Out-of-pocket healthcare spending by the poor and chronically ill in the Republic of Korea.
OBJECTIVE
We estimated out-of-pocket health care spending and out-of-pocket spending burden ratio employing household equivalent income in the Republic of Korea. We examined variations in out-of-pocket spending, estimated out-of-pocket spending burden ratio employing household equivalent income, and identified factors associated with out-of-pocket spending.


METHODS
We used the 1998 Korean National Health and Nutrition Survey, a nationally representative survey of 39,060 individuals. Our analyses examined out-of-pocket spending, out-of-pocket spending burden ratio, and health care use by socioeconomic status, insurance type, health care facility type, and chronic condition after we controlled for sociodemographic variables.


RESULTS
The lowest income quintile spent 12.5% of their total income out-of-pocket on medical expenditures, which was 6 times that of the highest income quintile (2%). Among those with 3 or more chronic conditions, low-income Koreans had the highest out-of-pocket spending burden ratio (20%), which was 5 times the spending burden among high-income Koreans (4%). In multivariate analyses, the number of chronic conditions, insurance type, health care use, and health care facility type were associated with out-of-pocket spending.


CONCLUSIONS
Out-of-pocket spending in Korea is regressive, because lower-income groups pay disproportionately more of their income compared with higher-income groups. Low-income individuals with multiple chronic conditions are particularly vulnerable.
Ruger
Jennifer Prah
JP
Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Conn 06520-8034, USA. jennifer.ruger@yale.edu
Kim
Hak-Ju
HJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology; D017281:Cost of Illness; D005260:Female; D005382:Financing, Personal; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D007223:Infant; D019458:Insurance Coverage; D007723:Korea; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012923:Social Class