Effects of private health insurance on medical expenditure and health service utilization in South Korea: a quantile regression analysis

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Despite universal health insurance, South Korea has seen a sharp increase in the number of people enrolled in supplemental private health insurance (PHI) during the last decade. This study examined how private health insurance enrollment affects medical expenditure and health service utilization.

Methods

Unbalanced panel data for adults aged 19 and older were constructed using the 2016–2018 Korea Health Panel Survey. Quantile regression for medical cost, and quantile count regression for health service utilization were utilized using propensity score-matched data. We included 17 variables representing demographic, socioeconomic, and health information, as well as medical costs and use of outpatient and inpatient care.

Results

We discovered that PHI enrollees’ socioeconomic and health status is more likely to be better than PHI non-enrollees’. Results showed that private health insurance had a greater effect on the lower quantiles of the conditional distribution of outpatient costs (coefficient 0.149 at the 10th quantile and 0.121 at the 25th quantile) and higher quantiles of inpaitent care utilization (coefficient 0.321 at the 90th quantile for days of hospitalization and 0.076 at the 90th quantile for number of inpatient visits).

Conclusions

PHI enrollment is positively correlated with outpatient costs and inpatient care utilization. Government policies should consider these heterogeneous distributional effects of private health insurance.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-023-10251-x.

Related collections

Most cited references 41

Record: found
Abstract: found
Article: not found

Gender differences in the utilization of health care services.

K D Bertakis, R Azari, L J Helms … (2000)

Studies have shown that women use more health care services than men. We used important independent variables, such as patient sociodemographics and health status, to investigate gender differences in the use and costs of these services. New adult patients (N = 509) were randomly assigned to primary care physicians at a university medical center. Their use of health care services and associated charges were monitored for 1 year of care. Self-reported health status was measured using the Medical Outcomes Study Short Form-36 (SF-36). We controlled for health status, sociodemographic information, and primary care physician specialty in the statistical analyses. Women had significantly lower self-reported health status and lower mean education and income than men. Women had a significantly higher mean number of visits to their primary care clinic and diagnostic services than men. Mean charges for primary care, specialty care, emergency treatment, diagnostic services, and annual total charges were all significantly higher for women than men; however, there were no differences for mean hospitalizations or hospital charges. After controlling for health status, sociodemographics, and clinic assignment, women still had higher medical charges for all categories of charges except hospitalizations. Women have higher medical care service utilization and higher associated charges than men. Although the appropriateness of these differences was not determined, these findings have implications for health care.

0 comments Cited 447 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Modeling Health Care Expenditures and Use

Edward C Norton, Partha Deb (2018)

Health care expenditures and use are challenging to model because these dependent variables typically have distributions that are skewed with a large mass at zero. In this article, we describe estimation and interpretation of the effects of a natural experiment using two classes of nonlinear statistical models: one for health care expenditures and the other for counts of health care use. We extend prior analyses to test the effect of the ACA's young adult expansion on three different outcomes: total health care expenditures, office-based visits, and emergency department visits. Modeling the outcomes with a two-part or hurdle model, instead of a single-equation model, reveals that the ACA policy increased the number of office-based visits but decreased emergency department visits and overall spending.

0 comments Cited 164 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Factors associated with mammography utilization: a systematic quantitative review of the literature.

Kristin M Schueler, Philip Chu, Rebecca Smith-Bindman (2008)

A significant segment of women remains underscreened with mammography. We sought to summarize literature related to factors associated with receipt of mammography. For data sources, we used English language papers published between 1988 and 2007, including 221 studies describing 4,957,347 women. We calculated odds ratios (ORs) associated with receipt of mammography. Random effects modeling was used to assess trends in mammography utilization and to calculate summary multivariate point estimates. Results were stratified by age, race/ethnicity, and study year. We summarized results between 1988 and 2004 and compared recent years with these results. Physician access barriers, such as not having a physician-recommend mammography (adjusted OR 0.16, 95% CI 0.08-0.33) and having no primary care provider (OR 0.41, 95% CI 0.32-0.53), were highly predictive of not obtaining mammography. Past screening behavior correlated strongly with receipt of mammography (clinical breast examination, adjusted OR 9.15, 95% CI 3.49-23.98) and Pap test (adjusted OR 3.45, 95% CI 2.12-5.62). With the exception of having no insurance (adjusted OR 0.47, 95% CI 0.39-0.57), several potential socioeconomic barriers did not appear to have an important impact on screening. Racial and ethnic differences were seen. Concerns about cost, mammography safety, and pain were more important to African American and Latina women, and having no insurance was more important to white and Chinese women. Cost concerns and the presence of a family history of breast cancer were less important to older women, whereas screening knowledge had a stronger impact on mammography use in women aged > or =65 years. When we compared study results before 2004 with those later, we found very little difference in the multivariate, adjusted ORs over time. Women with poor access to physicians are much less likely to undergo mammography. Improving the frequency and scope of mammography recommendation by primary care providers is the single most important direct contribution the medical community can make toward increasing mammography use.

0 comments Cited 94 times – based on 0 reviews      Review now

All references

Author and article information

Contributors

Wankyo Chung: wankyo@snu.ac.kr

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 7 November 2023

Publication date PMC-release: 7 November 2023

Publication date Collection: 2023

Volume: 23

Electronic Location Identifier: 1219

Affiliations

[1 ]GRID grid.253615.6, ISNI 0000 0004 1936 9510, Department of Health Policy and Management, , Milken Institute School of Public Health, George Washington University, ; Washington, DC USA

[2 ]Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, ( https://ror.org/04h9pn542) Seoul, South Korea

Article

Publisher ID: 10251

DOI: 10.1186/s12913-023-10251-x

PMC ID: 10629166

PubMed ID: 37936179

SO-VID: 5fc0c095-acf7-410a-ac14-23fc2eccb5be

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 23 December 2022

Date accepted : 30 October 2023

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: private health insurance,medical expenditure,moral hazard,quantile regression,quantile count regression,propensity score matching

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: private health insurance, medical expenditure, moral hazard, quantile regression, quantile count regression, propensity score matching