Moral hazard or utilization hazard refers to the phenomenon during which patients overuse medical services under national health insurance (NHI) because the services are free or the patients are required to pay only a portion of the utilization costs. The aim of this study is to investigate how NHI and private health insurance (PHI) systems influence increases in health care utilization rates. We designed a longitudinal study to examine the utilization of healthcare services between those insured with NHI or PHI and uninsured Koreans using nationally representative four-year panel data from 13,798 participants. This study was conducted using hierarchical multivariate Poisson regression analyses in which covariates and interaction terms are applied after adjusting for the heterogeneous treatment effect. After adjusting covariates including disease status, lower income Koreans who were covered by medical aid were respectively 2.26 and 1.23 times more likely to receive inpatient care and outpatient care than those who were covered by NHI. When the interaction term of type of insurance was included in the model, those were covered by both medical aid and PHI were respectively 2.38 and 1.25 times more likely to receive inpatient care and outpatient care than those who were covered by only NHI. The moral hazard behind insurance membership, depending on how NHI maintains policies to confer benefits, may give rise to differences in medical utilization. This phenomenon must be closely monitored to find a way to reform NHI when the rights of medical service consumers are solidified through PHI.

The objective of this study was to identify the association between social deprivation, outdoor air pollution, and tuberculosis (TB) incidence rate or mortality rate. The study sample comprised 25 districts in Seoul, Korea. We used two public data derived from the Community Health Survey and Seoul Statistics. The geographic information system analysis and random effects Poisson regression were applied to explore the association of social deprivation and air pollution with TB incidence and mortality. An 1 ppb increase in sulfur dioxide (SO₂) concentration was significantly associated with the risk of TB incidence (risk ratio [RR] = 1.046, 95% confidence interval [CI]: 1.028, 1.065). An 1 unit increase in the deprivation index was significantly related to a6% increase in the mortality of TB (RR = 1.063, 95% CI: 1.031, 1.097). : Our results imply that social deprivation and air pollution may affect the different TB outcomes. Effective policy-making for TB control should reflect the differing outcomes between TB incidence and mortality.

This study examined the effects of healthcare inequality on personal health. It aimed to determine how health insurance type and income level influence catastrophic health expenditure and unmet healthcare needs among South Koreans. Unbalanced Korean Health Panel data from 2011 to 2015, including 33,374 adults, were used. A time-trend and panel regression analysis were performed. The first to identify changes in the main variables and, the second, mediating effects of unmet healthcare needs and catastrophic health expenditure on the relationship between health insurance type, income level, and health status. The independent variables were: high-, middle-, low-income employee insured, high-, middle-, low-income self-employed insured, and medical aid. The dependent variable was health status, and the mediators were unmet needs and catastrophic health expenditure. The medical aid beneficiaries and low-income self-employed insured groups demonstrated a higher probability of reporting poor health status than the high-income, insured group (15.6%, 2.2%, and 2.3%, respectively). Participants who experienced unmet healthcare needs or catastrophic health expenditure were 10.7% and 5.6% higher probability of reporting poor health, respectively (Sobel test: p < 0.001). National policy reforms could improve healthcare equality by integrating insurance premiums based on income among private-sector employees and self-employed individuals within the health insurance network.

Background: In South Korea, the number of workers suffering from mental illnesses, such as depression, has rapidly increased. There is growing concern about depressive symptoms being associated with both working conditions and psychosocial environmental factors. Objectives: To investigate potential psychosocial environmental moderators in the relationship between working conditions and occupational depressive symptoms among wage workers. Methods: Data were obtained from the wage worker respondents (n = 4,095) of the Korean National Health and Nutrition Examination Survey of 2009. First, chi-square tests confirmed the differences in working conditions and psychosocial characteristics between depressive and non-depressive groups. Second, multivariate logistic regression analysis was performed to examine the moderating effects of the psychosocial environmental factors between working conditions and depressive symptoms. Results: After adjusting for potential covariates, the likelihood of depressive symptomatology was high among respondents who had dangerous jobs and flexible work hours compared to those who had standard jobs and fixed daytime work hours (OR = 1.66 and 1.59, respectively). Regarding psychosocial factors, respondents with high job demands, low job control, and low social support were more likely to have depressive symptoms (OR = 1.26, 1.58 and 1.61, respectively). Conclusions: There is a need to develop non-occupational intervention programs, which provide workers with training about workplace depression and improve social support, and the programs should provide time for employees to have active communication. Additionally, companies should provide employees with support to access mental healthcare thereby decreasing the occurrence of workplace depression.