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Association between all-cause mortality and insurance status transition among the elderly population in a rural area in Korea: Kangwha Cohort Study

 Sung-In Jang  ;  Sang-Wook Yi  ;  Jae-Woong Sull  ;  Eun-Cheol Park  ;  Jae-Hyun Kim  ;  Heechoul Ohrr 
 HEALTH POLICY, Vol.119(5) : 680-687, 2015 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Humans ; Insurance Coverage/statistics & numerical data* ; Male ; Mortality/trends* ; National Health Programs/statistics & numerical data ; Republic of Korea/epidemiology ; Rural Population ; State Medicine* ; Surveys and Questionnaires ; Universal Coverage
Aged ; Cohort studies ; Korea ; Medicaid ; Mortality ; National Health Insurance
The study purpose was to examine the association between health insurance transition and all-cause mortality. 3206 residents in Korea who participated in two surveys in 1985 and 1994, were followed-up during 1994-2008. Adjusted hazard ratios (aHR) were calculated using Cox hazard model. Participants were divided into four groups by insurance transition (the "National Health Insurance (NHI)-NHI", "NHI-Medicaid", "Medicaid-NHI", and "Medicaid-Medicaid" groups), where NHI-Medicaid means participants covered by NHI in 1985 but by Medicaid in 1994. For men covered by NHI in 1985, the mortality risk in the NHI-Medicaid was higher (aHR=1.47) than in the NHI-NHI. For men and women, covered by Medicaid in 1985, aHR was non-significantly lower in the Medicaid-NHI than in the Medicaid-Medicaid. When four groups were analyzed together, men in the Medicaid-Medicaid (aHR=1.67) and NHI-Medicaid (aHR=1.46) groups had higher mortality risk than males in the NHI-NHI, whereas no significant difference was observed for females. In conclusion, transition from NHI to Medicaid increases mortality risk, and transition from Medicaid to NHI may mitigate risk, while remaining on Medicaid pose the greatest risk, especially for men. Therefore, policy makers should strengthen coverage for Medicaid. The weak effects of transition from NHI to Medicaid on mortality for women require validation.
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1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jae-Hyun(김재현)
Park, Eun-Cheol(박은철) ORCID logo https://orcid.org/0000-0002-2306-5398
Ohrr, Hee Choul(오희철)
Jang, Sung In(장성인) ORCID logo https://orcid.org/0000-0002-0760-2878
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