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KMID : 1124020160320020135
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Korean Social Security Studies
2016 Volume.32 No. 2 p.135 ~ p.164
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A Study on Effectiveness of Out-of-Pocket Maximum in the National Health Insurance
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Yoo Hye-Rim
Kim Jin-Soo
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Abstract
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Out-of-Pocket Maximum in the National Health Insurance is a institutional device to maximize positive aspects of cost-sharing and minimize negative effects of pay system related to in cash benefit. Out-of-Pocket Maximum has a limit that do not effects on uninsured benefit. Nevertheless, it is necessary to improve the role of social security by preventing poverty transition or restricting health care utilization. In this aspect, the differentiation of Out-of-Pocket Maximum by income level in 2009 has important meaning on national health insurance system. However, there was no preceding research. This study analysis statistical findings as follows. First, in spite of differentiation by income level in Out-of-Pocket Maximum, the increasement rate of cost-sharing is ascending. In addition, the real coverage is too small range so the system has limitation to perform the institutional goals. Moreover, the differentiation by seven grades in 2014 made just a slight increase in policy target comparing to previous three grades. As a result, the current system is just a nominal system. Meanwhile, setting the upper limit should consider catastrophic health expenditure based on personal income status. Therefore, it is necessary to improve the system of Out-of-Pocket Maximum to perform a substantially policy objectives in national health system.
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KEYWORD
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national health insurance, out-of-pocket maximum, differentiation by income level, improvement effect
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