The Impact of Private Health Insurance on Healthcare Utilization : Empirical Study of Moral Hazard in Private Health Insurance = 민간의료보험이 의료이용에 미치는 영향: 민간의료보험의 도덕적 해이에 대한 실증 연구

국문 초록 (Abstract)

Background: 우리나라의 국민건강보험은 단기간 내에 전국민건강보험을 달성했다는 점에서 성공적이란 평가를 받고 있지만, 저부담-저급여 정책으로 인하여 보장성의 수준이 낮아 의료서비스 이용에 장벽이 되고 있다. 이와 같은 공보험의 낮은 보장성으로 이용자들은 가계의 경제적 부담을 덜기 위하여 민간의료보험에 가입하고 있으며, 통계청 발표에 따르면 204년 기준 80.4%가 넘는 가구가 민간의료보험에 가입하고 있다. 민간의료보험의 문제점 중 하나는 도덕적 해이로 인한 의료이용의 증가이다. 민간의료보험 가입여부가 아닌 민간의료보험료에 의한 도덕적 해이에 관한 연구는 아직 부족한 실정이다.

Objective: 민간의료보험료 관련 요인들을 분석하고, 민간의료보험료와 의료이용의 연관성을 파악한다.

Method: 한국의료패널 2012년도와 2013년도 자료를 이용하였으며, 연구대상자는 6,628명이다. 첫 번째 분석에서 민간의료보험료 관련 요인들에 대하여 경제적 요인, 건강관련 요인, 인구·사회학적 요인을 독립변수로 선형회귀분석을 실시하였다. 두 번째 분석에서 민간의료보험료와 의료이용의 관련성을 파악하기 위하여 Two part model을 이용하였다. 첫 번째 파트에서는 입원과 외래 이용여부에 대하여 로지스틱 회귀분석을, 두 번째 파타에서는 입원(일수, 총 본인부담금액, 법정본인부담금액, 비급여진료비), 외래(방문횟수, 총 본인부담금액, 법정본인부담금액, 비급여진료비)에 대하여 음이항 회귀분석과 로지스틱 회귀분석을 실시하였다.

Result: 민간의료보험료 관련 요인들에 대하여, 경제활동을 하지 않는 사람이 경제활동을 하는 사람에 비해 22% 더 적은 민간의료보험료를, 가구소득수준이 증가할수록 민간의료보험료는 8% 증가하였다. 장애를 가지고 있는 사람에 비해서 장애가 없는 사람이 보험료가 45% 더 많았다. 남성에 비해서 여성이 22% 보험료가 더 적었으며, 연령이 증가할수록 보험료는 1%씩 감소하였고, 배우자가 없는 사람이 있는 사람에 비해서 25% 더 적은 보험료를 냈다. 민간의료보험과 의료이용의 관련성 분석에 대해서, 민간의료보험료가 10% 증가할 때마다 입원 비급여는 4.9%, 외래 총 본인부담금액은 1.3%, 법정본인부담금액은 1.6% 증가하였다.

Conclusion: 경제활동과 가구소득 등 경제적 수준이 좋을수록 많은 보험료를 지불하는 보장성이 높은 민간의료보험 상품을 이용하고 있어 경제적 능력에 따라서 민간의료보험에 의한 보장 정도의 불평등이 발생하고 있음을 확인할 수 있다. 높은 수준의 지출을 요구하는 입원 비급여 의료비 지출에 대해서 민간의료보험료에 의한 도덕적 해이 현상이 발생하였다. 상대적으로 단기간에 필요한 금액은 더 적지만, 외래 이용은 의료수요에 대한 탄력성이 더 높기 때문에 수요자의 의료이용 의사결정이 더 크게 반영될 수 있다는 점에서 환자들이 직접 체감할 수 있는 외래 총 본인부담금액과 외래 법정본인부담금에서 도덕적 해이 현상이 발생하였다.

다국어 초록 (Multilingual Abstract)

Background: In Korea, the National Health Insurance is relatively successful in that it achieved the national health insurance in a short period of time. However, it is a barrier to the use of medical services because of low level of coverage due to low burden - low pay policy. In order to reduce the economic burden of households, people are buying private health insurance. According to the Statistics Korea, more than 80.4% of households are covered by private health insurance. One of the problems with private health insurance is the increase in medical use due to moral hazard. There is still a lack of research on moral hazard caused by private health insurance premiums, not whether they are covered by private health insurance.
Background: In Korea, the National Health Insurance is relatively successful in that it achieved the national health insurance in a short period of time. However, it is a barrier to the use of medical services because of low level of coverage due to low burden - low pay policy. In order to reduce the economic burden of households, people are buying private health insurance. According to the Statistics Korea, more than 80.4% of households are covered by private health insurance. One of the problems with private health insurance is the increase in medical use due to moral hazard. There is still a lack of research on moral hazard caused by private health insurance premiums, not whether they are covered by private health insurance.
Objective: Analyze the factors related to private health insurance premium and identify the relationship between private health insurance premium and healthcare utilization.

Method: Korea Health Panel data for 2012 and 2013 were used, and the study population were 6,628. In the first analysis, linear regression analysis was performed on economic, health related, socio-demographic factors as independent variables for the private health insurance premium related factors. In the second analysis, the two part model was used to determine the relevance of private health insurance premium to medical use. In the first part, logistic regression analysis was conducted on the inpatient and outpatient use. In the second part, inpatient(the number of days, the total expenditure, cost sharing, out of pocket), outpatient(total number of visits, the total expenditure, cost sharing, out of pocket) use were subjected to negative binomial regression analysis and logistic regression analysis.

Result: Private health insurance premium increased by 22% compared to those who did not do economic activities, and private health insurance premiums increased by 8% as household income level increased. Compared to people with disabilities, people without disabilities paid 45% more. Compared to men, women paid 22% less, and as the age increased, premiums decreased by 1% and 25% lower than those who had no spouses. Regarding the analysis of the relationship between private health insurance and medical use, the increase in private health insurance premium by 10% increased 4.9% for out of pocket of inpatient, 1.3% for total outpatient expenditure and 1.6% for cost sharing of outpatient.

Conclusion: It can be seen that inequality by private health insurance occurred according to economic ability because private health insurance product which has high guarantee to pay a lot of insurance premium was used as economic level such as economic activity and household income. There was a moral hazard phenomenon caused by private health insurance premium on the out of pocket for inpatient requiring high level of expenditure. outpatient total burden and cost sharing, patients can experience direct medical expenses, and because outpatient medical services are relatively more flexible than inpatient services, the moral hazard was occurred.

목차 (Table of Contents)

• Ⅰ. INTRODUCTION 1
• 1. Background 1
• 2. Research Question 5
• Ⅱ. LITERATURE REVIEW 6
• 1. Theoretical Study 6
• 2. Empirical Study 13
• 3. Conclusion 33
• Ⅲ. HYPOTHESIS AND RESEARCH MODEL 34
• 1. Hypothesis 34
• 2. Research Model 35
• Ⅳ. METHOD 36
• 1. Data Source and Study Population 36
• 2. Operational Definition and Measurement of Variables 38
• 3. Data Analysis Method 42
• 4. Ethical Consideration 46
• Ⅴ. RESULT 47
• 1. Trends of Private Health Insurance and Healthcare Utilization 47
• 2. Characteristics of Study Population 50
• 3. The Related Factors of Private Health Insurance Premium 56
• 4. The Impact of Private Health Insurance Premium on
• Healthcare Utilization 59
• Ⅵ. DISCUSSION 64
• 1. Summary of the Result 64
• 2. Implication of the Study 68
• 3. Limitation of the Study 70
• Ⅶ. CONCLUSION 72
• REFERENCE 74
• ABSTRACT 79