title: Effect of the Crisis Assistance Program on poverty transition for seriously ill people in South Korea: a quasi-experimental study.
abstract: The Crisis Assistance Program (CAP) is a newly developed social protection scheme in South Korea. It was implemented in 2006 in order to assist individuals experiencing a sudden or temporary financial emergency. CAP provides temporary assistance to cover the direct user fees associated with inpatient care up to three or six million KRW (US $2673-5346). In this study, we aimed to compare the poverty dynamics in recipients versus non-recipients and to determine whether there is an association between participation in CAP and poverty transition. For the purpose, we analyzed longitudinal data from 2009 to 2011 from 55,710 people who requested CAP during a serious illness at local governmental offices throughout South Korea. During the 1.6 years of follow-up, 8712 (15.6%) of those who requested CAP fell into absolute poverty. Results showed that there was a 16% reducing effect of CAP on poverty transition (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.79-0.90, p < 0.001) and there was a 33% delay in the time to falling into poverty (time ratio [TR] 1.33, 95% CI 1.20-1.47, p < 0.001) after adjusting for covariates. In this analysis model, the risk of poverty transition induced by experiencing a serious illness decreased rapidly with time (ancillary parameter [AP] 0.61, 95% CI 0.59-0.62). The results were essentially unchanged even after performing a rigorous propensity analysis, which limited the analyses to 12,944 propensity-matched subjects (HR 0.84, 95% CI 0.77-0.91, p < 0.001; TR 1.38, 95% CI 1.18-1.61, p < 0.001; AP 0.54, 95% CI 0.52-0.57). Our findings provide additional evidence for recommending the use of a payment strategy that relieves out-of-pocket payments so as to reduce medical impoverishment. A temporary assistance scheme for people experiencing a serious illness may be an alternative healthcare financing strategy to confront the issue of health inequality among the medically and socioeconomically vulnerable.
authors.affiliation: Department of Social Welfare, Seoul National University, Gwanak Street 1, Gwanak-gu, 151-746, Seoul, Republic of Korea. Electronic address: nationi@korea.kr.
authors.forename: Chang-O
authors.initials: CO
authors.lastname: Kim
authors.affiliation: Department of Social Welfare, Sung-Kong-Hoe University, Hang-dong 1-1, Guro-gu, 152-716, Seoul, Republic of Korea. Electronic address: wojong@skhu.ac.kr.
authors.forename: Won Oh
authors.initials: WO
authors.lastname: Joung
mesh_terms: D000328:Adult; D000368:Aged; D002388:Catastrophic Illness / Q000191:economics*; D005260:Female; D005382:Financing, Personal / Q000191:economics*; D005500:Follow-Up Studies; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D015397:Program Evaluation; D056910:Republic of Korea; D012947:Social Work
keywords: Catastrophic health expenditure; Medical impoverishment; Out-of-pocket payment; Poverty transition; Propensity analysis; Risky life course event; South Korea; Weibull regression