Research Article: Association between supplementary private health insurance and visits to physician offices versus hospital outpatient departments among adults with diabetes in the universal public insurance system

Date Published: April 13, 2018

Publisher: Public Library of Science

Author(s): Chang Hoon You, Ji Heon Choi, Sungwook Kang, Eun-Hwan Oh, Young Dae Kwon, Iratxe Puebla.


Diabetes mellitus is a chronic disease with a high prevalence across the world as well as in South Korea. Most cases of diabetes can be adequately managed at physician offices, but many diabetes patients receive outpatient care at hospitals. This study examines the relationship between supplementary private health insurance (SPHI) ownership and the use of hospitals among diabetes outpatients within the universal public health insurance scheme.

Data from the 2011 Korea Health Panel, a nationally representative sample of Korean individuals, was used. For the study, 6,379 visits for diabetes care were selected while controlling for clustered errors. Multiple logistic regression models were used to examine determinants of hospital outpatient services.

This study demonstrated that the variables of self-rated health status, comorbidity, unmet need, and alcohol consumption significantly correlated with the choice to use a hospital services. Patients with SPHI were more likely to use medical services at hospitals by 1.71 times (95% CI 1.068–2.740, P = 0.026) compared to patients without SPHI.

It was confirmed that diabetic patients insured by SPHI had more use of hospital services than those who were not insured. People insured by SPHI seem to be more likely to use hospital services because SPHI lightens the economic burden of care.

Partial Text

Diabetes mellitus is a chronic disease with a high prevalence across the world. In South Korea, the prevalence rate of diabetes among adults aged 30 or over is 8.03% in 2013 [1], and the incidence is on the rise. As of 2013, diabetes is the fifth main cause of death in South Korea. Because diabetes causes a high socioeconomic burden, the importance of early diagnosis and continuous optimal management is becoming more widely understood. Most diabetes patients, except for those with serious cases or complications, can be managed at physician offices, which maximizes the efficiency of healthcare resources [2]. Therefore, since 2011, the South Korean government has been implementing a system that increases a patient’s coinsurance payment for pharmaceuticals when the patient uses a hospital for outpatient care for any of 52 illnesses, including diabetes, which can be suitably treated at primary healthcare facilities. It has been reported that the implementation of this system has somewhat mitigated the influx of patients with minor illnesses at hospitals [3]. Along with this, in 2012, the South Korean government has been implementing a system that encourages the use of physician offices for diabetes care by reducing the patient’s copayment and offering various support services.

We analyzed data from 6,379 visits following our sample criteria. Table 1 presents the characteristics of all visits according SPHI status in 2011. About 45.5% of the 6,379 visits were covered by an SPHI. We found a significant difference between males and females in SPHI status. Respondents with SPHI were younger, more highly educated, and had higher incomes than their counterparts without SPHI. The non-SPHI insured evaluated themselves as less healthy than did the privately insured respondents. With regard to health-related behaviors, the proportion of non-SPHI insured who did not exercise regularly was lower than that among the privately insured. Regarding selection of medical provider for diabetes care, 85.8% of the non-SPHI insured visited a physician office compared to 79.3% of the SPHI insured (Table 1).

This study demonstrated that SPHI ownership was related to diabetes patients’ use of hospital outpatient departments. Specifically, diabetes patients insured by SPHI were 1.711 times more likely than non-SPHI insured patients to choose hospitals over physician offices for outpatient care. Despite the fact that diabetes is a chronic disease that can be managed appropriately at physician offices, and that it is more efficient to manage it at the primary level of the healthcare system, many patients use a higher-level of medical institution for outpatient care.




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