Health Expenditure Difference according to Individual Copayment in National Health Insurance System

Abstract

Background: South Korea adopt a mandatory national health care system covering all citizens and consisting of the National Health Insurance System (NHIS) and Medical Aid Program (MAP), which cover individuals of non-low and low Socioeconomic Status (SES), respectively. Objective: We investigated and compared the medical expenses per claim in South Korea for SES individuals, to predict health care expenditure and provide fundamental data regarding care for individuals with limited finances. Methods: The inpatient data on NHIS and MAP beneficiaries were derived from the National Health Insurance Statistical Annual Report of South Korea from 2011 to 2015. Medical expenses per claim for the NHIS and MAP were investigated by gender and age, and the ratio of expenses per claim under MAP to that under NHIS was calculated. Results: The ratio from 2011 to 2015 was consistently larger than 1 and increased at an inconsistent rate with each consecutive age group until 30-39 years, and decreased thereafter (Males: 1.09-3.47, Females: 1.07-1.95). Conclusion: The results of this study indicated that higher medical expenditures and longer durations of claim in the low SES group may become obstacles to developing a sustainable health care system. The government should induce social activities of working-age low-SES people to reduce the burden on the government and help them lead a healthy life.