Document Type : Original Article
Authors
1
Department of Public Health Policy, Seoul Public Health Research Institute, Seoul Medical Center, Seoul, Republic of Korea
2
Department of Health Services Management, Daegu Haany University, Gyeongsan, Republic of Korea
3
Department of Humanities and Social Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
4
Catholic Institute for Public Health and Healthcare Management, The Catholic University of Korea, Seoul, Republic of Korea
Abstract
Background
Korea has experienced rapid growth in healthcare expenditure alongside increasing enrollment in indemnity-type private health insurance (PHI), which reduces out-of-pocket costs. Prior studies have shown higher utilization among PHI subscribers, but little is known about whether patients’ disclosure of PHI enrollment to providers is associated with outpatient utilization and whether this association differs between clinic- and hospital-level institutions.
Methods
Using nationally representative data from the 2023 Korea Health Panel, we analyzed 4948 adults enrolled in indemnity-type PHI. Disclosure was assessed by whether respondents reported informing any outpatient provider of their PHI enrollment during the past 12 months. Outcomes were outpatient visits and average out-of-pocket cost per visit. We used negative binomial regression for visit counts and a gamma generalized linear model with a log link for costs, overall and by institution type.
Results
Overall, 10.9% of respondents reported disclosing their PHI enrollment. Disclosure was associated with higher outpatient visit frequency (incidence rate ratio [IRR] = 1.157, 95% CI: 1.077–1.244), corresponding to approximately 15.7% more visits among disclosers than non-disclosers. It was also associated with higher average out-of-pocket cost per visit (coefficient = 0.145, 95% CI: 0.028–0.262), corresponding to approximately 15.6% higher per-visit out-of-pocket costs. At clinic-level institutions, disclosure was significantly associated with more visits and higher per-visit costs; no significant associations were observed at hospital-level institutions.
Conclusion
Patients’ disclosure of indemnity-type PHI enrollment is associated with higher outpatient visit frequency and per-visit out-of-pocket costs, particularly at clinic-level institutions. Insurance-status information may contribute to higher outpatient utilization in settings with strong fee-for-service incentives; however, these associations do not establish provider-induced demand.
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