Page 147 - GHES-2-2

Global Health Econ Sustain The influence of coverage expansion

most of the changes in the cost of hospitalization for cancer medical compensation from the National Health Insurance
patients. The two decomposed effects somewhat mitigated emerge as the two groups of insureds who will reap the most
or aggravated the overall change effect. benefits from the coverage expansion policy. Meanwhile,
other factors are at play driving the overspending among
4. Discussion those in the middle expenditure range.
The study investigates the effect of coverage expansion
policy on the distribution of medical costs by each Acknowledgments
group’s initial medical expenditure level instead of None.
by income level. The results showed that insurance
subscribers whose medical costs are categorized at the Funding
lowest and highest levels reap the most benefits from None.
policy change. The observable variables seem to affect
the overall differences in the cancer inpatient cost for Conflict of interest
those at the middle medical cost level. The structural
changes seem to account for the overall change in the The author declares no conflicts of interest.
cancer inpatient cost for those at the lowest or the Author contributions
highest medical cost level. This implies that the increase
in inpatient cost for both the lowest and the highest This is a single-authored article.
levels is attributed to the coverage expansion; however,
the increase in inpatient cost for middle level is due to Ethics approval and consent to participate
sociodemographic changes. Not applicable.
The results of this study provide an explanation why the
coverage expansion policy does not influence the equity in Consent for publication
health utilization and financial burden. Previous studies Not applicable.
have not found an association between coverage expansion
and income equity, probably due to the exclusive influence Availability of data
of the policy change on the lowest and highest medical National Health Insurance (NHI) data can be obtained
cost level, as shown by the current findings. Still, their at the National Health Insurance Sharing Service website
observable characteristics mainly affect the middle cost (https://nhiss.nhis.or.kr/bd/ay/bdaya001iv.do).
level group. This suggests that health insurance coverage
policies may alter the health-care preferences of those at References
low and high health-care utilization extremes. Therefore, Chernozhukov, V., Fernández-Val, I., & Melly, B. (2013).
to improve equity in health-care utilization, insurance Inference on counterfactual distributions. Econometrica,
coverage policies need to be revised considering the 81(6):2205-2268.
existing health-care utilization levels.
https://doi.org/10.3982/ECTA10582
One caveat in this study is that information on the 100%
out-of-pocket service cost is not available in the national Choi, J.K. (2012). Equity in the health care financing and
payment. The Korean Journal of Health Economics and
health insurance data. If the inpatient with cancer at the Policy, 18(1):49-66.
middle cost level has utilized more than 100% out of pocket
service compared to other groups, insurance coverage for Kim, D., Kim, Y., Lee, S., Seo, J., & Kim, J. (2016). The Effect of
those at the middle cost level will be significantly affected Increased Health Care Coverage on Provider behavior in
due to the policy change. Another limitation of this study Cancer Care. Korea Institute for Health and Social Affairs.
is that the transition effect from the insurance-covered Available from: https://www.kihasa.re.kr/en/publish/paper/
research/view?searchText=cancer&page=1&seq=30657
service to the 100% OOP service could not be captured in [Last accessed on 2024 Feb 05].
this study.
Kim, J.H., Kim, S.J., & Kwon, S. (2014). Effect of expanding
5. Conclusion benefit coverage for cancer patients on equity in health care
utilization and catastrophic expenditure. Health Policy and
The coverage expansion policy encouraged insurance Management, 24(3):228-241.
subscribers with high and low medical expenditures to
increase their medical service utilization. In other words, https://doi.org/10.4332/KJHPA.2014.24.3.228
those who have received the highest and lowest amount of Kim, S., & Kwon, S. (2014a). The effect of extension of benefit

Volume 2 Issue 2 (2024) 6 https://doi.org/10.36922/ghes.2001