Health Policy Manag.  2021 Mar;31(1):125-139. 10.4332/KJHPA.2021.31.1.125.

The Effect of Residential Migration on the Utilization and Accessibility of Medical Care

• Lee WR
• Choi YS
• Lee GM
• Kim LH
• Yoo KB

• KMID: 2514668
• DOI: http://doi.org/10.4332/KJHPA.2021.31.1.125

Abstract

Background
In Korea, the health gap widens due to the number of medical resources and access to medical services between metropolitan and rural. The purpose of this study is to identify the impact of residential migration on medical utilization and accessibility.
Methods
This study extracted 528,516 claimed cases in the National Health Insurance Service-Cohort Sample Database from 2006 to 2015. Subjects were classified into two groups by the magnitude of the region, the metropolitan and the rural. The inversed probability weights were calculated for each group. And coefficients of the two-part model were estimated by generalized estimation equation.
Results
Those who moved region from metropolitan to rural tend to increase the length of stay and inpatients with ambulatory care sensitive conditions (ACSC) disease. Contrariwise, those who moved areas from rural to metropolitan tend to decrease the total medical cost, the adjusted patient days, the number of outpatients and the number of outpatients and inpatients with ACSC disease.
Conclusion
This study identified that between the residents who continued to reside in the region and the migrants, there were significant differences in the medical accessibility, quality of primary care, and unmet medical need.

Keyword

Residential migrant; Health gap; Medical utilization; Medical accessibility; Marginal structural model; Two-part model; Generalized estimating equations; NHIS-National Sample Cohort Database