Spatial analysis of the relationship between out-of-pocket expenditure and socioeconomic status in South Korea

Abstract

The rapid increase in the out-of-pocket expenditure for healthcare in South Korea (the share of the total cost paid by the patient) negatively affects public health and raises the issue of equity in medical access opportunities according to the level of income. Most previous studies on out-of-pocket expenditure do not consider the environmental impact at the regional level. Individual health and quality of life improve as social relationships are formed and centred on the individual residential situation when seen in the local community context. Therefore, this study investigated the potential gap with respect to out-of-pocket expenditures by examining the factors influencing co-payments by region using a geographically weighted regression (GWR) model. A spatial analysis of outpatient out-of-pocket expenditures for 237 local governments across the country, excluding islands and island regions, was conducted from 2015 to 2020. The out-of-pocket expenditure incurred was found to have regional correlations and be influenced by community factors. The GWR model showed a better fit than the ordinary least squares (OLS) one. Significant hotspots were identified and the influence of regional factors on out-patient out-of-pocket expenditure was shown to vary by region. The results showed that if social and economic resources are appropriately invested in areas identified as vulnerable, a spill-over effect in neighbouring areas can be expected. This study provides new insights on policy strategies for co-payment management to regional healthcare policymakers and it can be used as a basis for the distribution of customised healthcare resources by region.