Abstract
Background: Korea's health security system named National Health Insurance and Medical Aid has revolutionized the nation's mandatory health insurance and continues to reduce excessive copayments. However, few have been studied on healthcare utilization and expenditure according to the health security system in case of severe disease. This study looked at reverse discrimination within End-stage Renal Disease between National Health Insurance and Medical Aid. Methods: Subjects were a total of 305 diagnosed with End-stage Renal Disease in Korea Health Panel from 2008 to 2013. Chi-square, t-test, and ANCOVA were conducted to identify healthcare utilization rate, out-of-pocket expenditure, and prevalence of catastrophic expenditure. Mixed effect panel analysis was used to evaluate total out-of-pocket expenditure over a 6-year trend by National Health Insurance and Medical Aid. Results: There were no significant differences in healthcare utilization rate in emergency-room visits, admission, or out-patient department visits between National Health Insurance and Medical Aid because healthcare service was essential for a serious disease such as End-stage Renal Disease. Meanwhile, each out-of-pocket expenditure for admission and out-patient department in National Health Insurance was 2.6 and 3.1 times higher than Medical Aid (P<0.05). A total of out-of-pocket expenditure including emergency-room visits, admission, out-patient department visits, and prescribed drug expenditure was 2.9 times higher in National Health Insurance than those of Medical Aid (P<0.001). Over a 6-year trend for a total of out-of-pocket expenditure, subjects with National Health Insurance spent more than those of Medical Aid (P<0.01). If total household income decile was less than the median and subjects were covered by National Health Insurance, the catastrophic health expenditure rate was 92.2%, but 58.8% in Medical Aid (P<0.001). Conclusion: Serious disease such as End-stage Renal Disease can result in reverse discrimination depending on the type of health security system. It is necessary to consider those who belong to National Health Insurance but are still poor.
Health care trajectories and barriers to treatment for patients with end-stage renal disease without health insurance in Mexico: a mixed methods approach
