Poverty in the Midst of Plenty: Unmet Needs and Distribution of Health Care Resources in South Korea

Jongho Heo,S V Subramanian,Ichiro Kawachi,Manwoo Lee,Soonman Kwon,Jukyung Kim,Juwhan Oh,Jin-Seok Lee

doi:10.1371/journal.pone.0051004

Abstract

BackgroundThe unmet needs for health care have been used as an alternative measurement to monitor equity in health services. We sought to examine contextual influences on unmet needs for health care whereas precedent studies have been focused on individual characteristics on them.Methods and FindingsThe current study conducted multilevel logistic regression analysis to assess the effects of individual- and contextual-level predictors in meeting individual health care needs in South Korea. We sampled 7,200 individuals over the age of 19 in the Fourth Korea National Health and Nutrition Examination Survey in 2009. Included in the regression model were individual predictors such as demographic variables, socio-economic status, and self-rated health; the density of beds and physicians in public and private sectors within different regions were used as contextual-level predictors. This study showed the inverse association between unmet needs and regional resources in private sectors after controlling for the effects of individual-level predictors.ConclusionOur findings suggest that increasing regional resources in private sectors might produce inefficiency in the health care system and inequity in access to health services, particularly where the competition in private health care sectors was highly stimulated under the fee-for-service reimbursement scheme. Policies for the reallocation of health care resources and for reduction of individual health care costs are needed in Korea.

Highlights

The performance of health systems is a fundamental determinant of population health
Our findings suggest that increasing regional resources in private sectors might produce inefficiency in the health care system and inequity in access to health services, where the competition in private health care sectors was highly stimulated under the fee-for-service reimbursement scheme
Policies for the reallocation of health care resources and for reduction of individual health care costs are needed in Korea

Summary

Introduction

The performance of health systems is a fundamental determinant of population health. Many countries pay particular attention to achieving equity in the health care delivery system. Direct measurement of unmet needs for health care has been used to complement the limitation of the utilization-based indicators. Studies have primarily focused on individual-level characteristics as influential factors on the unmet needs for health care [10,11,12,13,14,15,16,17]. There have been a few studies of unmet health needs focused on community-level variations, these studies were largely ecological and did not control for individual-level characteristics. The unmet needs for health care have been used as an alternative measurement to monitor equity in health services. We sought to examine contextual influences on unmet needs for health care whereas precedent studies have been focused on individual characteristics on them

Methods

Results

Conclusion