중·고령자 가구의 과부담 의료비 발생의 결정요인에 관한 연구

Despite the Korea’s achievement of the universal health coverage, there have been a number of households experiencing catastrophic and impoverishing health spending. Since Korea has one of the fastest aging populations in the world, it is one of the critical issues that the middle- and old-aged may not be well-prepared to finance needed health services. Although people with chronic conditions were shown to have a higher chance to experience catastrophic health expenditure(CHE), there have been only few studies related specific chronic diseases leading to CHE in middle- and old-aged households. Therefore, the aim of this study is to determine the impact of certain conditions middle- and old-aged households have on occurrence of CHE and find the differences between the two groups. This study used data from the Korea Welfare Panel Study conducted in 2012. We defined catastrophic expenditure if a household’s health expenditure is equal or greater than 20% of income remaining after subsistence needs have been met. The samples are divided into two groups based on the age of household head. Specifically, the middle-aged group is referred to those who are aged 45-64 and the old-aged group is 65 years or older. The results are presented by descriptive and logistic regression analysis. The results of this study showed notable differences between two groups in terms of variables affecting the occurrence of CHE. The old-aged households may experience catastrophic expenditure if they are in low-income, have no private health insurance, and have heart disease or diabetes. However, the middle-aged households are not affected by those factors except the marital status of a household head, which has an opposite effect to CHE. The common conditions which affect the CHE in both groups were education level, occupation and subjective health status of a household head, the number of household members, type of health coverage, long-term care insurance, chronic disease and cancer. People particularly in old-aged households are more needed in not only health services but also financial protection from CHE. Also, middle-aged households have distinctive characteristics and will be the largest old generation in 10 years. Therefore, health policy makers may be recognize the difference between those two groups and develop not only health policies but also a variety of health programs which may help people with chronic diseases to have better health conditions in order to keep them from facing CHE.