한국의료패널자료 성향점수매칭 후 민간의료보험이 의료이용에 미치는 영향 = The Impact of Private Health Insurance on Healthcare Utilization : A Propensity Score Matching Analysis of Korea Health Panel Survey 2019-2023

다국어 초록 (Multilingual Abstract)

This study analyzed the impact of private health insurance on healthcare utilization
and medical expenditure using the Korea Health Panel Survey Wave 2 (2019-2023).
Through propensity score matching for age, sex, education, household income, and
household size, we examined 1,251 individuals (417 per group): those with Indemnity
Health Insurance group, Fixed Amount Health Insurance group, and the Person without
PRIVETE HEALTH insurance group.
Results showed that private insurance differentially affects healthcare services
based on coverage status and out-of-pocket payment levels. Indemnity insurance
holders utilized non-covered services like manual therapy 2-3 times more than the
uninsured (p<0.001). Significant differences were also observed in high-cost services
including MRI/CT and dental implants (p=0.022, p=0.017), while no differences existed
in low-cost basic services like vaccinations.
Private insurance demonstrated both positive and negative effects. Positive effects
included 15-18 percentage points higher screening participation rates (p<0.001) and
2.6 times higher polyp detection rates (16.8% vs 6.5%, p<0.001), indicating benefits
in preventive care and early disease detection. Treatment rates after disease
detection showed no differences (p=0.532). Negative effects included potential
overutilization of manual and physical therapy. Indemnity insurance holders spent
1.05 million won more in out-of-pocket costs and 430,000 won more in non-covered
expenses over five years (p<0.001, p=0.012), suggesting moral hazard.
Policy implications include: strengthening regulations on non-covered services to
curb moral hazard, continuously enhancing National Health Insurance coverage,
promoting screening among vulnerable populations to prevent health inequalities, and
implementing differential regulatory strategies to maximize benefits while minimizing
adverse effects.
This study provides rigorous analysis of private insurance effects through
propensity score matching and five-year data integration, offering balanced
evaluation of both benefits and drawbacks. The findings provide empirical evidence
for healthcare system reforms aimed at strengthening National Health Insurance
coverage and regulating Private Health Hnsurance.
Keywords: Private Health Insurance, Indemnity Health Insurance, Fixed Amount Health
Insurance, Healthcare utilization, Medical expenditure, Propensity score matching,
Korea Health Panel Survey

목차 (Table of Contents)

• Ⅰ. 서론 1
• 1. 연구배경 및 필요성 1
• 2. 연구목적 7
• Ⅱ. 연구대상 및 방법 8
• 1. 연구 대상 8
• 2. 변수 정의 14
• 3. 분석방법 19
• Ⅲ. 연구결과 21
• 1. 성향점수매칭에 의한 연구 대상자의 특성 21
• 1.1 성향점수매칭 전-후 연구 대상자의 일반적 특성 21
• 1.2 성향점수매칭 후 균형성 평가 24
• 1.3 성향점수 매칭 후 대상자의 의료 이용의 필요 요인 비교 28
• 2. 민간의료보험 가입형태에 따른 의료서비스 이용 32
• 2.1 응급입원외래 의료서비스 이용 32
• 2.2 의과치과한방 외래 의료서비스 이용 34
• 2.3 의과 외래진료 이용 양상 및 집단 간 차이 36
• 2.4 치과 외래진료 이용 양상 및 집단 간 차이 39
• 2.5 한방 외래진료 이용 양상 및 집단 간 차이 43
• 3. 민간의료보험 가입형태에 따른 건강검진 이용 46
• 3.1 건강검진 이용 현황 및 집단 간 차이 46
• 3.2 건강검진 질병발견 및 집단 간 차이 48
• 4. 민간의료보험 가입형태에 따른 의료비 지출 추정 51
• 4.1 민간보험 가입에 따른 외래 의료비 지출 추정 51
• 4.2 민간보험 가입에 따른 입원 의료비 지출 추정 53
• Ⅳ. 고찰 55
• Ⅴ. 요약 및 결론 65
• 참고문헌 67
• 영문초록 72