Gaps in universal health coverage in South Korea: Association with depression onset in a community cohort

Background: While controversies on limitation of coverage by the national health insurance and relatively high direct or “out-of-pocket” household payments by the national health insurance in South Korea still remain, potential unfavorable influence of the insufficiency of the universal health coverage on depression has not yet been evaluated. Methods and findings Baseline information were obtained from a community cohort (The Korean Genome and Epidemiology Study) of middle-aged subjects without depression at enrollment period (2001–2002). Subjects were followed-up biennially, and new onset depression was assessed using Becks Depression Inventory at 2nd round follow-up (2005–2006). Influence of direct medical expenditure on depression onset was investigated in all subjects and in stratified groups of different income level. Increasing risk of depression onset was observed for increased medical expenditure (OR [95% CI];1.44 [0.97–2.13], 1.90 [1.19–3.05], 1.71 [1.01–2.91] for spending