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KMID : 1124020140300040171
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Korean Social Security Studies
2014 Volume.30 No. 4 p.171 ~ p.193
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A Study identifying the factors determining private health insurance claims pa
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Lee Hyun-Boc
Hwang Youn-Hee
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Abstract
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This study was conducted both by cross-section and panel analysis to identify the factors determining private health insurance(PHI) claims paid using the data of the 2008~2011 Korea Health Panel(KHP). As a result, the factors of calculating the ratio of risk or PHI premiums such as age, sex, disease, inpatient utilization also affected the PHI claims paid. However smoking and drinking were not affects to the PHI claim paid. The people purchasing multiple PHIs, paying high levels of PHI premium, or having both fee-for service PHI and fixed-amount PHI have a high probability of over using medical facilities which is shown by the higher number of insurance claims and high levels of PHI claim payments. This research implication is needed for future management plans concerning consumers with multiple private health insurances, consumers with PHI premiums which entail over than able to pay premium, level income, double purchasing fee-for-service health insurance and fixed-amount PHI.
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KEYWORD
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private health insurance, PHI, the factors determining PHI claims paid, panel analysis
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