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Differential Ceiling on Out-of-pocket Payments

Country: 
Südkorea
Partner Institute: 
Department of Health Policy and Management, School of Public Health, Seoul National University
Survey no: 
(13) 2009
Author(s): 
Kwon, Soonman
Health Policy Issues: 
Leistungskatalog, Zugang
Current Process Stages
Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? ja nein nein nein ja nein nein

Abstract

The exisiting ceiling on the cumulative out-of-pocket payments has had a limitation because the ceiling is not linked to the ability to pay of patients. To make the ceiling effective in reducing the financial burden of patients and in minimizing the catastroophic effects of illness on the poor, government decided to differentiate the ceiling into three levels depending on the income of the insured, namely top 20%, middle 30%, and bottom 50%

Purpose of health policy or idea

To reduce the financial burden on patients, in 2004 the government introduced a ceiling on the cumulative out-of-pocket payments made within half a year. However, the measure has had a limitation because the ceiling is not linked to the ability to pay of patients. To make the ceiling effective in ensuring financial protection and minimizing the catastrophic effects of illness on the poor, the government (on January 1, 2009) decided to differentiate the ceiling into three levels depending on the income of the insured: top 20%, middle 30%, and bottom 50% of the insured. The greater the income, the higher the ceiling on the cumulative out-of-pocket payment per year, leading to increased risk protection for the worse off.

Main points

Main objectives

To reduce the burden of health expenditure and increase financial risk protection

Type of incentives

Financial incentive

Groups affected

Patients, the worse off

 Suchhilfe

Characteristics of this policy

Innovationsgrad traditionell recht innovativ innovativ
Kontroversität unumstritten kaum umstritten kontrovers
Strukturelle Wirkung marginal recht fundamental fundamental
Medienpräsenz sehr gering recht hoch sehr hoch
Übertragbarkeit sehr systemabhängig neutral systemneutral

 

Political and economic background

 

Purpose and process analysis

Current Process Stages

Idee Pilotprojekt Strategiepapier Gesetzgebung Umsetzung Evaluation Veränderung/Richtungswechsel
Implemented in this survey? ja nein nein nein ja nein nein

Origins of health policy idea

The financial burden of out-of-pocket payment for health care is heavier for the poor than for the better off. The existing system of a uniform ceiling on cumulative out-of-pocket payments, namely 2,000 USD for six months, has been criticized to have a limited effect on reducing the financial burden of the worse off.

Differentiated ceilings for different income groups

After research by the National Health Insurance Corporation (NHIC), the Ministry of Health and Welfare differentiated the ceiling into three levels. The ceiling was set at 4,000 USD in one year for top 20% of the insured in terms of income, 3,000 USD for middle 30% of the insured, and 2,000 USD for bottom 50% of the insured.

Initiators of idea/main actors

  • Regierung

Approach of idea

The approach of the idea is described as:
renewed: A (uniform) ceiling on cumulative out-of-pocket payments was introduced in 2004.

Stakeholder positions

The upper 50% of the insured, for whom the ceiling has increased from the previous level, can be opposed to the policy change, but there was no active opposition to the new policy. The overall support for the policy is grounded in the legitimacy of the policy change toward increased financial risk protection and the consensus on the limitations of the previous uniform ceiling on out-of-pocket payments.

Actors and positions

Description of actors and their positions
Regierung
Ministry of Health and Welfaresehr unterstützendsehr unterstützend stark dagegen
Health Services Researcherssehr unterstützendsehr unterstützend stark dagegen
progressive civic groupssehr unterstützendsehr unterstützend stark dagegen
Better offsehr unterstützenddagegen stark dagegen

Influences in policy making and legislation

 

Actors and influence

Description of actors and their influence

Regierung
Ministry of Health and Welfaresehr großsehr groß kein
Health Services Researcherssehr großgroß kein
progressive civic groupssehr großneutral kein
Better offsehr großgering kein
progressive civic groupsHealth Services ResearchersMinistry of Health and WelfareBetter off

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The ceiling is differentiated on the basis of the ability to pay (or income) of the insured, which is measured by the insurance contribution that they pay. Income assessment of the self employed is not as transparent as that of employees, and there may be some issues in the future on how to measure the ability to pay of the insured and set the ceiling accurately.

Monitoring and evaluation

 

Results of evaluation

 

Expected outcome

A ceiling on out-of-pocket payments is a crucial mechanism for financial protection. With differentiated ceilings based on the income level of the insured, the new policy is expected to reduce the financial burden or catastrophic effects of illness on the worse off.

Impact of this policy

Qualität kaum Einfluss neutral starker Einfluss
Gerechtigkeit System weniger gerecht System gerechter System gerechter
Kosteneffizienz sehr gering neutral sehr hoch

 

References

Sources of Information

 

Author/s and/or contributors to this survey

Kwon, Soonman

 

Empfohlene Zitierweise für diesen Online-Artikel:

Kwon, Soonman. "Differential Ceiling on Out-of-pocket Payments". Health Policy Monitor, April 2009. Available at http://www.hpm.org/survey/rok/a13/2