An evaluation of universal health insurance in the elderly: burden of disease, utilization, and costs in the Republic of Korea.

OBJECTIVE

This article evaluates Korea's national health insurance system for the elderly by simultaneously examining disease patterns, demand for care, utilization, costs of care, and facility type.

METHODS

Claim records (N = 8,306,976) for 1995 to 1997 were obtained from the Youndeoung-Po district for four insurance categories. Utilization is examined using a probit model; a linear regression model is used to compare costs.

FINDINGS

Insurees averaged 10.6 medical visits per year, most commonly for acute respiratory diseases. The elderly were more likely to seek care for circulatory problems, use more inpatient services, and rely on hospitals for outpatient care. Insurance costs for the elderly poor were markedly higher, and overall care for the elderly was higher per visit.

DISCUSSION

By simultaneously analyzing utilization rates, disease patterns, and relative costs of care, policymakers may be able to avert a financing crisis. Stronger pricing strategies and better disease targeting would adjust utilization and increase efficiency of health expenditures.