Equity in health care: current situation in South Korea

ABSTRACT

Health care has contributed improvement of health, however, it may aggravate health inequity if there is socioeconomic disparities in access to health care service or quality in health care. Health care interventions may cause health inequalities if there is difference in effectiveness among different socioeconomic groups (SEG) because of difference in access, diagnostic accuracy, provider and consumer compliance. In Korea, there are disparities in access to health care between urban and rural population due to geographical maldistribution of medical personnels and facilities. Health care financing was regressive due to reliance on health insurance contribution. Private insurance is more prevalent among higher income group. Health care utilization is more common among lower SEG, however differences nearly disappeared or changed to favor higher SEG when need is considered. This trend is more serious in elderly and for tertiary hospitals. Preventive services including hepatitis B vaccination and cancer screening showed inequality favoring higher SEG, however influenza vaccination among elderly showed opposite and national cancer screening program has reduced the gap. Quality of health care was worse among lower SEG with shorter survival for cancer patients after diagnosis or surgery, patients with myocardial infarction, ischemic and hemorrhagic stroke, hip fracture and burn among lower SEG. Moreover, checkup for diabetes complications and hypertension treatment were less complete among lower SEG. Every health policy should be equity sensitive. Monitoring on health care service equity should be introduced and measures to correct distal and proximal causes of health care inequity should be introduced.