Department of Economics, George Mason University Korea, Songdomunhwa-ro 119-4, Yeonsu-gu, Incheon, 21985, South Korea.
Health Res Policy Syst. 2023 Jun 22;21(1):60. doi: 10.1186/s12961-023-00993-9.
To address concerns over the financial stability of South Korea's National Health Insurance (NHI) programme, the government transitioned from an outpatient copayment system to a coinsurance system in 2007. This policy aimed to reduce healthcare overutilization by increasing patients' financial responsibility for outpatient services.
Using comprehensive data on NHI beneficiaries, this study employs a regression discontinuity in time (RDiT) design to assess the policy's impact on outpatient healthcare utilization and expenditures. We focus on changes in overall outpatient visits, average healthcare cost per visit and total outpatient healthcare expenditures.
Our findings indicate that the transition from outpatient copayment to coinsurance led to a substantial increase in outpatient healthcare utilization (up to 90%) while decreasing medical expenditures per visit by 23%. The policy shift incentivized beneficiaries to seek more medical treatments during the grace period and enroll in supplemental private health insurance, which provided access to additional medical services at lower marginal costs.
The policy change and the emergence of supplemental private insurance contributed to moral hazard and adverse selection issues, culminating in South Korea becoming the country with the highest per capita utilization of outpatient health services worldwide since 2012. This study underscores the importance of carefully considering the unintended consequences of policy interventions in the healthcare sector.
为了解决韩国国民健康保险（NHI）计划财务稳定性方面的担忧，政府于 2007 年从门诊共付制转为按比例分担制。该政策旨在通过增加患者对门诊服务的经济责任，减少医疗保健过度利用。
本研究利用 NHI 受益人的综合数据，采用时间上的回归不连续性（RDiT）设计来评估该政策对门诊医疗保健利用和支出的影响。我们重点关注总门诊就诊次数、每次就诊的平均医疗费用和总门诊医疗支出的变化。
研究结果表明，从门诊共付制转为按比例分担制导致门诊医疗保健利用率大幅增加（高达 90%），同时每次就诊的医疗费用降低了 23%。政策转变促使受益人在宽限期内寻求更多的医疗治疗，并参加补充私人健康保险，这使他们以较低的边际成本获得更多的医疗服务。
政策变化和补充私人保险的出现导致了道德风险和逆向选择问题，最终导致韩国自 2012 年以来成为全球人均门诊医疗服务利用率最高的国家。本研究强调了在医疗保健领域，仔细考虑政策干预的意外后果的重要性。
