The Differences in Health Care Utilization between Medical Aid and Health Insurance: A Longitudinal Study Using Propensity Score Matching

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Abstract

Study Objectives

Health care utilization has progressively increased, especially among Medical Aid beneficiaries in South Korea. The Medical Aid classifies beneficiaries into two categories, type 1 and 2, on the basis of being incapable (those under 18 or over 65 years of age, or disabled) or capable of working, respectively. Medical Aid has a high possibility for health care utilization due to high coverage level. In South Korea, the national health insurance (NHI) achieved very short time to establish coverage for the entire Korean population. However there there remaine a number of problems to be solved. Therefore, the objective of this study was to investigate the differences in health care utilization between Medical Aid beneficiaries and Health Insurance beneficiaries.

Methods & Design

Data were collected from the Korean Welfare Panel Study from 2008 to 2012 using propensity score matching. Of the 2,316 research subjects, 579 had Medical Aid and 1,737 had health insurance. We also analyzed three dependent variables: days spent in the hospital, number of outpatient visits, and hospitalizations per year. Analysis of variance and longitudinal data analysis were used.

Results

The number of outpatient visits was 1.431 times higher (p<0.0001) in Medical Aid beneficiaries, the number of hospitalizations per year was 1.604 times higher (p<0.0001) in Medical Aid beneficiaries, and the number of days spent in the hospital per year was 1.282 times higher (p<0.268) for Medical Aid beneficiaries than in individuals with Health Insurance. Medical Aid patients had a 0.874 times lower frequency of having an unmet needs due to economic barrier (95% confidence interval: 0.662-1.156).

Conclusions

Health insurance coverage has an impact on health care utilization. More health care utilization among Medical Aid beneficiaries appears to have a high possibility of a moral hazard risk under the Health Insurance program. Therefore, the moral hazard for Medical Aid beneficiaries should be avoided.

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Most cited references 9

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Effect of private health insurance on health care utilization in a universal public insurance system: a case of South Korea.

Soonman Kwon, B. C. Jeon (2013)

This study examined the effect of private health insurance (PHI) on health care utilization in South Korea using a nationally representative sample of 9512 adults participating in Korea Health Panel Survey (KHPS). We compared the health care utilization and subsequent expenditure according to whether or not and how many PHIs are purchased, controlling for the endogeneity of insurance purchase by propensity score matching method and Heckman-type treatment effect model. The results of this study show that the probability of any health care utilization, both outpatient care and inpatient care, is higher for the people who have PHI. For those who utilize health care, PHI has a positive impact on outpatient expenditure, but not on the number of outpatient visits. The effect of PHI on the number of inpatient days and expenditure is not statistically significant among the users of inpatient care. These results imply a need for policy options to mitigate the moral hazard effect of PHI in the outpatient care sector. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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Korea's National Health Insurance--lessons from the past three decades.

Hii-Sun Jeong (2010)

This study presents data on health care spending in South Korea in the three decades since 1977, the year its national health insurance--enacted in 1963--was enforced. National health insurance in South Korea is currently a single-payer program (that is both publicly and privately financed) that pays for privately provided health care. Universal coverage was achieved in 1989. As a result, the household share of total national health spending fell from 87.8 percent to 54.6 percent during the three decades, and the out-of-pocket share dropped from 87.2 percent to 38.0 percent. Although covered services have gradually expanded, benefits remain relatively low, and public funding is limited, leaving beneficiaries with relatively high copayments. Coupled with the fact that the government manages the schedule of fees paid to providers, the health care share of gross domestic product was a low 6.3 percent in 2007. An analysis such as this may be of particular interest in middle- or low-income countries contemplating expansions of coverage or undertaking insurance reforms.

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Nurse case management improves blood pressure, emotional distress and diabetes complication screening.

R Gabbay, D Mauger, Rosemary C Polomano … (2005)

We studied the impact of nurse case management (NCM) on blood pressure (BP), hemoglobin A1C, lipids, and diabetes complication screening. A 1-year randomized-controlled trial was conducted in two primary care clinics of the Penn State Hershey Medical Center. Diabetes patients were randomized to control group (CG) (n=182) who received usual care by their primary care provider and intervention group (IG) (n=150) who received additional NCM care, including self-management education, and implementation of diabetes guidelines. Primary outcomes included BP, A1C, lipid, process measures, and secondary outcome was diabetes-related emotional distress as assessed by Problem Areas in Diabetes (PAID). BP significantly decreased from 137/77 to 129/72 in IG as compared to an increase from 136/77 to 138/79 in CG after 1 year. PAID scores improved significantly in IG (from 23 to 10) due to reduced emotional stress. A1C (7.4) and LDL (105) were unaffected. Complications screening significantly improved in IG compared to CG: opthalmologic exam 26 to 68%, foot exam 47 to 64%, and nephropathy screening 34 to 72%. NCM improved BP, diabetes-related emotional distress, and process measures in primary care. Unchanged A1C and lipids might be due to a threshold effect. Intervention based upon initial risk assessment may prove more cost-effective.

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Author and article information

Contributors

Joan A Caylà: Role: Academic Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 27 March 2015

Publication date Collection: 2015

Volume: 10

Issue: 3

Electronic Location Identifier: e0119939

Affiliations

[1 ]Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea

[2 ]Institute of Health Services Research, Yonsei University, Seoul, South Korea

[3 ]Department of Health Administration, College of Health Sciences, Yonsei University, Wonju, Gwangwondo, South Korea

[4 ]Department of Healthcare Management, Eulji University, Sungnam, Korea

[5 ]Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea

Public Health Agency of Barcelona, SPAIN

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: JHK. Performed the experiments: KSL. Analyzed the data: JHK KBY. Contributed reagents/materials/analysis tools: ECP. Wrote the paper: JHK. Contributed to the discussion: JHK. Reviewed the overall manuscript: JHK.

* E-mail: ecpark@ 123456yuhs.ac

Article

Publisher ID: PONE-D-14-28514

DOI: 10.1371/journal.pone.0119939

PMC ID: 4376904

PubMed ID: 25816234

SO-VID: ea3b9ff1-f5f2-42d4-9a2e-97b2afac4da7

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 26 June 2014

Date accepted : 26 January 2015

Page count

Figures: 1, Tables: 6, Pages: 13

Funding

The authors have no support or funding to report.

Custom metadata

Data Availability The authors do not own the data underlying this study. The data is available at http://www.koweps.re.kr/data/data/list.do. The authors used wave 1 to wave 7.

The Differences in Health Care Utilization between Medical Aid and Health Insurance: A Longitudinal Study Using Propensity Score Matching

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Abstract

Study Objectives

Methods & Design

Results

Conclusions

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PLOS Global Public Health

Most cited references 9

Effect of private health insurance on health care utilization in a universal public insurance system: a case of South Korea.

Korea's National Health Insurance--lessons from the past three decades.

Nurse case management improves blood pressure, emotional distress and diabetes complication screening.

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