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Effect of patient cost sharing in South Korea: ACG risk-adjusted differences in health care utilization and expenditures among National Health Insurance and Medical Aid enrollees, 2004-2005

Baltimore, MD, USA: Johns Hopkins University (doctoral dissertation).

Johns Hopkins University, Baltimore, MD, USA

Korea has experienced a period of rapid economic development and industrialization since the 1960s. This was paralleled by noticeable improvements in the health of the population and by reforms in the health care sector. Korea achieved universal public health insurance in a remarkably short period of time between 1977 and 1989 but continued to rely greatly on patient cost sharing to help ensure that there is parsimonious consumption of health care services and to contain public expenditure on health. For the provision of health care, it continues to depend largely on the market, with mainly private providers who are paid by fee-for-service. Although the Korean health system is unique, the concerns with which Korean health policy makers are facing (improvement in health, resource allocation, and cost containment), are expected to be very familiar with those in other countries.
This introduction describes demographic, epidemiologic and socioeconomic characteristics of the Korean population first. Then key elements of the Korean health care systems are introduced and explained. They include the uniqueness of health care providers (physicians and hospitals) in Korea, the weakness of primary care system, the overview of health care spending in Korea, general patient satisfaction, and roles of government (oversight and utilization review). The dissertation chooses two specific topics, which are usual source of care and ambulatory care sensitive conditions (and incidence of hospitalizations for those conditions), in order to examine the determinants of using ambulatory care sites and having hospitalizations for ambulatory care sensitive conditions. Also, it discusses how those two concepts are used in Korea, addresses the importance of usual source of care with the U.S. example, and describes some of ambulatory care sensitive conditions used in the United States. In this dissertation, the link between the health care systems in Korea and Korean population is conceptually explained by a Behavioral Model (Andersen, 1995) and empirically examined with the Korean health insurance claims data using a case-mix risk adjustment. Finally, this chapter provides main research questions and hypotheses.

Predictive Risk Modeling,Sensitivity,Korea,Resource Allocation,United States,