DOI QR코드

DOI QR Code

A Difference in Utilization of Cancer Inpatient Services by Income Class of Residents in Jeju Island

제주도 주민의 소득계층에 따른 암 입원 의료이용의 차이

  • Published : 2003.09.01

Abstract

Equity in health care has taken priority in the Korean government's policy agenda after the government-led national health insurance achieved universal coverage in 1989 along with the final inclusion of the self-employed as beneficiary. The purpose of this study is to examine the extent to which there exists difference or inequality in the utilization of health care, especially cancer inpatient services among income classes. We analysed the utilization of cancer inpatient services of residents in Jeju Island for a year of 2000, using the national health insurance data for qualification of beneficiaries and utilization of health care. The independent variable are 10 income classes based on the national health insurance fee imposed on each household for a year of 2000. The dependent variables of this study are an amount of cancer inpatient health care utilization measured by cancer admission days and cancer treatment costs. Also, cancer inpatient health care utilization is analysed by three categories divided into utilization in medical care institutions (1) within Jeju Island, (2) outside Jeju Island, and (3) all within and outside Jeju Island. We measured concentration index of cancer inpatient health care utilization. This analysis showed negative concentration index within Jeju Island and positive outside Jeju Island, and positive in all within and outside Jeju Island. This results suggest inequality against the relatively poor income groups in utilization of cancer inpatient health care services. Especially, inequity of cancer inpatient health care would be more serious in Jeju Island of Korea, considering that lower income groups reportedly have higher incidence rates in most of cancer and thus use more health services.

Keywords

References

  1. 국민건강보험공단. 건강보험통계연보 2000. 22호. 서울;국민건강보험공단:2001.
  2. 김석범, 강복수. 지역의료보험 실시전후 도시 일부주민의 의료이용양상 비교 - 소득계층별 의료필요충족도와 주민만족도를 중심으로. 예방의학회지1994;27(1):117-134
  3. 김일순, 박종구, 오희철. 강화군에서의 중풍의 유병율, 발생율, 치명율 및 사망률, 1976-1979. 한국역학회지 1980;2(1):83-88.
  4. 김창엽, 이진석, 강길원, 김용익. 의료보험 환자가 병원진료시 부담하는 본인부담 크기. 보건행정학회지 1999;9(4):1-14.
  5. 명지영, 문옥륜. 의료이용의 형평성에 관한 실증적 연구. 보건행정학회지 1995;5(2):155-172.
  6. 문옥륜, 이규식, 이기효, 장동민, 이해종, 김창엽, 신영전. 의료서비스의 배분적 정의. 서울:서울대학교 출판부;1999.
  7. 박실비아, 신영전, 문옥륜. 의료보험의 재원조달과 의료이용의 형평성에 관한 연구. 보건경제학회지 1996.
  8. 배상수. 지역의료보험의 실시에 따른 의료이용변화 분석 - 소득계층별 의료필요 충족도를 중심으로. 보건행정학회지 1992;2(1):167-203.
  9. 보건복지부, 한국보건사회연구원, 한국보건산업진흥원. 2001 국민건강.영양조사. 서울;보건복지부:2002.
  10. 보건복지부. 2001 국민건강.영양조사 - 만성질병편. 서울 : 보건복지부;2002.
  11. 오영호. 도시와 농촌간 의사외래의료이용 차이의 계량적 분석. 보건사회연구 1999;19(1):103-121.
  12. 이상이. 한국 보건의료체계의 진단과 과제. 보건과 사회과학 2002;12:115-156.
  13. 이상일, 최현림, 안형식, 김용익, 신영수. 1개군지역 의료보험제도에서의 보험료 부담수준별 병.의원 의료이용에 관한 연구. 예방의학회지 1989;22(4):578-590.
  14. 이선민. 소득계층에 따른 건강수준 및 의료이용의 차이에 관한 연구 [석사학위논문]. 서울: 서울대학교 보건대학원;1996.
  15. 이성권, 김두희, 정종학, 정국수, 박상빈, 최정헌, 홍선호, 라진훈. 농촌주민들의 의료필요성에 관한 연구. 예방의학회지 1974;7(1):29-94.
  16. 이수연. 도시 근로자 소득수준간 의료서비스 이용 및 치료비 부담률의 형평성[박사학위논문]. 서울 :서울대학교 대학원;1997.
  17. 이혜훈. 국민건강보험공단의 과제와 발전방향. 국민건강보험공단. 건강보험동향 2001;4(6):48-75
  18. 장동민, 문옥륜. 의료서비스에 대한 접근성의 형평분석. 보건행정학회지 1996;6(1):110-143.
  19. 제16대 대통령직 인수위원회. 참여복지와 삶의 질 향상. 참여복지와 삶의 질 향상 TF 팀 내부자료. 2003.
  20. 주경식, 김한중, 이선희, 민혜영. 도시 농촌 간 의료이용수준의 분석. 대한예방의학회지 1996;29(2):311-330.
  21. Acheson D, Barker D, Chambers J, Graham H, Marmot M, Whitehead M. The Report of the Independent Inquiry into Inequalities in Health. London: The Stationery Office, 1998 cited from Anand S, Diderichsen F, Evans T, Shkolnikov VM, Wirth M. Measuring disparities in health: methods and indicators. In: Evans T, Whitehead M, Diderichsen F, Buyia A, Wirth M (eds): Challenging Inequalities in Health. New York: Oxford University Press;2001. pp.49-67.
  22. Amartya Sen. Health: perception versus observation. self reported morbidity has severe limitations and can be extremely misleading. BMJ 2002;324:860-861 https://doi.org/10.1136/bmj.324.7342.860
  23. Anand S, Diderichsen F, Evans T, Shkolnikov VM, Wirth M. Measuring disparities in health: methods and indicators. In: Evans T, Whitehead M, Diderichsen F, Buyia A, Wirth M (eds): Challenging Inequalities in Health. New York: Oxford University Press;2001. pp.49-67.
  24. Baker JL, Van Der Gagg J. Equity in health care and health care financing: evidence from five developing countries. In: Van Doorslaer E, Wagstaff A, Rutten F, eds. Equity in the Finance and Delivery of Health Care: An international Perspective. Oxford: Oxford University Press; 1993: 356-394.
  25. Culyer AJ. Wagstaff A. Equity and equality in health and health care. Journal of Health Economics 1992;12:431-57. https://doi.org/10.1016/0167-6296(93)90004-X
  26. Faggiano F, Partanen T, Kogevinas M, Boffetta P, Socioeconomic differences in cancer incidence and mortality. Social inequalities and cancer : Edited by Kogevinas M. et al. IARC Scientific Publication; 1997. No. 138.
  27. Judge, K. Income distribution and life expectancy: a critical appraisal. BMJ 1995;311:1282-1285. https://doi.org/10.1136/bmj.311.7015.1282
  28. 신영전, 김명희, 전희진, 김석현. 사회역학. 서울: 한울아카데미; 2003
  29. Mackenbach JP, Kunst AE. Measuring the magnitude of socio-economic inequalities in health: An overview of available measures illustrated with two examples from Europe. Soc Sci Med 1997;44:757-771. https://doi.org/10.1016/S0277-9536(96)00073-1
  30. Normand D, Weber A. Social Health Insurance. WHO. 1994.
  31. Penchansky R, Thomas JW. The concept of access: Definition and relationship to consumer satisfaction. Medical Care 1981;19(2):127-140. https://doi.org/10.1097/00005650-198102000-00001
  32. Whitehead M, Evandrou M, Haglund B, Diderichsen F. As the health divide widens in Sweden and Britain, what's happening to access to care? BMJ 1997;315:1006-9. https://doi.org/10.1136/bmj.315.7114.1006

Cited by

  1. Health care utilization and costs among medical-aid enrollees, the poor not enrolled in medical-aid, and the near poor in South Korea vol.14, pp.1, 2015, https://doi.org/10.1186/s12939-015-0257-9