The effect of shifting medical coverage from National Health Insurance to Medical Aid type I and type II on health care utilization and out-of-pocket spending in South Korea

BMC Health Services Research

Jieun Jang¹  Dong-Woo Choi²  Doo Woong Lee²  Sung-In Jang³  Eun-Cheol Park³ 

[1] Department of Preventive Medicine, Ajou University School of Medicine, 16499, Suwon, Republic of Korea;Institute of Health Services Research, Yonsei University, 03722, Seoul, Republic of Korea;Department of Public Health, Graduate School, Yonsei University, 03722, Seoul, Republic of Korea;Department of Preventive Medicine, Ajou University School of Medicine, 16499, Suwon, Republic of Korea;Institute of Health Services Research, Yonsei University, 03722, Seoul, Republic of Korea;Department of Preventive Medicine, Yonsei University College of Medicine, 03722, Seoul, Republic of Korea;

关键词: South Korea;    Medical aid;    National Health Insurance;    Health care utilization;    Out-of-pocket medical spending;    Difference-in-differences;    Propensity score;   

DOI  :  10.1186/s12913-020-05778-2

来源: Springer

【 摘 要 】

BackgroundThis study examines the effects of a shift in medical coverage, from National Health Insurance (NHI) to Medical Aid (MA), on health care utilization (measured by the number of outpatient visits and length of stay; LOS) and out-of-pocket medical expenses.MethodsData were collected from the Korean Welfare Panel Study (2010–2016). A total of 888 MA Type I beneficiaries and 221 MA Type II beneficiaries who shifted from the NHI were included as the case group and 2664 and 663 consecutive NHI holders (1:3 propensity score-matched) were included as the control group, respectively. We used the ‘difference-in-differences’ (DiD) analysis approach to assess changes in health care utilization and medical spending by the group members.ResultsDifferential average changes in outpatient visits in the MA Type I panel between the pre- and post-shift periods were significant, but differential changes in LOS were not found. Those who shifted from NHI to MA Type I had increased number of outpatient visits without changes in out-of-pocket spending, compared to consecutive NHI holder who had similar characteristics. However, this was not found for MA Type II beneficiaries.ConclusionOur research provides evidence that the shift in medical coverage from NHI to MA Type I increased the number of outpatient visits without increasing the out-of-pocket spending. Considering the problem of excess medical utilization by Korean MA Type I beneficiaries, further researches are required to have in-depth discussions on the appropriateness of the current cost-sharing level on MA beneficiaries.

【 授权许可】

CC BY