- Has the Copayment Ceiling Improved Financial Protection in the Korean National Health Insurance System? Evidence From the 2009 Policy Change
-
Tae-Jin Lee, Chelim Cheong
-
J Prev Med Public Health. 2017;50(6):393-400. Published online November 9, 2017
-
DOI: https://doi.org/10.3961/jpmph.17.151
-
-
13,739
View
-
175
Download
-
6
Crossref
-
 Abstract
 PDF
- Objectives
To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a “copayment ceiling,” which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients’ income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups.
Methods
This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics.
Results
The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients.
Conclusions
The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.
-
Summary
-
Citations
Citations to this article as recorded by  - What influences the impact of health financing reforms? Using qualitative comparative analysis to identify patterns in health financing systems and their effects on financial protection
Justine Hsu, Matthew Jowett, Anne Mills, Kara Hanson
SSM - Health Systems.2025; : 100055. CrossRef - Network analysis of stroke systems of care in Korea
Jihoon Kang, Hyunjoo Song, Seong Eun Kim, Jun Yup Kim, Hong-Kyun Park, Yong-Jin Cho, Kyung Bok Lee, Juneyoung Lee, Ji Sung Lee, Ah Rum Choi, Mi Yeon Kang, Philip B Gorelick, Hee-Joon Bae
BMJ Neurology Open.2024; 6(1): e000578. CrossRef - Has South Korea achieved the goals of national health insurance? Trends in financial protection of households between 2011 and 2018
Sujin Kim, Soonman Kwon
Social Science & Medicine.2023; 326: 115929. CrossRef - Cancer care patterns in South Korea: Types of hospital where patients receive care and outcomes using national health insurance claims data
Dong‐Woo Choi, Sun Jung Kim, Seungju Kim, Dong Wook Kim, Wonjeong Jeong, Kyu‐Tae Han
Cancer Medicine.2023; 12(13): 14707. CrossRef - Changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes in Beijing, China
Zhenyu Shi, Ping He, Dawei Zhu, Feng Lu, Qingyue Meng
BMC Health Services Research.2022;[Epub] CrossRef - News media’s framing of health policy and its implications for government communication: A text mining analysis of news coverage on a policy to expand health insurance coverage in South Korea
Wonkwang Jo, Myoungsoon You
Health Policy.2019; 123(11): 1116. CrossRef
|
KSPM
