Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea

Moon, Dae‐Gyu; Kim, Saerom; Kim, Myoung-Hee; Jeong, Dawoon; Choi, Hong-Jo

doi:10.3389/fpubh.2021.769176

Cited by 5 publications

(5 citation statements)

References 32 publications

(39 reference statements)

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“…Prior studies show mixed evidence on merits of contracting private sector health services on access and equity in access to health services [38,39]. For example, the South Korean contracting influenza vaccination to private providers neither improved vaccination coverage nor reduced inequity, similar to studies in Cambodia and Guatemala [40,41]. The inconclusive outcomes of contracting can be influenced by market structure, contextual environment and purchasing design.…”

Section: Discussionmentioning

confidence: 95%

Contracting the private health sector in Thailand’s Universal Health Coverage

Marshall¹,

Witthayapipopsakul²,

Chotchoungchatchai³

et al. 2023

PLOS Glob Public Health

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Private sector plays an import role in health service provision, therefore the engagement of private health facilities is important for ensuring access to health services. In Thailand, two of the three public health insurance schemes, Universal Coverage Scheme and Social Health Insurance, contract with private health facilities to fill gaps of public providers for the provision of health services under Universal Health Coverage. The National Health Security Office (NHSO) and Social Security Office (SSO), which manage the schemes respectively, have designed their own contractual agreements for private facilities. We aim to understand the current situation of contracting private health facilities within UHC of the two purchasing agencies. This qualitative descriptive case study was conducted through document review and in-depth interviews with key informants to understand how they contract private primary care facilities, service types, duration of contract, standard and quality requirement and renewal and termination of contracts. Private providers make a small contribution to the service provision in Thailand as a whole but they are important actors in Bangkok. The current approaches used by two purchasers are not adequate in engaging private sector to fill the gap of public provision in urban cities. One important reason is that large private hospitals do not find public contracts financially attractive. NHSO classifies contracts into 3 categories: main contracting units, primary care units, and referral units; while SSO only contracts main contracting units. Both allows subcontracting by the main contractors. Contractual agreements are effective in ensuring mandatory infrastructure and quality standards. Both purchasers have established technical capacities to enforce quality monitoring and financial compliance although there remains room for improvement especially on identifying fraud and taking legal actions. Contracting private healthcare facilities can fill the gap of public healthcare facilities, especially in urban settings. Purchasers need to balance the right level of incentives and accountability measures to ensure access to quality of care. In contracting private-for-profit providers, strong regulatory enforcement and auditing capacities are necessary. Further studies may explore various aspects contracting outcomes including access, equity, quality and efficiency impacts.

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Section: Discussionmentioning

confidence: 95%

Contracting the private health sector in Thailand’s Universal Health Coverage

Marshall¹,

Witthayapipopsakul²,

Chotchoungchatchai³

et al. 2023

PLOS Glob Public Health

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“…Although Korea has a health insurance system for the entire population, National health insurance subscriptions are limited to population in the top 97% of incomes. For those in poverty (i.e., the bottom 3% of incomes), a separate medical aid program is provided, allowing them to receive medical services without having to pay an insurance fee ( 17 ). Because the OOP exception policy applies to health insurance beneficiaries, we set them as the treatment group and medical aid beneficiaries as the control group.…”

Section: Methodsmentioning

confidence: 99%

Beyond reducing direct medical cost: examining health outcomes in tuberculosis through a difference-in-differences analysis of South Korea’s out-of-pocket payment exception policy

Yu,

Moon,

Jeong

et al. 2024

Front. Public Health

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BackgroundUniversal health coverage and social protection are major global goals for tuberculosis. This study aimed to investigate the effects of an expanded policy to guarantee out-of-pocket costs on the treatment outcomes of patients with tuberculosis.MethodsBy linking the national tuberculosis report and health insurance data and performing covariate-adjusted propensity-score matching, we constructed data on health insurance beneficiaries (treatment group) who benefited from the out-of-pocket payment exemption policy and medical aid beneficiaries as the control group. Using difference-in-differences analysis, we analyzed tuberculosis treatment completion rates and mortality in the treatment and control groups.ResultsA total of 41,219 persons (10,305 and 30,914 medical aid and health insurance beneficiaries, respectively) were included in the final analysis (men 59.6%, women 40.4%). Following the implementation of out-of-pocket payment exemption policy, treatment completion rates increased in both the treatment and control groups; however, there was no significant difference between the groups (coefficient, −0.01; standard error, 0.01). After the policy change, the difference in mortality between the groups increased, with mortality decreasing by approximately 3% more in the treatment group compared with in the control group (coefficient: −0.03, standard error, 0.01).ConclusionThere are limitations to improving treatment outcomes for tuberculosis with an out-of-pocket payment exemption policy alone. To improve treatment outcomes for tuberculosis and protect patients from financial distress due to the loss of income during treatment, it is essential to proactively implement complementary social protection policies.

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“…A previousprior study on vaccination trends in Korea confirmedindicated that socioeconomic inequalities inequalities were almost removed in disparities were largely eliminated due to nationwide vaccination due to the national coverage of vaccination [30]. However, another study including thea more recent time trend of Korea, presented continuous vaccinationstudy revealed ongoing inequality ofin seasonal influenza vaccination among the elder, even though all costs were coveredelderly, despite full coverage by national health insurance [31].…”

Section: E P U B a H E A D O F P R I N Tmentioning

confidence: 97%

Unequal burdens of COVID-19 infection: a nationwide cohort study of COVID-19-related health inequalities in Korea

Jeon,

Park,

Choi

et al. 2023

Epidemiol Health

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OBJECTIVES: While the Korean government’s response to the coronavirus disease 2019 (COVID-19) pandemic is considered effective given the relatively low mortality rate, issues of inequality have been insufficiently addressed. This study explored COVID-19-related health inequalities in Korea.METHODS: Age standardization for various health inequality indices was derived using data from the Korean National Health Insurance Service, the Korea Disease Control and Prevention Agency, and the Microdata Integrated Service of Statistics Korea. The slope index of inequality (SII) and relative index of inequality (RII) were calculated for socioeconomic variables, while absolute difference (AD) and relative difference (RD) were used for gender and disability inequalities.RESULTS: We observed a number of COVID-19-related health outcome inequalities. Gender inequality was particularly noticeable in infection rates, with the rate of women 1.16 times higher than that of men. In contrast, socioeconomic inequality was evident in vaccination rates, with a 4.5-fold (SII, -4.519; 95% confidence interval, -7.403 to -1.634) difference between the highest and lowest household income groups. Regarding clinical progression post-infection, consistent findings indicated higher risk for men (RD for hospitalization, 0.90; severe cases, 0.54; and fatality, 0.65), individuals with disabilities (RD for hospitalization, 2.27; severe cases, 2.29; and fatality, 2.37), and those from lower socioeconomic groups (SII for hospitalization, 1.778; severe cases, 0.089; and fatality, 0.451).CONCLUSIONS: While the infection risk was nearly ubiquitous, not everyone faced the same level of risk post-infection. To prevent further health inequalities, it is crucial to develop a thoughtful policy acknowledging individual health conditions and resources.

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Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea

Cited by 5 publications

References 32 publications

Contracting the private health sector in Thailand’s Universal Health Coverage

Contracting the private health sector in Thailand’s Universal Health Coverage

Beyond reducing direct medical cost: examining health outcomes in tuberculosis through a difference-in-differences analysis of South Korea’s out-of-pocket payment exception policy

Unequal burdens of COVID-19 infection: a nationwide cohort study of COVID-19-related health inequalities in Korea

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