Socioeconomic Equity in Health Care Utilization in South Korea

Study Purpose : This study aims to investigate socioeconomic status (SES) related inequity in health care utilisation in Korea, comparing differences between income, wealth and education dimensions of socioeconomic status and inequity changes between 2005 and 2008, before and after implementation of the health insurance benefit expansion policy in 2006. Research Method: Korean Welfare Panel Study (KOWEPS) data on 14,463 individuals in 2005 and 11,909 in 2008 are used to measure income, wealth and education-related inequity for multiple indicators of health care utilisation with varying depth of coverage in the Korean National Health Insurance program, after regression-based indirect standardization for health care need variables (including age, gender, self-assessed health and chronic conditions). Concentration indices are used for statistical tests and extreme group gaps are used to interpret the magnitude of inequity. Results: After allowing for need, considerable pro-advantaged inequality is found for services with relatively shallow coverage, in particular, as medical checkups, total health care expenditure and tertiary hospital use. Conversely, with relatively deep coverage (outpatient visit, inpatient admissions and inpatient days) are utilized equally or favouring the less advantaged across the three socioeconomic dimensions. There was no change in pro-rich or pro-wealth inequality between 2005 and 2008 for any indicator, apart from a small reduction in pro-wealthy inequality for tertiary hospital visits in probability, but on several indicators there was an apparent reduction in pro-educated inequality. Conclusions: There is substantial socioeconomic inequity in health care in Korea for services not fully covered by the National Health Insurance program, with similar patterns of inequity for pro-rich, pro-wealthy and pro-educated dimensions of socioeconomic status. There was no reduction in pro-rich or pro-wealthy inequity in health care between 2005 an 2008. There were signs of a reduction in pro-educated inequality but this may just be a statistical artefact of sample attrition due to confounding between birth cohort and education group. Korea continues to have higher out-of-pocket expenditure and larger socioeconomic inequalities in health care than most other high income OECD countries, despite the health benefit expansion policy of 2006.