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Comparison of health status and the effectiveness of health cost between rural and urban residents
Author An, Sok
Views 43883 Publication Date 2020.05.30
Original
This study investigated the extent of the medical and health gaps between rural and urban areas through the perspective of health disparity and suggested policy directions to improve the disparity which rural residents have experienced.
For this purpose, we analyzed the disease prevalence, mortality rate, and other relevant health indices of rural and urban residents by using the national health insurance data provided by the National Health Insurance Data Sharing Service (NHISS) along with existing data sets regarding health in South Korea. Also, we compared health service use and health cost between rural and urban residents.
The medical gap appears to be the difference in the number of medical facilities and medical professionals. Based on the analysis, only 12.9% out of all medical institutions in South Korea are distributed in rural areas, and 23% of rural areas do not have emergency medical facilities. Also, 5.7% of doctors are working in rural areas, while half of the doctors treat patients in the capital area.
The health indicators including disease prevalence and mortality rates, confirmed that there was a health gap between rural and urban residents. Rural areas had higher disease prevalence and mortality rates of circulatory, respiratory, digestive and digestive disorders, urinary diseases, metabolic syndrome (cancer), pneumonia, heart disease, musculoskeletal diseases, dementia and hypertension than urban areas did. Although rural areas showed the lower age-standard prevalence rates of infectious diseases and cancers, they had higher mortality rates.
There were different hospital utilization patterns by disease between rural and urban areas. For chronic diseases, rural patients were more likely to use medical institutions, in particular in-town hospitals and clinics, than urban patients were. However, they used out-of-town medical institutions more often than in-town clinics for serious disease such as cancer. In other words, rural residents tended to visit out-of-town medical facilities due to the big difference in medical service qualities between rural and urban medical institutions.
Rural patients were likely to pay more medical costs when they visited advanced hospitals located mainly in urban areas than urban residents were. One interpretation of this fact is that rural patients are apt to delay visiting the health care institutions until their diseases get worse. Also, the cost-effectiveness analysis revealed that the effectiveness of medical services in rural areas was less than that in urban areas. The more medical expenses insurance paid for rural patients, the more mortality rates and life expectancy losses they experienced.
The Korean government has not considered the characteristics of rural areas while designing health plans, which resulted in critical inequality of the medical service quality and health status between rural and urban areas. Even though health authorities made an effort to improve the quality of medical care by expanding medical resources, the health disparity has not significantly improved.
For better medical and health services, this study suggests that the government should implement health and medical policies of rural areas targeting to address health inequalities. For this purpose, it should expand medical infrastructure, improve medical access, provide more medical professionals, and establish a medical system to reflect rural characteristics deviating from the urban point of view.


Researchers: An, Sok; Kim, Namhoon; Kim, Yuna
Research period: 2019. 5. ∼ 2019. 12.
E-mail address: ansok@krei.re.kr

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