Poor People and Poor Health: Examining the Mediating Effect of Unmet Healthcare Needs in Korea / 예방의학회지

OBJECTIVES: The purpose of this study was to estimate the mediating effect of subjective unmet healthcare needs on poor health. The mediating effect of unmet needs on health outcomes was estimated. METHODS: Cross-sectional research method was used to analyze Korea Health Panel data from 2011 to 2015, investigating the mediating effect for each annual dataset and lagged dependent variables. RESULTS: The magnitude of the effect of low income on poor health and the mediating effect of unmet needs were estimated using age, sex, education level, employment status, healthcare insurance status, disability, and chronic disease as control variables and self-rated health as the dependent variable. The mediating effect of unmet needs due to financial reasons was between 14.7% to 32.9% of the total marginal effect, and 7.2% to 18.7% in lagged model. CONCLUSIONS: The fixed-effect logit model demonstrated that the existence of unmet needs raised the likelihood of poor self-rated health. However, only a small proportion of the effects of low income on health was mediated by unmet needs, and the results varied annually. Further studies are necessary to search for ways to explain the varying results in the Korea Health Panel data, as well as to consider a time series analysis of the mediating effect. The results of this study present the clear implication that even though it is crucial to address the unmet needs, but it is not enough to tackle the income related health inequalities.

Effect of Having a Usual Source of Care on Medical Expenses – Using the Korea Health Panel Data

BACKGROUND: There is a controversy about the effect of having a usual source of care on medical expenses. Although many studies have shown lower medical expenses in a group with a usual source of care, some have shown higher medical expenses in such a group. This study aimed to empirically demonstrate the effect of having a usual source of care on medical expenses. METHODS: The participants included those aged 20 years and older who responded to the questionnaire about “having a usual source of care” from the Korean Health Panel Data of 2012, 2013, and 2016 (6,120; 6,593; and 7,598 respectively). Those who responded with “I do not get sick easily” or “I rarely visit medical institutions” as the reasons for not having a usual source of care were excluded. The panel regression with random effects model was performed to analyze the effect of having a usual source of care on medical expenses. RESULTS: The group having a usual source of care spent 20% less on inpatient expenses and 25% less on clinic expenses than the group without a usual source of care. Particularly, the group having a clinic-level usual source of care spent 12% less on total medical expenses, 9% less on outpatient expenses, 35% less on inpatient expenses, and 74% less on hospital expenses, but 29% more on clinic expenses than the group without a usual source of care. CONCLUSION: This study confirmed that medical expenses decreased in the group with a usual source of care, especially a clinic-level usual source of care (USC), than in the group without a usual source of care. Encouraging people to have a clinic-level USC can control excessive medical expenses and induce desirable medical care utilization.

Association of Supplementary Private Health Insurance Type with Unmet Health Care Needs / 보건행정학회지

BACKGROUND: The extent of coverage rate of the public health insurance is still insufficient to meet healthcare needs. Private health insurance (PHI) plays a role to supplement coverage level of national health insurance in Korea. It is expected that reduce unmet need healthcare. This study was aimed to identify relationship between PHI type and the unmet healthcare need and its associated factors. METHODS: Data were obtained from the 2014 Korea Health Panel Survey using nationally representative sample was analyzed. Respondents were 8,667 who were adults over 20 years covered by PHI but have not changed their contract. According to the enrollment form, PHI was classified into three types: fixed-benefit, indemnity, and mixed-type. To identify factors associated with unmet needs, multiple logistic regression conducted using the Andersen model factors, which are predisposing factors, enabling factors, and need factors. RESULTS: Our analysis found that subjects who had PHI with mixed-type were less likely to experience unmet health care needs compared than those who did not have it (odds ratio, 0.80; 95% confidence interval, 0.66–0.98). As a result of analyzing what affected their unmet healthcare needs, the significant factors associated with unmet medical need were gender, marital status, residence in a metropolitan area, low household income, economic activity participation, self-employed insured, physically disabled, low subjective health status, and health-risk factors such as current smoking and drinking. CONCLUSION: The results of this study suggest that having PHI may reduce experience of unmet healthcare needs. Findings unmet healthcare needs factors according to various subjects may be useful in consideration of setting policies for improving accessibility to healthcare in Korea.

The Effect of Occurrence and Reoccurrence of Catastrophic Health Expenditure on Transition to Poverty and Persistence of Poverty in South Korea / 보건행정학회지

BACKGROUND: The objective of this study was to examine the effect of occurrence and reoccurrence of catastrophic health expenditure (CHE) on transition to poverty and persistence of poverty in South Korea. METHODS: The data of the year 2008-2011 from the Korea Health Panel were used. CHE was defined as the share of total health expenditure in a household out of a household's total income at various threshold levels (more than 5%, 10%, 15%, and 20%). The effect of catastrophic expenditure on transition to poverty and persistence of poverty was analyzed through multivariate logistic regression. RESULTS: The shares of households facing CHE at various threshold levels have increased gradually with 37.7%, 21%, 13.1%, and 9.5% in 2011. Households facing CHE were more likely to experience transition to poverty at thresholds level of more than 5% and 20% in 2010 set. Households facing CHE seemed to experience persistence of poverty, but it was not statistically significant. About 40% of households facing CHE in 2009 encountered another shock of CHE in 2010. Households without CHE seemed to experience more transition to poverty and persistence of poverty, but it was not statistically significant. For household with multiple CHE, those with medical aid were more likely to experience transition to poverty with statistical significance, but the statistical significance disappeared in case of persistence of poverty. CONCLUSION: The Korean health system needs to be improved to serve as a social security net for addressing transition to poverty and persistence of poverty due to facing CHE.

The Effect of Having Usual Source of Care on the Choice among Different Types of Medical Facilities / 보건행정학회지

BACKGROUND: Concentration of patients to large hospitals is serious problem in Korea. The purpose of this paper is to propose appropriate policy direction to relieve concentration of patients to large hospitals. It is focused on evaluation of the possibility of family doctor system as a policy alternative to relieve concentration of patients to large hospital by empirically analyzing the effect of usual source of care (USC) on large hospitals medical care use. METHODS: Korea Health Panel conducted 2009, 2012, 2013 by KIHASA (Korea Institute for Health and Social Affairs) and NHIS (National Health Insurance Service) was used for analysis. For dependent variables, first, the ratio of the amount of using large hospital to total amount of using medical care, and second, the amount of using large hospital are estimated. Independent variables are having an USC and type of USC. Panel analysis was done with above variables. RESULTS: Main results are as follows. First, having an USC increases using large hospital. Second, having a domestic clinic type USC decreases using large hospital and ratio of using large hospital. Third, the effect of domestic clinic type USC is greater in older group, less income group, worse health status group, not having private insurance group, and having chronic disease group. CONCLUSION: These results show that family doctor program can be a policy alternative to relieve concentration of patients to large hospital. Nonetheless, primary care system in Korea is unsatisfied. It is recommended to reinforce primary care system and family doctor system to relieve concentration of patients to large hospitals.

Dental care utilization by diabetics according to the Korea Health Panel Survey / 대한구강보건학회지

OBJECTIVES: The objective of this study was to examine the difference in dental care utilization between diabetics (diabetes group) and nondiabetics (normal group). METHODS: We examined the data of 5108 subjects enrolled in the Korea Health Panel Survey, every year for three years between 2010 and 2012. Of these, 458 subjects were included in the diabetes group and 458 in the normal group using the propensity score matching method to control confounding variables. To compare dental care utilization by the diabetes and normal groups, we examined the odds ratio (OR) and 95% confidence interval (CI) using a generalized estimating equation. RESULTS: We found that the odds of dental care utilization by the diabetes group compared with the normal group was significantly high (OR=1.82, 95% CI: 1.60-2.09). The result was consistent according to sensitivity analysis (OR=1.96, 95% CI: 1.63-2.35). CONCLUSIONS: Dental care utilization by the diabetes group was 82% higher than that by the normal group. Therefore, patients with diabetes need to be more concerned about oral health care.

Dental care utilization patterns by the status of ADL and IADL in the elderly / 대한구강보건학회지

OBJECTIVES: This study sought to analyze the effects of ADL and IADL on dental care utilization behaviors for the elderly 65 years of age and older. METHODS: Using data from the Korea Health Panel 2010-2011, we examined 2683 elderly people who did not use dental care and 12,550 cases of dental care utilization of 963 elderly people who used dental care among people aged 65 and older who responded to the items of ADL and IADL limitations. We employed two-part model (TPM) including logistic regression analysis in a first part of the model and negative binomial regression analysis in a second part of the model to estimate dental care utilization patterns associated with ADL and IADL of elderly adults. RESULTS: A frequency analysis revealed that dental care utilization was more frequent in the elderly with IADL limitations than in the elderly with ADL limitations. The first part of TPM predicted that dental care utilization was more likely to be present in males and younger age group along with increasing number of chronic diseases and independence in ADL and IADL. The results of the second part of TPM estimated the quantity of dental care utilization increased among high income groups. CONCLUSIONS: Limitations in ADL and IADL were found to affect the decision to seek dental care utilization, but physical limitations to have no statistical effect on the quantity of dental care utilization, once dental care utilization was taken for treatment. These findings suggested that dental care utilization would be determined by supplier induced demand and patient's own power to obtain treatment. Since decision to take dental care utilization, despite the barriers of limitations in activities, is an important factor which can satisfy medical needs, various policies to reflect oral health and physical fitness are required.

Trends of household income and dental care spending / 대한구강보건학회지

OBJECTIVES: This empirical study aimed to identify the differences in expenditures by household income level, as well as the patterns of dental care spending by dental services. METHODS: We analyzed the Korea Health Panel's data collected between 2008 and 2010. We calculated expenditures by service items by itemizing dental care services such as conservative, prosthetic, orthodontic, periodontal, surgical, preventive, dental implant care. Then we obtained the ratios of spending per item and per visit to overall out-of-pocket spending on dental care and used these as the weights for dental care cost allocation. Income quintiles were derived using the equivalence scale. Kakwani's concentration index was used to determine the degree of disparity by income quintile, and 95% confidence intervals were computed. RESULTS: Out-of-pocket expenditures on dental care steadily increased over time and income quintile. The analysis of dental care spending by income quintile revealed that the level of expenditure of the first income quintile was 3.6 times lower than that of the fifth income quintile. In terms of expenditure comparison between 2008 and 2010, the first quintile households showed an increased spending on prosthetic and periodontal treatments, whereas the fifth quintile households spent a relatively high proportion on orthodontic and dental implant care. The concentration index revealed that conservative services and root canal treatments was significant and positive, indicating that the demand for, and utilization of, these services increase as household income increases. In contrast, prosthetic services showed a significant negative trend, indicating that these services are not as common among those with higher incomes. CONCLUSIONS: To address the problems associated with the disparity in dental care expenditures based on income levels, it is necessary to establish policies that expand health insurance coverage and provide other supportive measures for low-income populations.

Drug prescription rates in dental health services / 대한구강보건학회지

OBJECTIVES: This study examined the misuse and abuse of antibiotics in relation to the demographic and socioeconomic characteristics of patients given prescriptions by dental providers. METHODS: We examined data collected in 2011 by the Korea Health Panel from 3,836 dental visits. The data included multiple visits per individual for 3,738 household members of 2,588 households using outpatient dental services. The data were analyzed by dental service provider type, using four types of beta-regression. Model analysis and comparison were performed using Akaike's information criterion (AIC) and Bayesian information criterion (BIC) to select the best model. RESULTS: Prescription rates according to type of dental service provider are as follows: 18% by dental hospitals and 19%-20% by dental clinics. The patient factors contributing to the prescription rate are gender, age, education, and income level. Higher antibiotics exposure was found in patients who were male, older, with less education, and lower incomes. Patient exposure to antibiotics did not significantly differ between dental hospitals and dental clinics. CONCLUSIONS: When prescribing antibiotics in dental practices, patient safety can be improved by reducing misuse and abuse of antibiotics through consideration of individual patient characteristics.