背景:韩国的国民健康保险(NHI)系统追求全民健康覆盖,但由于覆盖范围有限和自付费用比例很高,它未能减轻患者的经济负担。2017年,政府宣布了一项计划,通过覆盖所有未包含的服务来加强普遍性,扩大覆盖范围,减轻家庭经济负担。我们旨在评估“月球护理”的效果,重点是政策实施后卫生支出的变化,并为未来加强NHI系统普遍性的政策提供经验证据。
方法:使用2016年和2018年韩国卫生小组(KHP)的数据,我们建立了受政策影响的治疗组和未受影响的对照组;我们使用倾向评分匹配(PSM)确保了组间的同质性.随后,我们检查了NHI付款的变化,不付款,和自付支付(OOP);我们进行了差异分析(DID)来评估政策的效果。
结果:在政策实施之后,对照组在所有类别的卫生支出中都比治疗组有更高的增长,包括NHI付款,不付款,OOP。在比较政策实施前后的差异时,我们注意到所有三类卫生支出均显着下降,以及治疗组和对照组之间。然而,我们见证了交互项的显著减少,这证实了政策的效果,但仅限于不付款。
结论:我们观察到政策的干预效果随着时间的推移而减少,关于支付承保医疗服务报酬的有效性。然而,该政策不适用于NHI付款和OOP,暗示其未能控制新的非承保服务的创建,因为非承保服务已转换为承保服务。因此,关于将非承保服务纳入NHI福利计划,讨论健康保险的财政支出至关重要。
BACKGROUND: South Korea\'s National Health Insurance (NHI) system pursues universal health coverage, but it has not been able to alleviate patients\' financial burden owing to limited coverage and a high proportion of out-of-pocket expenses. In 2017, the government announced a plan to strengthen universality by providing coverage for all unincluded services, expanding coverage, and alleviating household financial burden. We aimed to evaluate the effect of \"Moon Care\" with a focus on changes in health expenditures following policy implementation, and to provide empirical evidence for future policies to strengthen the NHI system\'s universality.
METHODS: Using data from the 2016 and 2018 Korea Health Panel (KHP), we established a treatment group affected by the policy and an unaffected control group; we ensured homogeneity between the groups using propensity score matching (PSM). Subsequently, we examined changes in NHI payments, non-payments, and out-of-pocket payments (OOP); we performed difference-in-differences (DID) analysis to evaluate the policy\'s effect.
RESULTS: Following policy implementation, the control group had a higher increase than the treatment group in all categories of health expenditures, including NHI payments, non-payments, and OOP. We noted significant decreases in all three categories of health expenditures when comparing the differences before and after policy implementation, as well as between the treatment and control groups. However, we witnessed a significant decrease in the interaction term, which confirms the policy\'s effect, but only for non-payments.
CONCLUSIONS: We observed the policy\'s intervention effect over time as a decrease in non-payments, on the effectivity of remunerating covered medical services. However, the policy did not work for NHI payments and OOP, suggesting that it failed to control the creation of new non-covered services as noncovered services were converted into covered ones. Thus, it is crucial to discuss the financial spending of health insurance regarding the inclusion of non-covered services in the NHI benefits package.