title: The effect of high medical expenses on household income in South Korea: a longitudinal study using propensity score matching.
abstract: BACKGROUND
  Almost 97% of the Korean population is covered by National Health Insurance and are entitled to receive the same level of insurance benefits, regardless of how much each enrollee contributes to the system. However, the percentage of out-of-pocket payments is still high. This study examines whether the incurrence of high medical expenses affects household income.
  
  
  METHODS
  We use the Korea Welfare Panel and select 4,962 households to measure repeatedly over 5 years. Using propensity score matching, we set households with medical expenses of three times the annual average as "occurrence households" while "non-occurrence households" are those below the cut-off but with all other factors, such as income, held constant. We analyze whether the income of occurrence households differs significantly from the comparison group using a linear mixed effect model.
  
  
  RESULTS
  After the occurrence of high medical expenditure, occurrence households (n = 825) had US$ 1,737 less income than non-occurrence households. In addition, the income of households (n = 200) that incurred high medical costs repeatedly for 2 years was US$ 3,598 lower than the non-occurrence group.
  
  
  CONCLUSIONS
  Although it is important for the government to focus on medical assistance for households that have medical expense burdens, it needs to consider providing income indemnity insurance to protect them.
authors.affiliation: Department of Public Health, Yonsei University College of Medicine, Seoul, Republic of Korea. jwchoi2695@hanmail.net.|Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea. jwchoi2695@hanmail.net.
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Choi
authors.affiliation: Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea. ecpark@yuhs.ac.|Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. ecpark@yuhs.ac.
authors.forename: Eun Cheol
authors.initials: EC
authors.lastname: Park
authors.affiliation: Department of Public Health, Yonsei University College of Medicine, Seoul, Republic of Korea. kb53545@gmail.com.|Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea. kb53545@gmail.com.
authors.forename: Ki Bong
authors.initials: KB
authors.lastname: Yoo
authors.affiliation: Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea. leevan@yuhs.ac.|Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea. leevan@yuhs.ac.
authors.forename: Sang Gyu
authors.initials: SG
authors.lastname: Lee
authors.affiliation: Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea. jangsi@yuhs.ac.|Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. jangsi@yuhs.ac.
authors.forename: Sung In
authors.initials: SI
authors.lastname: Jang
authors.affiliation: Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea. thkim@yuhs.ac.|Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea. thkim@yuhs.ac.
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005382:Financing, Personal / Q000191:economics* / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D057216:Propensity Score; D056910:Republic of Korea; D012959:Socioeconomic Factors