• /
• pp.239-250
• /
• 2012

In recent years, national health insurance(NHI) coverage had been expanded gradually for cancer as a severe disease requiring high level of medical expenditure, to reduce patient's financial burden. But, subjective burdens level for out-of-pocket(OOP) money expense are still considerable owing to high medical cost and decent numbers of services not covered by benefit plan. This study aimed to investigate OOP medical expenditures and identify factors influencing subjective financial burden in cancer patients. A 28-items questionnaire for self-reporting by responders was designed to satisfy study goal and finalized following by one pilot study and experts' verification process. Subjects were enrolled during July to October 2010 through regular meetings organized by five patient or patient-advocacy groups had acknowledged the study purpose. Subjects who aged 20 or more, have histories of cancer diagnosis and anticancer drug use, and voluntarily agreed to participate in this study were recruited. Total 107 subjects included in the analysis have cancer lesions in breast, colon, kidney, liver or stomach at the stages from I to IV. Approximately 73% of them has passed less than 5 years since cancer diagnosis. For the OOP medical expenditure regarding cancer, less 6 million won was in 31%, 6-15 million won in 35% and more than 15 million won in 28% of responders, and more than half responders(58%) felt financial burden subjectively. 63% of responders had subscribed commercial insurances, resulting in money receipts of more than 10 million won since cancer diagnoses in 76% of responders. Logistic regression results showed significant differences in subjective OOP financial burden level depending on gender, household income level, benefit type, commercial insurance money receipt degree, year cancer diagnosed, cancer lesion, therapy type, duration of anticancer drug use, drug listing in national formulary, total OOP medical expenditure and total OOP anticancer drug expense. They had mixed feelings both wishes to expand NHI coverage to reduce financial burden(70%) and no willingness to increase premium(59%). This result suggested that NHI might direct future strategies to reduce absolute total OOP medical cost and expand benefit plan coverage in higher burden groups in particular.

• 보건행정학회지
• /
• 제31권1호
• /
• pp.17-23
• /
• 2021

With the introduction of national health insurance, the burden of health care costs decreased and choices of medical services widened. However, because of the rapid expansion of non-covered medical services by health insurance, financial security for health care expenditure is still low. This gives patients barriers to choose medical services especially for non-covered medical services, and it becomes narrower. Compared to Korea, Japan has high financial protection in health care utilization, but there exists a limitation using covered and non-covered medical services both together. This is called a prohibition of mixed treatment in health care. This study reviews the Japanese health care system that limits choosing medical services and the burden of health care costs. The prohibition of mixed treatment can alleviate the out-of-pocket burden in the non-benefit sector, but it can be found that it has a huge limitation in that it places restrictions on choices for both healthcare professionals and patients.

• 지적과 국토정보
• /
• 제51권2호
• /
• pp.151-168
• /
• 2021

본 연구는 수도권과 비수도권의 가계지출 부담이 기혼여성의 출산 의사에 미치는 영향을 패널로짓 모형을 이용해 비교분석하였다. 실증분석의 핵심 대상인 기혼여성의 범위는 가임 가능성이 높은 25세부터 39세까지로 한정하였다. 주요 분석 결과는 다음과 같다. 첫째, 거주 지역과는 관계없이 대체로 배우자의 경제력이 기혼여성의 출산 의사에 있어 중요한 요인일 수 있다는 점을 확인하였다. 둘째, 결혼생활 만족도는 높을수록 출산 의사에 긍정적인 영향을 미치고 있었으며, 자녀가 반드시 있어야 한다는 가치관이 있을수록 출산 의사가 높아지는 것으로 나타났다. 셋째, 가계지출 부담은 기존 자녀 수와 같은 내부요인을 제외하고 기혼여성의 출산 의사에 있어 가장 중요한 영향을 미치는 요인임을 확인하였다. 특히 수도권과 비수도권 모두 교육비 지출에 대한 부담은 출산 의사를 큰 폭으로 감소시키는 핵심 원인으로 나타났다. 넷째, 가계지출 부담은 거주 지역에 따라 출산 의사에 상이한 영향을 보이는 것으로 나타났는데, 수도권은 의료비 및 원리금 대출이, 비수도권은 교통통신비가 출산 의사에 더 큰 영향을 미치고 있었다. 이를 통해 본 연구는 출산 제고를 위해서는 가계지출에 대한 부담완화가 지속적으로 필요하며, 거주 지역에 따라 차별적인 정책접근이 요구된다는 시사점을 확인하였다.

• 한국사회복지학
• /
• 제48권
• /
• pp.150-178
• /
• 2002

The elderly have higher potential for contracting chronic diseases and suffering from development of a complication. Also, the extended old age period leads the elderly to demand more medical services. All those facts indicate that the elderly need more medical services than any other age groups. Consequently, medical care for the elderly with chronic diseases causes high costs burden. However, there is few studies researching the financial burden of chronic illness of the elderly. This study aimed to 1) understand how much the elderly with chronic diseases pay for medical expenses; 2) find out some specific factors related to health care financial burden; 3) suggest the alternative policies to decrease excessive financial burden of caring for the elderly with chronic illness. National Health and Nutrition Survey, which was surveyed by the Korea Institute for Health and Social Affairs in 1998, was used in this study. 4,707 persons with chronic diseases out of 5385 persons over age 60 were selectively sampled. Using SPSSWIN, correlation analysis, T-test, ANOVA and Regression were used as statistical methods in this study. Stepwise multiple regression was employed to analyze the data with a ratio of health care expenditure to income(financial burden) as a dependent variable. Out of Korean old people, 87% had the chronic diseases and their health care financial burden rate showed the average of 17.9%, which meaned they expended almost 20% income to buy medical services. The variables having a great influence on financial burden were monthly income, activity, limitation and single household of an old person. The excessive financial burden was experienced by people who had more than 4 activity limitations(37.1%) and were in the lowest Income level(32.6%), and single household of an old person(31.4%). The new policies should be considered to 1) reduce the financial burden in these groups and to develop the sliced medical cost system considering the characteristics of chronic illness and income level; and 2) develop the medical management system to care for the elderly with chronic illness.

• 간호행정학회지
• /
• 제17권2호
• /
• pp.147-157
• /
• 2011

Purpose: This study was done to investigate factors affecting perceived financial burden of medical expenditures. Method: The participants were 2,024 inpatients who were enrolled in a survey on the benefit coverage rate of the National Health Insurance in 2006. The collected data were analyzed using t-test, ANOVA-test, Mann-Whitney-test, Kruskal-Wallis-test, Chi-square test and logistic regression. Results: The crucial factors for perceived financial burden were age, job, equivalence scale, ratio of annual family income vs medical expenditure, and private health insurance. Perceived financial burden was higher for people who were older, who were unemployed, whose medical expenditures were high compared to annual family income, whose index of family equalization was low and for those who had no private health insurance. Conclusion: The results of the study indicate a demand for system reform that will enable management of no-pay hospital bills in the National Health Insurance to decrease the medical expense of people in the low-income bracket.