Lee Hye Myung, Ko Hansoo
Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, United States.
Department of Health Administration & Policy, George Mason University, 4400 University Drive Peterson Hall 4421, Fairfax, VA 22030, United States.
Health Policy. 2022 Sep;126(9):925-932. doi: 10.1016/j.healthpol.2022.06.009. Epub 2022 Jun 27.
Despite mandatory social health insurance in Korea, the fraction of total healthcare spending paid out-of-pocket has been considerably high. In 2013, the Korean government expanded benefits coverage of social insurance for patients diagnosed with the costliest disease groups (cardiovascular and cerebrovascular diseases, cancer, and intractable diseases). We analyze individual longitudinal information from the 2010 to 2016 Korea Health Panel to estimate the impact of the policy change on healthcare spending, utilization, and enrollment in private supplemental health insurance. Impacts on other health-related and financial measures are additionally assessed to evaluate the effects in multiple dimensions. Our difference-in-differences approach with entropy balancing weights shows that the expansion of benefits coverage of public health insurance reduced out-of-pocket spending on health by 30% without accompanying increases in healthcare utilization. The impact was smaller for the individuals with high socioeconomic characteristics, who are more likely to use other costly services that remained unaffected by the policy. We do not find evidence that expanding social insurance benefits coverage changed the demand for supplemental private health insurance.
尽管韩国实行强制性社会医疗保险，但自付的医疗保健支出在总医疗支出中所占比例一直相当高。2013年，韩国政府扩大了对诊断患有最昂贵疾病组（心血管和脑血管疾病、癌症及疑难病症）患者的社会保险福利覆盖范围。我们分析了2010年至2016年韩国健康面板的个人纵向信息，以估计政策变化对医疗支出、医疗服务利用以及私人补充医疗保险参保率的影响。此外，还评估了对其他与健康相关和财务指标的影响，以从多个维度评估效果。我们采用熵平衡权重的双重差分法表明，公共医疗保险福利覆盖范围的扩大使自付医疗费用降低了30%，且未伴随医疗服务利用率的提高。对于社会经济特征较高的个人，影响较小，因为他们更有可能使用其他不受该政策影响的昂贵服务。我们没有发现证据表明扩大社会保险福利覆盖范围改变了对补充私人医疗保险的需求。
