Park Sungchul, Eggleston Karen, Do Young Kyung, Cutler David M
Department of Health Policy and Management, College of Health Science, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea.
Shorenstein Asia-Pacific Research Center, Stanford University, 616 Jane Stanford Way Stanford University Stanford, Stanford, CA 94305, United States.
Health Aff Sch. 2025 Jul 22;3(8):qxaf145. doi: 10.1093/haschl/qxaf145. eCollection 2025 Aug.
Health care spending in South Korea is associated with improvements in health. However, it remains unclear whether the value of this spending is equally distributed across income groups.
We analyzed lifetime health care spending and quality-adjusted life expectancy (QALE) by income quintile among South Korean adults from 2010 to 2018. We then calculated the ratio of changes in health care spending to changes in QALE to estimate the value of health care spending across income groups. Additionally, we investigated mechanisms underlying income-related differences in the value of health care.
Assuming 80% of QALE gains are attributable to health care, adults in the lowest-income quintile received the least value, incurring $78 209 per QALE gained. However, middle- and higher-income quintiles achieved greater value ($47 831, $46 905, $31 757, and $53 889 from the second to highest quintile), although the highest value did not occur in the highest-income quintile. The higher spending per QALE gained in the lowest-income quintile reflects smaller improvements in QALE, likely driven by poorer baseline health and greater unmet needs.
These findings highlight structural inequities in the South Korean health system and emphasize the need for targeted policies to promote equitable health care value.
韩国的医疗保健支出与健康状况改善相关。然而，这笔支出的价值是否在各收入群体中平均分配仍不明确。
我们分析了2010年至2018年韩国成年人按收入五分位数划分的终身医疗保健支出和质量调整生命预期（QALE）。然后，我们计算了医疗保健支出变化与QALE变化的比率，以估计各收入群体的医疗保健支出价值。此外，我们还研究了医疗保健价值中与收入相关差异的潜在机制。
假设QALE增加的80%归因于医疗保健，最低收入五分位数的成年人获得的价值最低，每增加一个QALE需花费78209美元。然而，中等收入和高收入五分位数群体获得了更高的价值（从第二高到最高五分位数分别为47831美元、46905美元、31757美元和53889美元），尽管最高价值并非出现在最高收入五分位数群体中。最低收入五分位数群体每增加一个QALE的支出较高，反映出QALE的改善较小，这可能是由于基线健康状况较差和未满足的需求较大所致。
这些发现凸显了韩国医疗体系中的结构性不平等，并强调需要制定针对性政策以促进公平的医疗保健价值。
