Abstract
BackgroundKorea achieved universal health insurance coverage in only 12 years; however, insufficient government funding has resulted in high out-of-pocket payments and, in turn, a demand for supplementary private health insurance (PHI). Supplementary PHI provides a fixed amount of benefits in the event of critical illness (e.g., cancer or stroke), surgery, or hospitalization. In this study, we tried to identify factors that influence the decision to purchase supplementary PHI and investigate the impacts of PHI on various aspects of cancer care.MethodsIn a cross-sectional study of 391 patients with gastric cancer, we collected data on demographic and clinical variables, coverage by PHI at the time of diagnosis, and patients' cancer care experiences from surgery databases and patient questionnaires. Two separate multivariate logistic regression models were used 1) to determine whether various sociodemographic and clinical variables influence the purchase of supplementary PHI, and 2) to determine if there is a difference in various outcome measures between individuals with and without PHI.ResultsWe studied 187 subjects (49.6%) who were covered under PHI at the time of diagnosis. Subjects who purchased PHI tended to be younger (aOR = 5.01, 95% C.I. = 2.05 – 12.24), and more educated (aOR = 2.67, 95% C.I. = 1.04 – 6.86). Supplementary PHI coverage was significantly associated with financial independence (aOR = 2.07, 95% CI = 1.19 – 3.61), but not with other aspects of cancer care, such as access to healthcare, quality of care, communication and patient autonomy.ConclusionOur findings demonstrate that supplementary PHI neither serves as a safety net for vulnerable patients nor improves cancer care experience, except for maintaining the financial independence of beneficiaries.
Highlights
Korea achieved universal health insurance coverage in only 12 years; insufficient government funding has resulted in high out-of-pocket payments and, in turn, a demand for supplementary private health insurance (PHI)
83 patients had died and 97 refused to participate in the study because of time constraints, inability to communicate verbally or in writing, or the study was regarded as an inconvenience or a violation of privacy
Our findings provide valuable lessons for developing countries aiming to achieve universal healthcare coverage in a short time
Summary
Korea achieved universal health insurance coverage in only 12 years; insufficient government funding has resulted in high out-of-pocket payments and, in turn, a demand for supplementary private health insurance (PHI). When healthcare topped the list of concerns in China [1], the Chinese government released a draft of healthcare reform plans on Oct 14, 2008. These ambitious plans aim to provide safe, effective, convenient, and affordable basic care for all citizens by 2020 [2]. Coverage by the Chinese government has decreased and out-of-pocket payments have risen, implying that insufficient funds are available [3,4]. The demand for private health insurance (PHI) has become intense and the market, with regards to supplementary insurance, has dramatically expanded [5]
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