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KMID : 1124020190350030001
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Korean Social Security Studies
2019 Volume.35 No. 3 p.1 ~ p.37
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A study on the equity in health care expenditure burden of disabled household in Korea: assessment of vertical and horizontal equity by using progressive index and redistribution index
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Lee Dong-Young
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Abstract
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This study aims to contribute basic data for the guarantee of the right to health of the disabled. To do this, the study took an approach in an aspect of burden equity, which takes into consideration the capacity to pay of the disabled household, and evaluated its pattern through the objective index. Based on the “Korean Health Panel(KHP) of 2015,” which is assessed to have a high fitness as analysis data, the study set income as a variable of the capacity to pay, and the health and medical expenditure(including the items such as tax, social insurance premium, private insurance premium, deductible expenditure, etc.) as a variable of burden. The study then analyzed the two following equity with a calculated index value and effect decomposition: 1) the vertical equity based on Kakwani progressivity index and 2) the horizontal equity based on Reynolds-Smolensky redistribution index. The analysis results show that in case of progressive index, tax was progressive(direct tax was progressive, indirect tax was regressive), social insurance and private insurance premium showed weak regression, and deductible expenditure represented strong regression, respectively. Moreover, the degree of regression of deductible expenditure was considerably high than that of ordinary households. In case of redistribution index, the relatively lower value than ordinary households was observed, and it is confirmed that health and medical expenditure had bad influence to income inequity. Meanwhile, when examining the existence and effect of horizontal inequity through effect decomposition of redistribution index, considerable significance was confirmed at indirect tax, social insurance premium, deductible expenditure items. Based on these results, to enhance the equity considered the characteristics of the disabled households, the study proposed expansion of public medical services such as adjustment of indirect tax structure and tax rate related to health and medical service, improvement of imposition system of health insurance premium, differential application of deductible expenditure for reduction of deductible burden, and systematization of family doctor system.
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KEYWORD
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the disabled household, health and medical expenditure burden, equity, Kakwani progressivity index, Reynolds-Smolensky redistribution index, vertical equity, horizontal equity
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