Effects of the Out-of-pocket Payment Exemption in the Public Health Center on Medical Utilization of the Korean Elderly
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초록
Objectives: The distribution of hospitals in Korea is unbalanced in terms of accessibility. Many local public health centers (PHCs) exempt out-of-pocket payments (OOPs) based on local government laws to increase coverage. However, this varies across administrative regions, as many make this exemption for the elderly, while others do not. This study aimed to evaluate the effects of the OOP exemption at local PHCs among elderly individuals. Methods: This study used online data on Korean national law to gather information on individual local governments’ regulations regarding OOP exemptions. Individual-level data were gathered from the 2018 Community Health Survey and regional-level data from public online sources. Results: The study analyzed 132 regions and 44 918 elderly people. A statistical analysis of rate differences and 2-level multiple logistic regression were carried out. The rate difference according to whether elderly individuals resided in areas with the OOP exemption was 1.97%p (95% confidence interval [CI], 1.07 to 2.88) for PHC utilization, 1.37%p (95% CI, 0.67 to 2.08) for hypertension treatment, and 2.19%p (95% CI, 0.63 to 3.74) for diabetes treatment. The regression analysis showed that OOP exemption had an effect on hypertension treatment, with a fixed-effect odds ratio of 1.25 (95% CI, 1.05 to 1.48). Conclusions: The OOP exemption at PHCs can affect medical utilization in Korea, especially for hypertension treatment. The OOP exemption should be expanded to improve healthcare utilization in Korea.
Abstract
Objectives: The distribution of hospitals in Korea is unbalanced in terms of accessibility. Many local public health centers (PHCs) exempt out-of-pocket payments (OOPs) based on local government laws to increase coverage. However, this varies across administrative regions, as many make this exemption for the elderly, while others do not. This study aimed to evaluate the effects of the OOP exemption at local PHCs among elderly individuals. Methods: This study used online data on Korean national law to gather information on individual local governments’ regulations regarding OOP exemptions. Individual-level data were gathered from the 2018 Community Health Survey and regional-level data from public online sources. Results: The study analyzed 132 regions and 44 918 elderly people. A statistical analysis of rate differences and 2-level multiple logistic regression were carried out. The rate difference according to whether elderly individuals resided in areas with the OOP exemption was 1.97%p (95% confidence interval [CI], 1.07 to 2.88) for PHC utilization, 1.37%p (95% CI, 0.67 to 2.08) for hypertension treatment, and 2.19%p (95% CI, 0.63 to 3.74) for diabetes treatment. The regression analysis showed that OOP exemption had an effect on hypertension treatment, with a fixed-effect odds ratio of 1.25 (95% CI, 1.05 to 1.48). Conclusions: The OOP exemption at PHCs can affect medical utilization in Korea, especially for hypertension treatment. The OOP exemption should be expanded to improve healthcare utilization in Korea.
참고문헌 (19)
- Beck RG, "The effects of co-payment on the poor", J Hum Resour, 9(1), pp.129~142 (1974)
- 하민지, "한국 지방정부의 정책확산 영향요인에 관한 연구: 정책행위자와 환경적 결정요인을 중심으로", 한국행정학보, 45(4), pp.151~179 (2011), 한국행정학회
- 유한별, "지방자치단체의 갈등 관련 조례 제정에 미치는 영향 요인 연구: 신제도주의 동형화(isomorphism) 이론을 중심으로", 지방정부연구, 23(2), pp.47~70 (2019), 한국지방정부학회[DOI]
- 배상석, "출산장려금제도 도입에 관한 연구 - 수도권 자치단체를 중심으로 -", 한국정책학회보, 19(4), pp.273~298 (2010), 한국정책학회
- 최상한, "지방정부 주민참여예산제도의 확산과 영향요인", 한국행정학보, 44(3), pp.87~113 (2010), 한국행정학회
- Rice T, "The impact of cost-sharing on appropriate utilization and health status : a review of the literature on seniors", Med Care Res Rev, 61(4), pp.415~452 (2004)
- Qin VM, "The impact of user charges on health outcomes in low-income and middle-income countries : a systematic review", BMJ Glob Health, 3(Suppl 3), pp.e001087~ (2019)
- 박언아, "한국의 보건소 이용률에 영향을 미치는 요인 분석", 한국산학기술학회논문지, 20(3), pp.203~215 (2019), 한국산학기술학회[DOI]
- Suttorp MM, "Graphical presentation of confounding in directed acyclic graphs", Nephrol Dial Transplant, 30(9), pp.1418~1423 (2015)
- "Out-of-pocket payments, user fees and catastrophic expenditure"[URL]
- Andersen R, "Societal and individual determinants of medical care utilization in the United States", Milbank Mem Fund Q Health Soc, 51(1), pp.95~124 (1973)
- Andersen RM, "Changing the U.S. health care system: key issues in health services policy and management", pp.33~69 (2013), Jossey-Bass
- "Cost-sharing mechanisms in health insurance schemes: a systematic review" (2011)[URL]
- "The impact of increased cost-sharing on utilization of low value services: evidence from the State of Oregon (No. w22875)" (2016)[URL]
- 홍선우, "본인부담제도가 의료급여 1종 수급권자의 의료이용에 미치는 영향", 간호행정학회지, 15(1), pp.136~146 (2009), 간호행정학회
- 김명화, "노인의 외래본인부담제도에 따른 의료이용의 변화", 예방의학회지, 43(6), pp.496~504 (2010), 대한예방의학회
- Thomson S, "Can people afford to pay for health care? New evidence on financial protection in Europe", Eurohealth, 25(3), pp.41~46 (2019)
- Eaddy MT, "How patient cost-sharing trends affect adherence and outcomes : a literature review", P T, 37(1), pp.45~55 (2012)
- Abel-Smith B, "Can the poor afford ‘free’health services? A case study of Tanzania", Health Policy Plan, 7(4), pp.329~341 (1992)