Changes in Morbidity and Medical Care Utilization after the Recent Economic Crisis in the Republic of Korea
Kim, Hanjoong, Chung, Woo Jin, Song, Young Jong, Kang, Dae Ryong, Yi, Jee Jeon, Nam, Chung Mo, Bulletin of the World Health Organization
Voir page 571 le resume en francais. En la pagina 571 figura un resumen en espanol.
On 3 December 1997, the Republic of Korea was obliged to receive financial support from the International Monetary Fund (IMF) because of a Foreign currency crisis. This event marked a national economic crisis that was unprecedented in modern history of the Republic of Korea. After 1995, the economy grew rather sluggishly until the first three quarters of 1997, and this growth rate continued to decline to 3.6%, until the last quarter of 1997 (1, 2) (Fig. 1). However, in the first quarter of 1998 the growth rate had fallen dramatically to -4.6%, and in the fourth quarter of 1998 it had fallen to -5.9%. Only in 1999 did the economy begin to show definite signs of a recovery. Before the economic crisis the economy of the Republic of Korea had been able to maintain a stable unemployment rate, which did not exceed 3%. However, the unemployment rate rose to 5.6% in the first quarter of 1998 and then to 8.4% in the first quarter of 1999. Unemployment then began to respond to the general recovery, but as yet it has not reached its pre-economic-crisis levels.
[FIGURE 1 OMITTED]
The health care system of the Republic of Korea can be described as a privately controlled delivery system in combination with a publicly regulated financing system. The national health security system is administered in two tiers: Health Insurance and the Medical Aid programme. As of 1998, Health Insurance was an income-based contributory insurance programme covering 97% of the population, whereas Medical Aid was a government-subsidized public assistance programme for the poor and the medically indigent. Compared with other countries that have national health insurance, the Republic of Korea has a relatively high rate of direct payment because of the limited coverage and high co-payment rate. In 1998, Koreans paid 41.6% of total health care expenditures out of their own pockets. Both hospital and physician services covered by insurance are reimbursed on a fee-for-service basis, which offers a strong incentive to provide extensive services. All health care institutions in the Republic of Korea are legally designated to provide health services to the insured. In the Republic of Korea, the private sector plays a major role in delivering health care services. In 1996, 87% of all hospital beds were private, and 93% of hospitals in the Republic of Korea were owned or operated by private or not-for-profit organizations (3).
The economic crisis produced nationwide changes in the health sector (4). In January 1998, the numbers of outpatients and inpatients in general hospitals fell by 18.7% and 16.1%, respectively, compared with the pre-crisis period of January 1997 (5).
Some findings indicate that an economic crisis affects peoples' health status. Throughout Cuba, Indonesia, and Poland, increased stress, morbidity, suicide, and a shortened life expectancy were observed for those who had experienced or were experiencing economic crises (6-8). Research in Australia, Denmark, England, Finland, and Wales has also shown that there are relationships between economy, unemployment, and health status (9-18).
In this paper, we analyse data from two nationwide surveys of the Republic of Korea conducted in 1995 and 1998. We explore whether or not an economic crisis has an influence on the rates of morbidity and medical care utilization and, on the basis of the results, we show that the impacts of the economic crisis vary depending on the types of medical services and diseases.
Source of data
This study mainly analysed the data of the National Health Interview Surveys, which were conducted in 1995 and 1998, respectively (19, 20). The Korea Institute for Health and Social Affairs conducted the two surveys on behalf of the Ministry of Health and Welfare. The purpose of the surveys was to estimate the national prevalence of diseases and the medical care utilization and to investigate health-related behaviours in the Republic of Korea. …