The impact of the policy of expanding coverage for 4 major diseases on out-of-pocket payments

Abstract

Abstract In South Korea, Cancers, cardiac disease, cerebrovascular diseases and rare incurable disease cause high medical expenses which are putting a heavy burden on the household economy. They are called '4 Major Severe Diseases'. The government has established the plan of Expanding Coverage for Four Major Severe Diseases. The Policy of Expanding Coverage for the 4 Major Severe Diseases is to apply the necessary medical services including coverage for uncovered services to national health insurance payments in stages. This study aims to evaluate the effects of the policy implemented from 2013 to 2015 by comparing the changes in the out-of-pocket payments before and after the policy. Using the data from the Korea Health Panel(2012, 2016), the policy effect was evaluated by the Difference-In-Difference analysis. A total of 4,686 patients (2,343 in 2012 and 2,343 in 2016) were included, who are enrolled in National Health Insurance, and have at least one chronic disease. People who are under 20 years old were excluded. In addition, severity of disease was adjusted by CCI(Charson's comorbidity index). Compared to before the policy was implemented, the Out-of-pocket payments significantly decreased. In addition, there were significant differences in gender, types of health care system, disabled, economic activity, income level, and CCI. According to previous studies, the policy of Expanding health insurance coverage since 2005 has been criticized for its low effectiveness. However, It is revealed that the Policy of Expanding Coverage for 4 Major Severe Diseases has an effect in this study. Given that the policy needs time to work, this study showed the effect of the policy more comprehensively compared to previous studies evaluating the effectiveness for just one year. Key messages Due to the Policy of Expanding Coverage for 4 Major Severe Diseases, the out-of-pocket health expenditure were reduced in the policy group. Given that the policy needs time to work, this study has shown more comprehensive results than previous studies that evaluated the effect of policy carried out over a short period.