[Changes in distributive equity of health insurance contribution burden].
OBJECTIVE
We analyzed the changes from 1996 to 2002 in distributive equity of the contribution burden in the Korean National Health Insurance.


METHODS
The study subjects were a total of 8923 employee households and a total of 7296 self-employed households over the period from 1996 to 2002. Those were the households meeting the two criteria as completing each annual survey and having no change in the job of head of the household during that period from the raw data of the Household Income and Expenditure Survey annually conducted by the Korean National Statistical Office. The unit of analysis was a household, and this was the standard for assessing the contribution that is now applied on a monthly basis. Deciles Distribution Ratio, Contribution Concentration Curve and Contribution Concentration Index were estimated as the index of inequality. Multiple regression analysis was conducted to compare the annual ability-to-pay elasticity of the contribution to the reference year of 1996 for three groups (all households, the employee households, and the self-employed households).


RESULTS
For the index of inequality, the distributive equity of contribution was improved in all three groups. In particular, the employee group experienced a substantial improvement. Using multiple regression analysis, the ability-to-pay elasticity of the contribution in the employee group significantly increased (beta = 0.232, p < 0.0001) in the year 2002 as compared to the reference year of 1996. The elasticity in the self-employed group also significantly increased (beta = 0.186, p < 0.05), although its change was smaller than that in the employee group.


CONCLUSIONS
The employee group had a greater improvement for the distributive equity of the contribution burden than the self-employed group. Within the observation period, there were two important integration reforms: one was the integration of 227 self-employed societies in 1998 and the other was the integration of 139 employee societies in 2000. We expected that the equity of the contribution burden would be improved for the self-employed group since the integration reform of 1998. However, it was not improved for the self-employed group until the year 2000. This result suggests that capturing exactly the beneficiaries' ability-to-pay such as income is the precedent for distributive equity of the contribution burden, although a more sophisticated imposition standard of contribution is needed.
Kang
Hee Chung
HC
Yonsei University Graduate School of Public Health, National Cancer Center.
Park
Eun Cheol
EC
Lee
Kyu Sik
KS
Park
Tae Kyu
TK
Chung
Woo Jin
WJ
Kim
Han Joong
HJ
D000328:Adult; D000368:Aged; D017047:Cost Sharing; D005260:Female; D005382:Financing, Personal; D006264:Health Benefit Plans, Employee / Q000191:economics*; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D007723:Korea; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged