Lee Tae-Jin, Cheong Chelim
Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Korea.
J Prev Med Public Health. 2017 Nov;50(6):393-400. doi: 10.3961/jpmph.17.151.
To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a "copayment ceiling," which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients' income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups.
This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics.
The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients.
The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.
为减轻家庭面临的经济负担，韩国国民健康保险（NHI）系统引入了“自付费用上限”，该上限在2009年演变为差异化上限，自付费用上限取决于患者收入。本研究旨在检验差异化自付费用上限对经济保护和医疗服务利用的影响，尤其关注其影响在不同收入群体中是否存在差异。
本研究从韩国健康面板获取数据。分析纳入的家庭数量在2008年为6555户，2009年为5859户，2010年为5539户，2011年为5372户。为评估差异化自付费用上限对医疗服务利用、自付费用和灾难性支出的影响，应用了各种随机效应模型。医疗服务利用以治疗天数衡量，而灾难性支出定义为自付费用超过家庭收入的10%。右侧变量包括新政策与收入水平的交互项以及一系列家庭特征。
无论在所有患者还是癌症患者中，差异化自付费用上限均促使医疗服务利用增加，而不论收入水平如何。然而，新政策似乎并未显著降低癌症患者中灾难性支出的发生率，甚至在所有患者中还增加了发生率。
差异化上限效果有限可归因于国民健康保险未涵盖服务的直接支付比例较高，以及受益于差异化上限的家庭数量相对较少；这些因素需要更好的政策设计。
