Long-run measurement of income-related inequalities in health care under universal coverage: evidence from longitudinal analysis in Korea.

IF 2.7 3区 经济学 Q1 ECONOMICS
Yuichi Watanabe
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引用次数: 0

Abstract

Background: Many countries have sought to promote well-being for their entire populations through the implementation of universal health coverage (UHC). To identify the extent to which UHC has been attained, it is necessary to evaluate equity of access to use of needed care and the cost burden of health services for the country's entire population. This study considers income-related inequalities in health care utilization and spending in a long-term perspective for the case of the Republic of Korea.

Methods: Exploiting longitudinal data from a nationally representative health survey from 2008 to 2018, this study investigates how income-related inequalities in health care in Korea have varied over time and examines the extent to which need and non-need factors contribute those inequalities, using an in-depth decomposition analysis, allowing for heterogeneous responses across income groups.

Results: The empirical results show that overall health care utilization is disproportionately concentrated among the poor over both the short and long run. Income-group differences and non-need determinants, such as marital status and private health insurance, make larger pro-poor contributions to inequality in inpatient care use, while chronic disease prevalence greatly pushes outpatient care utilization in a pro-poor direction. The results regarding inpatient care expenses indicate a similar pattern of pro-poor bias. Long-run inequality favors the better-off in terms of outpatient care expenses, where the contribution of income-group differences has the largest impact.

Conclusion: My findings suggest that it is important for health care policy in Korea to focus on improvements in the health status and well-being of low-income groups, as poor people are likely to be in poorer health. Non-need contributors could worsen pro-poor inequalities if the economic disparity across households were to increase due to the demographic transition. Higher spending on inpatient care may be a heavier financial burden for low-income people. Additional supportive measures should be provided to prevent them from suffering economic hardship. By contrast, people in high-income groups may spend most on costly services in outpatient care, including uninsured services, with the help of private health insurance. Nevertheless, the expansion of income disparity should be alleviated even from a health care policy perspective.

全民医保下与收入相关的医疗不平等的长期衡量:韩国纵向分析的证据。
背景:许多国家都寻求通过实施全民医保(UHC)来促进全体人民的福祉。为了确定全民医保的实现程度,有必要对全国人口在获得所需医疗服务方面的公平性以及医疗服务的成本负担进行评估。本研究以大韩民国为例,从长远角度考虑了与收入有关的医疗保健使用和支出方面的不平等现象:本研究利用 2008 年至 2018 年具有全国代表性的健康调查的纵向数据,调查了韩国医疗保健中与收入相关的不平等是如何随着时间的推移而变化的,并通过深入的分解分析,考察了需求和非需求因素在多大程度上造成了这些不平等,同时考虑到了不同收入群体的异质性反应:实证结果表明,无论从短期还是长期来看,医疗保健的总体利用率都不成比例地集中在穷人身上。收入群体差异和非需求决定因素(如婚姻状况和私人医疗保险)对住院医疗使用的不平等起到了更大的扶贫作用,而慢性病的流行则极大地推动了门诊医疗使用向扶贫方向发展。住院费用方面的结果也显示出类似的有利于穷人的偏向。在门诊费用方面,长期不平等有利于较富裕的人群,而收入群体差异对门诊费用的影响最大:我的研究结果表明,韩国的医疗政策必须注重改善低收入群体的健康状况和福祉,因为穷人的健康状况可能更差。如果人口结构转型导致家庭之间的经济差距扩大,那么非贫困人口缴费可能会加剧贫困人口之间的不平等。住院治疗费用的增加可能会加重低收入者的经济负担。应提供额外的支持措施,防止他们陷入经济困境。与此相反,高收入群体在私人医疗保险的帮助下,可能会在门诊护理(包括未投保的服务)上花费最多。尽管如此,即使从医疗政策的角度来看,也应缓解收入差距的扩大。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.90
自引率
4.20%
发文量
59
审稿时长
13 weeks
期刊介绍: Health Economics Review is an international high-quality journal covering all fields of Health Economics. A broad range of theoretical contributions, empirical studies and analyses of health policy with a health economic focus will be considered for publication. Its scope includes macro- and microeconomics of health care financing, health insurance and reimbursement as well as health economic evaluation, health services research and health policy analysis. Further research topics are the individual and institutional aspects of health care management and the growing importance of health care in developing countries.
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