Out-of-pocket healthcare spending by the poor and chronically ill in the Republic of Korea

Am J Public Health. 2007 May;97(5):804-11. doi: 10.2105/AJPH.2005.080184. Epub 2007 Mar 29.


Objectives: We estimated out-of-pocket health care spending and out-of-pocket spending burden ratio employing household equivalent income in the Republic of Korea. We examined variations in out-of-pocket spending, estimated out-of-pocket spending burden ratio employing household equivalent income, and identified factors associated with out-of-pocket spending.

Methods: We used the 1998 Korean National Health and Nutrition Survey, a nationally representative survey of 39,060 individuals. Our analyses examined out-of-pocket spending, out-of-pocket spending burden ratio, and health care use by socioeconomic status, insurance type, health care facility type, and chronic condition after we controlled for sociodemographic variables.

Results: The lowest income quintile spent 12.5% of their total income out-of-pocket on medical expenditures, which was 6 times that of the highest income quintile (2%). Among those with 3 or more chronic conditions, low-income Koreans had the highest out-of-pocket spending burden ratio (20%), which was 5 times the spending burden among high-income Koreans (4%). In multivariate analyses, the number of chronic conditions, insurance type, health care use, and health care facility type were associated with out-of-pocket spending.

Conclusions: Out-of-pocket spending in Korea is regressive, because lower-income groups pay disproportionately more of their income compared with higher-income groups. Low-income individuals with multiple chronic conditions are particularly vulnerable.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Chronic Disease / economics
  • Chronic Disease / epidemiology
  • Cost of Illness
  • Female
  • Financing, Personal*
  • Health Care Surveys
  • Health Expenditures / statistics & numerical data*
  • Health Services / statistics & numerical data
  • Humans
  • Income*
  • Infant
  • Insurance Coverage
  • Korea
  • Male
  • Middle Aged
  • Poverty
  • Social Class