Effect of Having a Usual Source of Care on Medical Expenses - Using the Korea Health Panel Data

The ecology of medical care in Korea: the association of a regular doctor and medical care utilization

BACKGROUNDS

There is no registered regular doctor system in Korea, but people voluntarily select regular doctors for medical services. This study aims to study the ecology of medical care in Korea according to the presence and type of a regular doctor.

METHODS

This study was conducted using Korean Health Panel survey in 2018. The proportion of people who had health problems and received medical care in various settings was analyzed per 1,000 people according to the following groups: without a regular doctor, having a clinic physician as a regular doctor, and having a hospital physician as a regular doctor. The adjusted odds ratio for usage of medical services was calculated.

RESULTS

Health problems and medical care use increased in the groups in this order: group without a regular doctor, group with a clinic physician as a regular doctor, the group with a hospital physician a regular doctor. Having a hospital physician as a regular doctor was associated with higher odds of inpatient care and emergency room visits, and having a clinic physician as a regular doctor was not associated with odds of inpatient care and emergency room visits when adjusting demographic and health-related variables.

CONCLUSION

Depending on whether having a regular doctor and a regular doctor's type, different ecology of medical care was observed. The position and role of a regular doctor in the context of the Korea health care system should be considered from the perspective of primary care.

Which indicator should be used? A comparison between the incidence and intensity of catastrophic health expenditure: using difference-in-difference analysis

BACKGROUND

Catastrophic health expenditure (CHE) represents out-of-pocket payment as a share of household income. Most previous studies have focused on incidence aspects when assessing health policy effects. However, because CHE incidence is a binary variable, the effect of the health policy could not accurately be evaluated. On the contrary, the intensity of CHE is a continuous variable that can yield completely different results from previous studies. This study reassesses the coverage expansion plan for four serious diseases using the intensity of CHE in Korea.

METHODS

We used the Korea Health Panel Study from 2013 to 2015 to conduct the analysis. The study population is households with chronic diseases patients. We divided the population into two groups: the policy beneficiary group, i.e., households with a patient of any of the four serious diseases, and the non-beneficiary group. A difference-in-difference model was employed to compare the variation in the intensity and incidence of CHE between the two groups. We defined the incidence of CHE as when the ratio of out-of-pocket medical expenses to household income is more than a threshold of 10%, and the intensity of CHE is the height of the ratio subtracting the threshold 10%.

RESULTS

The increased rate of CHE intensity in households with four serious diseases was lower than that in households with other chronic diseases. The interaction term, which represents the effect of the policy, has a significant impact on the intensity but not on the incidence of CHE.

CONCLUSIONS

CHE indicators should be applied differently according to the purpose of policy evaluation. The incidence of CHE should be used as the final achievement indicator, and the intensity of CHE should be used as the process indicator. Furthermore, because CHE has an inherent characteristic that is measured by the ratio of household income to medical expenses, to lower this, a differential out-of-pocket maximum policy for each income class is more appropriate than a policy for strengthening the coverage for specific diseases.

Did Expanded Dental Insurance Reduce Out-of-Pocket Expenditures on Dental Care among Older Adults in Korea? Interrupted Time-Series Analysis

The Korean National Health Insurance extended its coverage to reduce the economic burden of receiving dentures and implants for older adults in 2012 and 2014, respectively. We examined whether the new policy resulted in reduced out-of-pocket dental care expenditure in the eligible population, specifically focusing on low-income adults. We used interrupted time-series analysis (ITSA), a quasi-experimental design, to identify the effects of the policy among persons aged 65 or older. Data were extracted from the Korea Health Panel Survey (KHP; 2008–2017). The main outcome was out-of-pocket expenditures on dental care. The ITSA showed that expenditures decreased annually by 4.5% (RR: 0.96, 95% CI: 0.95–0.96) between 2012 and 2014. However, expenditure increased by 7.8% (RR: 1.08, 95% CI: 1.07–1.08) after 2014. Dental insurance coverage did not contribute to reducing the out-of-pocket expenses for dentures among low-income adults, while coverage of dental implants led to an increase in dental expenditure.