Koo Jun Hyuk, Jung Hyun Woo
Yonsei University Wonju Industry-Academic Cooperation Foundation, Wonju, South Korea.
Department of Health Administration, Graduate School BK21 Graduate Program of Developing Glocal Experts in Health Policy and Management, Yonsei University, Wonju, South Korea.
Health Econ Rev. 2022 Nov 11;12(1):58. doi: 10.1186/s13561-022-00403-w.
Catastrophic health expenditure (CHE) represents out-of-pocket payment as a share of household income. Most previous studies have focused on incidence aspects when assessing health policy effects. However, because CHE incidence is a binary variable, the effect of the health policy could not accurately be evaluated. On the contrary, the intensity of CHE is a continuous variable that can yield completely different results from previous studies. This study reassesses the coverage expansion plan for four serious diseases using the intensity of CHE in Korea.
We used the Korea Health Panel Study from 2013 to 2015 to conduct the analysis. The study population is households with chronic diseases patients. We divided the population into two groups: the policy beneficiary group, i.e., households with a patient of any of the four serious diseases, and the non-beneficiary group. A difference-in-difference model was employed to compare the variation in the intensity and incidence of CHE between the two groups. We defined the incidence of CHE as when the ratio of out-of-pocket medical expenses to household income is more than a threshold of 10%, and the intensity of CHE is the height of the ratio subtracting the threshold 10%.
The increased rate of CHE intensity in households with four serious diseases was lower than that in households with other chronic diseases. The interaction term, which represents the effect of the policy, has a significant impact on the intensity but not on the incidence of CHE.
CHE indicators should be applied differently according to the purpose of policy evaluation. The incidence of CHE should be used as the final achievement indicator, and the intensity of CHE should be used as the process indicator. Furthermore, because CHE has an inherent characteristic that is measured by the ratio of household income to medical expenses, to lower this, a differential out-of-pocket maximum policy for each income class is more appropriate than a policy for strengthening the coverage for specific diseases.
灾难性卫生支出（CHE）指现金支付占家庭收入的比例。以往大多数研究在评估卫生政策效果时侧重于发生率方面。然而，由于CHE发生率是一个二元变量，无法准确评估卫生政策的效果。相反，CHE强度是一个连续变量，可能会得出与以往研究完全不同的结果。本研究使用韩国的CHE强度重新评估了四种重大疾病的覆盖范围扩大计划。
我们使用2013年至2015年的韩国健康面板研究进行分析。研究人群为患有慢性病患者的家庭。我们将人群分为两组：政策受益组，即有四种重大疾病之一患者的家庭，和非受益组。采用差异中的差异模型比较两组之间CHE强度和发生率的变化。我们将CHE发生率定义为现金医疗费用与家庭收入之比超过10%的阈值时，CHE强度为该比例减去阈值10%后的高度。
四种重大疾病家庭的CHE强度增长率低于其他慢性病家庭。代表政策效果的交互项对CHE强度有显著影响，但对CHE发生率没有影响。
应根据政策评估目的不同应用CHE指标。CHE发生率应用作最终成果指标，CHE强度应用作过程指标。此外，由于CHE具有通过家庭收入与医疗费用之比来衡量的固有特征，为降低这一比例，针对每个收入阶层的差异化自付费用上限政策比加强特定疾病覆盖范围的政策更为合适。
