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KMID : 1170320230290020035
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Korean Journal of Health Economics and Policy
2023 Volume.29 No. 2 p.35 ~ p.53
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Financial Estimation to Adjusting Out-of-Pocket Maximum Rules to Reduce Burden of health expenditure in Children and Adolescents
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Gu Yeo-Jeong
Choe Eun-Hee
Lim SeungJi
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Abstract
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Limited coverage of the current National Health Insurance(NHI) cost-sharing for children and adolescents separate standards by age, disease, or medical service types, so need to adjust the system for them. Some European countries apply differential co-payment ceilings on various criteria such as age, income, and types of diseases or medical utilization, whereas the co-payment ceiling in Korea only varies across income groups, with limited consideration of medical utilization by age or diseases. This study aimed to suggest strategies to reinforce the medical security of the population under age 18 by examining the out-of-pocket maximum rules of the NHI, using NHI Claim data and Medical Cost Survey on NHI Patients from 2020. Based on this co-payment ceiling, it was expected that the number of benefited children and adolescents would considerably increase by 318%, while health finance would need an additional 45.4 billion KRW. The results demonstrate that 100 million KRW cap of co-payment for children and adolescents is effective to relieve the burden of medical expenses on households with children and adolescents.
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KEYWORD
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Out-of-Pocket Maximum, Burden of health expenditure, health expenditure in Children and Adolescents, health insurance coverage
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