Healthcare utilization among foreign beneficiaries of the National Health Insurance program in Korea.

Abstract

To explore the factors related to healthcare utilization (both inpatient and outpatient services) among foreign beneficiaries of the National Health Insurance (NHI) in Korea. The total foreign beneficiaries of the NHI in Korea 2022 were included (n = 1,386,329). For the dependent variables, utilization and either hospital stays or count of visits were used. And the independent variables were selected guided by Andersen's behavioral framework: predisposing characteristics (e.g., sex, age, nationality), enabling characteristics (e.g., insurance premium ranking, residency status, residency period, place of residency, beneficiary type), and need characteristics (e.g., disability, CCI, chronic diseases). We conducted a two-part model analysis employing Andersen's behavioral framework, using health insurance claims data from 2022. The results indicated that individual need characteristics, such as disability, CCI, and chronic diseases, had the most significant impact on total healthcare utilization and its associated costs. The next significant characteristic was the residence period; the longer the period, the higher the likelihood of healthcare utilization, but the lower the associated costs. Among the predisposing characteristics, individuals aged 65 years and older had the most significant impact on healthcare costs. Additionally, among the enabling characteristics, residency period, residency status, and beneficiary type were most significant. Foreigners residing in Korea are eligible to use the Korean healthcare system by enrolling in NHI. As the foreign population is projected to grow even faster due to Korea's aging society and low birth rate, this study can assist public health administrators in formulating evidence-based policies.