Dataset Information

Impact of supplementary private health insurance on stomach cancer care in Korea: a cross-sectional study.

ABSTRACT:

Background

Korea achieved universal health insurance coverage in only 12 years; however, insufficient government funding has resulted in high out-of-pocket payments and, in turn, a demand for supplementary private health insurance (PHI). Supplementary PHI provides a fixed amount of benefits in the event of critical illness (e.g., cancer or stroke), surgery, or hospitalization. In this study, we tried to identify factors that influence the decision to purchase supplementary PHI and investigate the impacts of PHI on various aspects of cancer care.

Methods

In a cross-sectional study of 391 patients with gastric cancer, we collected data on demographic and clinical variables, coverage by PHI at the time of diagnosis, and patients' cancer care experiences from surgery databases and patient questionnaires. Two separate multivariate logistic regression models were used 1) to determine whether various sociodemographic and clinical variables influence the purchase of supplementary PHI, and 2) to determine if there is a difference in various outcome measures between individuals with and without PHI.

Results

We studied 187 subjects (49.6%) who were covered under PHI at the time of diagnosis. Subjects who purchased PHI tended to be younger (aOR = 5.01, 95% C.I. = 2.05 - 12.24), and more educated (aOR = 2.67, 95% C.I. = 1.04 - 6.86). Supplementary PHI coverage was significantly associated with financial independence (aOR = 2.07, 95% CI = 1.19 - 3.61), but not with other aspects of cancer care, such as access to healthcare, quality of care, communication and patient autonomy.

Conclusion

Our findings demonstrate that supplementary PHI neither serves as a safety net for vulnerable patients nor improves cancer care experience, except for maintaining the financial independence of beneficiaries.

SUBMITTER: Shin DW

PROVIDER: S-EPMC2726135 | biostudies-literature | 2009 Jul

REPOSITORIES: biostudies-literature

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Publications

Impact of supplementary private health insurance on stomach cancer care in Korea: a cross-sectional study.

Shin Dong Wook DW Jung Kee-Taig KT Kim Sung S Bae Jae-Moon JM Kim Young-Woo YW Ryu Keun Won KW Lee Jun Ho JH Noh Jae-Hyung JH Sohn Tae-Sung TS Yun Young Ho YH

BMC health services research 20090731

<h4>Background</h4>Korea achieved universal health insurance coverage in only 12 years; however, insufficient government funding has resulted in high out-of-pocket payments and, in turn, a demand for supplementary private health insurance (PHI). Supplementary PHI provides a fixed amount of benefits in the event of critical illness (e.g., cancer or stroke), surgery, or hospitalization. In this study, we tried to identify factors that influence the decision to purchase supplementary PHI and invest ...[more]

PMID: 19643032

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Project description:Supplementary private health insurance (PHI) provides better access to healthcare, improves health outcomes, potentially lowers the costs for health systems and supports the social security system. Improperly regulated PHI, however, may aggravate inequity of access towards preferential care and encourage moral hazard among PHI purchasers, altering the health-seeking behaviour, which is often observed through the pattern of health care utilisation. We investigated the effect of PHI ownership on private inpatient care utilisation, its frequency of admission and length of stay by conducting secondary data analysis of the Malaysian National Health Morbidity Survey (NHMS) 2015 data, a nationally representative community health survey. Malaysian adults 18 years of age and above who utilised inpatient healthcare facilities were included. In this cross-sectional study, we addressed the endogeneity effect of health insurance by employing instrumental variable estimation and a two-stage residual inclusion analysis. We found a significant increase in private inpatient utilisation among those who owned PHI compared to those who did not (β = 4.39, p < 0.001). There was no significant difference in the frequency of admission and length of stay. The increase in private inpatient utilisation among PHI owners may reflect the demand for timely care and hospitality provided by the private sector, potentially exacerbating the moral hazard behaviour among PHI owners. Further exploration of this issue could impact future healthcare systems financing designs and PHI regulation. Highlights • Private health insurance is supplementary to Malaysia's comprehensive public health care system.• There was a significant increase in private inpatient utilisation among those who owned PHI compared to those who did not.• However, there was no significant difference in the frequency of admission and length of stay.• It may reflect the demand for timely access to health services and preferred care pathways the private sector provides.• Otherwise, it potentially exacerbates the moral hazard behaviour among PHI owners.• Further exploration of the issue and examining the current policy on private health regulation in Malaysia are required.

Project description:BackgroundHealth literacy (HL) is crucial for effective healthcare utilization, but its relationship with private health insurance (PHI) enrollment and medical expenditure in South Korea remains unexplored.ObjectivesThis study aimed to examine the associations between HL, PHI enrollment, and annual out-of-pocket (OOP) medical expenditure in South Korea's universal healthcare system.MethodsUsing data from the 2021 Korea Health Panel Study, we analyzed 5,469 participants aged 19-65. Logistic and multinomial logistic regression models were employed to assess factors influencing PHI enrollment. A Gamma GLM with a log- link function was used to examine the relationship between HL, PHI status, and OOP medical expenditure.ResultsAmong participants, 70.05% had indemnity insurance coverage, and 88.02% held at least one PHI policy. Individuals with sufficient HL showed higher indemnity insurance enrollment (71.47%) compared to those with inadequate HL (63.17%). In unadjusted analyses, those with sufficient HL were more likely to have indemnity insurance (OR = 1.46, 95% CI: 1.19-1.80) and PHI policies. However, after adjusting for sociodemographic and health-related factors, these associations became non-significant. Individuals with indemnity insurance spent 36% more on OOP medical expenditure compared to those without (p < 0.01), and OOP medical expenditure increased with the number of insurance policies (39.1%, 71.6%, and 107.5% higher for one, two, and three or more policies, respectively, all p < 0.01). Those with sufficient HL spent 18.9% less on OOP medical expenditure compared to those with inadequate HL (p < 0.01). However, after adjusting for other variables, the coefficients lost statistical significance. After adjusting for other variables, higher education levels were associated with lower OOP medical expenditure.ConclusionsWhile HL initially showed an association with PHI enrollment and reduced OOP medical expenditure, these relationships became non-significant after adjusting for socioeconomic and health-related factors. Higher education levels were associated with lower OOP medical expenditure, suggesting that educational attainment may better explain the observed HL effects. The positive association between PHI and OOP medical expenditure highlights the need for policy attention to ensure sustainable healthcare financing and appropriate medical service utilization in Korea's healthcare system.

Project description:BACKGROUND:In China, the local health insurance coverage is usually related to timely reimbursement of hypertensive care in primary care settings, while health insurance that is not local could represent an obstacle for accessibility and affordability of primary care for hypertensive patients. OBJECTIVE:To investigate whether local health insurance schemes have a positive impact on hypertension management and control. DESIGN:We performed an on-site, face-to-face, patients survey in community health centres (CHCs) in Shenzhen, China. SETTING AND PARTICIPANTS:Hypertensive patients seeking healthcare from CHCs were selected as study participants using a systematic sampling design. MAIN MEASURES:We obtained information about insurance status, social capital, drug treatment and control of hypertension. Multivariable stepwise logistic regression models were constructed to test the associations between insurance status and hypertension management, as well as insurance status and social capital. RESULTS:A total of 867 participants were included in the final study analysis. We found that the participants covered by local insurance schemes were more likely to be managed in primary care facilities (61.1% vs 81.9%; OR=2.58, 95% CI: 1.56 to 4.28), taking antihypertensive drugs (77.2% vs 88.0%; OR=2.23, 95% CI: 1.37 to 3.62) and controlling blood pressure (43.0% vs 52.4%; OR=1.46, 95% CI: 1.03 to 2.07) when compared with those with insurance coverage that is not local. The participants covered by local insurance schemes reported a higher score of perceived generalised trust than those without (4.23 vs 3.97; OR=0.74, 95% CI: 0.53 to 0.86). CONCLUSION:Our study demonstrates that local health insurance coverage could help improve management and control of hypertension in a primary care setting. Policymakers suggest initiating social interventions for better management and control of hypertension at the primary care level, although the causal pathways across insurance status, social capital and control of hypertension deserve further investigations.

Dataset Information

Impact of supplementary private health insurance on stomach cancer care in Korea: a cross-sectional study.

Background

Methods

Results

Conclusion

Publications

Impact of supplementary private health insurance on stomach cancer care in Korea: a cross-sectional study.

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