재난적 의료비 예방을 위한 포괄적 의료비 상한제: 비용 추계를 통한 적용 가능성을 중심으로

초록

The low benefit coverage rate of South Korea’s health security system can cause catastrophic health expenditure, and catastrophic health expenditure can be the cause of impoverishment. This study was conducted to ascertain the applicability of the comprehensive health expenditure ceiling system to prevent catastrophic health expenditure and impoverishment using cost estimation. The applicability was ascertained by analysis on data from the Korea Health Panel, 2011. Catastrophic health expenditure was defined as equal to or exceeding the thresholds (10%, 20%, 30%, and 40%) of the household’s capacity to pay. Ceiling limits of health expenditures were estimated by income groups, and the additional costs were also estimated. 5.9 - 23.7% of the households are facing catastrophic health expenditure. The estimated ceiling limits of the comprehensive health expenditure ceiling system were 0.0–2.9 (T/y≥10%), 0.0–6.1 (T/y≥20%), 0.0–11.0 (T/y≥30%), and 0.0–17.0 million won (T/y≥40%). The estimated additional costs were 15.9–26.3 (T/y≥10%), 11.9–19.7 (T/y≥20%), 9.3–15.4 (T/y≥30%), and 7.8–12.8 trillion won (T/y≥40%). The additional costs were estimated to 18.0-60.6% of total private health insurance premiums. There is a need for application of the comprehensive health expenditure ceiling system to prevent catastrophic health expenditure and impoverishment.

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