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Care no better when insurance added to government plan

NEW YORK (Reuters Health) - As the U.S. grapples with health care reform, a study out of South Korea suggests that private health insurance meant to bolster that country’s universal healthcare system seems to have little effect on cancer patients’ quality of care. However, such insurance did offer financial benefits.

Korea’s entire population has been covered by public health insurance since 1989, but individuals still pay a large share of their medical expenses out-of-pocket. As of 2006, Koreans had co-payments of 20 percent for their inpatient care, and were covering one-third to one-half of their hospital outpatient expenses themselves.

In recent years, the government has been encouraging people to purchase supplemental health insurance from private companies to help fill the coverage gap.

But in the new study, researchers found that among cancer patients, the most vulnerable people -- including the elderly and lower-income individuals -- usually had no private insurance. And even among patients who did, there was no evidence that private coverage improved their care.

Instead, the benefits were financial, lead researcher Dr. Dong Wook Shin, of the National Cancer Center in Goyang, Korea, told Reuters Health in an email.

The “better-off” people who could afford supplemental private insurance, Shin said, got extra help paying their medical bills.

On the other hand, the availability of private supplemental insurance appears to offer no financial “safety net” for the people who need it the most, Shin’s team reports in the journal BMC Health Services Research.

The study included 391 patients with stomach cancer, which until recently was the most common cancer among Koreans. Of these, half had private supplemental insurance at the time of diagnosis.

Shin’s team found that patients with private coverage tended to be younger, more educated and earn higher incomes. More than two-thirds patients lacking private insurance were age 51 or older, while a similar percentage had less than a high school education.

When the researchers looked at patients’ healthcare quality, there was no evidence that extra insurance made a difference. Patients with private insurance, as a group, were not diagnosed earlier or more likely to receive treatment according to standard guidelines.

They were, however, twice as likely as other patients to be able to pay their own medical bills, rather than depending on family members for help.

According to Shin, the findings suggest that supplementary private insurance is not a good replacement for adequate government funding of a universal healthcare system.

The researcher said that the results may offer a lesson to developing countries, such as China, that are considering universal healthcare plans -- where the temptation may be great to limit government financing and rely partially on private supplemental insurance.

SOURCE: BMC Health Services Research, online July 31, 2009.

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