title: Has the National Health Insurance improved the inequality in the use of tertiary-care hospitals in Korea?
abstract: BACKGROUND
  To improve financial protection against catastrophic illness, the Korean government expanded the benefit coverage of the National Health Insurance (NHI) for cancer patients in 2005. This paper examined whether the policy has reduced income-inequality in the use of tertiary care hospitals.
  
  
  METHODS
  We evaluated the effect of the policy on income-inequalities in outpatient visits and inpatient admissions to tertiary care hospitals, based on triple difference estimators. Using nationwide claims data of the NHI from 2002 to 2010, we compared cancer patients as a treatment group with liver disease and cardio-cerebrovascular disease as control groups and the lower-income with the highest-income group.
  
  
  RESULTS
  Before the introduction of the policy, lower-income cancer patients utilized less inpatient and outpatient services in tertiary care hospitals than high-income patients did. After the benefit coverage was expanded, while the incidence and total number of inpatient admissions to tertiary care hospitals increased among cancer patients compared with liver diseases, lower-income cancer patients experienced a greater increase than those of higher-income did compared with both diseases. The use of outpatient services increased more in cancer patients than those of both diseases; however, the gap between the highest- and the lowest-income rarely decreased, except the incidence of visits when compared to liver disease.
  
  
  CONCLUSIONS
  Our findings indicated that the expanded NHI benefits coverage partially improved income-related inequalities in inpatient admissions to tertiary-care hospital, but not in outpatient visits.
authors.affiliation: National Evidence-based Healthcare Collaborating Agency (NECA), 28-7 Wonnam-dong, Jongno-gu, Seoul 110-450, South Korea; School of Public Health, Seoul National University, Kwanak-ro, Kwanak-gu, Seoul 151-742, South Korea; Takemi Program, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, United States.
authors.forename: Sujin
authors.initials: S
authors.lastname: Kim
authors.affiliation: National Evidence-based Healthcare Collaborating Agency (NECA), 28-7 Wonnam-dong, Jongno-gu, Seoul 110-450, South Korea; School of Public Health, Seoul National University, Kwanak-ro, Kwanak-gu, Seoul 151-742, South Korea. Electronic address: kwons@snu.ac.kr.
authors.forename: Soonman
authors.initials: S
authors.lastname: Kwon
mesh_terms: D002318:Cardiovascular Diseases / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000628:therapy; D005260:Female; D006291:Health Policy; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008107:Liver Diseases / Q000628:therapy; D008297:Male; D009313:National Health Programs; D009369:Neoplasms / Q000628:therapy; D011050:Policy Making; D056910:Republic of Korea; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*
keywords: Cancer; Equity; Health care utilization; National health insurance; South Korea; Tertiary care hospital