Division of Health Care Management and Policy, Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, 08826, Republic of Korea.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21218, USA.
BMC Health Serv Res. 2021 Aug 28;21(1):886. doi: 10.1186/s12913-021-06881-8.
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.
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.
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.
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.
韩国的公共医疗保健系统是一个双层系统。最低收入人群由医疗救助计划覆盖，其余人群由国家健康保险覆盖。“准穷人”是一个相对低收入的群体，由于收入超过了医疗救助计划的门槛而被排除在外，他们在国家健康保险（NHI）计划下的覆盖范围不足，因此医疗服务的利用率较低，自付费用较高。本研究旨在考察与医疗救助计划的受益人以及其他（收入较高）NHI 成员相比，“准穷人”群体的医疗利用、自付支出和灾难性卫生支出的发生情况。
本研究采用了一项基于 2018 年韩国福利小组研究的全国代表性数据集的横断面研究。研究将人群分为三组：医疗救助计划的受益人；收入低于中位数收入的 50%但仍不符合医疗救助条件而参加 NHI 的“准穷人”群体；以及收入超过中位数收入的 50%的 NHI 成员。使用广义增强模型估计研究组之间的倾向评分权重，本研究考察了研究组之间的医疗利用、自付支出和灾难性卫生支出的发生情况。
研究结果表明，三组研究人群的医疗服务利用率没有显著差异。然而，“准穷人”群体的自付支出和灾难性卫生支出的发生概率显著高于其他两组。
本研究发现，“准穷人”群体是韩国人口中最脆弱的群体，因为他们比医疗救助计划的受益人和高于贫困线的群体更容易产生更大的自付支出和灾难性的卫生支出。卫生政策需要考虑到这一“准穷人”群体的脆弱性。
