Abstract
INTRODUCTION: Health care spending in South Korea is associated with improvements in health. However, it remains unclear whether the value of this spending is equally distributed across income groups. METHODS: We analyzed lifetime health care spending and quality-adjusted life expectancy (QALE) by income quintile among South Korean adults from 2010 to 2018. We then calculated the ratio of changes in health care spending to changes in QALE to estimate the value of health care spending across income groups. Additionally, we investigated mechanisms underlying income-related differences in the value of health care. RESULTS: Assuming 80% of QALE gains are attributable to health care, adults in the lowest-income quintile received the least value, incurring $78 209 per QALE gained. However, middle- and higher-income quintiles achieved greater value ($47 831, $46 905, $31 757, and $53 889 from the second to highest quintile), although the highest value did not occur in the highest-income quintile. The higher spending per QALE gained in the lowest-income quintile reflects smaller improvements in QALE, likely driven by poorer baseline health and greater unmet needs. CONCLUSION: These findings highlight structural inequities in the South Korean health system and emphasize the need for targeted policies to promote equitable health care value.