scholarly journals Data Analysis on Medical Service Utilization and Out-of-pocket Spending among Near-poor National Health Insurance Members in South Korea

2020 ◽  
Author(s):  
sooyeol park
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Low Income ◽  
Study Groups ◽  
Medical Utilization ◽  
Medical Services ◽  
Median Income ◽  
Poor Group ◽  
Poor Population

Abstract Background: The near poor, a low income population which is excluded from the Republic of Korea's Medical Aid (MA) program, experiences insufficient use of medical services and high out-of-pocket (OOP) spending due to insufficient coverage by the country's National Health Insurance (NHI). This study aims to examine medical utilization, OOP spending, and occurrence of catastrophic health expenditures (CHE) among the near poor compared to MA beneficiaries and other NHI members.Methods: A cross-sectional study was conducted drawing upon a nationally representative dataset based on the 2018 Korea Welfare Panel Study (KOWEPS). We classified people into MA beneficiaries, the near-poor population below 50% of the median income threshold, and other NHI members above the 50% median income threshold. Using propensity score matching between MA beneficiaries and the near poor and between the near-poor group and the group of those above the poverty line, this study examined medical utilization, OOP spending, and the occurrence of CHE among the study groups. Results: The findings suggest that MA beneficiaries make greater use of outpatient services compared to the near poor, but other uses of medical services were not significantly different among the study groups. However, OOP spending and occurrence of CHE were significantly higher in the near-poor group compared to the other two groups. Conclusion: We found that the near-poor group was the most vulnerable group in these terms among the Korean population. Health policy needs to take into account the vulnerability of the near-poor population.

scholarly journals Data Analysis on Medical Service Utilization and Out-of-Pocket Spending Among Near-Poor National Health Insurance Members in South Korea

2020 ◽  
Author(s):  
Sooyeol Park
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Low Income ◽  
Study Groups ◽  
Medical Utilization ◽  
Medical Services ◽  
Median Income ◽  
Poor Group ◽  
Poor Population

Abstract Background: The near poor, a low income population which is excluded from the Republic of Korea's Medical Aid (MA) program, experiences insufficient use of medical services and high out-of-pocket (OOP) spending due to insufficient coverage by the country's National Health Insurance (NHI). This study aims to examine medical utilization, OOP spending, and occurrence of catastrophic health expenditures (CHE) among the near poor compared to MA beneficiaries and other NHI members.Methods: A cross-sectional study was conducted drawing upon a nationally representative dataset based on the 2018 Korea Welfare Panel Study (KOWEPS). We classified people into MA beneficiaries, the near-poor population below 50% of the median income threshold, and other NHI members above the 50% median income threshold. Using propensity score matching between MA beneficiaries and the near poor and between the near-poor group and the group of those above the poverty line, this study examined medical utilization, OOP spending, and the occurrence of CHE among the study groups. Results: The findings suggest that MA beneficiaries make greater use of outpatient services compared to the near poor, but other uses of medical services were not significantly different among the study groups. However, OOP spending and occurrence of CHE were significantly higher in the near-poor group compared to the other two groups. Conclusion: We found that the near-poor group was the most vulnerable group in these terms among the Korean population. Health policy needs to take into account the vulnerability of the near-poor population.

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sooyeol Park
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Study Groups ◽  
Catastrophic Health Expenditure ◽  
Medical Utilization ◽  
Median Income ◽  
Medical Aid ◽  
Catastrophic Health Expenditures ◽  
Poor Group

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.

Paying the Doctor: Systems of Remuneration and their Effects, by William A. Glaser. Baltimore: The Johns Hopkins Press, 1970, 323 pp., $10.00

PEDIATRICS ◽  
1971 ◽  
Vol 47 (1) ◽  
pp. 160-163
Author(s):  
Allan M. Butler
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Private Practice ◽  
Payment System ◽  
European Countries ◽  
Medical Services ◽  
Payment Systems

From his personal studies, Glaser analyzes the establishment and summarizes the methods of paying doctors in 16 European countries that have national health insurance programs. Unfortunately, to quote Glaser, "a country's current payment system under its public medical services is usually the arrangement it had before the services were created. . . . Most payment systems in public schemes are simply those inherited from prior practice, since the doctors would be disturbed by changes. Most payment procedures under ‘socialized medicine’ are simply more bureaucratized versions of the methods that were used and often even invented by the doctors under earlier private practice."

scholarly journals National Health Insurance Scheme: Internal and External Barriers in the Use of Reproductive Health Services among Women

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Evi Martha ◽  
Herna Lestari ◽  
Resvi Siti Zulfa ◽  
Yoslien Sopamena
Keyword(s):  
Health Insurance ◽  
Reproductive Health ◽  
Health Services ◽  
National Health Insurance ◽  
National Health ◽  
Rapid Assessment ◽  
Medical Services ◽  
Assessment Procedure ◽  
Reproductive Health Services ◽  
Internal Barriers

Lack of familiarity among the community, medical workers, and administrative staff regarding reproductive health services covered by Badan Penyelenggara Jaminan Sosial (BPJS) or the National Health Insurance (NHI) in Indonesia, remained a problem. Therefore, this resulted in sub-optimal use of the medical services, as shown by surveys from the Women's Health Foundation for three consecutive years (2015-2017). This qualitative study was conducted with a Rapid Assessment Procedure design in three cities within Indonesia, namely Padang Pariaman, Manado, and Kupang. Data were collected through IDIs (n = 47 informants) and 6 FGDs (7 persons/group). Participants also consisted of NHI RHS users (mothers and young women), administrative officers at health facilities, medical services providers, and officials related to the NHI assistance. Data were managed using NVivo version 2.0 software, accompanied by thematic analysis. The internal barriers in the use of NHI included inadequate knowledge of RHS covered by NHI, and a culture of shame in informants. External barriers included additional costs for medicines not covered by NHI, the dissatisfaction of health services provided by medical workers, busy work and household activities, with the lack of women's role in decision-making within families, which related to reproductive wellness.

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