Lee Jeehye, Min Hye Sook, Ryu Dong-Hee
Department of Preventive Medicine, School of Medicine, Konkuk University, Chungju, Korea.
KU Open Innovation Center, Chungju, Korea.
BMC Health Serv Res. 2025 Jan 20;25(1):106. doi: 10.1186/s12913-025-12210-0.
Health literacy (HL) is crucial for effective healthcare utilization, but its relationship with private health insurance (PHI) enrollment and medical expenditure in South Korea remains unexplored.
This study aimed to examine the associations between HL, PHI enrollment, and annual out-of-pocket (OOP) medical expenditure in South Korea's universal healthcare system.
Using data from the 2021 Korea Health Panel Study, we analyzed 5,469 participants aged 19-65. Logistic and multinomial logistic regression models were employed to assess factors influencing PHI enrollment. A Gamma GLM with a log- link function was used to examine the relationship between HL, PHI status, and OOP medical expenditure.
Among participants, 70.05% had indemnity insurance coverage, and 88.02% held at least one PHI policy. Individuals with sufficient HL showed higher indemnity insurance enrollment (71.47%) compared to those with inadequate HL (63.17%). In unadjusted analyses, those with sufficient HL were more likely to have indemnity insurance (OR = 1.46, 95% CI: 1.19-1.80) and PHI policies. However, after adjusting for sociodemographic and health-related factors, these associations became non-significant. Individuals with indemnity insurance spent 36% more on OOP medical expenditure compared to those without (p < 0.01), and OOP medical expenditure increased with the number of insurance policies (39.1%, 71.6%, and 107.5% higher for one, two, and three or more policies, respectively, all p < 0.01). Those with sufficient HL spent 18.9% less on OOP medical expenditure compared to those with inadequate HL (p < 0.01). However, after adjusting for other variables, the coefficients lost statistical significance. After adjusting for other variables, higher education levels were associated with lower OOP medical expenditure.
While HL initially showed an association with PHI enrollment and reduced OOP medical expenditure, these relationships became non-significant after adjusting for socioeconomic and health-related factors. Higher education levels were associated with lower OOP medical expenditure, suggesting that educational attainment may better explain the observed HL effects. The positive association between PHI and OOP medical expenditure highlights the need for policy attention to ensure sustainable healthcare financing and appropriate medical service utilization in Korea's healthcare system.
健康素养（HL）对于有效利用医疗保健至关重要，但在韩国，其与私人医疗保险（PHI）参保情况及医疗支出之间的关系仍未得到探索。
本研究旨在探讨韩国全民医疗保健系统中健康素养、私人医疗保险参保情况与年度自付医疗费用之间的关联。
利用2021年韩国健康面板研究的数据，我们分析了5469名年龄在19至65岁之间的参与者。采用逻辑回归和多项逻辑回归模型来评估影响私人医疗保险参保的因素。使用具有对数链接函数的伽马广义线性模型来研究健康素养、私人医疗保险状况与自付医疗费用之间的关系。
在参与者中，70.05%拥有 indemnity 保险，88.02%持有至少一份私人医疗保险政策。健康素养充足的个体的 indemnity 保险参保率（71.47%）高于健康素养不足的个体（63.17%）。在未调整的分析中，健康素养充足的个体更有可能拥有 indemnity 保险（OR = 1.46，95%CI：1.19 - 1.80）和私人医疗保险政策。然而，在调整社会人口统计学和健康相关因素后，这些关联变得不显著。拥有 indemnity 保险的个体的自付医疗费用比没有保险的个体多36%（p < 0.01），且自付医疗费用随着保险政策数量的增加而增加（一份、两份和三份或更多份保险政策的自付医疗费用分别高出39.1%、71.6%和107.5%，均p < 0.01）。健康素养充足的个体的自付医疗费用比健康素养不足的个体少18.9%（p < 0.01）。然而，在调整其他变量后，系数失去了统计学意义。在调整其他变量后，较高的教育水平与较低的自付医疗费用相关。
虽然健康素养最初显示出与私人医疗保险参保及降低自付医疗费用有关，但在调整社会经济和健康相关因素后，这些关系变得不显著。较高的教育水平与较低的自付医疗费用相关，这表明教育程度可能能更好地解释观察到的健康素养影响。私人医疗保险与自付医疗费用之间的正相关突出了政策关注的必要性，以确保韩国医疗保健系统中可持续的医疗融资和适当的医疗服务利用。
