Abstract
This study examined the effects of healthcare inequality on personal health. It aimed to determine how health insurance type and income level influence catastrophic health expenditure and unmet healthcare needs among South Koreans. Unbalanced Korean Health Panel data from 2011 to 2015, including 33,374 adults, were used. A time-trend and panel regression analysis were performed. The first to identify changes in the main variables and, the second, mediating effects of unmet healthcare needs and catastrophic health expenditure on the relationship between health insurance type, income level, and health status. The independent variables were: high-, middle-, low-income employee insured, high-, middle-, low-income self-employed insured, and medical aid. The dependent variable was health status, and the mediators were unmet needs and catastrophic health expenditure. The medical aid beneficiaries and low-income self-employed insured groups demonstrated a higher probability of reporting poor health status than the high-income, insured group (15.6%, 2.2%, and 2.3%, respectively). Participants who experienced unmet healthcare needs or catastrophic health expenditure were 10.7% and 5.6% higher probability of reporting poor health, respectively (Sobel test: p < 0.001). National policy reforms could improve healthcare equality by integrating insurance premiums based on income among private-sector employees and self-employed individuals within the health insurance network.
Highlights
After Korea implemented universal health insurance for employees at large corporations in 1977, the range of beneficiaries expanded gradually, and universal health coverage for all was achieved in [1]
Health insurance beneficiaries can be classified into three groups, including (a) employees, for whom both the employer and employee each contribute to half of the insurance premium, and (b) self-employed workers, who pay their entire premium
The result of the Sobel test showed p < 0.001 for low-income insured employees; low-income insured self-employed individuals; medical aid (MA) beneficiaries. These results indicate that poor health was more common among low-income national health insurance (NHI) recipients and MA beneficiaries, and it was mediated by catastrophic health expenditure and unmet healthcare needs
Summary
After Korea implemented universal health insurance for employees at large corporations in 1977, the range of beneficiaries expanded gradually, and universal health coverage for all was achieved in [1]. Health insurance beneficiaries can be classified into three groups, including (a) employees, for whom both the employer and employee each contribute to half of the insurance premium, and (b) self-employed workers, who pay their entire premium. Approximately 3–4% of the population in the low-income bracket are (c) medical aid (MA) beneficiaries who are entitled to free insurance premiums and medical services. According to the national poverty standard, the bottom 7–8% of those in the low-income bracket live. 15% of the population lives in relative poverty, meaning that they earn ≤50%
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