Dataset Information

Gaps in universal health coverage in South Korea: Association with depression onset in a community cohort.

ABSTRACT: While controversies on limitation of coverage by the national health insurance and relatively high direct or "out-of-pocket" household payments by the national health insurance in South Korea still remain, potential unfavorable influence of the insufficiency of the universal health coverage on depression has not yet been evaluated.Baseline information were obtained from a community cohort (The Korean Genome and Epidemiology Study) of middle-aged subjects without depression at enrollment period (2001-2002). Subjects were followed-up biennially, and new onset depression was assessed using Becks Depression Inventory at 2nd round follow-up (2005-2006). Influence of direct medical expenditure on depression onset was investigated in all subjects and in stratified groups of different income level. Increasing risk of depression onset was observed for increased medical expenditure (OR [95% CI];1.44 [0.97-2.13], 1.90 [1.19-3.05], 1.71 [1.01-2.91] for spending <50000 KRW, 50000-100000 KRW, and ?100000 KRW, respectively, vs. almost no expenditure per month; P for trend = 0.012), after adjusting for covariates such as monthly income and chronic disease history. Similar associations were observed in subjects less than or at average national income, but results were not significant in subgroup with monthly income above national average.Even with the universal coverage, high co-payments and uninsured services in the Korean health insurance system yet possibly make the insured pay much for medical service utilization. This might have led to onset of an unfavorable health condition such as depression.

SUBMITTER: Park HY

PROVIDER: S-EPMC5995437 | biostudies-other | 2018

REPOSITORIES: biostudies-other

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Gaps in universal health coverage in South Korea: Association with depression onset in a community cohort.

Park Hye Yin HY Hong Yun-Chul YC Kawachi Ichiro I Oh Juhwan J

PloS one 20180611 6

<h4>Background</h4>While controversies on limitation of coverage by the national health insurance and relatively high direct or "out-of-pocket" household payments by the national health insurance in South Korea still remain, potential unfavorable influence of the insufficiency of the universal health coverage on depression has not yet been evaluated.<h4>Methods and findings</h4>Baseline information were obtained from a community cohort (The Korean Genome and Epidemiology Study) of middle-aged su ...[more]

PMID: 29889833

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Project description:BackgroundIn sub-Saharan Africa, universal health coverage (UHC) reforms have often adopted a technocratic top-down approach, with little attention being paid to the rural communities' perspective in identifying context specific gaps to inform the design of such reforms. This approach might shape reforms that are not sufficiently responsive to local needs. Our study explored how rural communities experience and define gaps in universal health coverage in Malawi, a country which endorses free access to an Essential Health Package (EHP) as a means towards universal health coverage.MethodsWe conducted a qualitative cross-sectional study in six rural communities in Malawi. Data was collected from 12 Focus Group Discussions with community residents and triangulated with 8 key informant interviews with health care providers. All respondents were selected through stratified purposive sampling. The material was tape-recorded, fully transcribed, and coded by three independent researchers.ResultsThe results showed that the EHP has created a universal sense of entitlements to free health care at the point of use. However, respondents reported uneven distribution of health facilities and poor implementation of public-private service level agreements, which have led to geographical inequities in population coverage and financial protection. Most respondents reported affordability of medical costs at private facilities and transport costs as the main barriers to universal financial protection. From the perspective of rural Malawians, gaps in financial protection are mainly triggered by supply-side access-related barriers in the public health sector such as: shortages of medicines, emergency services, shortage of health personnel and facilities, poor health workers' attitudes, distance and transportation difficulties, and perceived poor quality of health services.ConclusionsMoving towards UHC in Malawi, therefore, implies the introduction of appropriate interventions to fill the financial protection gaps in the private sector and the access-related gaps in the public sector and/or an effective public-private partnership that completely integrates both sectors. Current universal health coverage reforms need to address context specific gaps and be carefully crafted to avoid creating a sense of universal entitlements in principle, which may not be effectively received by beneficiaries due to contextual and operational bottlenecks.

Dataset Information

Gaps in universal health coverage in South Korea: Association with depression onset in a community cohort.

Publications

Gaps in universal health coverage in South Korea: Association with depression onset in a community cohort.

Similar Datasets

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