• Health Policy and Management
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• v.24 no.3
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• pp.228-241
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• 2014

Background: The purpose of this study is to evaluate the effect of health insurance coverage expansion for cancer patients on equity in health care utilization and catastrophic expenditure. Methods: To analyze the causal relationship between the policy to expand benefit coverage and the change in health care utilization and out-of-pocket payments of cancer patients, this study employed a difference-in-differences (DID) method. In the DID model, the change in health care utilization, such as health care expenditure, visit days and length of stay, of cancer patients was compared with that of liver disease patients, using Korea Health Panel Data in 2009 and 2010. Results: The policy of reducing cost sharing from 10% to 5% for cancer patients did not have significant effects on equity in health care utilization. The results of this study were different from those of the previous study that showed that the reduction of cost sharing from 20% to 10% significantly improved the equity in health care utilization of cancer patients. In addition, the result of catastrophic expenditures analysis showed the policy did not change the probability of catastrophic expenditures. Conclusion: The results of this study imply that payment for non-covered services account for high out-of-pocket payments, and the reduction in cost sharing for covered services alone may have a limited effect on total financial burden on patients.

• Health Policy and Management
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• v.18 no.3
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• pp.90-109
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• 2008

Government has extended the benefit coverage and reduced out-of-pocket (OOP) payment for cancer patients in 2005. This paper intends to examine the impact of the above policy on the equity in health care utilization. This paper analyzed the national health insurance data and compared the health care utilization of cancer patients before and after the policy change for people with 10 different income levels. For the equity in health care utilization, we examined the change in concentration index (CI) for visit days, inpatient days, and health expenditure. In the case of outpatient care, CI of visit days and health expenditure were positive(favoring the rich) in both regional and employee health insurance members and both 'before' and 'after' the policy change. CI values rarely changed after the policy change, and the policy change seems to have little impact on the equity of outpatient care utilization except expenditure of regional subscriber. In the case of inpatient care, CI of inpatient days was negative and CI of health expenditure was positive in both regional and work subscriber and both 'before' and 'after' the policy change. After the policy change, CI of inpatient expenditure in both groups of members decreased. CI of inpatient days changed in the direction favoring the poor in regional insurance members, but it rarely changed in employee insurance members. These results suggest that the policy of reducing OOP payment has a positive impact and reduced the inequity particularly in the utilization of inpatient care of cancer patients.

• Health Policy and Management
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• v.17 no.3
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• pp.26-49
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• 2007

The purpose of this study is to analyze the equity of health care utilization by income groups in terms of both quantity and quality of care, which is measured by expenditure, type of care, and type of health care institutions. Equity in health care utilization is measured by HIwv index, based on the survey of 1,480 Gwangju-Jeonnam residents. Health care utilization in terms of the probability and quantity of outpatient and inpatient care show equitable or pro-poor inequitable distribution, whereas the distribution of health care expenditure, which can account for the quality of care, is pro-rich inequitable, implying that the better off tend to use more expensive medical care. In terms of the types of care, simple visits for basic care show equitable distribution, whereas the distribution of the utilization of traditional tonic medicine, comprehensive health examination, CT, MRI, and ultrasound is pro-rich inequitable. Utilization of general hospitals and traditional health institutions show pro-rich inequitable distribution, hospitals and dental care institutions equitable, and physician clinics and public health centers pro-poor inequitable.

• Korean Journal of Social Welfare Studies
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• v.43 no.2
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• pp.319-344
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• 2012

This study decomposed Concentration Index(CI) and Hiwv Index(HI) of medical care utilization by subgroups: sex, age group, and region. CI and HI were decomposed into "the between group" component, "within group" component, and a residual. The results of analysis are summarized as follows; First, there was no influence of sex on the equity of medical care utilization measured by the numbers of visiting clinic. However, "within group" component of female explained .0441 among HI, .1035. This means that poor women's underutilization of medical care is the important factor in determining its degree of equity. Second, age groups had a decisive effect on the equity of medical care utilization measured by the numbers of visiting clinic. they explained -.0085 among HI, -.0170. Third, internal equality within elderly group was the most important factor in determining HI measured by the medical care cost. Finally, "within group" component of urban area explained .0535 amomg HI, ,1035 measured by medical care cost. This indicated that the urban poor's underutilization of medical care was very important factor in explaining its degree of equity. There was the poor's underutilization of medical care within the groups as female, the elderly, and urban areas. This significantly explained the equity of medical care costs.

• Health Policy and Management
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• v.27 no.4
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• pp.304-314
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• 2017

Background: This study aimed to analyze effects of postpartum care services to women after birth, identify the factors affecting their use, and examine the extent of income-related inequality in the postpartum care services utilization and expenditures using Korean Health Panel data between 2010 and 2013. Methods: The panel data of the year 2010-2013 of the 247 women after birth were used. First, EuroQoL-5D was used to evaluate the effects of postpartum care service to women's quality of life. Second, multinominal logistic regression analysis was used to identify determinants of the use of the postpartum care services. Finally, concentration index and HIwv (horizontal equity) index were used to find that the concentration index for the inequality in the use of postpartum care services showed negative sign, which implied pro-rich. Results: The estimation results showed that utilization of the postpartum services has a positive effect on women after birth. Also age, area of residence, and number of household members turn out to be the factors of using postpartum services. And there are inequality in the use of postpartum care services whose HIwv index showed positive sign, which implied pro-rich. Conclusion: Therefore, the government's policy of the postpartum care service is necessary to be expanded and diversified considering the personal characteristics and equity of the women after birth.

• Journal of Korean Clinical Health Science
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• v.1 no.1
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• pp.9-17
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• 2013

Purpose. This study is to find the degree of variations and trends of hospital services utilization for hypertensive disease, and have done the comparative analysis of the factors affecting occurring some variations. For this, this study uses the data for patients-survey and health-survey of a regional society by Korea Institute for Heath and Social Affairs in 2008; The regional units are classified into 160 of medium size medical service areas. Methods. I understand the level of variation by using index of Extremal Quotient(EQ) and Coefficient Variation(CV), and analyze critical factors influencing some differences in hospital services utilization by using multi-regression model. Results. The main results are followed:The first, in case of rate of hospital services utilization according to standarization of sex and age by small area, I find the variations of EQ 5.3 and CV 0.3; In Ho-nam, especially, the variation of high rank of 10 of age shows higher distribution. The second, the results analyzing the factors influencing on hospital services utilization by multi regression model are that a number of bed hospitals is significant positive relationship and EQ-5D of health behavior is significant negative one. Conclusions. To increase equity of hospital services utilization for hypertensive disease, this study requests the appropriate supply management of bed hospitals by region, efficient allocation of resources, and revitalization of the health promotion program.

• Journal of Urban Science
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• v.8 no.1
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• pp.51-58
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• 2019

This study examines the determinants of emergency care utilization and equity of access to care in elderly Koreans. Based on the data from the 2014 Korea Health Panel Survey, descriptive and logistic regression analysis was performed. The sample for this study was 1,313 individuals who participated in interviews. Predisposing factors such as age, sex, and education were significant determinants of emergency care utilization. Differences in need do not fully account for the original differences observed between subgroups of older Koreans. Health status was important determinant of older Koreans using emergency care services. Spending medical expense did not ameliorate the subgroup differences in the use of emergency care services. Nonetheless, spending medical expense remains a particularly important predictor of emergency care utilization. Health care reforms in Korea should continue to concentrate on insuring effective universal emergency care, implying that all older Koreans with need receive effective coverage. Future study is also needed to understand the access barriers that may exist for the selected demographic subgroups, i.e., those over 75, women, less educated persons, and those with higher medical expense.

• Journal of the Korean Society of Clothing and Textiles
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• v.33 no.7
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• pp.1025-1037
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• 2009

This study- 1) identifies the distribution of customer equity in luxury brands, 2) identifies customer equity dimensions of luxury brands, 3) identifies the properties that influence the customer equity of a luxury brand, and 4) compares the differences in the properties of the luxury brands that influence customer equity by brand type and relationship duration. In this research, the survey method was conducted in Seoul and 500 responses were used for analysis. For the data analysis, descriptive statistics (i.e. frequency and percentage), t-test, factor analysis, and multiple-regression analysis were used through the utilization of the SPSS 12.0 program. The results of this study are as follows: First, the distribution of customer equity are found to be 50.8% of the customer equity distributes under 1 million Korean won and 34.8% between 1 million won and 3 million won. Second, the luxury brand dimension consists of 6 factors, 'differentiated brand image', 'personal ties', 'qualitative trust relation', 'rational price value', 'store value', and 'convenience value'. Third, the higher 'differentiated brand image', 'personal ties', 'qualitative trust relation', 'store value', and 'convenience value' were related to a higher customer equity. Fourth, in the case of the consumer group having a long-term relationship, the higher' differentiated brand image', 'personal ties', and 'store value' were related to a higher customer equity. Also, in the case of the consumer group of the traditional luxury brands, the higher 'personal ties', 'differentiated brand image', 'qualitative trust relation', and 'store value' were related to a higher customer equity.

• Health Policy and Management
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• v.13 no.3
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• pp.104-128
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• 2003

Equity in health care has taken priority in the Korean government's policy agenda after the government-led national health insurance achieved universal coverage in 1989 along with the final inclusion of the self-employed as beneficiary. The purpose of this study is to examine the extent to which there exists difference or inequality in the utilization of health care, especially cancer inpatient services among income classes. We analysed the utilization of cancer inpatient services of residents in Jeju Island for a year of 2000, using the national health insurance data for qualification of beneficiaries and utilization of health care. The independent variable are 10 income classes based on the national health insurance fee imposed on each household for a year of 2000. The dependent variables of this study are an amount of cancer inpatient health care utilization measured by cancer admission days and cancer treatment costs. Also, cancer inpatient health care utilization is analysed by three categories divided into utilization in medical care institutions (1) within Jeju Island, (2) outside Jeju Island, and (3) all within and outside Jeju Island. We measured concentration index of cancer inpatient health care utilization. This analysis showed negative concentration index within Jeju Island and positive outside Jeju Island, and positive in all within and outside Jeju Island. This results suggest inequality against the relatively poor income groups in utilization of cancer inpatient health care services. Especially, inequity of cancer inpatient health care would be more serious in Jeju Island of Korea, considering that lower income groups reportedly have higher incidence rates in most of cancer and thus use more health services.

• Health Policy and Management
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• v.6 no.1
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• pp.110-143
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• 1996

The purpose of this study is to assess the extent of inequality in health outcomes and the distribution of health services according to health need under National Health Insurance System in Korea. For the empirical analysis, data were collected through an interview survey during one month of October, 1994. Interview were conducted with a total of 10, 875 of the employees and the self-employed selected through cluster, systematic sampling. The major findings of this research are as follows: 1. The analysis of the differentials in morbidity rates by socio-economic group showed that health inequality in the pro-higher groups existed in all self-reported morbidity indicators. 2. The findings of the conventional use measures showed that the lower socio-economic groups had more ambulatory and inpatient services than the higher groups. In contrast to the level of the medical care utilization, however, the higher socio-economic groups were more likely to use the high-quality source of care in terms of their treatment place compared to the lower groups. 3. By using the need-based use measures, the results were different from each use-disability ration indicator. Using the use-disability ration measured by physician visits per 100 restricted-activity days in the population, it was found that there was no evidence favoring the higher socio-economic groups. In contrast, the use-disability ration based on physician visits per a chronic patient in one year displayed that there was remarkable relative difference by income group as well as the evidence of the pro-higher income groups. 4. The results of logistic regression analysis and two-stage estimation method indicated that although the utilization is significantly affected by type and duration of insurance coverage, the use or nonuse of service and the volume of physician care consumed is determined by health need and demographic characteristics rater than economic status. In sum, these findings suggest that physician service is equitably distributed according to health need under national health insurance system in Korea. As there were some evidences of inequality including the differential in physician visits of chronic patients by income group, however, the government should strengthen the activities to guarantee the equity of health services utilization.