title: Impact of supplementary private health insurance on stomach cancer care in Korea: a cross-sectional study.
abstract: BACKGROUND
  Korea achieved universal health insurance coverage in only 12 years; however, insufficient government funding has resulted in high out-of-pocket payments and, in turn, a demand for supplementary private health insurance (PHI). Supplementary PHI provides a fixed amount of benefits in the event of critical illness (e.g., cancer or stroke), surgery, or hospitalization. In this study, we tried to identify factors that influence the decision to purchase supplementary PHI and investigate the impacts of PHI on various aspects of cancer care.
  
  
  METHODS
  In a cross-sectional study of 391 patients with gastric cancer, we collected data on demographic and clinical variables, coverage by PHI at the time of diagnosis, and patients' cancer care experiences from surgery databases and patient questionnaires. Two separate multivariate logistic regression models were used 1) to determine whether various sociodemographic and clinical variables influence the purchase of supplementary PHI, and 2) to determine if there is a difference in various outcome measures between individuals with and without PHI.
  
  
  RESULTS
  We studied 187 subjects (49.6%) who were covered under PHI at the time of diagnosis. Subjects who purchased PHI tended to be younger (aOR = 5.01, 95% C.I. = 2.05 - 12.24), and more educated (aOR = 2.67, 95% C.I. = 1.04 - 6.86). Supplementary PHI coverage was significantly associated with financial independence (aOR = 2.07, 95% CI = 1.19 - 3.61), but not with other aspects of cancer care, such as access to healthcare, quality of care, communication and patient autonomy.
  
  
  CONCLUSIONS
  Our findings demonstrate that supplementary PHI neither serves as a safety net for vulnerable patients nor improves cancer care experience, except for maintaining the financial independence of beneficiaries.
authors: National Cancer Control Research Institute & Hospital, National Cancer Center, Goyang, Gyeonggi, Korea. jazzphil@ncc.re.kr
authors: Dong Wook
authors: DW
authors: Shin
authors: Kee-Taig
authors: KT
authors: Jung
authors: Sung
authors: S
authors: Kim
authors: Jae-Moon
authors: JM
authors: Bae
authors: Young-Woo
authors: YW
authors: Kim
authors: Keun Won
authors: KW
authors: Ryu
authors: Jun Ho
authors: JH
authors: Lee
authors: Jae-Hyung
authors: JH
authors: Noh
authors: Tae-Sung
authors: TS
authors: Sohn
authors: Young Ho
authors: YH
authors: Yun
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D007723:Korea; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017149:Private Sector / Q000706:statistics & numerical data*; D013274:Stomach Neoplasms / Q000628:therapy