Characteristics Associated With Financial or Non-financial Barriers to Healthcare in a Universal Health Insurance System: A Longitudinal Analysis of Korea Health Panel Survey Data.

Woojin Chung

doi:10.3389/fpubh.2022.828318

Abstract

While many studies have explored the financial barriers to healthcare, there is little evidence regarding the non-financial barriers to healthcare. This study identified characteristics associated with financial and non-financial barriers to healthcare and quantified the effects of these characteristics in South Korea, using a nationally representative longitudinal survey dataset. Overall, 68,930 observations of 16,535 individuals aged 19 years and above were sampled from Korea Health Panel survey data (2014–2018). From self-reported information about respondents' experiences of unmet healthcare needs, a trichotomous dependent variable—no barrier, non-financial barrier, and financial barrier—was derived. Sociodemographics, physical and health conditions were included as explanatory variables. The average adjusted probability (AAP) of experiencing each barrier was predicted using multivariable and panel multinomial logistic regression analyses. According to the results, the percentage of people experiencing non-financial barriers was much higher than that of people experiencing financial barriers in 2018 (9.6 vs. 2.5%). Women showed higher AAPs of experiencing both non-financial (9.9 vs. 8.3%) and financial barriers (3.6 vs. 2.5%) than men. Men living in the Seoul metropolitan area showed higher AAPs of experiencing non-financial (8.7 vs. 8.0%) and financial barriers (3.4 vs. 2.1%) than those living outside it. Household income showed no significant associations in the AAP of experiencing a non-financial barrier. People with a functional limitation exhibited a higher AAP of experiencing a non-financial barrier, for both men (17.8 vs. 7.8%) and women (17.4 vs. 9.0%), than those without it. In conclusion, people in South Korea, like those in most European countries, fail to meet their healthcare needs more often due to non-financial barriers than financial barriers. In addition, the characteristics associated with non-financial barriers to healthcare differed from those associated with financial barriers. This finding suggests that although financial barriers may be minimised through various policies, a considerable degree of unmet healthcare needs and disparity among individuals is very likely to persist due to non-financial barriers. Therefore, current universal health insurance systems need targeted policy instruments to minimise non-financial barriers to healthcare to ensure effective universal health coverage.

Highlights

To ensure that citizens have timely and adequate access to healthcare services, many countries strive to identify and minimise barriers to healthcare by providing a universal health coverage system [1, 2]
In 2018, the percentage of people experiencing a barrier to healthcare leading to unmet healthcare needs in the past 12 months was, on average, 5.6% for the 38 countries considered in this study including Korea (Figure 1)
Financial barriers that lead to unmet healthcare needs have long been recognised as a pivotal risk factor in healthcare access, many individuals have experienced unmet healthcare needs due to a variety of non-financial barriers [5, 83, 90–93]

Summary

Introduction

To ensure that citizens have timely and adequate access to healthcare services, many countries strive to identify and minimise barriers to healthcare by providing a universal health coverage system [1, 2]. Numerous studies have emphasised the detrimental effects of financial barriers to healthcare on the utilisation of healthcare services [3, 4]. A recent report documented that, in 2019, 2.2% of those aged 16 years and above in European countries did not receive healthcare due to a non-financial barrier in the 12 months prior to taking the survey [9]. This percentage is much higher than that of those who faced a financial barrier (0.9%)

Methods

Results

Discussion

Conclusion