Healthcare Utilization and Out-of-Pocket Expenditure Among Adults With and Without Cancer in Korea-Analysis of the Korea Health Panel Survey.

Abstract

Background: Cancer imposes substantial clinical and financial burdens worldwide. Although Korea operates a universal National Health Insurance system, concerns remain regarding healthcare utilization and out-of-pocket (OOP) costs among cancer patients. This study compared healthcare utilization and OOP expenditure between adults with and without cancer in Korea and quantified adjusted differences associated with cancer.

Methods: Data were obtained from the 2023 Korea Health Panel Survey and included adults aged ≥ 19 years. Healthcare utilization outcomes included outpatient visits, hospitalizations, emergency visits, total health encounters. OOP expenditures included inpatient, outpatient, emergency, pharmacy, and total annual healthcare expenditure. Survey-weighted Poisson or negative binomial regression models and generalized linear models with gamma distribution and log link were used to estimate adjusted differences in healthcare utilization and OOP expenditures associated with cancer status after controlling for sociodemographic, socioeconomic, behavioral, insurance-related, and clinical covariates.

Results: Among 10,911 participants, 626 (5.7%) reported a history of cancer and 10,285 (94.3%) had no history of cancer. Mean annual healthcare utilization was significantly higher among participants with cancer than those without cancer including hospitalization (0.78 vs. 0.19), outpatient visits (32.93 vs. 18.59), emergency visits (0.20 vs. 0.11), and total utilization (33.91 vs. 18.89) Cancer was independently associated with an adjusted difference of 8.93 total visits, 0.49 hospitalizations, 8.36 outpatient visits, and 0.08 emergency visits annually (all p < 0.001). OOP expenditure was substantially higher among cancer patients ($1,828 vs. $676; p < 0.001), with significant adjusted differences in total OOP expenditure ($917), inpatient ($639), outpatient ($224), and pharmacy ($53). Lung ($2453), cervical ($1341), colorectal ($1113), and other cancers ($1201) showed the highest expenditure.

Conclusion: Cancer is associated with markedly greater healthcare utilization and significant OOP expenditure burden despite Korea's National Health Insurance (NHI) coverage. Strengthening financial protection, expanding coverage for high-cost care, reinforcing OOP caps, and supporting vulnerable households are essential. Future longitudinal studies incorporating cancer stages, treatment pathways, and indirect costs are warranted.