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위험관리 수단으로서 민간의료보험의 중요성이 커지고 있고 민간의료보험에 가입하는 개인이 증가하고 있는 시점에서 본 연구는 국민노후보장패널조사 2차년(2007)도 학술대회자료를 사용하여 중ㆍ고령자들을 대상으로 민간의료보험의 가입과 지출에 대해 살펴보고, 민간의료보험의 가입 및 지출결정에 영향을 미치는 요인들을 더블허들모델을 사용하여 분석하였다. 주요한 연구결과는 다음과 같다. 첫째, 조사대상자의 30.2%가 민간의료보험에 가입한 것으로 나타났다. 민간의료보험 가입자의 특성을 살펴보면, 연령의 경우 50대, 교육수준이 높을수록, 배우자가 있는 경우, 거주지역은 서울이나 광역시, 취업형태에 있어서 임금근로자, 월평균 가구소득이 높을수록, 개인이 인지한 육체적, 정신적 건강상태가 좋은 경우, 질환/장애가 없는 경우, 월평균 가구의료비 지출이 상대적으로 적은 경우로 나타났다. 둘째, 민간의료보험 가입자들의 연평균 보험료 지출액은 98만 8천원이었다. 보험료 지출에 있어서는, 남성, 연령상 50대, 교육수준이 높을수록, 유배우자의 경우, 취업형태에 있어서 비임금근로자 경우, 월평균 가구소득이 높을수록, 개인이 인지한 육체적 건강상태가 나쁜 경우, 정신적 건강상태가 좋을 경우, 질환이나 장애가 없는 경우 민간건강보험에 더 많이 지출하였다. 셋째, 더블허들분석 결과, 개인의 민간의료보험의 가입결정과 지출결정에 영향을 미치는 요인들이 상이한 것으로 분석되었다. 민간의료보험 가입의 경우, 월평균 가구소득이 높을수록, 자가를 소유한 경우, 가구주가 임금근로자인 경우, 저축액이 많을수록, 부채 잔액이 많을수록, 개인이 인지한 육체적 건강이 좋은 경우 민간의료보험에 가입할 확률이 높은 반면, 남성이고 연령이 높을수록 민간의료보험에 가입할 확률은 적은 것으로 나타났다. 보험료 지출의 경우, 남성, 월평균 가구소득이 높을수록 보험료 지출액이 많은 반면, 연령이 증가할수록 배우자가 있는 경우 보험료 지출이 적은 것으로 나타났다.


Out-of-pocket health care expenditures paid by households in Korea have continuously increased because of the lots of exception provisions which is not covered by the National Health Insurance. Due to the financial burden of health care expenditures, many households or individuals, especially for the individuals over 50, have substantially increased to purchase private health insurance as a method of a risk management. However, fewer studies on purchase behavior of private health insurance. The purpose of this study is to present the characteristics of the individuals who purchased the private health insurance and to identify the factors that influence purchase and expenditure decision of private health insurance among middle-aged and old people. The specific research questions are (1)How do an individual’s purchase and expenditures of private health insurance vary for independent variables (demographic, economic, and health-related variables)? (2)What variables significantly impact on the purchase of private health insurance among middle- aged and old people? and (3)What variables significantly impact on the expenditure of private health insurance among middle-aged and old people? For the analyses, double-hurdle model is used to distinguish between the decision to purchase (purchase decision) and the decision of how much to expenditure (expenditure decision) of private health insurance. Data for this study were drawn from the second year(2007)’s Korean Retirement and Income Study by National Pension Research Institute. The sample was aged 50 and over and 6,613 persons were included in the analyses. The results indicated that only 30.2% of the sample purchased private health insurance. There were statistically significant at all independent variables except sex between purchase and not purchaser of private health insurance. For age, 62.8%of 50’s purchased private health insurance, while the percent of 60’s and 70’s that purchased private health insurance was 29.9% and 4.9% respectively. For the level of education, high school graduate and college graduate are more likely to, but less than high school are less likely to purchase private health insurance. For the presence of spouse, married couples are more likely to purchased private health insurance than single. For region, compared to live in city, Seoul and metropolitan are more likely to purchase private health insurance. For employment status, about half percent of a wage earner purchased private health insurance, while the percent of no employee and non worker was 34.8% and 21.6% respectively. Home owners are more likely to purchase private health insurance than not owning a house. As monthly household income increases, the individuals are more likely to purchase private health insurance. The average monthly household income for the purchaser was 3,150 thousand won, while those for the no purchaser was 1,770 thousand won. For the balances of saving, the individuals who saved more than 5,000 thousand won are more likely to purchase private health insurance than those who saved less than 5,000 thousand won. The individuals without a debt are more likely to purchase private health insurance than those with a debt. However, for the individuals with a debt, more debt balances are positively related to purchase private health insurance. For health related characteristics, the individuals who answered healthy at both physically or mentally are more likely to purchase private health insurance than those who answered unhealthy. And the individuals without a disease or a disability are more likely to purchase private health insurance than those with a disease or a disability. For monthly household health expenditures, spending less on health expenditures is positively related to purchase private health insurance. The results indicated that the average yearly expenditures of 2,000 persons who purchased private health insurance were 988,000 won. There were statistically significant at sex, age, the level of education, presence of spouse, employment status, monthly household income, ownership a debt, state of physical and mental health, and having a disease of a disability. For sex, male is more likely spend on private health insurance than a female does. Among the middle-aged and old people, 50’s are more likely to spend on private health insurance. And higher level of education is related to higher expenditures on private health insurance. For example, average yearly expenditures on private health insurance with college graduate was 1,540 thousand won, while those with no school was 765 thousand won. For presence of spouse, married couples are more likely to spend on private health insurance than singles do. For employment status, non workers spend more on private health insurance. Like the result of purchase of private health insurance, higher monthly household income is related to higher expenditures on private health insurance. Unlike the result of purchase of private health insurance, the unhealthy people at physically are more likely to spend, while the healthy people at mentally are more likely to spend on private health insurance. The people without a disease or a disabilities are more likely to spend on private health insurance. The results of double-hurdle analysis showed that significant factors at purchase decision of private health insurance are sex, age, monthly household income, home ownership, employment status, balance of saving, balance of debt, and good physical health, while significant factors at expenditure decision are sex, age, presence of spouse, and monthly household income. For the purchase decision, the people are likely to purchase private health insurance with higher household income, higher balances of saving and debt, owning a house, being a wage earner, and a good health condition, while they were not likely to purchase private health insurance with sex(a male) and an age. Among those who purchased private health insurance, a male and higher household income are positively related to, but an age and married couples are negatively related to the expenditures of private health insurance. The implications of this study are as follows. First, the important factor in both purchase and expenditure decisions of private health insurance was household income. This result implies that the people with relatively higher household income can manage the risk for a disease through purchase of private health insurance, while people with low household income cannot prepare the future risk because of the limitation of economic resources. Because it is not enough to manage a disease risk with the current medical services for low-income people provided by the National Health Insurance, thus, it is needed to expand medical services for them as a political aspect. Second, regarding a methodological matter, the double-hurdle model was employed to analyze both purchase and expenditure behaviors of private health insurance. Some changes in the signs of effects across the purchase and the expenditure on private health insurance were found. In spite of the same signs, some variables were significant in either the purchase or expenditure equation, but not both. These sign changes and the differences in significance highlight the main advantage of the double-hurdle model over the traditional models(tobit or multiple regression analyse). Thus, this study shows that the double-hurdle model is a better approach in explaining individuals’ insurance buying behavior.