Effects of national health benefits expansion policy on out-of-pocket payments and utilization of patients with four major catastrophic diseases

2024  Journal Article

Effects of national health benefits expansion policy on out-of-pocket payments and utilization of patients with four major catastrophic diseases

Pub TLDR

While a step in the right direction, Korea's policy had limited effectiveness in reducing out of pocket spending overall and utilization. More comprehensive reforms are likely needed to achieve equitable financial risk protection and access for patients with catastrophic diseases.

 

College of Health researcher(s)

OSU Profile

Highlights

  • Total and inpatient out-of-pocket (OOP) spending decreased significantly for the policy group compared to the control group after policy implementation. Total OOP spending fell by $175 and inpatient OOP spending fell by $359.
  • There was no significant change in outpatient OOP spending for the policy group after policy implementation compared to the control group.
  • There were no significant changes in healthcare utilization (number of visits or hospital stays) for the policy group after policy implementation compared to the control group.
  • The reductions in OOP spending were largely limited to inpatient services and patients with high incomes, suggesting equity issues in terms of the policy's benefits reaching only certain services and populations.

Abstract

Background

As South Korea achieved universal health care (UHC) in 1989, patients’ access to low-cost health services has highly increased. However, as liability for high-cost procedures is still high, patients’ accessibility to high-cost services is has been limited. For this reason, the Korean government has implemented an initiative of the “Mid-term Health Benefits Security Plan” to expand the health benefits coverage since 2005. Nevertheless, it has been criticized as the policy has yet to show any transparent evidence of reducing patients’ out-of-pocket costs since its implementation. This study aims to identify if the benefit expansion policy affected a reduction of patients’ health care spending and utilization after policy implementation.

Methods

We analyze data from the Korean Health Panel Survey for years 2009-2016, a nationally representative survey of non-institutionalized Korean citizens that provide the most comprehensive information on health care utilization and costs. We utilize two-part difference-in-differences (DID) models to estimate the patients' probability of accessing any care and the intensity of care, health care spending and utilization, conditional on the initiated care

Results

The total out-of-pocket(OOP) payments and inpatient spending decreased by USD 175.33 (p = 0.033) and USD 358.86 (p =0.018), respectively, which were statistically significant. Outpatient spending increased by USD 57.43 (p =0.607), but it was not statistically significantly associated with the policy implementation. In utilization, there were no significant changes in either the number of visits or hospital stays.

Conclusions

Even though we found that the policy led to a reduction in patients' OOP spending, the effects of the policy were largely limited to inpatient services and patients with high incomes. As the limited benefits of the policy to the particular services and patients might raise some equity issues, the government needs to extend the range of coverage more broadly so that a more comprehensive population can benefit from the policy.

Kim, M., Yoon, J., Chi, C.(2024)Effects of national health benefits expansion policy on out-of-pocket payments and utilization of patients with four major catastrophic diseasesHealth Open Research