J Korean Med Sci.  2016 Mar;31(3):336-344. 10.3346/jkms.2016.31.3.336.

Catastrophic Health Expenditures for Households with Disabled Members: Evidence from the Korean Health Panel

• Lee JE
• Shin HI
• Do YK
• Yang EJ

• KMID: 2363492
• DOI: http://doi.org/10.3346/jkms.2016.31.3.336

Abstract

Persons with disabilities use more health care services due to ill health and face higher health care expenses and burden. This study explored the incidence of catastrophic health expenditures of households with persons with disabilities compared to that of those without such persons. We used the Korean Health Panel (KHP) dataset for the years 2010 and 2011. The final sample was 5,610 households; 800 (14.3%) of these were households with a person with a disability and 4,810 (85.7%) were households without such a person. Households with a person with a disability faced higher catastrophic health expenditures, spending about 1.2 to 1.4 times more of their annual living expenditures for out-of-pocket medical expenses, compared to households without persons with disabilities. Households having low economic status and members with chronic disease were more likely to face catastrophic health expenditures, while those receiving public assistance were less likely. Exemption or reduction of out-of-pocket payments in the National Health Insurance and additional financial support are needed so that the people with disabilities can use medical services without suffering financial crisis.

Keyword

Disability; Household; Catastrophic Health Expenditure

MeSH Terms

Aged
Databases, Factual
Delivery of Health Care/*economics
Disabled Persons
Health Expenditures/*statistics & numerical data
Humans
Middle Aged
National Health Programs
Odds Ratio
Republic of Korea

Reference

1. Organization for Economic Cooperation and Development. Health at a glance 2013: OECD indicators. accessed on 26 May 2015. Available at http://dx.doi.org/10.1787/health_glance-2013-en.

2. Kwon S. Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage. Health Policy Plan. 2009; 24:63–71.

3. van Doorslaer E, O’Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, Harbianto D, Herrin AN, Huq MN, Ibragimova S, et al. Catastrophic payments for health care in Asia. Health Econ. 2007; 16:1159–1184.

4. Xu K. Distribution of health payments and catastrophic expenditures methodology: discussion paper number 2-2005. accessed on 26 May 2015. Available at http://apps.who.int/iris/bitstream/10665/69030/1/EIP_HSF_DP_05.2.pdf.

5. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. Lancet. 2003; 362:111–117.

6. Gotsadze G, Zoidze A, Rukhadze N. Household catastrophic health expenditure: evidence from Georgia and its policy implications. BMC Health Serv Res. 2009; 9:69.

7. Kronenberg C, Barros PP. Catastrophic healthcare expenditure - drivers and protection: the Portuguese case. Health Policy. 2014; 115:44–51.

8. Amaya Lara JL, Ruiz Gómez F. Determining factors of catastrophic health spending in Bogota, Colombia. Int J Health Care Finance Econ. 2011; 11:83–100.

9. Somkotra T, Lagrada LP. Which households are at risk of catastrophic health spending: experience in Thailand after universal coverage. Health Aff (Millwood). 2009; 28:w467–78.

10. Su TT, Kouyaté B, Flessa S. Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso. Bull World Health Organ. 2006; 84:21–27.

11. Yardim MS, Cilingiroglu N, Yardim N. Catastrophic health expenditure and impoverishment in Turkey. Health Policy. 2010; 94:26–33.

12. Anderson WL, Wiener JM, Finkelstein EA, Armour BS. Estimates of national health care expenditures associated with disability. J Disabil Policy Stud. 2011; 21:230–240.

13. Mitra S, Findley PA, Sambamoorthi U. Health care expenditures of living with a disability: total expenditures, out-of-pocket expenses, and burden, 1996 to 2004. Arch Phys Med Rehabil. 2009; 90:1532–1540.

14. Newacheck PW, Inkelas M, Kim SE. Health services use and health care expenditures for children with disabilities. Pediatrics. 2004; 114:79–85.

15. Palmer M, Nguyen T, Neeman T, Berry H, Hull T, Harley D. Health care utilization, cost burden and coping strategies by disability status: an analysis of the Viet Nam National Health Survey. Int J Health Plann Manage. 2011; 26:e151–68.

16. Wyszewianski L. Families with catastrophic health care expenditures. Health Serv Res. 1986; 21:617–634.

17. Kinne S, Patrick DL, Doyle DL. Prevalence of secondary conditions among people with disabilities. Am J Public Health. 2004; 94:443–445.

18. Shi J, Wheeler KK, Lu B, Bishai DM, Stallones L, Xiang H. Medical expenditures associated with nonfatal occupational injuries among U.S. workers reporting persistent disabilities. Disabil Health J. 2015; 8:397–406.

19. Zuvekas SH, Selden TM. Mental health and family out-of-pocket expenditure burdens. Med Care Res Rev. 2010; 67:194–212.

20. Lukemeyer A, Meyers MK, Smeeding T. Expensive children in poor families: out-of-pocket expenditures for the care of disabled and chronically ill children in welfare families. J Marriage Fam. 2000; 62:399–415.

21. Choi JW, Cho KH, Choi Y, Han KT, Kwon JA, Park EC. Changes in economic status of households associated with catastrophic health expenditures for cancer in South Korea. Asian Pac J Cancer Prev. 2014; 15:2713–2717.

22. Rahman MM, Gilmour S, Saito E, Sultana P, Shibuya K. Health-related financial catastrophe, inequality and chronic illness in Bangladesh. PLoS One. 2013; 8:e56873.

23. Kim Y, Yang B. Relationship between catastrophic health expenditures and household incomes and expenditure patterns in South Korea. Health Policy. 2011; 100:239–246.

24. Ruger JP, Kim HJ. Out-of-pocket healthcare spending by the poor and chronically ill in the Republic of Korea. Am J Public Health. 2007; 97:804–811.

25. Chan L, Beaver S, Maclehose RF, Jha A, Maciejewski M, Doctor JN. Disability and health care costs in the Medicare population. Arch Phys Med Rehabil. 2002; 83:1196–1201.

26. Pumkam C, Probst JC, Bennett KJ, Hardin J, Xirasagar S. Health care expenditures among working-age adults with physical disabilities: variations by disability spans. Disabil Health J. 2013; 6:287–296.

27. Iezzoni LI, Killeen MB, O’Day BL. Rural residents with disabilities confront substantial barriers to obtaining primary care. Health Serv Res. 2006; 41:1258–1275.

28. Lee JE, Kim HR, Shin HI. Accessibility of medical services for persons with disabilities: comparison with the general population in Korea. Disabil Rehabil. 2014; 36:1728–1734.

29. Altman BM, Cooper PF, Cunningham PJ. The case of disability in the family: impact on health care utilization and expenditures for nondisabled members. Milbank Q. 1999; 77:39–75.

30. Lee TJ, Lee HJ, Kim Y. Analysis of catastrophic health expenditures using 1^st wave Korea health panel data. Korean J Health Econ Policy. 2012; 18:95–111.

31. Roh SH. The longitudinal study on the factors of catastrophic health expenditure among disabled elderly households. Korean J Soc Welf. 2012; 64:51–77.

32. Lee JY, Kim BK, Eun SJ, Kim Y, Kim YI. Healthcare expenditures of disabled households in Seoul, Korea. J Rehabil Res. 2009; 13:199–223.

33. Jung YI, Lee HJ, Lee TJ, Kim H. Measures of household catastrophic health expenditure: systematic review and implications. Korean J Health Econ Policy. 2013; 19:1–27.