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Original Research

Open Access Special Issue

Impact of indemnity private health insurance on emergency department visits and expenditures

  • Jeong Wan Kwak1
  • Yu Jin Chung1
  • Hye Sun Lee2
  • Soyoung Jeon2
  • Je Sung You1
  • Hyun Soo Chung1
  • Sung Phil Chung1,*,

1Department of Emergency Medicine, Yonsei University College of Medicine, 06273 Seoul, Republic of Korea

2Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, 06229 Seoul, Republic of Korea

DOI: 10.22514/sv.2023.077 Vol.19,Issue 5,September 2023 pp.61-67

Submitted: 28 December 2022 Accepted: 08 March 2023

Published: 08 September 2023

*Corresponding Author(s): Sung Phil Chung E-mail:


Indemnity private health insurance (PHI) is a type of private insurance that pays actual medical expenses. We investigated the effect of subscriptions to indemnity PHI on emergency department (ED) expenses and the number of ED visits. This study was a retrospective study using Korea Health Panel Data from 2013 to 2017. The exposure variable was subscription of indemnity PHI. The control group did not subscribe to indemnity PHI throughout the study period, while the insured group had not subscribed to indemnity PHI in 2013 to 2014, but had done so in 2016 to 2017. The outcomes were ED expenses (per visit) and the number of ED visits. The outcomes were compared between before and after indemnity PHI subscription and between the insured and control groups. A total of 1919 subjects (265 insured and 1654 control group) were included. Univariable analyses indicated no difference in emergency medical use according to indemnity PHI subscription and the time period. However, multivariable modeling analysis showed that ED expenses were significantly higher for the insured group (US$5.7 more ED expense, p = 0.036; US$4.3 more ED expense per visit, p = 0.035). In addition, education level, chronic disease, disability status, economic activity and body mass index were associated with emergency medical use. This study suggests that indemnity PHI subscription can increase emergency medical expenses without an increase in visit frequency. Further studies are necessary to validate these results using another dataset.


Health expenditure; Indemnity; Health insurance; Emergency department

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Jeong Wan Kwak,Yu Jin Chung,Hye Sun Lee,Soyoung Jeon,Je Sung You,Hyun Soo Chung,Sung Phil Chung. Impact of indemnity private health insurance on emergency department visits and expenditures. Signa Vitae. 2023. 19(5);61-67.


[1] Trottmann M, Zweifel P, Beck K. Supply-side and demand-side cost sharing in deregulated social health insurance: which is more effective?Journal of Health Economics. 2012; 31: 231–242.

[2] Shami E, Tabrizi JS, Nosratnejad S. The effect of health insurance on the utilization of health services: a systematic review and meta-analysis. Galen Medical Journal. 2019; 8: e1411.

[3] Khandker RK, McCormack LA. Medicare spending by beneficiaries with various types of supplemental insurance. Medical Care Research and Review. 1999; 56: 137–155.

[4] Ko H. Moral hazard effects of supplemental private health insurance in Korea. Social Science & Medicine. 2020; 265: 113325.

[5] Yang JM, Lee SB, Kim YJ, Chon DY, Moon JY, Kim JH. Association between private health insurance and medical use by linking subjective health and chronic diseases. Medicine. 2022; 101: e29865.

[6] Kang S, You CH, Kwon YD, Oh E. Effects of supplementary private health insurance on physician visits in Korea. Journal of the Formosan Medical Association. 2009; 108: 912–920.

[7] Jeon B, Kwon S. Effect of private health insurance on health care utilization in a universal public insurance system: a case of South Korea. Health Policy. 2013; 113: 69–76.

[8] Moon TJ. Light and shadows of the korean healthcare system. Journal of Korean Medical Science. 2012; 27: S3.

[9] Kim D, Kim S, Park HK, Ha IH, Jung B, Ryu WH, et al. Effect of having a usual source of care on medical expenses—using the Korea health panel data. Journal of Korean Medical Science. 2019; 34: e229.

[10] Kim D, Sung S, Shin S, Park M. The effect of cancer on traditional, complementary and alternative medicine utilization in Korea: a fixed effect analysis using Korea health panel data. BMC Complementary Medicine and Therapies. 2022; 22: 137.

[11] Lee D, Choi J, Kim H, Myong J, Kang M. Differential impact of working hours on unmet medical needs by income level: a longitudinal study of Korean workers. Scandinavian Journal of Work, Environment & Health. 2022; 48: 109–117.

[12] Lee KJ, Kim MJ, Park JM, Kim KH, Park J, Shin DW, et al. Factors associated with satisfaction with pediatric emergency department services in Korea: analysis of Korea health panel data 2010 to 2012. Clinical and Experimental Emergency Medicine. 2018; 5: 156–164.

[13] Sohn M, Jung M. Effects of public and private health insurance on medical service utilization in the national health insurance system: national panel study in the republic of Korea. BMC Health Services Research. 2016; 16: 503.

[14] Li Y, Feng D, Sui Y, Li H, Song Y, Zhan T, et al. Analyzing longitudinal binary data in clinical studies. Contemporary Clinical Trials. 2022; 115: 106717.

[15] Lowe RA. Health insurance status change and emergency department use among us adults. Archives of Internal Medicine. 2012; 172: 642.

[16] Choi Y, Kim J, Yoo K, Cho KH, Choi J, Lee TH, et al. The effect of cost-sharing in private health insurance on the utilization of health care services between private insurance purchasers and non-purchasers: a study of the Korean health panel survey (2008–2012). BMC Health Services Research. 2015; 15: 489.

[17] Sabik LM, Gandhi SO. Copayments and emergency department use among adult medicaid enrollees. Health Economics. 2016; 25: 529–542.

[18] Stephens AS, Dinh MM, Kinsman L. Patterns of emergency department use in rural and metropolitan New South Wales by socioeconomic status: a population-based study. To be published in Emergency Medicine Australasia. 2022. [Preprint].

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