Data from: Catastrophic health expenditure according to employment status in South Korea: A population-based panel study

Objectives: Catastrophic health expenditure (CHE) means that medical spending of a household exceeds a certain level of capacity to pay. Previous studies of CHE have focused on benefits supported by the public sector or high medical cost incurred by treating diseases in South Korea. This study examines variance of CHE in these households according to changes in employment status. We also determine whether a relationship exists according to income level.
Design: A longitudinal study.
Setting: We used the Korea Welfare Panel Study (KOWEPS) conducted by the Korea Institute.
Participants: These data consisted of 5,335 households during 2009-2012.
Outcome measure: CHE defined as health expenditures that were 40% greater than the ability of the household to pay.
Results: Households with people who experienced changes in job status from employed to unemployed (OR 2.79, 95% CI 2.06-3.78) or were unemployed with no status change (OR 1.57, 95% CI 1.28-1.92) were more likely to incur CHE compared to those who were consistently employed. In addition, low-income families that either lost a job (OR 3.52, 95% CI 2.44-5.10) or were already unemployed (OR 1.67, 95% CI 1.29-2.16) were more likely to incur CHE compared to those with a consistent job.
Conclusions: Given the insecure employment status of people with low-income, they are more likely to face barriers in obtaining needed health services. Meeting their needs for health care is an important consideration.

研究目的：灾难性卫生支出（Catastrophic Health Expenditure, CHE）指家庭医疗支出超出其支付能力的既定阈值。既往针对灾难性卫生支出的研究多聚焦于韩国公共部门保障的医疗福利，或是疾病治疗产生的高额医疗成本。本研究旨在探讨此类家庭的灾难性卫生支出差异随就业状态变化的情况，并分析该差异是否因收入水平而异。研究设计：纵向研究。数据来源：本研究使用韩国研究院开展的韩国福利面板研究（Korea Welfare Panel Study, KOWEPS）数据。研究对象：本研究涵盖2009至2012年间的5335户家庭。结局指标：灾难性卫生支出定义为家庭医疗支出超出其支付能力40%的情形。研究结果：与持续就业的家庭相比，家庭成员就业状态从在职转为失业（比值比OR=2.79，95%置信区间CI=2.06~3.78），或始终处于失业状态且未发生就业状态变更（OR=1.57，95%CI=1.28~1.92）的家庭，发生灾难性卫生支出的风险更高。此外，与拥有稳定就业岗位的家庭相比，低收入家庭中要么失去工作（OR=3.52，95%CI=2.44~5.10），要么始终处于失业状态（OR=1.67，95%CI=1.29~2.16）的家庭，发生灾难性卫生支出的风险同样更高。研究结论：鉴于低收入群体就业状态缺乏稳定性，他们更易面临获取必要医疗服务的障碍。满足此类群体的医疗需求是一项重要的政策考量要点。