Jennifer Prah Ruger ^1* Hak-Ju Kim ²

¹ Yale University School of Medicine
² Gyeongsang University

^* To whom correspondence should be addressed. E-mail: jennifer.ruger{at}yale.edu.

	Abstract

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

Methods. We used the 1998 known 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.

Key Words: Ethics, Global Health, Health Care Facilities/Services, Insurance, Health Policy, Access to Care

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