Journal of Preventive Medicine and Public Health

Original Articles

The Impact of Public Transfer Income on Catastrophic Health Expenditures for Households With Disabilities in Korea: Eun Jee Chang, Sanggu Kang, Yeri Jeong, Sungchan Kang, Su Jin Kang; J Prev Med Public Health. 2023;56(1):67-76. Published online January 16, 2023; DOI: https://doi.org/10.3961/jpmph.22.183

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Objectives
Previous studies have reported that people with disabilities are more likely to be impoverished and affected by excessive medical costs than people without disabilities. Public transfer income (PTI) reduces financial strain in low-income households. This study examined the impact of PTI on catastrophic health expenditures (CHE), focusing on low-income households and households with Medical Aid beneficiaries that contained people with disabilities.
Methods
We constructed a panel dataset by extracting data on registered households with disabilities from the Korea Welfare Panel Study 2012-2019. We then used a generalized estimating equation model to estimate the impacts of PTI on CHE. A subgroup analysis was carried out to assess the moderating effects of family income levels and health insurance types.
Results
As PTI increased, the odds ratio (OR) of CHE in households that contained people with disabilities decreased significantly (OR, 0.92; 95% confidence interval [CI], 0.89 to 0.94; p<0.001). In particular, PTI effectively reduced the likelihood of CHE for low-income households (OR, 0.85; 95% CI, 0.81 to 0.89; p<0.001) and those who received medical benefits (OR, 0.78; 95% CI, 0.68 to 0.89; p<0.001).
Conclusions
This study highlights the positive effect of PTI on decreasing CHE. Household income and the health insurance type were significant effect modifiers, but economic barriers seemed to persist among low-income households with non-Medical Aid beneficiaries. Federal policies or programs should consider increasing the total amount of PTI targeting low-income households with disabilities that are not covered by the Medical Aid program.

Summary

Korean summary
장애인은 비장애인에 비해 소득수준이 낮고 빈곤율이 높으며, 저소득 장애인 가구일수록 소득원천 비중에서 공적이전소득 의존성이 높다. 본 연구는 공적이전소득이 장애인 가구의 재난적 의료비 발생 확률(Odds ratio)을 효과적으로 낮춘다는 점을 밝혔으며, 특히 저소득층 및 의료급여 수급 가구에서 의료비 부담 완화 효과가 큰 것을 확인하였다. 향후 의료급여 적용대상에서 제외되어 건강보험에 가입해 있는 저소득 장애인 가구를 대상으로 추가적인 맞춤형 지원 정책이 필요하다.

Citations

Citations to this article as recorded by

Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019
Abdoreza mousavi, Farhad lotfi, Samira Alipour, Aliakbar Fazaeli, Mohsen Bayati
Journal of Preventive Medicine and Public Health.2024; 57(1): 65. CrossRef

Evaluation of Geographic Indices Describing Health Care Utilization: Agnus M. Kim, Jong Heon Park, Sungchan Kang, Yoon Kim; J Prev Med Public Health. 2017;50(1):29-37. Published online December 19, 2016; DOI: https://doi.org/10.3961/jpmph.16.099

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Abstract PDF

Objectives
The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization.
Methods
We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates.
Results
In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index.
Conclusions
Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.

Summary

Citations

Citations to this article as recorded by

Development and Evaluation of Rehabilitation Service Areas for the United States
Timothy A. Reistetter, Julianna M. Dean, Allen M. Haas, John D. Prochaska, Daniel C. Jupiter, Karl Eschbach, Yong-Fang Kuo
BMC Health Services Research.2023;[Epub] CrossRef
Factors Associated with End-Of-Life Health Care Use and Spending in Korea in Comparison with the General Population
Agnus M. Kim, Yoon Kim
Journal of Aging & Social Policy.2023; : 1. CrossRef
Presence of Thrombectomy-capable Stroke Centers Within Hospital Service Areas Explains Regional Variation in the Case Fatality Rate of Acute Ischemic Stroke in Korea
Eun Hye Park, Yong Jin Gil, Chanki Kim, Beom Joon Kim, Seung-sik Hwang
Journal of Preventive Medicine and Public Health.2021; 54(6): 385. CrossRef
An ecological study of geographic variation and factors associated with cesarean section rates in South Korea
Agnus M. Kim, Jong Heon Park, Sungchan Kang, Tae Ho Yoon, Yoon Kim
BMC Pregnancy and Childbirth.2019;[Epub] CrossRef
Geographic variation and factors associated with rates of knee arthroplasty in Korea-a population based ecological study
Agnus M. Kim, Sungchan Kang, Jong Heon Park, Tae Ho Yoon, Yoon Kim
BMC Musculoskeletal Disorders.2019;[Epub] CrossRef
Factors associated with the rates of coronary artery bypass graft and percutaneous coronary intervention
Agnus M. Kim, Jong Heon Park, Seongcheol Cho, Sungchan Kang, Tae Ho Yoon, Yoon Kim
BMC Cardiovascular Disorders.2019;[Epub] CrossRef

The Effect of Geographic Units of Analysis on Measuring Geographic Variation in Medical Services Utilization: Agnus M. Kim, Jong Heon Park, Sungchan Kang, Kyosang Hwang, Taesik Lee, Yoon Kim; J Prev Med Public Health. 2016;49(4):230-239. Published online July 14, 2016; DOI: https://doi.org/10.3961/jpmph.16.034

10,588 View
159 Download
17 Crossref

Abstract PDF Supplementary Material

Objectives
We aimed to evaluate the effect of geographic units of analysis on measuring geographic variation in medical services utilization. For this purpose, we compared geographic variations in the rates of eight major procedures in administrative units (districts) and new areal units organized based on the actual health care use of the population in Korea.
Methods
To compare geographic variation in geographic units of analysis, we calculated the age–sex standardized rates of eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee-replacement surgery, caesarean section, hysterectomy, computed tomography scan, and magnetic resonance imaging scan) from the National Health Insurance database in Korea for the 2013 period. Using the coefficient of variation, the extremal quotient, and the systematic component of variation, we measured geographic variation for these eight procedures in districts and new areal units.
Results
Compared with districts, new areal units showed a reduction in geographic variation. Extremal quotients and inter-decile ratios for the eight procedures were lower in new areal units. While the coefficient of variation was lower for most procedures in new areal units, the pattern of change of the systematic component of variation between districts and new areal units differed among procedures.
Conclusions
Geographic variation in medical service utilization could vary according to the geographic unit of analysis. To determine how geographic characteristics such as population size and number of geographic units affect geographic variation, further studies are needed.

Summary

Citations

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BMJ Paediatrics Open.2024; 8(1): e002377. CrossRef
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Journal of Surgical Research.2022; 275: 115. CrossRef
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European Journal of Vascular and Endovascular Surgery.2022; 63(6): 874. CrossRef
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Cho Hee Kim, In Gyu Song, Min Sun Kim, Jin Yong Lee, Nam Gu Lim, Hee Young Shin
Scientific Reports.2020;[Epub] CrossRef
Regional Variation of Hospitalization Rates for Asthma in Korea: Association with Ambient Carbon Monoxide and Health Care Supply
Agnus M. Kim, Sungchan Kang, Jong Heon Park, Yoon Kim
International Journal of Environmental Research and Public Health.2020; 17(4): 1244. CrossRef
A spatial analysis of geographic variation and factors associated with hospitalization for bacterial pneumonia in Korea
Agnus M. Kim, Sungchan Kang, Jong Heon Park, Tae Ho Yoon, Yoon Kim
BMC Pulmonary Medicine.2019;[Epub] CrossRef
Regional Differences in Years of Life Lost in Korea from 1997 to 2015
Dun-Sol Go, Young-Eun Kim, Munkhzul Radnaabaatar, Yunsun Jung, Jaehun Jung, Seok-Jun Yoon
Journal of Korean Medical Science.2019;[Epub] CrossRef
Hospitalizations for ambulatory care sensitive conditions as an indicator of access to primary care and excess of bed supply
Agnus M. Kim, Jong Heon Park, Tae Ho Yoon, Yoon Kim
BMC Health Services Research.2019;[Epub] CrossRef
An ecological study of geographic variation and factors associated with cesarean section rates in South Korea
Agnus M. Kim, Jong Heon Park, Sungchan Kang, Tae Ho Yoon, Yoon Kim
BMC Pregnancy and Childbirth.2019;[Epub] CrossRef
Geographic variation and factors associated with rates of knee arthroplasty in Korea-a population based ecological study
Agnus M. Kim, Sungchan Kang, Jong Heon Park, Tae Ho Yoon, Yoon Kim
BMC Musculoskeletal Disorders.2019;[Epub] CrossRef
Factors associated with the rates of coronary artery bypass graft and percutaneous coronary intervention
Agnus M. Kim, Jong Heon Park, Seongcheol Cho, Sungchan Kang, Tae Ho Yoon, Yoon Kim
BMC Cardiovascular Disorders.2019;[Epub] CrossRef
Geographic variation in health insurance benefits in Qianjiang District, China: a cross-sectional study
Yue Wu, Liang Zhang, Xuejiao Liu, Ting Ye, Yongfei Wang
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Dan Peng, Xuan Li, Pin Liu, Mei Luo, Shuai Chen, Kewen Su, Zhongshuang Zhang, Qiang He, Jingfu Qiu, Yingli Li
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