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Global Health Econ Sustain The influence of coverage expansion

initiation of the policy, suggesting that the approach has care expenses and shared patient rooms, which accounted
not successfully improved public healthcare and health for most out-of-pocket costs. This study focused on the
performance at all levels of national insurance subscribers. Second Coverage Enhancement Plan for cancer because
subsequent policies are related to the overall coverage
The study primarily examines the impact of coverage
expansion on cancer as of December 2009, when the self- policy, not just cancer.
burden rate of medical spending decreased from 10% to 1.3. Previous studies
5%. Cancer was prioritized in this study due to its severity
and limited resources for treatment, as stipulated in the The effect of increased health insurance coverage on health
policy. status, health-care utilization, and health-care costs has been
well studied. Some studies have recently been published on
The decomposition method by Chernozhukov the outcomes of the expansion of Medicaid, ACA, and MA
et al. (2013) was used for the study. The decomposition statewide health insurance in the US, with Sommers et al.
method distinguishes the effect of structural change with (2017) providing good summarizations of these results.
coverage expansion as one of the structural changes from
that of covariates such as sex, age, location, duration of Some studies have investigated the effect of cancer
hospitalization until expiration, quality of the nursing coverage expansion on health-care utilization in South Korea
facility, and qualification for health insurance on the (Choi, 2012; Kim et al., 2016; Lee, 2009). According to Kim
change of medical expenditure. Data are obtained from et al. (2016), the policy is associated with increased medical
National Health Insurance cohort data from 2008 and utilization in terms of hospitalization days, outpatient
2010 to compare changes in colon, breast, and prostate visits, and total medical expenditures. In addition, when
cancer hospitalization expenditure. Lee (2009) controlled for characteristics of patients and
hospitals, the policy remained associated with increased
1.1. Theoretical background inpatient treatment costs and negatively associated with
There are two sides to this coverage expansion policy. It outpatient treatment costs. Choi (2012) studied the change
serves its justice to the insureds by reducing self-burden in “self-burden relative to the ability to afford medical cost”
expenses. However, it could also wear down the financial and the “number of households with overburdened medical
security of the National Health Insurance by desensitizing expenses” before and after the initiation of the policy. As
medical service recipients to the costs, leading to increased a result, the beneficiary group’s “medical expense burden”
unnecessary service utilization. This indicates that the role and the “frequency of overburdened medical expenses”
of cost sharing, a method by which NHS manages healthcare were decreased. However, looking at the interaction term
costs, should be diminished. As Zeckhauser (1970) between the time variable (before and after the policy) and

points out, there is a tradeoff between risk spreading and the group variable, there is insufficient evidence that the
appropriate incentives. This shows that a greater coverage policy has the expected effect of reducing the occurrence
may subject the insureds to less financial and health risks of “overburdened medical expenses” in beneficiary groups.
but expose the insureds to moral hazard. Despite the Previous studies on coverage expansion in South Korea
possible moral hazard, if coverage expansion could affect focus on its effect not only on medical service utilization
the health promotion of the national population, the policy but also on the equitable distribution of services, possibly
could bring positive benefits. because the coverage expansion of public health insurance
could improve the fair distribution of medical services
1.2. History of cancer coverage policies in (Kim et al., 2014; Kim & Kwon, 2014). Kim & Kwon (2014)
South Korea’s National Health Insurance employed difference-in-differences (DID) methodology to
National Health Insurance implemented the First analyze how the policy enhanced income-related equality
(2005 – 2008) and the Second (2009 – 2013) Coverage in healthcare utilization. Using National Health Insurance
Enhancement Plans and the Four Critical Illness Coverage data, the study compared two groups — a cancer patient
Enhancement Plan since 2013. For cancer, the copayment group with liver disease and a low-income group with a
rate was reduced from 20% before September 2005 to 10% high-income group — before and after the NHI coverage
in September 2005 and 5% in December 2009. However, expansion policy in 2005. The results showed that the policy
the Four Critical Illness Coverage Enhancement Plan extension increased outpatient service utilization in all
focused on the coverage expansion of drug use for cancer income groups but with a more significant increase for the
from 2013 to 2016. In 2017, the new administration low-income groups among cancer patients. Furthermore,
initiated expanding coverage for 100% out-of-pocket the policy decreased inpatient service utilization across all
service in public health insurance, especially for nursing income groups, but the low-income group was influenced

Volume 2 Issue 2 (2024) 2 https://doi.org/10.36922/ghes.2001