The reform of the military health care system of the Republic of Korea: The impact of health insurance on the choice of military versus civilian providers.

摘要

Persistent underfunding for Korean military direct care and the tension between growing demands for quality health care and increasing costs of supply have led to the reform of the Korean military health care system, which introduced universal health insurance on July 1994, partially integrating military health care into the national health insurance system. This policy change by the ROK Ministry of National Defense increased career soldiers' freedom of choice for health care between the military and civilian systems but also increased their cost burden.; This study estimates the impact of health insurance on the military health care system by using 1998–1999 health insurance claims data of the Korean Medical Insurance Corporation, which reflects health care delivered to career soldiers in both military and civilian hospitals. The study assumes that the probabilities of choosing military over civilian hospitals for career soldiers' health care are predicted by personal characteristics, clinical characteristics, hospital characteristics, costs factors, and geographic factors.; The study found that the choice of hospital providers varies widely across seven tracer conditions. The demand for civilian care is higher among “affluent” soldiers who are older, have more dependents, have more care episodes, and incurred greater previous out-of-pocket payments, and is higher among patients with comorbid conditions. The relative quality of care, in terms of relative bed size, and geographic access, in terms of the location of the military hospital and soldiers' office, both affect the choice of care between the two systems. In addition, soldiers' sex, affiliated military service, and phase of care also affect the choice of care providers.; In general, personal characteristics, clinical characteristics, hospital characteristics, costs factors, and geographic factors are all important in predicting the choice of care between the military and civilian systems. The regression results from three different groups of care (inpatient care, outpatient care, and both in- and out-patient care) show that the same explanatory variables have different impacts on the choice of care providers. The dissertation concludes with a discussion of policy issues.