{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:55:18Z","timestamp":1790963718229,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Economics"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Investigating the impact of healthcare expenditure on health is crucial for optimizing public resource allocation. This can inform the value of expanding healthcare budgets and provide a benchmark for allocations within healthcare systems. However, empirical evidence remains mixed. The potential causes of mixed results\u2014reverse causality and unobservable confounders\u2014need to be addressed through robust empirical methods. This study assesses the South Korean public healthcare cost of producing one quality\u2010adjusted life year (QALY) by using conversion factors\u2014elements in the pricing formula of healthcare services determined by negotiations\u2014as the instrument, with two\u2010way fixed effects. Moreover, since morbidity significantly affects health, it is crucial to estimate the impact of healthcare expenditure on morbidity using credible data. We use a unique dataset of directly measured regional EQ\u20105D indices from 240 municipalities for the period 2008\u20132019, which is unavailable in other countries. We estimate that $12,847 of public healthcare expenditure is required to gain one QALY. Sensitivity analyses using alternative calculation methods, data, and models produce estimates ranging from $8850 to $17,674 per QALY. Our findings suggest that the healthcare cost of producing one QALY is substantially lower than the GDP per capita and the willingness\u2010to\u2010pay for health in South Korea.<\/jats:p>","DOI":"10.1002\/hec.70134","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T18:00:08Z","timestamp":1785607208000},"page":"1678-1692","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["How Much Does It Cost the South Korean Public Healthcare System to Produce One Healthy Life Year?"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0250-8579","authenticated-orcid":false,"given":"Jinhyun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Economics and Related Studies University of York  York UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,1]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"Ahn J. H. Y. H.Kim S. J.Shin andJ. Y.Park.2012. \u201cA Joint Asian Study on Cost\u2010Effectiveness in Health Care Decision Making.\u201d17\u201320."},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev\u2010economics\u2010080218\u2010025643"},{"issue":"2","key":"e_1_2_13_4_1","article-title":"What Should the Cost\u2010Effectiveness Threshold Reflect?","volume":"24","author":"Bae E. Y.","year":"2018","journal-title":"Korean Journal of Health Economics and Policy"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00181\u2010011\u20100472\u20101"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/00036840210135665"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.1157"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1257\/jep.20231370"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.3650"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta19140"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475\u20105890.2016.12109"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/(sici)1099\u20101050(199911)8:7<627::aid\u2010hec474>3.0.co;2\u20108"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1257\/jep.20.3.97"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1257\/aer.20201480"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40273\u2010017\u20100585\u20102"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40273\u2010021\u201001087\u20106"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.1557"},{"key":"e_1_2_13_18_1","doi-asserted-by":"crossref","unstructured":"Felton C. andB. 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N.","year":"2023","journal-title":"Sociological Methods & Research"},{"key":"e_1_2_13_21_1","first-page":"223","volume-title":"Microeconomics","author":"Gravelle H.","year":"2004"},{"key":"e_1_2_13_22_1","article-title":"The First Open to the Public of the ICERs of Drugs Subjected to Economic Evaluation After Introducing the Positive List System","author":"HIRA","year":"2022","journal-title":"Health Insurance Review & Assessment Service"},{"key":"e_1_2_13_23_1","volume-title":"Current Status and Issues of Supplementary Health Insurance","author":"Kim G.\u2010S.","year":"2023"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12961\u2010023\u201000993\u20109"},{"key":"e_1_2_13_25_1","volume-title":"The Pandemic\u2019s Long Reach: South Korea\u2019s Fiscal and Fertility Outlook","author":"Kirkegaard J. 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