소득수준별 건강상태에 따른 보건의료서비스 이용 격차 분석

Abstract

This study examined changes to equity in the utilization of health care service according to health status between income classes by obtaining the Le Grand Index, which directly reflects health status as health care utilization demand, based on the data from the Korea National Health and Nutrition Examination Survey of 2007 and 2010. The major analysis results are as follows:First, a concentration index (CI) was obtained for health care utilization. The CI was negative (-) in the variables of health care utilization including the amount of outpatient care, number of hospitalizations, and total hospitalization costs except for total outpatient care costs from 2007 to 2010, which shows the concentration of health care utilization in the low income class. On the contrary, total outpatient care costs were positive (+) in every year during the period, findings which corresponded with the analysis result of health care utilization CI according to gender in each year. Gender differences did not have much impact on health care utilization according to differences in the sign and absolute value of CI. Secondly, CI was also obtained for health status. CI was negative (-) in all the measurement indexes of health status throughout the period, which indicates that poor health status was concentrated in the low income class. However, the concentration was weaker in 2010 than in 2007. When gender was considered, women exhibited poorer health status than men in most measurement indexes of health status in each year. However, gender differences seemed to have no great influence on health status as there was no big gap between CI analyzed according to the subjects as a whole and CI analyzed according to gender. Finally, the Le Grand Index (HILG) was positive (+) in every year during the period except for the number of outpatient care/subjective health statuses, the number of hospitalization/subjective health statuses, and total hospitalization costs/subjective health statuses. The index was favorable to the high income class in most of the categories in every year during the period, but its absolute value was relatively greater in 2007 than in 2010, when the gap was narrowed down. The CI of health care utilization, CI of health status, and Le Grand Index (HILG) results according to income levels show that there remains inequity favorable to the high income class in health care utilization reflecting health status and that inequity between the income classes was alleviated in the latest year of 2010 compared to 2007. The reality can be improved by reinforcing health insurance security further, reducing the number of non-reimbursable items, and increasing the percentage of public expenditure in national health expenditure. The top priority for those improvement measures should be social consensus on financing, whose first step will be an agreement among people that income redistribution through health insurance is the starting point of the welfare state the nation strives to become. The government and politics are desperately required to play proper roles to help the nation reach a consensus.