Health Policy Manag.  2023 Dec;33(4):400-410. 10.4332/KJHPA.2023.33.4.400.

Analysis of Influencing Factors of High-Cost Beneficiaries of Catastrophic Health Expenditure Support Project

• Kim N
• Lee H
• Lim S

• KMID: 2551395
• DOI: http://doi.org/10.4332/KJHPA.2023.33.4.400

Abstract

Background
As the government has recently been discussing the expansion of the disaster health expenses support project, we would like to confirm the characteristics of beneficiaries of the support project, particularly those of high-cost beneficiaries.
Methods
Using the database of catastrophic health expenditure support project from 2019–2020, this study aims to confirm the characteristics of high-cost beneficiaries focusing on the overlap of the relieved out-of-pocket systems, known as the out-of-pocket ceiling system and the system for rare incurable diseases. Logistic regression analysis is used to examine this issue.
Results
In order to analyze the factors influencing high-cost beneficiaries, five models were created and analyzed, including the status of duplicated beneficiaries for relieved out-of-pocket systems, sociodemographic and economic factors, and individual health status as sequential independent variables. All five models were statistically significant, of which economic factors had the greatest impact on the model’s predictions. The main results indicated that those who benefited from multiple systems in duplicate were more likely to be high-cost beneficiaries, and there is a higher probability of incurring high health expenses among the underage. In addition, within the beneficiaries of catastrophic health expenditure support project, it was observed that higher health insurance premium percentiles are associated with a higher proportion of high-cost beneficiaries.
Conclusion
This study examined the characteristics of high-cost beneficiaries by encompassing reimbursement and nonreimbursement. According to this study, it is expected to be used as basic data for setting priorities and improving the current criteria of catastrophic health expenditure support project, aiming to sequentially expand the program.

Keyword

Catastrophic health expenditure support project; High-cost beneficiaries