Power of universal health coverage in the era of COVID-19: A nationwide observational study

Abstract

Background: During the COVID-19 pandemic, South Korea has achieved perfect universal health coverage (UHC)-all Koreans receive UHC regardless of their socioeconomic status. The current study investigated whether socioeconomic disparities remained in COVID-19 health outcomes under UHC.

Methods: This retrospective, observational study included all 7,590 confirmed COVID-19 patients in South Korea up to 15 May 2020. We used the official medical claim database, and socioeconomic status was estimated by insurance type (National Health Insurance Service [NHIS] beneficiaries and Medical Aid [MA] recipients). Type of insurance is a well-known indicator of socioeconomic status. Prevalence (per one million), mortality rate (per one million), and case fatality rate were calculated. To determine the factors associated with case fatality rate, multivariable logistic regressions were performed.

Findings: The nationwide prevalence, mortality rate, and case fatality rate of COVID-19 was 144•4, 4•3 and 3•0%, respectively. MA recipients had higher prevalence (424•3 vs 136.3), mortality rate (28•3 vs 3•6), and case fatality rate (6•7 vs 2•7) than NHIS beneficiaries. However, the adjusted analysis showed that the type of insurance was not associated with higher odds of case fatality.

Interpretation: We found socioeconomic disparities in COVID-19 prevalence and fatality despite UHC. However, disparities in fatality were not due to socioeconomic status, but due to the poor underlying health conditions of the people. This result can be explained by a combination of UHC, rapid early testing and treatment, transmission-reducing behaviours, and regional preparedness.

Funding: This research did not receive any funding.

Keywords: COVID-19; Case Fatality; Health disparity; Mortality; Prevalence; SARS-CoV-2.

Fig. 1

Prevalence, Mortality rate, and case fatality rate of Covid-19 in South Korea. Covid-19 = Coronavirus Infectious Disease 2019. NHIS = National Health Insurance Service beneficiaries. MA =Medical Aid recipients. * Prevalence (per one million), mortality rate (per one million), and case fatality rate were calculated at the national and regional levels. The whole number of National Health Insurance Service Beneficiaries and Medical Aid recipients was determined from annual statistics of the National Health Insurance Service and official statistics of South Korea. Confirmed cases and number of death were determined by using the official medical database, released from the Ministry of Health and Welfare and Health Insurance Review and Assessment Service in South Korea.