PREDICTORS OF HEALTHCARE OUTCOMES AT THE LOCAL COMMUNITY LEVEL: VARIATIONS IN THE VALUE OF HEALTHCARE SERVICES UNDER KOREA’S UNIVERSAL HEALTH INSURANCE SYSTEM

Abstract

Abstract Objectives: To determine the possible relationship between the premature death and national health insurance (NHI) healthcare services expenditures (HE) at the local community level, and possible local determinants of health that might affect the variation in premature deaths among 231 local communities (n=231). Methods: Based on the simplified Local Determinants of Health (LDH) framework, a value of HE model for local healthcare services (HS) was designed, and the following health outcome variables were defined: Years of Potential Life Lost before age 75 (YPLL-75) of all premature deaths and YPLL-75s of premature deaths due to Cancers and Suicide in 231 local communities. The incremental Value of HS models and Multiple Linear Regression (MLR) models (n = 231 local communities) for all NHI HS as well as healthcare services for cancers and mental health problems were constructed to determine the relationships between the averted YPLLs (the dependent variables) and the changes of NHI HE (the main independent variable) between 2007 and 2012 at the local community level. In the MLR models, 16 independent variables were included in order to represent determinants of health outcomes. Results: Overall, the recently increased NHI HE at the local community level was associated with a decrease of premature deaths under the Korean NHI system. But the regional variations in the values of HS were somewhat large. Specifically, when the various determinants of health were considered and controlled in the MLR model, the influences of the NHI HE increases on the health outcomes (the averted YPLLs) were very limited. More specifically it was found that in the important healthcare service areas like cancer care and mental health care, the values of HS showed negative ratios and diminishing trends as the NHI HE increased among communities. Regardless of NHI HE’s increases, certain determinants of health including some biological and behavioral factors, affected the health outcomes directly and modified the values of NHI HE as well. Conclusions: Improving the biological and behavioral health status and targeted health policies for low health performance areas are important to improve the health outcomes in terms of YPLLs and the value of NHI HE in Korea