Comparison of catastrophic out-of-pocket medical expenditure among older adults in the United States and South Korea: what affects the apparent difference?

BACKGROUND

Medical spending rises sharply with age. Even with universal health insurance, older adults may be at risk of catastrophic out-of-pocket medical spending. We aimed to compare catastrophic out-of-pocket medical spending among adults ages 65 and older in the United States, where seniors have near-universal coverage through Medicare, versus South Korea, where all residents have national health insurance.

METHODS

We used the 2016 Health and Retirement Study and the Korean Longitudinal Study of Aging. The study population were adults ages 65 and over in the US (n = 9,909) and South Korea (n = 4,450; N = 14,359). The primary outcome of interest was older adults' exposure to catastrophic out-of-pocket medical expenditure, defined as out-of-pocket medical spending over the past two years that exceeded 50% of annual household income. To examine the factors affecting catastrophic out-of-pocket medical spending of older adults in both countries, we performed logistic regression analyses. To compare the contribution of demographic factors versus health system-level factors to catastrophic out-of-pocket medical spending, we performed a Blinder-Oaxaca decomposition.

RESULTS

The proportion of respondents with catastrophic out-of-pocket medical expenditure was 5.8% and 3.0% in the US and South Korea, respectively. A Blinder-Oaxaca decomposition showed that the difference in the rate of catastrophic out-of-pocket medical expenditure spending between the two countries was attributable largely to unobservable system-level factors, rather than observed differences in the sociodemographic characteristics.

CONCLUSIONS

Exposure to catastrophic out-of-pocket medical spending is considerably higher in the US than South Korea. Most of the difference can be attributed to unobserved health system-level factors.

Appearance Comparison, Appearance Self-Schema, Perfectionism, and Body Esteem Among Korean College Students

In this study, we examined whether the constructs of appearance self-schema and perfectionistic self-presentation were significant mediators for the direct association between physical appearance comparison and body esteem. A total of 290 South Korean students from a university in South Korea participated in this study. Results from structural equation modeling supported that both appearance self-schema and perfectionistic self-presentation were significant mediators for the relationship between physical appearance comparison and body esteem. A bootstrap method was used to assess the magnitude of the indirect effect, with 33% of the variance in body esteem accounted for by physical appearance comparison, appearance self-schema, and perfectionistic self-presentation. A multiple-group analysis showed that the mediation model could be applied equally to both men and women students in South Korea. The current study demonstrates how body esteem issues may unfold in a Korean cultural context where appearance is highly salient to one’s identity.

Using helping skills with Korean clients: The perspectives of Korean counselors

Objective: The purpose of this study was to investigate how Korean counselors modify the helping skills they learned during training in their work with Korean clients. Method: Thirteen practicing Korean therapists who had taken two master's level courses in the Hill helping skills model were interviewed about their experiences in applying the model in their work with clients. Data were analyzed using consensual qualitative research (CQR). Results: Several characteristics were noted of Korean clients that might influence the appropriateness of the helping skills model (e.g., clients regard counseling as authorities and wise experts). Participants had a number of reactions to the overall helping skills model (e.g., noting that Korean counselors deliver empathy and genuineness more through non-verbal rather than verbal channels). Participants also noted needed modifications to specific stages or skills in the model (e.g., using the insight stage less than the exploration stage). Discussion: Based on these findings, six guidelines are offered for modifying the Hill helping skills approach to fit the needs of Korean clients: Provide a pre-exploration stage to educate clients about approach, utilize indirect and non-verbal communication more than verbal communication, validate client's experiences, work cautiously with emotions, be cautious about using insight skills, and respond to clients' implicit communication when they ask for action.

Estimating the economic value of counselling services using the contingent valuation method

This study aimed to justify the use of the contingent valuation method to elicit the willingness to pay (WTP) for counselling services and to analyse the socio-demographic and psychological factors that influence WTP (through an increase in insurance premiums) for counselling services in South Korea. Regarding WTP for counselling services, the researchers asked 561 participants double-bounded dichotomous choice questions, which is one of the major estimation methods. Two survival analysis models were set up with their corresponding variables to investigate the factors affecting the WTP for an increase in insurance premiums to cover counselling services. The results indicate that a person in South Korea who makes KRW 2,500,000 (USD 2223.21) per month and pays KRW 66,625 (USD 59.25) per month in insurance premiums is willing to pay a roughly 1% premium to receive additional counselling services. The first regression analysis model for WTP showed that pocket money and counselling experience had significant positive effects while gender had a significant negative effect. The second model included four additional psychological factors and the significant effects of gender and counselling experience that had been found in the first model disappeared while only pocket money showed a significant effect on WTP.