The effect of high medical expenses on household income in South Korea: A longitudinal study using propensity score matching Utilization, expenditure, economics and financing systems

Background: Almost 97 % of the Korean population is covered by National Health Insurance and are entitled to receive the same level of insurance benefits, regardless of how much each enrollee contributes to the system. However, the percentage of out-of-pocket payments is still high. This study examines whether the incurrence of high medical expenses affects household income. Methods: We use the Korea Welfare Panel and select 4,962 households to measure repeatedly over 5 years. Using propensity score matching, we set households with medical expenses of three times the annual average as "occurrence households" while "non-occurrence households" are those below the cut-off but with all other factors, such as income, held constant. We analyze whether the income of occurrence households differs significantly from the comparison group using a linear mixed effect model. Results: After the occurrence of high medical expenditure, occurrence households (n∈=∈825) had US$ 1,737 less income than non-occurrence households. In addition, the income of households (n∈=∈200) that incurred high medical costs repeatedly for 2 years was US$ 3,598 lower than the non-occurrence group. Conclusions: Although it is important for the government to focus on medical assistance for households that have medical expense burdens, it needs to consider providing income indemnity insurance to protect them.