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Jennifer Prah Ruger, PhD and Hak-Ju Kim, PhD

Jennifer Prah Ruger is with the Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Conn, the Yale Graduate School of Arts and Sciences, New Haven, and the Yale Law School, New Haven. Hak-Ju Kim is with the Department of Social Welfare, Gyeongsang National University, Jinju, Kyungnam, Republic of Korea.

Correspondence: Requests for reprints should be sent to Jennifer Prah Ruger, PhD, Yale University, 60 College St, PO Box 208034, New Haven, CT 06520-8034 (e-mail: jennifer.ruger{at}yale.edu).

Objectives. We estimated out-of-pocket health care spending and out-of-pocket spending burden ratio employing household equivalent income in the Republic of Korea. We examined variations in out-of-pocket spending, estimated out-of-pocket spending burden ratio employing household equivalent income, and identified factors associated with out-of-pocket spending.

Methods. We used the 1998 Korean National Health and Nutrition Survey, a nationally representative survey of 39 060 individuals. Our analyses examined out-of-pocket spending, out-of-pocket spending burden ratio, and health care use by socioeconomic status, insurance type, health care facility type, and chronic condition after we controlled for sociodemographic variables.

Results. The lowest income quintile spent 12.5% of their total income out-of-pocket on medical expenditures, which was 6 times that of the highest income quintile (2%). Among those with 3 or more chronic conditions, low-income Koreans had the highest out-of-pocket spending burden ratio (20%), which was 5 times the spending burden among high-income Koreans (4%). In multivariate analyses, the number of chronic conditions, insurance type, health care use, and health care facility type were associated with out-of-pocket spending.

Conclusions. Out-of-pocket spending in Korea is regressive, because lower-income groups pay disproportionately more of their income compared with higher-income groups. Low-income individuals with multiple chronic conditions are particularly vulnerable.

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