Health Policy Manag.  2019 Sep;29(3):288-302. 10.4332/KJHPA.2019.29.3.288.

The Equity in Health Care Utilization of One-Person Households: By Comparison with Multi-Person Households

Affiliations
  • 1Health Insurance Review Office, Chungnam National University Hospital, Daejeon, Korea. nabeenet@cnuh.co.kr
  • 2Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, Korea.

Abstract

BACKGROUND
The one-person households (OPH) are rapidly increasing and vulnerable to socioeconomic and health problems. Because it is predicted to be inequitable to health care utilization, we would like to find out about the equity of health care utilization of the OPH by comparison with the multi-person households (MPH).
METHODS
This study followed the theoretical framework of Wagstaff and van Doorslaer (2000), O'Donnell and his colleagues (2008), where the horizontal inequity index is the difference between the concentration indices of actual health care utilization and health care needs. This study employed the 9th Korea Health Panel survey, and a total of 10,807 cases were analyzed. Health care needs were measured by age, sex, subjective health status, chronic disease count, Charlson's Comorbidity Index, limitation of activities, and disability.
RESULTS
Compared with the MPH, there were pro-poor inequities in hospitalization, emergency utilization, hospitalization out-of-pocket payments, and pro-rich inequities in outpatient out-of-pocket payments for the OPH. The decomposition of the concentration index revealed that chronic disease count made the largest contribution to socioeconomic inequality in outpatient utilization. Age, health insurance, economic activities, and subjective health status also proved more important contributors to inequality. The variables contributing to the hospitalization and emergency utilization inequity were age, education, Charlson's Comorbidity Index, marital status, and income.
CONCLUSION
Because the OPH was more vulnerable to health problems than the MPH and there were pro-poor inequities in medical utilization, hospitalization, and emergency costs, it is necessary to develop a policy that can correct and improve the portion of high contribution to medical utilization of the OPH.

Keyword

Horizontal inequity index; Health care utilization; One-person households

MeSH Terms

Chronic Disease
Comorbidity
Delivery of Health Care*
Diagnostic Self Evaluation
Education
Emergencies
Family Characteristics*
Health Expenditures
Hospitalization
Humans
Insurance, Health
Korea
Marital Status
Outpatients
Patient Acceptance of Health Care*
Socioeconomic Factors
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