J Prev Med Public Health.  2016 Mar;49(2):118-128. 10.3961/jpmph.16.003.

Enrollment in Private Medical Insurance and Utilization of Medical Services Among Children and Adolescents: Data From the 2009-2012 Korea Health Panel Surveys

• Ryu DH
• Kam S
• Doo YT

• KMID: 2373655
• DOI: http://doi.org/10.3961/jpmph.16.003

Abstract

OBJECTIVES
The purposes of this study were to examine the status of children and adolescents with regard to enrollment in private medical insurance (PMI) and to investigate its influence on their utilization of medical services.
METHODS
The present study assessed 2973 subjects younger than 19 years of age who participated in five consecutive Korea Health Panel surveys from 2009 to 2012.
RESULTS
At the initial assessment, less than 20% of the study population had not enrolled in any PMI program, but this proportion decreased over time. Additionally, the number of subjects with more than two policies increased, the proportions of holders of indemnity-type only ('I'-only) and of fixed amount+indemnity-type ('F+I') increased, whereas the proportion of holders with fixed amount-type only ('F'-only) decreased. Compared with subjects without private insurance, PMI policyholders were more likely to use outpatient and emergency services, and the number of policies was proportionately related to inpatient service utilization. Regarding out-patient care, subjects with 'F'-only PMI used these services more often than did uninsured subjects (odds ratio [OR], 1.69), whereas subjects with 'I'-only PMI or 'F+I' PMI utilized a broad range of inpatient, outpatient, and emergency services relative to uninsured subjects (ORs for 'I'-only: 1.39, 1.63, and 1.38, respectively; ORs for 'F+I': 1.67, 2.09, and 1.37, respectively).
CONCLUSIONS
The findings suggest public policy approaches to standardizing PMI contracts, reform in calculation of premiums in PMI, re-examination regarding indemnity insurance products, and mutual control mechanisms to mediate between national health insurance services and private insurers are required.

Keyword

Insurance; Health services; Child; Adolescent

MeSH Terms

Adolescent
Ambulatory Care/*utilization
Child
Child, Preschool
Female
Health Surveys
Humans
Income
Infant
Infant, Newborn
Insurance, Health/economics/*statistics & numerical data
Male
Medically Uninsured
Odds Ratio
Republic of Korea