Has income-related inequity in health care utilization and expenditures been improved? Evidence from the Korean National Health and Nutrition Examination Survey of 2005 and 2010

Abstract

Objectives: The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea.

Methods: We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners.

Results: The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010.

Conclusions: We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.

Keywords: Decomposition; Delivery of health care; Health expenditures; Income-related inequity; Korea.

Figure 1

(A) Decomposition of inequality for the probability of visits of outpatient care. (B) Decomposition of inequality for the number of visits of outpatient care. (C) Decomposition of inequality for total visits of outpatient care. The left figures are for 2005 and the right figures are for 2010. The Income variable was transformed into logarithm form. LTMPs, licensed traditional medical practitioners; GC (ε), contribution of the error term.

Figure 2

(A) Decomposition of inequality for the probability of days of inpatient care. (B) Decomposition of inequality for the number of days of inpatient care. (C) Decomposition of inequality for total days of inpatient care. The left figures are for 2005 and the right figures are for 2010. The Income variable was transformed into logarithm form. GC (ε), contribution of the error term.

Figure 3

(A) Decomposition of inequality for medical expenditure per use (or day) in 2005. (B) Decomposition of inequality for medical expenditure per use (or day) in 2010. The Income variable was transformed into logarithm form. GC (ε), contribution of the error term.

Figure 4

Horizontal inequity index (HI) in primary outpatient care in comparison with selected OECD countries. (B) HI indices in secondary outpatient care in comparison with selected OECD countries. (C) HI indices in inpatient care in comparison with selected OECD countries. Yellow color indicates data for Korea in 2005 and red color indicates data for Korea in 2010. Modified from Van Doorslaer E, et al. Health Econ 2004;13(7):629-647 [11] for (A) and (B), and Van Doorslaer E, et al. Income-related inequality in the use of medical care in 21 OECD countries. Paris: OECD Publishing; 2004 [4] for (C). LTMP_S, licensed traditional medical practitioners.