Household Catastrophic Health Expenditure in South Korea

Background Despite South Korea's universal coverage under National Health Insurance (NHI), the financing of healthcare is still dependent heavily on out-of-pocket payment (OOP). The high OOP payment can lead many households to significant loss of disposable income and subsequent impoverishment. This study attempted to investigate how many households experienced the catastrophic health spending and identify the factors related to the incidence of catastrophic health expenditure in South Korea. Methods Household health expenditure along with socio-economic variables were analyzed, using the first wave data of Korea Health Panel Survey. We defined a health expenditure as being catastrophic if a household's spending for healthcare exceeded 10% of total household income. Incidence of catastrophic health expenditure was explored, depending on household income quintile and selected chronic diseases of household members. The variables associated with catastrophic health expenditure were identified using a logistic regression model. Results This study revealed that as of 2008, 19% of households spent on health in excess of the 10% threshold in South Korea. The low-income households and the households with chronically ill patients were shown to be more vulnerable to catastrophic health expenditure. Some chronic diseases, including diabetes, strokes, and renal dysfunction were associated with the increased probability of catastrophic health expenditure, while stomach cancer, breast cancer, hypertension, and arthritis had no significance. Public health financing like NHI contributed to reducing the probability of catastrophic health expenditure, but private health insurance had no significant influence on reducing the incidence of catastrophic health expenditure. Conclusion This study is the first attempt to investigate the determinants of household catastrophic health expenditure in Korea, considering undiscovered variables on this issue such as family members with chronic diseases and private health insurance. The positive or negative contributions of each chronic disease and private health insurance identified from this study can guide policymakers to design better way for healthcare financing. Protecting of people from catastrophic payments should be highly considered as a desirable objective of health policy.