Having Private Cancer Insurance in Korea: Gender Differences

European Journal of Cancer Care, 2018

Cancer is a disease that poses a great burden not only on the patients and their families but also in terms of socioeconomic aspects. As of 2013, the incidence of cancer in Korea was 445.7 per 100,000 persons, and if Koreans live to the average lifespan, they appear to have a 36.6% chance of getting cancer. Mortality due to cancer is 150.8 per 100,000 persons as of 2015, which takes up the biggest portion (27.9%) of the cause of death. In addition, health insurance medical expenditure for cancer in 2015 was 4.9 trillion KRW, which is 8.5% of total health insurance medical expenditures. The government consistently implemented the insurance guarantee reinforcement policy to protect patients with cancer financially and focused on increasing coverage by switching nonpayment items to payment items. However, the health insurance coverage for beneficiaries of the special benefit system for patients with cancer is 72.6%, which indicates that patients cover at least 1/4 of the total health expenditures through out-of-pocket payments, and nonpayment out-ofpocket fees is approximately 20% of total health expenditures. As such, cancers result in a great burden of health expenditures and have a significant impact on household income (Berkowitz & Johnson, 1974). The concept of catastrophic health expenditure (CHE) is a typical indicator that measures households' economic burden. CHE occurs if the household's health expenditure compared to its economic capacity (ability to pay) exceeds a certain threshold (Wyszewianski, 1986; Xu et al., 2003). This concept measures the economic burden and loss due to health expenditures, and researchers use it to indirectly evaluate the health security system in terms of its

Journal of Korean medical science, 2018

To better understand cancer-related health behaviors, it is critical to know how general populations with different socioeconomic and demographic backgrounds perceive cancer. The current paper explored differences in general attitudes and beliefs towards cancer among Koreans. A cross-sectional national survey was conducted for 1,000 Korean participants who were not cancer patients and did not have immediate family members with cancer via proportional quota random sampling. General attitudes and beliefs about cancer were measured by face-to-face interview using the awareness and beliefs about cancer (ABC) measure. Most respondents (84.8%-88.5%) had optimistic attitudes towards cancer. However, 35.6% to 87.7% agreed with negative cancer beliefs across all age groups simultaneously. Socioeconomic disparity of positive cancer beliefs was not evident. Unexpectedly, the highest income group agreed more strongly with the negatively framed statements that cancer treatment is worse than the ...

Asian Pacific Journal of Cancer Prevention, 2014

Background: Cancer imposes significant economic challenges for individuals, families, and society. Households of cancer patients often experience income loss due to change in job status and/or excessive medical expenses. Thus, we examined whether changes in economic status for such households is affected by catastrophic health expenditures. Materials and Methods: We used the Korea Health Panel Survey (KHPS) Panel 1 st-4 th (2008-2011 subjects) data and extracted records from 211 out of 5,332 households in the database for this study. To identify factors associated with catastrophic health expenditures and, in particular, to examine the relationship between change in economic status and catastrophic health expenditures, we conducted a generalized linear model analysis. Results: Among 211 households with cancer patients, 84 (39.8%) experienced catastrophic health expenditures, while 127 (40.2%) did not show evidence of catastrophic medical costs. If a change in economic status results from a change in job status for head of household (job loss), these households are more likely to incur catastrophic health expenditure than households who have not experienced a change in job status (odds ratios (ORs)=2.17, 2.63, respectively). A comparison between households with a newly-diagnosed patient versus households with patients having lived with cancer for one or two years, showed the longer patients had cancer, the more likely their households incurred catastrophic medical costs (OR=1.78, 1.36, respectively). Conclusions: Change in economic status of households in which the cancer patient was the head of household was associated with a greater likelihood that the household would incur catastrophic health costs. It is imperative that the Korean government connect health and labor policies in order to develop economic programs to assist households with cancer patients.

Preventive Medicine, 2000

Amid current changes in health care access across the United States, the importance of health insurance status and insurance type relative to demographic, actual, and perceived health variables as determinants of screening for breast, colorectal, and cervical cancer is uncertain. This analysis evaluates the hypothesis that health insurance independently predicts cancer screening in the Women's Health Initia tive Observational Study cohort. Questionnaire data from 55,278 women en rolled in the Women's Health Initiative Observational Study between September 1994 and February 1997 were analyzed by multiple logistic regression to identify predictors of self-reported mammography within 2 years, Pap smear within 3 years, and stool guaiac or flexible sigmoidoscopy within 5 years. Positive determinants of reporting cancer screening were age, ethnic origin, household income, educational level, family history of cancer, having a usual care provider, time since last provider visit, and insurance status and type. Smoking, diabetes, and, among older women, prior cardiovascular events were negative determinants of cancer screening. Among women younger than 65, lacking health insurance or having fee-for-service insurance was strongly associated with failure to report cancer screening, independently of having or using a usual care provider and of demographics, self-perceived health, and health characteristics. Among women 65 and older, those with Medicare alone were less likely, whereas those with Medicare + prepaid insurance were more likely, to report cancer screening. In the Women's Health Initiative Obser vational Study, a large, diverse group of older women, health insurance type and status were among the most important determinants of cancer screening indepen dent of demographics, chronic health conditions, and self-perceived health characteristics.

Cancer, 2017

Out-of-pocket expenditures are thought to be an important barrier to the receipt of cancer preventive services, especially for those of a lower socioeconomic status (SES). The Affordable Care Act (ACA) eliminated out-of-pocket expenditures for recommended services, including mammography and colonoscopy. The objective of this study was to determine changes in the uptake of mammography and colonoscopy among fee-for-service Medicare beneficiaries before and after ACA implementation. Using Medicare claims data, this study identified women who were 70 years old or older and had not undergone mammography in the previous 2 years and men and women who were 70 years old or older, were at increased risk for colorectal cancer, and had not undergone colonoscopy in the past 5 years. The receipt of procedures in the 2-year period before the ACA's implementation (2009-2010) and after its implementation (2011 to September 2012) was also identified. Multivariate generalized estimating equation m...

Environmental Health, 2011

This paper provides a synthesis on socioeconomic inequalities in cancer incidence, mortality and survival across countries and within countries, with particular focus on the Italian context; the paper also describes the underlying mechanisms documented for cancer incidence, and reports some remarks on policies to tackle inequalities. From a worldwide perspective, the burden of cancer appears to be particularly increasing in developing countries, where many cancers with a poor prognosis (liver, stomach and oesophagus) are much more common than in richer countries. As in the case of incidence and mortality, also in cancer survival we observe a great variability across countries. Different studies have suggested a possible impact of health care on the social gradients in cancer survival, even in countries with a National Health System providing equitable access to care. In developed countries, there is increasing awareness of social inequalities as an important public health issue; as a consequence, there is a variety of strategies and policies being implemented throughout Europe. However, recent reviews emphasize that present knowledge on effectiveness of policies and interventions on health inequalities is not sufficient to offer a robust and evidence-based guide to the choice and design of interventions, and that more evaluation studies are needed. The large disparities in health that we can measure within and between countries represent a challenge to the world; social health inequalities are avoidable, and their reduction therefore represents an achievable goal and an ethical imperative.

2009

This paper summarizes key literature on the relationship between health care insurance status and screening, diagnosis, and medical care patterns and outcomes for individuals with cancer. All studies included for this literature synthesis were identified using the National Library of Medicine's Medline database; only English language articles published in the past 10 years were considered. Based on article titles and abstracts, we selected the most relevant studies for full review and inclusion in this manuscript. Although the summarized literature is mixed, individuals who are uninsured or have insurance coverage through programs for low-income persons (e.g., Medicaid coverage) are significantly less likely to use cancer screening services and significantly more likely to present with advanced stage cancer at diagnosis and to have significantly worse survival. The relationship between insurance status and cancer treatment patterns is less clear, as fewer studies have examined t...

Tohoku Journal of Experimental Medicine, 2009

Social health insurance (SHI) has covered only 60% of healthcare payments in Korea; therefore, Koreans rely upon supplementary private health insurance (SPHI) to cover the rest of the payments. SPHI status is assumed to affect clinical treatment and outcome of patients with stomach cancer, which is the most prevalent cancer among Koreans. This study examined the relationships between SPHI and diagnosis, treatment, utilization, and survival among stomach cancer patients. Patients (n = 3,780) who underwent a radical gastrectomy from 2000 to 2003 were examined retrospectively. The mean age of all patients was 58 years, and 1,377 patients (36%) had one or more SPHI plan. Univariate analysis was used to examine differences between SPHI and non-SPHI patients in terms of demographic, socioeconomic, and clinical characteristics, followed by a multiple analysis with adjustment for the above parameters. SPHI patients were 5% more likely to visit a physician (p < 0.001) and were 0.8 times less likely to die (p = 0.03) than non-SPHI patients. In contrast, no difference was observed between the two groups in the stage of cancer at diagnosis, which may reflect the fact that the majority of Korean SPHI plans do not cover cancer screening services. Moreover, no significant difference was detected in the use of adjuvant therapy between groups, because it was covered by SHI. In conclusion, SPHI is a determinant of healthcare utilization and survival among stomach cancer patients. It is necessary for health policymakers to consider the benefits of SPHI in financing healthcare services. ──── Diagnosis; Stomach Cancer; Supplementary

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014

The purpose of this study was to determine the association of insurance status with disease stage at presentation, treatment, and survival among the top 10 most deadly cancers using the SEER database. A total of 473,722 patients age 18 to 64 years who were diagnosed with one of the 10 most deadly cancers in the SEER database from 2007 to 2010 were analyzed. A Cox proportional hazards model was used for multivariable analyses to assess the effect of patient and tumor characteristics on cause-specific death. Overall, patients with non-Medicaid insurance were less likely to present with distant disease (16.9%) than those with Medicaid coverage (29.1%) or without insurance coverage (34.7%; P &lt; .001). Patients with non-Medicaid insurance were more likely to receive cancer-directed surgery and/or radiation therapy (79.6%) compared with those with Medicaid coverage (67.9%) or without insurance coverage (62.1%; P &lt; .001). In a Cox regression that adjusted for age, race, sex, marital s...

BMC Public Health, 2009

Background: Cancer survival has been observed to be poorer in low socioeconomic groups, but the knowledge about the underlying causal factors is limited. The purpose of this study was to examine how cancer survival varies by socioeconomic status (SES) among women in Norway, and to identify factors that explain this variation. SES was measured by years of education and gross household income, respectively.