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Pediatric Health Access and Private Medical Insurance: Based on the Ecology of Medical Care in Korea
Dong-Hee Ryu1, Yong-Jun Choi2,3, Jeehye Lee4
1Department of Preventive Medicine, Daegu Catholic University School of Medicine, Daegu 42472, Korea.
Insights
Children with private medical insurance are more likely to use clinic services. This highlights the need for balanced national health insurance and private medical insurance regulation for pediatric health access.
Area of Science:
- Health Services Research
- Pediatric Health
- Health Insurance Policy
Background:
- Pediatric health access is influenced by the interplay between national health insurance (NHI) and private medical insurance (PMI).
- Understanding the utilization patterns of medical care among children and adolescents is crucial for effective healthcare system management.
Purpose of the Study:
- To investigate pediatric health access by describing the medical care utilization patterns of children and adolescents.
- To analyze the impact of private medical insurance on healthcare-seeking behaviors within a mixed insurance environment.
Main Methods:
- Utilized data from 2746 individuals aged 18 and younger.
- Employed generalized estimating equation models for multivariate analysis, adjusting for demographic and clinical factors.
- Examined monthly healthcare utilization, including clinic visits, outpatient departments, and inpatient care.
Main Results:
- 87.3% of participants had private medical insurance.
- Children with private medical insurance were significantly more likely to receive ambulatory care services in clinics (aOR = 1.16).
- Indemnity and single policyholders showed increased likelihood of utilizing clinic-based ambulatory care.
Conclusions:
- Private medical insurance is associated with higher utilization of ambulatory care services in clinics among pediatric populations.
- Continuous regulation and management of private medical insurance are essential for national health insurance schemes.
- Recommendations include reviewing compensation measures, NHI reimbursement standards, and consumer perspectives on dual insurance systems.
Abstract:
This study aimed to investigate pediatric health access by describing the ecology of medical care for children and adolescents in a medical environment where a well-balanced system between national health insurance (NHI) and private medical insurance (PMI) is required. Data from 2746 individuals aged 18 years old and younger were used. Of the participants, 87.3% had private medical insurance. Of the 1000 children, in an average month, 404 visited a clinic, 67 visited a hospital outpatient department (OPD), 49 visited an OPD in a tertiary hospital, 11 received emergency care, 5 received inpatient care in a hospital, and 9 were hospitalized. The generalized estimating equation models adjusted for age, sex, economic status, and pediatric comorbidity index were used for multivariate analysis. Receiving ambulatory care services in clinics was significantly more likely among children and adolescents with private medical insurance (adjusted odds ratio [aOR] = 1.16 [95% confidence interval [CI]: 1.00-1.35]). Receiving ambulatory care services in clinics was significantly more likely among indemnity type policyholders (aOR = 1.23 [1.05-1.45]) and single policyholders (aOR = 1.18 [1.00-1.37]). Countries with national health insurance schemes should continuously practice the proper regulation and management of PMI, including reviewing PMI compensation measures, NHI reimbursement standards, and consumers' perspectives on NHI and PMI.
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