Journal List > J Korean Acad Oral Health > v.39(3) > 1057642

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

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.

References

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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
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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