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

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.