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공간효과분석을 이용한 건강보험 환자 관외 의료이용도와 관련된 요소분석

Analysis on Factors Relating to External Medical Service Use of Health Insurance Patients Using Spatial Regression Analysis

  • 노윤호 (고려대학교 보건과학연구소)
  • Roh, Yun Ho (Health Science Research Institute, Korea University)
  • 투고 : 2013.08.23
  • 심사 : 2013.11.25
  • 발행 : 2013.12.31

초록

Background: The purpose of this study was to analyze the association between areas of Korea Train Express (KTX) region and external medical service use in Korean society using spatial statistical model. Methods: The data which was used in this study was extracted from 2011 regional health care utilization statistics and health insurance key statistics from National Health Insurance Corporation. A total spatial units of 229 districts (si-gun-gu) were included in this study and spatial area was all parts of the country excepted Jeju, Ulleungdo island. We conducted Kruskal-Wallis test, correlation, Moran's I and hot-spot analysis. And after, ordinary linear regression, spatial lag, spatial error analysis was performed in order to find factors which were associated with external medical service use. The data was processed by SAS ver. 9.1 and Geoda095i (windows). Results: Moran's I of health insurance patients' external medical service use was 0.644. Also, population density, Seoul region, doctor factors positively associated with health insurance patients' external medical service. In contrast, average age, health care organization per 100 thousand were negatively associated with health insurance patients' external medical service use. Conclusion: The finding of this study suggested that health insurance patient's external medical service use correlated for seoul region in korea. The study results imply the need for more attention medical needs in the region (si-gun-gu unit) for health insurance patients of seoul region. It is important to adapt strategy to activation of primary health care as well as enhancing public health institution for prevent leakage of patients to other areas.

키워드

참고문헌

  1. Lee OH, Tae YH, Seo SR, Seo NK. Health insurance medical expenses after the configuration change protection-enhanced. Seoul: Health Insurance Policy Institute; 2012.
  2. Oh YH. 2011 National Health Care Survey. Seoul: Korea Institute for Health and Social Affairs; 2011.
  3. Lee JH, Lee WJ, Jung HY. Determinants of bypass healthcare utilization for hospitals in Seoul: the case of KTX passengers. J Korea Contents Assoc 2011;11(7):259-274. https://doi.org/10.5392/JKCA.2011.11.7.259
  4. Lee CG, Kwok JM. The opening of the regional economic impact analysis of KTX. Daegu: Daegu Gyeongbuk Institute; 2005.
  5. Khamis FG. The relationship between spatial patterns of illnesses and unemployment in Iraq-2007. Glob J Health Sci 2011;4(1):192-203. https://doi.org/10.5539/gjhs.v4n1p192
  6. Kim KY, Shin JY, Lee GH, Cho DH. A location model and algorithm for visiting health-care districting for the rural elderly. J Korean Geogr Soc 2009;44(6):813-832.
  7. Loughnan ME, Nicholls N, Tapper NJ. Demographic, seasonal, and spatial differences in acute myocardial infarction admissions to hospital in Melbourne Australia. Int J Health Geogr 2008;7:42. https://doi.org/10.1186/1476-072X-7-42
  8. Nam KW, Kim JG. Temporal and spatial distributions of emergency medical service-Busan. J Korean Assoc Geogr Inf Stud 2007:10(1):113-123.
  9. Park SK. Geographical characteristics and patients' determinants of online referrals: a case study of Choongbuk, Korea. J Korean Assoc Reg Geogr 2011:17(5);617-637.
  10. Shin HS, Lee SH. Regional disparity of ambulatory health care utilization. J Korean Assoc Geogr Inf Stud 2012;15(4):138-150. https://doi.org/10.11108/kagis.2012.15.4.138
  11. Kim JH, Lee JH, Lee JH. Changes in healthcare utilizations of cancer patients since the launch of KTX. J Korean Soc Railw 2010;13(4):236-243.
  12. Park GD. Research on regional disparities of medical use. J Korean Assoc Policy Stud 2012;21(3):387-414.
  13. Kim EJ, Kang MG. Effects of built environmental factors on obesity and self-reported health status in seoul metro politan area using regression model. Land Res 2011;68(3):85-98.
  14. Lee SJ, Park JY. Changing trends in Daegu and Gyeongbuk-based patients' use of health facilities in seoul. Korean J Health Policy Adm 2010; 20(4):19-44.
  15. Hyun KR, Choi KC, Lee DH, Lee SY, Lim HA. Analysis of changes in health insurance medical expenses. Seoul: Health Insurance Policy Institute; 2012.
  16. Lee YJ. The relation between the kind of medical institution and utilization in national health insurance. J Korean Soc Welf Adm 2007;9(2):1-28.
  17. Seo YS. A study on regional medical utilization of hospital inpatients in korea [master's thesis]. Gimhae: Inje University; 2009.
  18. Choi MS, Byeon SI. Analysis on leading industries of KTX cities for promoting inter-regional industrial linkage. J Korea Spat Plan Rev 2011; 68(3):43-60. https://doi.org/10.15793/kspr.2011.68..003
  19. Connell FA, Day RW, LoGerfo JP. Hospitalization of medicaid children: analysis of small area variations in admission rates. Am J Public Health 1981;71(6):606-613. https://doi.org/10.2105/AJPH.71.6.606
  20. Roos NP, Roos LL Jr. Surgical rate variations: do they reflect the health or socioeconomic characteristics of the population? Med Care 1982;20(9): 945-58. https://doi.org/10.1097/00005650-198209000-00007
  21. Stockwell H, Vayda E. Variations in surgery in Ontario. Med Care 1979; 17(4):390-396. https://doi.org/10.1097/00005650-197904000-00007
  22. Wennberg J, Gittelsohn A. Variations in medical care among small areas. Sci Am 1982;246(4):120-134. https://doi.org/10.1038/scientificamerican0482-120
  23. Wilson P, Tedeschi P. Community correlates of hospital use. Health Serv Res 1984;19(3):333-355.
  24. Roemer MI. Bed supply and hospital utilization: a natural experiment. Hospitals 1961;35:36-42.
  25. Rosenblatt RA, Moscovice IS. The physician as gatekeeper: determinants of physicians' hospitalization rates. Med Care 1984;22(2):150-159. https://doi.org/10.1097/00005650-198402000-00006
  26. Shin UG. Study of the cause and differences in medical care utilization among areas in Korea [dissertation]. Seoul: Kyung Hee University; 2005.
  27. Kim YM. Small area variation in rates of common surgery [dissertation]. Seoul: Seoul National University; 2003.
  28. Noguchi H, Shimizutani S, Masuda Y. Physician-induced demand for heart attack patients in Japan-evidence from the Tokai acute myocardial study. Tokyo: Economic and Social Research Institute; 2005.
  29. Roos NP. Predicting hospital utilization by the elderly: the importance of patient, physician, and hospital characteristics. Med Care 1989;27(10): 905-919. https://doi.org/10.1097/00005650-198910000-00001
  30. Joo JM, Kwon SM, Difference in outpatient medical expenditure and physician practice patterns between medicaid and health insurance patients. Korean J Health Policy Adm 2009;19(3):125-141. https://doi.org/10.4332/KJHPA.2009.19.3.125
  31. Kwon SM, Yang BM, Lee TJ, Oh JW, Lee SH. Equity in heath care utilization in korea. Korean Health Econ Rev 2003;9(2):13-24.
  32. Kim JH. Health impact assessment of KTX. Seoul: Korea Institute for Health and Social Affairs; 2008.
  33. Kwok JM. The local economy has had on the opening KTX cod ramifications. Daegu: Daegu Gyeongbuk Institute; 2009.
  34. Moran PA. Notes on continuous stochastic phenomena. Biometrika 1950; 37(1-2):17-23. https://doi.org/10.1093/biomet/37.1-2.17
  35. Anselin L. Local indicators of spatial association-lisa. Geogr Anal 1995; 27(2):93-115. https://doi.org/10.1111/j.1538-4632.1995.tb00338.x
  36. Shin HS. Regional inequalities in health care use: the importance of community-based approaches. Seoul: Korea Institute for Health and Social Affairs; 2012.
  37. Lee YJ. Regional analysis of the equity and causes in utilization of the national health insurance [dissertation]. Seoul: Chung-Ang University; 2006.
  38. Lee JY. A study on the regional variation of outpatient utilization in Korea [master's thesis]. Gimhae: Inje university; 2010.
  39. Wennberg J, Gittelsohn. Small area variations in health care delivery. Science 1973;182(4117):1102-1108. https://doi.org/10.1126/science.182.4117.1102
  40. Wennberg JE. Population illness rates do not explain population hospitalization rates: a comment on Mark Blumberg's thesis that morbidity adjusters are needed to interpret small area variations. Med Care 1987; 25(4):354-359. https://doi.org/10.1097/00005650-198704000-00008
  41. Fisher ES, Wennberg JE, Stukel TA, Skinner JS, Sharp SM, Freeman JL, et al. Associations among hospital capacity, utilization, and mortality of US Medicare beneficiaries, controlling for sociodemographic factors. Health Serv Res 2000;34(6):1351-1362.
  42. Hong SO, Suh WS. Factors associated with utilization patterns of provincial patients discharged from general hospitals located in seoul area. Korean J Health Educ Promot 2009;26(4):117-127.
  43. Moon YO, Park EC, Shin HR, Won YJ, Jung KW, Lee JH, et al. Regional variation in accessing regional hospitals for cancer patients. Korean J Epidemiol 2006;28(2):152-161.
  44. Pope DG. Reacting to rankings: evidence from “America's Best Hospitals”. J Health Econ 2009;28(6):1154-1165. https://doi.org/10.1016/j.jhealeco.2009.08.006