OUT-OF-POCKET HEALTH CARE SPENDING IN SOUTH KOREA
The equity and efficiency of health care systems is an important policy issue. In 1989, after roughly a decade of comprehensive national health reforms, South Korea achieved universal health insurance coverage at a low cost to the government by offering limited benefits, charging high copayments and coinsurance rates, imposing low fees on providers, and restricting fee growth to the level of general inflation. Despite these efforts, financial barriers to access care were still insurmountable among those with low incomes, particularly among patients with multiple chronic conditions.
In our study, we examined out-of-pocket spending, out-of-pocket spending burden ratio, and health care use by socioeconomic status, insurance type, health care facility type, and chronic condition. Our findings demonstrated that, on average, both the annual out-of-pocket spending and the out-of-pocket burden spending ratios increased with the number of chronic conditions. Many people with low incomes paid a substantial share of their incomes out-of-pocket for health care. As a result of our findings, we recommended six strategies for policy reform.
RECOMMENDED STRATEGIES FOR POLICY REFORM
(1) setting caps for low-income individuals’ financial burden
(2) determining premiums and copayments on the basis of income levels
(3) expanding benefits
(4) removing informal treatment charges
(5) changing NHI’s cost-sharing structure
(6) making upward adjustments in fee schedules and premiums for system sustainability.