패널자료 분석을 이용한 중․고령자 단독가계의 의료비지출 영향 요인

Abstract

Korea is approaching an aged society faster than most OECD countries. By 2014, the 65and older population will account for 14 percent of the population. In 2005, every fifth Korean household was a single-person household mainly due to the elderly living alone. The elderly are facing many problems today, but healthcare and economic hardship are their utmost concern. This study uses the 2005, 2007 and 2009 surveys of the Korean Retirement and Income Study (KReIS) to explore how income, health status, and socio-demographic characteristics determine health care expenditures among older Koreans in single-person households. This study is different from previous studies in several aspects: first, it takes advantage of panel data analysis; second, the sample includes the near elderly, which age group is identified as significant consumers of health care; and third, it adds to the literature by contrasting men against women as health care consumers. The sample consisted of 1,794 observations from 683 single householders aged 50 years or older in 2005. Both the size and share of health care expenditures, the latter of which was defined as a fraction of total consumption expenditures, were regressed on income, health status, and other socio-demographic characteristics of the household. The socio-demographic variables were selected based on the literature and included age, gender, cohort, education,area of residence, assets, debts, home ownership, employment status, health insurance coverage,and receipt of other social insurance and welfare benefits. Regression coefficients were obtained through Ordinary Least Squares (OLS), individual fixed effects, and random effects models. The main findings can be summarized as the following:First, in all models income is positively associated with health care expenditures, with the fixed-effect income elasticity at 0.14, suggesting that health care consumption is a normal good and necessary. Second, having disease or disability is positively associated with both the size and the share of health care expenditures. In addition, after controlling for the survey year and birth cohort, older age is positively associated with the size of health care expenditure. This suggests that health status is a significant predictor of health care expenditures. Third, the size of health care expenditures has decreased over the 2005-2009 period. It can be inferred that macroeconomic and institutional factors like nationwide expansion of long-term care insurance in 2008, and economic recession during the late 2000’s played a role in reducing health care expenditures by the elderly. Fourth, education is negatively associated with the share of health care expenditures as a fraction of total consumption expenditures of the household. This appears to suggest that human capital plays a role in reducing the need for health care expenditure at an older age. Fifth, when income, health status, and other socio-demographic characteristics were controlled,women spend significantly more on health care than men. This gender difference is robust in both dependent variables - the size as well as the share of health care expenditures. Income elasticity of health care expenditures is also much greater for men than for women. Furthermore, health care expenditures by men vary more markedly by age and health status compared to those by women. Sixth, economic status such as assets, debt, and employment status are also significant,most likely due to endogeneity arising from inherent healthiness. Findings from this study offer several policy implications. First, it is suggests that the health care policy for the older single-person households target low-income households in all phases of prevention, treatment, and cost reduction. Second, such policy should particularly focus on the older single-person households who have disease or disability. Third, it is important to provide support for disease prevention before the individuals reach old age and develop educational programs on health management and disease prevention for the middle-age population. Fourth, this study suggests that policies that aim to reduce health care costs should be genderspecific. Such policies should be directed at older women in general and older men especially in low-income households.