The effect of shifting medical coverage from National Health Insurance to Medical Aid type I and type II on health care utilization and out-of-pocket spending in South Korea

Doo Woong Lee, Jieun Jang, Dong Woo Choi, Sung In Jang, Eun Cheol Park

Research output: Contribution to journalArticlepeer-review

Abstract

Background: This study examines the effects of a shift in medical coverage, from National Health Insurance (NHI) to Medical Aid (MA), on health care utilization (measured by the number of outpatient visits and length of stay; LOS) and out-of-pocket medical expenses. Methods: Data were collected from the Korean Welfare Panel Study (2010–2016). A total of 888 MA Type I beneficiaries and 221 MA Type II beneficiaries who shifted from the NHI were included as the case group and 2664 and 663 consecutive NHI holders (1:3 propensity score-matched) were included as the control group, respectively. We used the ‘difference-in-differences’ (DiD) analysis approach to assess changes in health care utilization and medical spending by the group members. Results: Differential average changes in outpatient visits in the MA Type I panel between the pre- and post-shift periods were significant, but differential changes in LOS were not found. Those who shifted from NHI to MA Type I had increased number of outpatient visits without changes in out-of-pocket spending, compared to consecutive NHI holder who had similar characteristics. However, this was not found for MA Type II beneficiaries. Conclusion: Our research provides evidence that the shift in medical coverage from NHI to MA Type I increased the number of outpatient visits without increasing the out-of-pocket spending. Considering the problem of excess medical utilization by Korean MA Type I beneficiaries, further researches are required to have in-depth discussions on the appropriateness of the current cost-sharing level on MA beneficiaries.

Original languageEnglish
Article number979
JournalBMC health services research
Volume20
Issue number1
DOIs
Publication statusPublished - 2020 Dec 1

Bibliographical note

Funding Information:
This study was supported by a faculty research grant of Yonsei University College of Medicine (6–2018-0174 and 6–2017-0157). Acknowledgments

Publisher Copyright:
© 2020, The Author(s).

All Science Journal Classification (ASJC) codes

  • Health Policy

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