체납된 건강보험료 징수 가능성 예측모형 개발 연구

• Published in: Health policy and management Vol. 33; no. 4; pp. 450 - 456
• Main Authors: 나영균, Young-kyoon Na
• Format: Journal Article
• Language: Korean
• Published: 한국보건행정학회 31.12.2023
• Subjects: Collection management; Default; Health insurance contribution; Low income; Non-payment; Predictive model; Health insurance contribution; Non-payment; Low income; Default; Collection management; Predictive model
• ISSN: 1225-4266

Background: This study aims to develop a “Predictive Model for the Possibility of Collection Delinquent Health Insurance Contributions” for the National Health Insurance Service to enhance administrative efficiency in protecting and collecting contributions from livelihood-type defaulters. Additionally, it aims to establish customized collection management strategies based on individuals’ ability to pay health insurance contributions. Methods: Firstly, to develop the “Predictive Model for the Possibility of Collection Delinquent Health Insurance Contributions,” a series of processes including (1) analysis of defaulter characteristics, (2) model estimation and performance evaluation, and (3) model derivation will be conducted. Secondly, using the predictions from the model, individuals will be categorized into four types based on their payment ability and livelihood status, and collection strategies will be provided for each type. Results: Firstly, the regression equation of the prediction model is as follows: phat = exp (0.4729 + 0.0392 × gender + 0.00894 × age + 0.000563 × total income - 0.2849 × low-income type enrollee - 0.2271 × delinquency frequency + 0.9714 × delinquency action + 0.0851 × reduction) / [1 + exp (0.4729 + 0.0392 × gender + 0.00894 × age + 0.000563 × total income - 0.2849 × low-income type enrollee - 0.2271 × delinquency frequency + 0.9714 × delinquency action + 0.0851 × reduction)]. The prediction performance is an accuracy of 86.0%, sensitivity of 87.0%, and specificity of 84.8%. Secondly, individuals were categorized into four types based on livelihood status and payment ability. Particularly, the “support needed group,” which comprises those with low payment ability and low-income type enrollee, suggests enhancing contribution relief and support policies. On the other hand, the “high-risk group,” which comprises those without livelihood type and low payment ability, suggests implementing stricter default handling to improve collection rates. Conclusion: Upon examining the regression equation of the prediction model, it is evident that individuals with lower income levels and a history of past defaults have a lower probability of payment. This implies that defaults occur among those without the ability to bear the burden of health insurance contributions, leading to long-term defaults. Social insurance operates on the principles of mandatory participation and burden based on the ability to pay. Therefore, it is necessary to develop policies that consider individuals’ ability to pay, such as transitioning livelihood-type defaulters to medical assistance or reducing insurance contribution burdens.