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KMID : 0386819920020020161
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Journal of the Institute of Health Environmental Sciences
1992 Volume.2 No. 2 p.161 ~ p.183
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A Study on the Medical Care Utilization of the Insured under the Korean Medical Insurance Corporation
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Abstract
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In order to identify the medical care utilization rates. The 1989 KMIC data file, both the eligibility file and the benefit file, were combined for analyzing their major characteristics. The results is summarized as follows:
The insured persons who have ever received medical treatment more than once for the last one year amounted to 71.8% of the total, and the rest never having used any medical facilities to 28.2%. Of the users, 67% have visited physicians at least
more
than once, and 0.4% have been admitted to hospitals, and 4.4% have used both inpatients care and outpatient. Medical care utilization rate by age is the highest at the age group between 0 and 4, and the rate of the aged is significantly low,
which
indicates the existence of use barrier for the elderlies. The unequitable financial burden due to the current high cost sharing by the insured is one of the example.
Concerning the medcal care utilization are by sex, females show a much higher rate than males. The lower income group show lower utilization rate than the higher and the amount of medical care utilization per person has a tendency to increase
proportionally to the income. Consequently, under the current health insurance system, the lower income group are suffering from obstacles preventing them from entering the medical market and utilizing medical care.
This study reveals that there is no meaningful difference in the utilization rare by health service district. The utilization rates in diseases of the respiratory and digestive system are high, and the rate in chronic degenerative diseases
increases in
proportion to age. The lower income group show the higher benefit rate and also higher cost sharing rate which have resulted in the regressiveness of the current KMIC programme. Thus, measures should be taken to counteract such undesirability.
This
is
because a health insurance programme can be justified and maintained if and when it is able to satisfy the essential medical need of the lower income class.
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KEYWORD
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