Health Policy Manag.  2023 Sep;33(3):325-337. 10.4332/KJHPA.2023.33.3.325.

Disparities in High-cost Outpatient Imaging Test Utilization between Private Health Insurance Subscribers and Non-subscribers: Changes Following the National Health Insurance Benefit Expansion Policy

• Shin Y
• Do YK

• KMID: 2549117
• DOI: http://doi.org/10.4332/KJHPA.2023.33.3.325

Abstract

Background
While there are many studies estimating the effects of private health insurance on various types of health care utilization, few have examined how such effects change in conjunction with important policy reforms in national health insurance (NHI). This study examined how the effect of private health insurance (supplemental and fixed cash benefit) on high-cost outpatient imaging test utilization changed following the expansion of magnetic resonance imaging (MRI) coverage in 2018, which is a key example of the NHI benefit expansion policy in recent years.
Methods
Data from the 2017 and 2019 Korea Health Panel Survey, which contained information about healthcare utilization before and after the expansion of MRI coverage in 2018, were used. The incremental effect of private health insurance on high-cost outpatient imaging test utilization for each period were quantified and compared, with special attention given to the type of private health insurance.
Results
While people with supplemental private health insurance were more likely to use high-cost outpatient imaging tests than those without, both before and after the expansion of MRI coverage, the incremental effect increased from 1.6% points in 2017 to 2.5% points in 2019.
Conclusion
Benefit expansion in NHI does not necessarily reduce disparities in the use of health care between private health insurance subscribers and non-subscribers. The results of our study also suggest that the path through which private health insurance affects healthcare utilization may not be limited to the price mechanism alone but can be more complex.

Keyword

Health care utilization; High-cost imaging test; Private health insurance; National health insurance; Benefit expansion policy