The effect of economic factors on private health insurance enrollment and dental care utilization

Sun Mi Kim; Hosung Shin

doi:10.11149/jkaoh.2015.39.3.161

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Kim and Shin: The effect of economic factors on private health insurance enrollment and dental care utilization

Original Article

J Korean Acad Oral Health 2015;39(3):161-167.

Published online: 12 September 2015

DOI: https://doi.org/10.11149/jkaoh.2015.39.3.161

The effect of economic factors on private health insurance enrollment and dental care utilization

Sun Mi Kim, Hosung Shin

Department of Social and Humanity in Dentistry, Wonkwang University School of Dentistry, Iksan, Korea

Corresponding Author: Hosung Shin Department of Social and Humanity in Dentistry, Wonkwang University School of Dentistry, 460 Iksan-dearo, Iksan 570-749, Korea Tel: +82-63-850-6995 Fax: +82-63-850-6934 E-mail: shinhosung@gmail.com

Received 16 April 2015 Revised 20 May 2015 Accepted 1 June 2015

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

The study aimed to examine and derive policy implications from the contribution of private health insurance towards the effectiveness and equity of dental care utilization.

Methods

The study used 2010-2011 Korea Health Panel data. We applied a two-stage probit least square (2SPLS) analysis method to 10,577 people who were aged 20 years and over and had outpatient health care utilization. Under the assumption that high demanders for dental outpatient health services try to subscribe and hold private health insurance, the study focuses on the changes in income and private health insurance status.

Results

The results of the descriptive statistics indicated that the number of employed enrolled in private health insurance increased as age decreased and income increased. Two-year consecutive non-enrollment of private health insurance was highest in the groups aged 65 years or above, those that had completed primary school or below, and those that belonged to the top income bracket. The highest rates of continued enrollment in private health insurance were observed in the top fifth income group (highest quintile) and those with a college degree. Income was observed to have an effect on private health insurance enrollment status and the frequency of dental care services used. The results of the analysis indicated that changes in private health insurance status did not affect the frequency of dental care services used, but the frequency of dental care services used had a significantly positive effect on continued enrollment in private health insurance.

Conclusions

To secure the right of health for citizens, it is necessary to establish measures that emphasize equity and strengthen benefit coverage of health insurance. Moreover, regulatory policies that support the low-income population are required.

Keywords: Delivery of health care, Dental care utilization, Private health insurance, Simultaneity

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Table 1.

Definition of operational variables

	Variables	Detail
Dependent variables	Private health insurance type of subscription status	Model 1 : Uninsured over 2 years(0), Insured over 2 years(1)
		Model 2 : Uninsured over 2 years(0), Cancellation/New(1)
	The visit number of dental care utilization for a year	The visit number of dental care utilization for a year
Independent variables	Gender	Male (1), Female (2)
	Age	20-45 years (1), 45-65 years (2), ≥65 years (3)
	Marital status	Married (1), Unmarried (2), Divorced/Widowed/Separated (3)
	Education level	≤Primary school (1), Middle school (2), High school (3), ≥College (4)
	Chronic disease	No (1), Yes (2)
	Household income quintile	1st quintile (1), 2nd quintile (2), 3rd quintile (3), 4th quintile (4), 5th quintile (5
	The change of income (2010-2011 years)	Difference variables

Table 2.

Sample characteristics (2010-2011)

Characteristics	Classification	2010 years		2011 years
Characteristics	Classification	Total outpatient (N=10,949)	Dental outpatient (N=2,579)	Total outpatient (N=10,577)	Dental outpatient (N=2,636)
		Frequency (%)	Frequency (%)	Frequency (%)	Frequency (%)
Gender	Male	4,712 (43.04)	1,097 (42.54)	4,558 (43.09)	1,132 (42.94)
	Female	6,237 (56.96)	1,482 (57.46)	6,019 (56.91)	1,504 (57.06)
Age	20-45 years	4,130 (37.72)	916 (35.52)	3,817 (36.09)	887 (33.65)
	45-65 years	4,108 (37.52)	1,070 (41.49)	3,980 (37.63)	1,078 (40.90)
	≥65 years	2,711 (24.76)	593 (22.99)	2,780 (26.28)	671 (25.46)
Marital status	Married	8,279 (75.61)	1,956 (75.84)	7,916 (74.84)	2,004 (76.02)
	Unmarried	1,250 (11.42)	316 (12.25)	1,239 (11.71	318 (12.06)
	Divorced/Widowed/Separated	1,420 (12.97)	307 (11.90)	1,422 (13.44)	314 (11.91)
Economic activity	Activity	6,381 (58.28)	1,497 (58.05)	6,141 (58.06)	1,523 (57.78)
	Non-activity	4,568 (41.72)	1,082 (41.95)	4,436 (41.94)	1,113 (42.22)
Education level	≤Primary school	2,741 (25.03)	598 (23.18)	2,630 (24.87)	581 (22.04)
	Middle school	1,384 (12.64)	353 (13.69)	1,325 (12.53)	377 (14.30)
	High school	3,407 (31.12)	784 (30.40)	3,282 (31.03)	828 (31.41)
	≥College	3,417 (31.21)	844 (32.73)	3,340 (31.58)	850 (32.25)
Household income quintile	1st quintile	2,191 (20.01)	433 (16.78)	2,116 (20.01)	459 (17.41)
	2nd quintile	2,190 (20.00)	506 (19.62)	2,115 (20.00)	516 (19.58)
	3rd quintile	2,189 (19.99)	491 (19.03)	2,117 (20.02)	516 (19.58)
	4th quintile	2,200 (20.09)	548 (21.25)	2,115 (20.00)	566 (21.47)
	5th quintile	2,179 (19.90)	601 (23.30)	2,114 (19.99)	579 (21.97)
Chronic disease	Yes	7,293 (66.61)	1,790 (69.41)	7,396 (69.93)	1,905 (72.27)
	No	3,656 (33.39)	789 (30.59)	3,181 (30.07)	731 (27.73)
Average number of visits		1.05 (3.07)*	4.47 (4.99)*	1.22 (3.34)*	4.91 (5.16)*

*Mean (Standard Deviation).

Table 3.

Demographic characteristics of the study subjects by private health insurance subscription status (2010-2011)

	Classification	Uninsured → Uninsured (3,428)	Insured → Insured (6,810)	Uninsured → New (205)	Insured → Cancellation (134)	P*
Gender	Male	1,522 (44.39)	2,893 (42.48)	77 (37.56)	66 (49.25)	0.060
	Female	1,906 (55.60)	3,917 (57.51)	128 (62.43)	68 (50.74)
Age	20-45 years	603 (17.59)	3,022 (44.37)	125 (60.97)	67 (50.00)	<0.001
	45-65 years	844 (24.62)	3,014 (44.25)	72 (35.12)	50 (37.31)
	≥65 years	1,981 (57.78)	774 (11.36)	8 (3.90)	17 (12.69)
Marital status	Married	2,251 (65.67)	5,408 (79.41)	154 (75.12)	103 (76.87)	<0.001
	Unmarried	343 (10.01)	838 (12.30)	40 (19.51)	18 (13.43)
	Divorced/Widowed/Separated	834 (24.33)	564 (8.28)	11 (5.36)	13 (9.70)
Economic activity	Activity	1,439 (58.02)	4,477 (65.74)	144 (70.24)	81 (60.44)	<0.001
	Non-activity	1,989 (41.98)	2,333 (34.25)	61 (29.75)	53 (39.55)
Education level	≤Primary school	1,573 (45.88)	1,028 (15.09)	12 (5.83)	17 (12.68)	<0.001
	Middle school	469 (13.68)	826 (12.12)	13 (6.34)	17 (12.68)
	High school	783 (16.51)	2,363 (34.69)	88 (42.92)	48 (35.82)
	≥College	603 (17.59)	2,593 (38.07)	92 (44.87)	52 (38.80)
Household income quintile	1st quintile	1,394 (40.66)	687 (10.08)	9 (4.39)	26 (19.40)	<0.001
	2nd quintile	795 (23.19)	1,261 (18.51)	36 (17.56)	23 (17.16)
	3rd quintile	566 (27.92)	1,469 (21.57)	49 (23.90)	33 (24.62)
	4th quintile	353 (18.25)	1,672 (24.33)	56 (27.31)	34 (25.37)
	5th quintile	320 (16.60)	1,721 (25.27)	55 (26.82)	18 (13.43)
Chronic disease	Yes	2,874 (83.83)	4,336 (63.67)	104 (50.73)	77 (57.46)	<0.001
	No	554 (16.16)	2,474 (36.32)	101 (49.26)	57 (42.53)

*P-value by chi-square test.

Table 4.

2SPLS results on the private health insurance and dental care utilization for a year

	Model 1			Model 2
Classification	(Uninsured over 2 years/ Insured over 2 years)			(Uninsured over 2 years/Cancellation, New)
	Coef	SE	95% CI	Coef	SE	95% CI
The visit number of dental utilization for a year (by OLS)
Private health insurance status	―0.204	0.119	―0.437 0.029	0.878	0.211	―0.544 0.284
Gender (ref. Male)	0.004	0.105	―0.202 0.210	0.980	0.211	―0.433 0.393
Marital status (ref. Married)	―0.102	0.086	―0.271 0.068	0.912	0.162	―0.409 0.225
Chronic disease (ref. No)	0.178	0.122	―0.060 0.417	1.152	0.324	―0.495 0.778
Household income quintile
2nd quintile	0.457**	0.206	0.054 0.860	1.629	0.291	―0.083 1.059
3rd quintile	0.552**	0.226	0.109 0.995	1.617	0.335	―0.177 1.138
4th quintile	0.662***	0.251	0.169 1.155	1.387	0.391	―0.440 1.094
5th quintile	0.722***	0.266	0.200 1.243	1.816	0.419	―0.224 1.418
Difference variable (2011 years total	―0.088*	0.043	―0.173 ―0.004	0.936	0.086	―0.234 0.102
income-2010 years total income)
Private health insurance type of subscription status (by Probit)
The visit number of dental utilization	0.624**	0.203	0.226 1.023	0.232	0.276	―0.309 0.774
Education (ref.Primary school)	―0.027	0.046	―0.117 0.064	0.110	0.078	―0.042 0.263
Age (ref.20~45 years)	―0.755***	0.075	―0.903 ―0.608	―0.607***	0.106	―0.815 ―0.399
2011 years total income	0.469***	0.062	0.347 0.591	0.353***	0.087	0.182 0.525

*Coef: Coefficient, SE:Standard Error, 95% CI: 95% Confidence Interval. ***P<0.001, **P<0.01, *P<0.05, P-value by 2SPLS.

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