4대 중증질환 가구에서 민간의료보험과 소득의 상호작용이 재난적 의료비에 미치는 영향

Background: Citizens enroll in private health insurance (PHI) to reduce the financial burden of uncovered medical expenses, considering both their economic capacity and the limitations of the public health system. This study aims to analyze the comprehensive interaction between PHI enrollment and income and its impact on catastrophic health expenditure (CHE) that exceed individuals’ financial capacity. Methods: Using data from the first wave of the Korea Health Panel (2014–2018), this study analyzed 8,452 observations from 3,558 households with four severe diseases (cancer, cerebrovascular disease, cardiovascular disease, or rare intractable diseases). A two-part model (Part 1: logit model, Part 2: generalized estimating equations) was employed to account for the incidence and intensity of CHE. Control variables were based on Andersen’s behavioral model, including predisposing factors (gender, age, education, household size, region), enabling factors (type of health coverage, employment status), and need factors (subjective health status, disability, chronic disease prevalence). Results: PHI enrollment reduced the incidence of CHE across all income groups. However, in low-income households, enrollment in all types of PHI (fixed-benefit, supplementary, or mixed) increased CHE intensity. In contrast, enrollment in fixed-benefit and supplementary PHI in middle- and high-income households reduced intensity, while mixed-type enrollment increased it. There was no significant difference in intensity between one or two plans and three or more plans. Conclusion: PHI enrollment does not significantly reduce the financial burden on households, and excessive enrollment has minimal benefits. The government should implement policies to ensure the effective use of PHI and provide support to low-income groups excluded from PHI benefits.