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Original Article
Has Income-related Inequity in Health Care Utilization and Expenditures Been Improved? Evidence From the Korean National Health and Nutrition Examination Survey of 2005 and 2010
Eunkyoung Kim, Soonman Kwon, Ke Xu
J Prev Med Public Health. 2013;46(5):237-248.   Published online September 30, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.5.237
  • 12,287 View
  • 97 Download
  • 10 Crossref
AbstractAbstract PDF
Objectives

The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea.

Methods

We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners.

Results

The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010.

Conclusions

We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.

Summary

Citations

Citations to this article as recorded by  
  • Increase in Potential Low-value Magnetic Resonance Imaging Utilization Due to Out-of-pocket Payment Reduction Across Income Groups in Korea: An Experimental Vignette Study
    Yukyung Shin, Ji-su Lee, Young Kyung Do
    Journal of Preventive Medicine and Public Health.2022; 55(4): 389.     CrossRef
  • Factors associated with the preventive healthcare service use among older adults in Korea: Focusing on age variation
    Jane Park, Sang Kyoung Kahng
    Asian Social Work and Policy Review.2021; 15(1): 24.     CrossRef
  • Effect of a Mobile Phone–Based Glucose-Monitoring and Feedback System for Type 2 Diabetes Management in Multiple Primary Care Clinic Settings: Cluster Randomized Controlled Trial
    Yeoree Yang, Eun Young Lee, Hun-Sung Kim, Seung-Hwan Lee, Kun-Ho Yoon, Jae-Hyoung Cho
    JMIR mHealth and uHealth.2020; 8(2): e16266.     CrossRef
  • Health Care Utilization Inequality in a Mixed Public-Private Health Care System: An Insight from the National Survey in Iran
    Mohammadreza Zakeri, Kamran Bagheri Lankarani, Zahra Kavosi, Ramin Ravangard
    Health Scope.2019;[Epub]     CrossRef
  • The inequity of inpatient services in rural areas and the New-Type Rural Cooperative Medical System (NRCMS) in China: repeated cross sectional analysis
    Bingbing Pan, Samuel D Towne, Yuxing Chen, ZhaoKang Yuan
    Health Policy and Planning.2017; 32(5): 634.     CrossRef
  • The association between objective income and subjective financial need and depressive symptoms in South Koreans aged 60 and older
    Woorim Kim, Tae Hyun Kim, Tae‐Hoon Lee, Yeong Jun Ju, Eun‐Cheol Park
    Psychogeriatrics.2017; 17(6): 389.     CrossRef
  • The Effect of Occurrence and Reoccurrence of Catastrophic Health Expenditure on Transition to Poverty and Persistence of Poverty in South Korea
    Eunkyoung Kim, Soonman Kwon
    Health Policy and Management.2016; 26(3): 172.     CrossRef
  • Socioeconomic Disparities in Osteoporosis Prevalence: Different Results in the Overall Korean Adult Population and Single-person Households
    Jungmee Kim, Joongyub Lee, Ju-Young Shin, Byung-Joo Park
    Journal of Preventive Medicine and Public Health.2015; 48(2): 84.     CrossRef
  • Horizontal inequities in dental service utilization
    Eunsuk Ahn, Min Young Kim, Hosung Shin
    Journal of Korean Academy of Oral Health.2015; 39(1): 9.     CrossRef
  • Equity in the Utilization of Healthcare Services in India: Evidence From National Sample Survey
    Soumitra Ghosh
    SSRN Electronic Journal.2014;[Epub]     CrossRef
English Abstracts
Impact of DRG Payment on the Length of Stay and the Number of Outpatient Visits After Discharge for Caesarean Section During 2004-2007.
Changwoo Shon, Seolhee Chung, Seonju Yi, Soonman Kwon
J Prev Med Public Health. 2011;44(1):48-55.
DOI: https://doi.org/10.3961/jpmph.2011.44.1.48
  • 5,082 View
  • 151 Download
  • 9 Crossref
AbstractAbstract PDF
OBJECTIVES
The purpose of this study was to examine the impact of Diagnosis-Related Group (DRG)-based payment on the length of stay and the number of outpatient visits after discharge in for patients who had undergone caesarean section. METHODS: This study used the health insurance data of the patients in health care facilities that were paid by the Fee-For-Service (FFS) in 2001-2004, but they participated in the DRG payment system in 2005-2007. In order to examine the net effects of DRG payment, the Difference-In-Differences (DID) method was adopted to observe the difference in health care utilization before and after the participation in the DRG payment system. The dependent variables of the regression model were the length of stay and number of outpatient visits after discharge, and the explanatory variables included the characteristics of the patients and the health care facilities. RESULTS: The length of stay in DRG-paid health care facilities was greater than that in the FFS-paid ones. Yet, DRG payment has no statistically significant effect on the number of outpatient visits after discharge. CONCLUSIONS: The results of this study that DRG payment was not effective in reducing the length of stay can be related to the nature of voluntary participation in the DRG system. Only those health care facilities that are already efficient in terms of the length of stay or that can benefit from the DRG payment may decide to participate in the program.
Summary

Citations

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  • The effects of DRGs-based payment compared with cost-based payment on inpatient healthcare utilization: A systematic review and meta-analysis
    Zhaolin Meng, Wen Hui, Yuanyi Cai, Jiazhou Liu, Huazhang Wu
    Health Policy.2020; 124(4): 359.     CrossRef
  • Effects of a mandatory DRG payment system in South Korea: Analysis of multi-year nationwide hospital claims data
    Jae Woo Choi, Seung-Ju Kim, Hye-Ki Park, Sung-In Jang, Tae Hyun Kim, Eun-Cheol Park
    BMC Health Services Research.2019;[Epub]     CrossRef
  • Early Impact on Outpatients of Mandatory Adoption of the Diagnosis‐Related Group‐Based Reimbursement System in Korea on Use of Outpatient Care: Differences in Medical Utilization and Presurgery Examination
    Seung Ju Kim, Kyu‐Tae Han, Woorim Kim, Sun Jung Kim, Eun‐Cheol Park
    Health Services Research.2018; 53(4): 2064.     CrossRef
  • The effect of competition on the relationship between the introduction of the DRG system and quality of care in Korea
    Seung Ju Kim, Eun-Cheol Park, Sun Jung Kim, Kyu-Tae Han, Euna Han, Sung-In Jang, Tae Hyun Kim
    The European Journal of Public Health.2016; 26(1): 42.     CrossRef
  • Impact of payment system change from per-case to per-diem on high severity patient's length of stay
    Sung-In Jang, Chung Mo Nam, Sang Gyu Lee, Tae Hyun Kim, Sohee Park, Eun-Cheol Park
    Medicine.2016; 95(37): e4839.     CrossRef
  • The Effect of Mandatory Diagnosis-Related Groups Payment System
    Jae-Woo Choi, Sung-In Jang, Suk-Yong Jang, Seung-Ju Kim, Hye-Ki Park, Tae Hyun Kim, Eun-Cheol Park
    Health Policy and Management.2016; 26(2): 135.     CrossRef
  • Is the Hospital Caseload of Diagnosis Related Groups Related to Medical Charges and Length of Stay?
    Jin-Mi Kwak, Kwang-Soo Lee
    The Korean Journal of Health Service Management.2014; 8(4): 13.     CrossRef
  • Perspectives on cost containment and quality of health care in the DRG payment system of Korea
    Jaewook Choi
    Journal of the Korean Medical Association.2012; 55(8): 706.     CrossRef
  • Nurses' Cognition of Diagnosis Related Group (DRG) in Long-term Care Hospitals and Changes in Nursing Care after Application of DRG
    Eun Ha, Kyeha Kim
    Journal of Korean Academy of Nursing Administration.2012; 18(2): 176.     CrossRef
The Effect of Outpatient Cost Sharing on Health Care Utilization of the Elderly.
Myunghwa Kim, Soonman Kwon
J Prev Med Public Health. 2010;43(6):496-504.
DOI: https://doi.org/10.3961/jpmph.2010.43.6.496
  • 5,016 View
  • 99 Download
  • 19 Crossref
AbstractAbstract PDF
OBJECTIVES
The purpose of this study was to analyze the effect of outpatient cost-sharing on health care utilization by the elderly. METHODS: The data in this analysis was the health insurance claims data between July 1999 and December 2008 (114 months). The study group was divided into two age groups, namely 60-64 years old and 65-69 years old. This study evaluated the impact of policy change on office visits, the office visits per person, and the percentage of the copayment-paid visits in total visits. Interrupted time series and segmented regression model were used for statistical analysis. RESULTS: The results showed that outpatient cost-sharing decreased office visits, but it also decreased the percentage of copayment-paid visits, implying that the intensity of care increased. There was little difference in the results between the two age groups. But after the introduction of the coinsurance system for those patients under age 65, office visits and the percentage of copayment-paid visits decreased, and the 60-64 years old group had a larger decrease than the 65-69 years old group. CONCLUSIONS: This study evaluated the effects of outpatient cost-sharing on health care utilization by the aged. Cost sharing of the elderly had little effect on controlling health care utilization.
Summary

Citations

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  • Out-of-pocket costs associated with chronic respiratory diseases in Korean adults
    Jun Su Park, Bomgyeol Kim, Yejin Kim, Sang Gyu Lee, Tae Hyun Kim
    Chronic Respiratory Disease.2024;[Epub]     CrossRef
  • The short-term effects of fixed copayment policy on elderly health spending and service utilization: evidence from South Korea’s age-based policy using exact date of birth
    SeungHoon Han, Hosung Sohn
    International Journal of Health Economics and Management.2023; 23(2): 255.     CrossRef
  • Analysis of Healthcare Utilization for Primary Dysmenorrhea in Korea: A Retrospective, Cross-Sectional Study
    Jinhun Park, Yu-Cheol Lim, Deok-Sang Hwang, In-Hyuk Ha, Ye-Seul Lee
    International Journal of Women's Health.2022; Volume 14: 1015.     CrossRef
  • Increase in Potential Low-value Magnetic Resonance Imaging Utilization Due to Out-of-pocket Payment Reduction Across Income Groups in Korea: An Experimental Vignette Study
    Yukyung Shin, Ji-su Lee, Young Kyung Do
    Journal of Preventive Medicine and Public Health.2022; 55(4): 389.     CrossRef
  • Changes in Pattern of the Medical Care Use of Outpatient With Mental Disorder According to Medical Coverage Types and Medical Payment System
    Ji-Woo Kim, Rye-Mi Ye, Myeng-hwa Kim, Dong Yun Lee
    Journal of Korean Neuropsychiatric Association.2022; 61(3): 150.     CrossRef
  • Evaluation of the effectiveness of the policy to expand the scope of national health insurance dental scaling service benefits
    Woo Jong Kim, Yong Jeon Shin
    Journal of Korean Academy of Oral Health.2022; 46(4): 192.     CrossRef
  • Impact of reimbursement rates on the length of stay in tertiary public hospitals: a retrospective cohort study in Shenzhen, China
    Jie Ning, Lingrui Liu, Emily Cherlin, Yarui Peng, Jingkai Yue, Haoling Xiong, Hongbing Tao
    BMJ Open.2020; 10(11): e040066.     CrossRef
  • Who Benefits from the Fixed Copayment of Medical and Pharmaceutical Expenditure among the Korean Elderly?
    Eunja Park, Sookja Choi
    International Journal of Environmental Research and Public Health.2020; 17(21): 8118.     CrossRef
  • Effects of the Out-of-pocket Payment Exemption in the Public Health Center on Medical Utilization of the Korean Elderly
    Kiryong Nam, Eunhye Park, Yuhjin Chung, Chang-yup Kim
    Journal of Preventive Medicine and Public Health.2020; 53(6): 455.     CrossRef
  • The impact of change from copayment to coinsurance on medical care usage and expenditure in outpatient setting in older Koreans
    Byoungjun Bae, Bo Ram Choi, Inmyung Song
    The International Journal of Health Planning and Management.2018; 33(1): 235.     CrossRef
  • Assessing quality of primary diabetes care in South Korea and Taiwan using avoidable hospitalizations
    Hongsoo Kim, Shou-Hsia Cheng
    Health Policy.2018; 122(11): 1222.     CrossRef
  • The effect of increasing the coinsurance rate on outpatient utilization of healthcare services in South Korea
    Hyo Jung Lee, Sung-In Jang, Eun-Cheol Park
    BMC Health Services Research.2017;[Epub]     CrossRef
  • The Effect of Having Usual Source of Care on the Choice among Different Types of Medical Facilities
    Doo Ri Kim
    Health Policy and Management.2016; 26(3): 195.     CrossRef
  • An evaluation on the effect of the copayment waiver policy for Korean hospitalized children under the age of six
    Sook Young Kwak, Seok-Jun Yoon, In-Hwan Oh, Young-eun Kim
    BMC Health Services Research.2015;[Epub]     CrossRef
  • The effect of cost-sharing in private health insurance on the utilization of health care services between private insurance purchasers and non-purchasers: a study of the Korean health panel survey (2008–2012)
    Young Choi, Jae-Hyun Kim, Ki-Bong Yoo, Kyoung Hee Cho, Jae-Woo Choi, Tae Hoon Lee, Woorim Kim, Eun-Cheol Park
    BMC Health Services Research.2015;[Epub]     CrossRef
  • Analyses of Impacts of the Outpatient Cost Sharing Reduction based on the Difference-in-differences Model
    Lee-Su Ahn
    The Journal of the Korea Contents Association.2013; 13(11): 187.     CrossRef
  • The Impact of Outpatient Coinsurance Rate Increase on Outpatient Healthcare Service Utilization in Tertiary and General Hospital
    Hyo-Jeong Kim, Young-Hoon Kim, Han-Sung Kim, Jung-Sik Woo, Su-Jin Oh
    Health Policy and Management.2013; 23(1): 19.     CrossRef
  • Effect of private health insurance on health care utilization in a universal public insurance system: A case of South Korea
    Boyoung Jeon, Soonman Kwon
    Health Policy.2013; 113(1-2): 69.     CrossRef
  • Use of Traditional Korean Medicine by Patients with Musculoskeletal Disorders
    Bo-Ram Wang, In Young Choi, Kwang-Jum Kim, Young Dae Kwon, C. Mary Schooling
    PLoS ONE.2013; 8(5): e63209.     CrossRef
The Determinants of Adolescent Smoking by Gender and Type of School in Korea.
Hyuncheol Kim, Eun Kyong Kim, Eun Sil Choi, Yu Jeong Kim, Hyun Ju Lee, Jong Ju Kim, Hyung Suk Jang, Kyung Seon Shim, Sang Nam Jeon, Yo Han Kang, Hyunseok Kang, Juwhan Oh, Kung Sook Cho, Soonman Kwon
J Prev Med Public Health. 2006;39(5):379-388.
  • 2,549 View
  • 67 Download
AbstractAbstract PDF
OBJECTIVES
This study assessed the influences of various factors that are related to youth smoking such as gender, age and type of school, and we wanted to provide supporting data for tailored and effective policy initiatives to reduce adolescent smoking. METHODS: A self-report survey was conducted on 14,910 teen-age students who were selected based on the nationwide distribution of students in large and small cities and counties, the gender ratio of the students and the ratio of students attending various type of school at 38 middle and high schools in six representative areas of each province. The survey was handled and managed by a health education teacher at each school. Binary and multinomial logistic regression was used in the analyses. RESULTS: Smoking by adolescents was associated with gender, age and even height. Male high school students tended to smoke more than female high school students, but this differences was not significant for middle school students. The older the adolescents were, the more likely that they smoked, except for the female high school students. Height was meaningful for all adolescents, except for the boys at the vocational high schools. Monthly allowance was significant for all adolescents. School factors such as type of school and the students' school performance were also crucial factors. Attending a vocational high school was strongly related to smoking, especially for girls. Students' school performance and the perceived level of stress were strongly associated with smoking, especially for boys. Home factors such as the relationship with parents and conversation time with family members were closely related to smoking behavior. Knowledge about the health hazard of smoking was also found to be strongly related to adolescent smoking. CONCLUSIONS: In conclusion, demographic factors, school factors, home surroundings and the perception on the harmfulness of smoking are strongly related to adolescent smoking behavior, but these differ from gender and type of school.
Summary

JPMPH : Journal of Preventive Medicine and Public Health