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Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019
Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
J Prev Med Public Health. 2024;57(1):65-72.   Published online November 25, 2023
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  • 66 Download
AbstractAbstract AbstractSummary PDF
Protecting people against financial hardship caused by illness stands as a fundamental obligation within healthcare systems and constitutes a pivotal component in achieving universal health coverage. The objective of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran, over the period of 2013 to 2019.
Data were obtained from 7 annual national surveys conducted between 2013 and 2019 on the income and expenditures of Iranian households. The prevalence of CHE was determined using a threshold of 40% of household capacity to pay for healthcare. A binary logistic regression model was used to identify the determinants influencing CHE.
The prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. In all the years analyzed, the extent of CHE occurrence among rural populations exceeded that of urban populations. Living in an urban area, having a higher wealth index, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of CHE (p<0.05). Conversely, the use of dental, outpatient, and inpatient care, and the presence of elderly members in the household, are associated with an increased probability of facing CHE (p<0.05).
Throughout the study period, CHE consistently exceeded the 1% threshold designated in the national development plan. Continuous monitoring of CHE and its determinants at both household and health system levels is essential for the implementation of effective strategies aimed at enhancing financial protection.
Key Message
• The aim of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran. • Catastrophic health expenditures (CHE) are used for monitoring financial protection within health systems. • The World Health Organization defines CHE as out-of-pocket payments for healthcare that exceed 40% of a household’s capacity to pay. • In Iran, the prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. • Continuous monitoring of CHE and its determinants is essential for implementing effective strategies aimed at enhancing financial protection.
Inequality in Private Health Care Expenditures: A 36-Year Trend Study of Iranian Households
Ehsan Aghapour, Mehdi Basakha, Seyed Hossein Mohaqeqi Kamal, Abolghasem Pourreza
J Prev Med Public Health. 2022;55(4):379-388.   Published online June 27, 2022
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  • 76 Download
  • 1 Crossref
AbstractAbstract PDF
Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households.
This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP.
Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively.
In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.


Citations to this article as recorded by  
  • Decomposition of Healthcare Utilization Inequality in Iran: The Prominent Role of Health Literacy and Neighborhood Characteristics
    Neda Soleimanvandiazar, Seyed Hossein Mohaqeqi Kamal, Mehdi Basakha, SalahEddin Karim, Sina Ahmadi, Gholamreza Ghaedamini Harouni, Homeira Sajjadi, Ameneh Setareh Forouzan
    INQUIRY: The Journal of Health Care Organization, Provision, and Financing.2024;[Epub]     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
J Prev Med Public Health. 2020;53(6):455-464.   Published online October 20, 2020
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  • 130 Download
AbstractAbstract PDF
The distribution of hospitals in Korea is unbalanced in terms of accessibility. Many local public health centers (PHCs) exempt out-of-pocket payments (OOPs) based on local government laws to increase coverage. However, this varies across administrative regions, as many make this exemption for the elderly, while others do not. This study aimed to evaluate the effects of the OOP exemption at local PHCs among elderly individuals.
This study used online data on Korean national law to gather information on individual local governments’ regulations regarding OOP exemptions. Individual-level data were gathered from the 2018 Community Health Survey and regional-level data from public online sources.
The study analyzed 132 regions and 44 918 elderly people. A statistical analysis of rate differences and 2-level multiple logistic regression were carried out. The rate difference according to whether elderly individuals resided in areas with the OOP exemption was 1.97%p (95% confidence interval [CI], 1.07 to 2.88) for PHC utilization, 1.37%p (95% CI, 0.67 to 2.08) for hypertension treatment, and 2.19%p (95% CI, 0.63 to 3.74) for diabetes treatment. The regression analysis showed that OOP exemption had an effect on hypertension treatment, with a fixed-effect odds ratio of 1.25 (95% CI, 1.05 to 1.48).
The OOP exemption at PHCs can affect medical utilization in Korea, especially for hypertension treatment. The OOP exemption should be expanded to improve healthcare utilization in Korea.
Measuring and decomposing socioeconomic inequality in catastrophic healthcare expenditures in Iran
Satar Rezaei, Mohammad Hajizadeh
J Prev Med Public Health. 2019;52(4):214-223.   Published online June 14, 2019
  • 6,269 View
  • 215 Download
  • 15 Crossref
AbstractAbstract PDF
Equity in financial protection against healthcare expenditures is one the primary functions of health systems worldwide. This study aimed to quantify socioeconomic inequality in facing catastrophic healthcare expenditures (CHE) and to identify the main factors contributing to socioeconomic inequality in CHE in Iran.
A total of 37 860 households were drawn from the Households Income and Expenditure Survey, conducted by the Statistical Center of Iran in 2017. The prevalence of CHE was measured using a cut-off of spending at least 40% of the capacity to pay on healthcare services. The concentration curve and concentration index (C) were used to illustrate and measure the extent of socioeconomic inequality in CHE among Iranian households. The C was decomposed to identify the main factors explaining the observed socioeconomic inequality in CHE in Iran.
The prevalence of CHE among Iranian households in 2017 was 5.26% (95% confidence interval [CI], 5.04 to 5.49). The value of C was -0.17 (95% CI, -0.19 to -0.13), suggesting that CHE was mainly concentrated among socioeconomically disadvantaged households in Iran. The decomposition analysis highlighted the household wealth index as explaining 71.7% of the concentration of CHE among the poor in Iran.
This study revealed that CHE is disproportionately concentrated among poor households in Iran. Health policies to reduce socioeconomic inequality in facing CHE in Iran should focus on socioeconomically disadvantaged households.


Citations to this article as recorded by  
  • Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019
    Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
    Journal of Preventive Medicine and Public Health.2024; 57(1): 65.     CrossRef
  • Examining the level and distribution of catastrophic health expenditure from 2013 to 2018: A province-level study in China
    Mingsheng Chen, Lizheng Xu, Lei Si, Zhonghua Wang, Stephen Jan
    Economic Modelling.2023; 121: 106233.     CrossRef
  • Equity and extent of financial risk protection indicators during COVID-19 pandemic in rural part of Tamil Nadu, India
    Yuvaraj Krishnamoorthy, Sathish Rajaa, Isha Sinha, Murali Krishnan, Gerald Samuel, Krishna Kanth
    Heliyon.2023; 9(8): e18902.     CrossRef
  • Catastrophic household expenditure associated with out-of-pocket payments for dental healthcare in Spain
    Samuel López-López, Raúl del Pozo-Rubio, Marta Ortega-Ortega, Francisco Escribano-Sotos
    The European Journal of Health Economics.2022; 23(7): 1187.     CrossRef
  • User fee removal for the poor: a qualitative study to explore policies for social health assistance in Iran
    Manal Etemadi, Mohammad Hajizadeh
    BMC Health Services Research.2022;[Epub]     CrossRef
  • A 25-Year Trend of Catastrophic Health Expenditure and Its Inequality in China: Evidence from Longitudinal Data
    Yongjian Xu, Yiting Zhou, Andi Pramono, Yazhuo Liu, Cong Jia
    Risk Management and Healthcare Policy.2022; Volume 15: 969.     CrossRef
  • Decomposition of Socioeconomic Inequality in Cardiovascular Disease Prevalence in the Adult Population: A Cohort-based Cross-sectional Study in Northwest Iran
    Farhad Pourfarzi, Telma Zahirian Moghadam, Hamed Zandian
    Journal of Preventive Medicine and Public Health.2022; 55(3): 297.     CrossRef
  • Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature
    Taslima Rahman, Dominic Gasbarro, Khurshid Alam
    Health Research Policy and Systems.2022;[Epub]     CrossRef
  • Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder
    Lina Diaz-Castro, Héctor Cabello-Rangel, Carlos Pineda-Antúnez, Alejandra Pérez de León
    Global Mental Health.2021;[Epub]     CrossRef
  • Unmet dental care need in West of Iran: determinants and inequality
    Amjad Mohamadi-Bolbanabad, Farman Zahir Abdullah, Hossein Safari, Satar Rezaei, Abdorrahim Afkhamzadeh, Shina Amirhosseini, Afshin Shadi, Jamal Mahmoudpour, Bakhtiar Piroozi
    International Journal of Human Rights in Healthcare.2021; 14(5): 426.     CrossRef
  • The impact of out-of pocket payments of households for dental healthcare services on catastrophic healthcare expenditure in Iran
    Abraha Woldemichael, Satar Rezaei, Ali Kazemi Karyani, Mohammad Ebrahimi, Shahin Soltani, Abbas Aghaei
    BMC Public Health.2021;[Epub]     CrossRef
  • Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017
    Akram Hernández-Vásquez, Carlos Rojas-Roque, Rodrigo Vargas-Fernández, Diego Rosselli
    Journal of Preventive Medicine and Public Health.2020; 53(4): 266.     CrossRef
  • Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality

    Bakhtiar Piroozi, Amjad Mohamadi-Bolbanabad, Ghobad Moradi, Hossein Safari, Shahnaz Ghafoori, Yadolah Zarezade, Farzam Bidarpour, Satar Rezaei
    Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2020; Volume 13: 2865.     CrossRef
  • Trend and status of out-of-pocket payments for healthcare in Iran: equity and catastrophic effect
    Satar Rezaei, Abraha Woldemichael, Mohammad Ebrahimi, Sina Ahmadi
    Journal of the Egyptian Public Health Association.2020;[Epub]     CrossRef
  • Catastrophic Out-of-Pocket Health Expenditure Among Rural Households in the Semi-Pastoral Community, Western Ethiopia: A Community-Based Cross-Sectional Study
    Debelo Shikuro, Mezgebu Yitayal, Adane Kebede, Ayal Debie
    ClinicoEconomics and Outcomes Research.2020; Volume 12: 761.     CrossRef
Effects of Air Pollution on Public and Private Health Expenditures in Iran: A Time Series Study (1972-2014)
Pouran Raeissi, Touraj Harati-Khalilabad, Aziz Rezapour, Seyed Yaser Hashemi, Abdoreza Mousavi, Saeed Khodabakhshzadeh
J Prev Med Public Health. 2018;51(3):140-147.   Published online May 14, 2018
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  • 194 Download
  • 16 Crossref
AbstractAbstract PDF
Environmental pollution is a negative consequence of the development process, and many countries are grappling with this phenomenon. As a developing country, Iran is not exempt from this rule, and Iran pays huge expenditures for the consequences of pollution. The aim of this study was to analyze the long- and short-run impact of air pollution, along with other health indicators, on private and public health expenditures.
This study was an applied and developmental study. Autoregressive distributed lag estimating models were used for the period of 1972 to 2014. In order to determine the co-integration between health expenditures and the infant mortality rate, fertility rate, per capita income, and pollution, we used the Wald test in Microfit version 4.1. We then used Eviews version 8 to evaluate the stationarity of the variables and to estimate the long- and short-run relationships.
Long-run air pollution had a positive and significant effect on health expenditures, so that a 1.00% increase in the index of carbon dioxide led to an increase of 3.32% and 1.16% in public and private health expenditures, respectively. Air pollution also had a greater impact on health expenditures in the long term than in the short term.
The findings of this study indicate that among the factors affecting health expenditures, environmental quality and contaminants played the most important role. Therefore, in order to reduce the financial burden of health expenditures in Iran, it is essential to reduce air pollution by enacting and implementing laws that protect the environment.


Citations to this article as recorded by  
  • Evaluating the Role of GDPPer Capita, Air Pollution and Non‐Economic Factors in Determining Health Expenditure: Evidence from Asian Region Using Instrumental Variables Techniques
    Samia Nasreen, Aviral Kumar Tiwari, Mehr‐un Nisa, Faryal Ishtiaq
    Economic Papers: A journal of applied economics and policy.2024; 43(1): 63.     CrossRef
  • Does climate change drive up government healthcare costs in the European Union?
    Adela Socol, Horia Iuga, Dragoș Socol, Iulia Cristina Iuga
    Frontiers in Environmental Science.2023;[Epub]     CrossRef
  • An analysis of emission reduction strategy for light and heavy-duty vehicles pollutions in high spatial–temporal resolution and emission
    Leila Khazini, Mina Jamshidi Kalajahi, Nadège Blond
    Environmental Science and Pollution Research.2022; 29(16): 23419.     CrossRef
  • Air pollution and economic growth under local government competition: Evidence from China, 2007–2016
    Shurui Jiang, Xue Tan, Peiqi Hu, Yue Wang, Lei Shi, Zhong Ma, Genfa Lu
    Journal of Cleaner Production.2022; 334: 130231.     CrossRef
  • Theoretical Model and Actual Characteristics of Air Pollution Affecting Health Cost: A Review
    Xiaocang Xu, Haoran Yang, Chang Li
    International Journal of Environmental Research and Public Health.2022; 19(6): 3532.     CrossRef
  • Health is Wealth: A Dynamic SUR Approach of Examining a Link Between Climate Changes and Human Health Expenditures
    Muhammad Azam, Abdul Majid Awan
    Social Indicators Research.2022; 163(2): 505.     CrossRef
  • Impact of Environmental Quality on Healthcare Expenditures in Developing Countries: A Panel Data Approach
    Asim Anwar, Shabir Hyder, Russell Bennett, Mustafa Younis
    Healthcare.2022; 10(9): 1608.     CrossRef
  • The impact of air pollution on urban residents’ health expenditure: spatial evidence from Yangtze River Delta, China
    Han Sun, Zhihui Leng, Hengsong Zhao, Shan Ni, Chao Huang
    Air Quality, Atmosphere & Health.2021; 14(3): 343.     CrossRef
  • Association between health expenditures, economic growth and environmental pollution: Long‐run and causality analysis from Asian economies
    Samia Nasreen
    The International Journal of Health Planning and Management.2021; 36(3): 925.     CrossRef
  • The relationship between renewable energy use and health expenditures in EU countries
    Mahmut Unsal Sasmaz, Aysun Karamıklı, Ulas Akkucuk
    The European Journal of Health Economics.2021; 22(7): 1129.     CrossRef
  • Do renewable energy and health expenditures improve load capacity factor in the USA and Japan? A new approach to environmental issues
    Ugur Korkut Pata
    The European Journal of Health Economics.2021; 22(9): 1427.     CrossRef
  • Development of Reduction Scenarios Based on Urban Emission Estimation and Dispersion of Exhaust Pollutants from Light Duty Public Transport: Case of Tabriz, Iran
    Mina Jamshidi Kalajahi, Leila Khazini, Yousef Rashidi, Saeed Zeinali Heris
    Emission Control Science and Technology.2020; 6(1): 86.     CrossRef
  • The Impact of Air Pollution on Healthcare Expenditure for Respiratory Diseases: Evidence from the People’s Republic of  China

    Lele Li, Tiantian Du, Chi Zhang
    Risk Management and Healthcare Policy.2020; Volume 13: 1723.     CrossRef
  • Are Air Pollution, Economic and Non-Economic Factors Associated with Per Capita Health Expenditures? Evidence from Emerging Economies
    Muhammad Usman, Zhiqiang Ma, Muhammad Wasif Zafar, Abdul Haseeb, Rana Umair Ashraf
    International Journal of Environmental Research and Public Health.2019; 16(11): 1967.     CrossRef
  • Health impact and related cost of ambient air pollution in Tehran
    Reza Bayat, Khosro Ashrafi, Majid Shafiepour Motlagh, Mohammad Sadegh Hassanvand, Rajabali Daroudi, Günther Fink, Nino Künzli
    Environmental Research.2019; 176: 108547.     CrossRef
  • Sağlık Harcamalarının Belirleyicileri Üzerine Bir Uygulama: Çevre Kirliliği ve Yönetişimin Etkilerinin İncelenmesi
    Alper KARASOY, Gökhan DEMİRTAŞ
    İnsan ve Toplum Bilimleri Araştırmaları Dergisi.2018; 7(3): 1917.     CrossRef
Medical Care Expenditure in Suicides From Non-illness-related Causes
Jungwoo Sohn, Jaelim Cho, Ki Tae Moon, Mina Suh, Kyoung Hwa Ha, Changsoo Kim, Dong Chun Shin, Sang Hyuk Jung
J Prev Med Public Health. 2014;47(6):327-335.   Published online November 4, 2014
  • 9,004 View
  • 89 Download
  • 2 Crossref
AbstractAbstract PDF
Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated.
Suicides motivated by non-illness-related factors were identified using the investigator’s note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status.
Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women.
Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.


Citations to this article as recorded by  
  • Socioeconomic factors associated with suicidal behaviors in South Korea: systematic review on the current state of evidence
    Nicolas Raschke, Amir Mohsenpour, Leona Aschentrup, Florian Fischer, Kamil J. Wrona
    BMC Public Health.2022;[Epub]     CrossRef
  • Impact of intergenerational support and medical expenditures on depression: Evidence from rural older adults in China
    Congrong Li, Qing Han, Jinrong Hu, Zeyu Han, Hongjuan Yang
    Frontiers in Public Health.2022;[Epub]     CrossRef
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
  • 12,108 View
  • 97 Download
  • 10 Crossref
AbstractAbstract PDF

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.


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.


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.


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.



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
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    Soumitra Ghosh
    SSRN Electronic Journal.2014;[Epub]     CrossRef
English Abstract
Effects of Private Health Insurance on Health Care Utilization and Expenditures in Korean Cancer Patients: Focused on 5 Major Cancers in One Cancer Center.
Jin Hwa Lim, Kui Son Choi, Sung Gyeong Kim, Eun Cheol Park, Jae Hyun Park
J Prev Med Public Health. 2007;40(4):329-335.
  • 4,517 View
  • 54 Download
  • 10 Crossref
AbstractAbstract PDF
To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. METHODS: The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. RESULTS: Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. CONCLUSIONS: We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.


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  • Treatment interruption during radiation therapy: Experience at a single institution in the Republic of Korea
    Jung Ae Lee, Nam Kwon Lee, Won Sup Yoon, Dae Sik Yang, Chul Yong Kim, Se Ryun Lee, Hwa Jeong Seong
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    Dong-Ruyl Jang, Seong-Woo Choi, Bu-Yeon Park, Sung-Gil Kim
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    Yan‐Mei Ma, Cai‐Feng Ba, Yu‐Bin Wang
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    Chang-Hoon You, Sung-Wook Kang, Ji-Heon Choi, Eun-Hwan Oh, Young-Dae Kwon
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    Chang-Hoon You, Young-Dae Kwon, Ji-Heon Choi, Sung-Wook Kang
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    Dong-Ryul Jang, Myung-Geun Kang
    Journal of agricultural medicine and community health.2012; 37(2): 84.     CrossRef
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    Jaeun Shin
    Health Policy.2012; 108(1): 76.     CrossRef
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    Mi Jin Park, Eun-Cheol Park, Kui Son Choi, Jae Kwan Jun, Hoo-Yeon Lee
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Original Article
Complementary and Alternative Medicine Use in Korea: Prevalence, Pattern of Use, and Out-of-pocket Expenditures.
Sang Il Lee, Young Ho Khang, Moo Song Lee, Hee Jo Koo, Weechang Kang, Changgi D Hong
Korean J Prev Med. 1999;32(4):546-555.
  • 2,433 View
  • 54 Download
AbstractAbstract PDF
To determine the prevalence, pattern, and out-of-pocket expenditure of complementary and alternative medicine (CAM) utilization in Korean adult population. METHODS: We conducted a representative telephone survey of 2,042 persons aged 18 or older. Data about any health problem, details of their use of medical doctors(MDs) offices/hospitals/ pharmacies services and CAM during the preceding 12 months were collected with structured questionnaire. RESULTS: The utilization rate of CAM among Korean adults was 29% in one year. A total of 231 kinds of CAM was identified from this survey. Annual out-of-pocket expenditure associated with CAM use in 1998 amounted to pound $1.88 billion and was comparable to 40.8% of out-of-pocket expenditure paid for MDs offices/ hospitals/pharmacies services. Among those(N=424) who paid for both MDs offices/hospitals/pharmacies services and CAM, 35.8% paid more for CAM. CAM gave more satisfaction than western medicine to those who had experience of both types of therapy. About half of CAM users were willing to recommend CAM to others. Disclosure rate to physician among CAM users was not high(40.6%). CONCLUSION: CAM became a popular source of health care in Korea. Korean spent a substantial amount of out-of-pocket money on CAM without any public control. Because CAM use is likely to be increased rapidly through lay referral system, health policy makers and health professionals should pay more attention to CAM for making appropriate utilization of CAM.
English Abstract
Out-of-pocket Health Expenditures by Non-elderly and Elderly Persons in Korea.
Sung Gyeong Kim, Seung Hum Yu, Woong Sub Park, Woo Jin Chung
J Prev Med Public Health. 2005;38(4):408-414.
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The purpose of this study was to determine the impact of the sociodemographic and health characteristics on the out-of-pocket health spending of the individuals aged 20 and older in Korea. METHODS: We used the data from the 2001 National Public Health and Nutrition Survey. The final sample size was 26, 154 persons. Multiple linear regression models were used according to the age groups, that is, one model was used for those people under the age of sixty-five and the other was used for those people aged sixty-five and older. In these analyses, the expenditures were transformed to a logarithmic scale to reduce the skewness of the results. RESULTS: Out-of-pocket health expenditures for those people under the age of 65 averaged 14, 800 won per month, whereas expenditures for those people aged 65 and older averaged 27, 200 won per month. In the regression analysis, the insurance type, resident area, self-reported health status, acute or chronic condition and bed-disability days were the statistically significant determinants for both age groups. Gender and age were statistically significant determinants only for the non-elderly. CONCLUSIONS: The findings from this study show that the mean out-of-pocket health expenditures varied according to the age groups and also several diverse characteristics. Thus, policymakers should consider the out-of-pocket health expenditure differential between the elderly and nonelderly persons. Improvement of the insurance coverage for the economically vulnerable subgroups that were identified in this study should be carefully considered. In addition, it is necessary to assess the impact of out-of-pocket spending on the peoples' health care utilization.

JPMPH : Journal of Preventive Medicine and Public Health