Factors associated with the choice of tertiary hospitals in patients with diabetes or hypertension

당뇨 또는 고혈압 환자의 상급종합병원 이용에 미치는 요인

  • Choi, Jae Woo (Dept. of Public Health, Graduate School, Yonsei University) ;
  • Park, So Hee (Institute of Health Services Research, Yonsei University College of Medicine) ;
  • Choi, Yun Su (Dept. of Public Health, Graduate School, Yonsei University) ;
  • Kim, Tae Kyung (Dept. of Public Health, Graduate School, Yonsei University) ;
  • Yun, Hyo Jung (Dept. of Public Health, Graduate School, Yonsei University) ;
  • Kim, Tae Hyun (Dept. of Public Health, Graduate School, Yonsei University)
  • 최재우 (연세대학교 대학원 보건학과) ;
  • 박소희 (연세대학교 보건정책 및 관리연구소) ;
  • 최윤수 (연세대학교 대학원 보건학과) ;
  • 김태경 (연세대학교 대학원 보건학과) ;
  • 윤효정 (연세대학교 대학원 보건학과) ;
  • 김태현 (연세대학교 보건정책 및 관리연구소)
  • Received : 2016.07.20
  • Accepted : 2016.10.25
  • Published : 2016.12.30


목적: 이 연구는 당뇨와 고혈압 환자의 상급종합병원 이용에 미치는 요인을 관찰하였다. 방법: 이 연구는 한국보건사회연구원과 국민건강보험공단이 공동으로 조사하는 한국의료패널 자료를 사용하였다(2008년, 2010년, 2012년). 연구대상은 20세 이상 성인이었으며 각 2008년에 2409명, 2010년에 2424명, 2012년에 2429명을 관찰하였다. 당뇨와 고혈압에 대한 외래방문 건수는 총 64,438건이었으며 당뇨 또는 고혈압 환자의 3차 의료기관 선택에 영향을 주는 요인을 관찰하기 위해 다수준 로지스틱 회귀분석을 활용하였다. 결과: 교육수준이 높은 환자가 낮은 환자에 비해 상급종합병원을 이용할 확률이 각각 2008년에 2.04배, 2010년에 1.83배, 그리고 2012년에 1.65배 더 높았다. 또한 고소득 환자가 저소득 환자에 비해 3차 의료기관을 이용할 확률이 2008년에 1.77배, 2010년 1.91배 그리고 2012년 1.94배 더 높았다. 결론: 정책입안자들은 의료전달 시스템과 관련하여 정책을 실행할 때 이러한 환자의 특징을 고려할 필요가 있다.


  1. Kim Y, Suh YK, Choi H. BMI and metabolic disorders in South Korean adults: 1998 Korea National Health and Nutrition Survey. Obes Res 2004;12:445-453. https://doi.org/10.1038/oby.2004.50
  2. Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: a systematic review. J Hypertens 2004;22:11-19. https://doi.org/10.1097/00004872-200401000-00003
  3. Hwang J, Shon C. Relationship between socioeconomic status and type 2 diabetes: results from Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012. BMJ Open 2014;4:e005710. https://doi.org/10.1136/bmjopen-2014-005710
  4. OECD. Health at a glance 2013: OECD indicators. Organisation for Economic Co-operation and Development (OECD) Publishing, 2013.
  5. Choi YJ, Kim HC, Kim HM, Park SW, Kim J, et al. Prevalence and management of diabetes in Korean adults: Korea National Health and Nutrition Examination Surveys 1998-2005. Diabetes Care 2009;32:2016-2020. https://doi.org/10.2337/dc08-2228
  6. Ofori SN, Unachukwu CN. Holistic approach to prevention and management of type 2 diabetes mellitus in a family setting. Diabetes Metab Syndr Obes 2014;7:159-168.
  7. Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet 2014;383:1999-2007. https://doi.org/10.1016/S0140-6736(14)60613-9
  8. Booth G, Cheng AY. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Methods. Can J Diabetes 2013;37 Suppl 1:S4-7.
  9. Kaczorowski J, Del Grande C, Nadeau-Grenier V. Community-based programs to improve prevention and management of hypertension: recent Canadian experiences, challenges, and opportunities. Can J Cardiol 2013;29:571-578. https://doi.org/10.1016/j.cjca.2013.02.011
  10. Tocci G, Giovannelli F, Sciarretta S, Ferrucci A, Zito GB, et al. Management of hypertension and stroke prevention: results of the Italian cardiologist survey. Int J Clin Pract 2009;63: 207-216. https://doi.org/10.1111/j.1742-1241.2008.01926.x
  11. Campbell N, Young ER, Drouin D, Legowski B, Adams MA, et al. A framework for discussion on how to improve prevention, management, and control of hypertension in Canada. Can J Cardiol 2012;28:262-269. https://doi.org/10.1016/j.cjca.2011.11.008
  12. Kim YK, Kim JS. A study on healthcare institution selection of healthcare consumers using theory of consumption values: focusing on relations among clinics or small sized hospitals, general hospitals, and large-sized hospitals. J Korean Soc Qual Manag 2009;37:71-86.
  13. Oh YH, Do SR, Son CK, Park DS, Kim JW, et al. Development and management of monitoring system to improve the efficiency of health care resources allocation: health care resources, Korea, 2010. Korea Institute for Health and Social Affairs.
  14. National Health Insurance Corporation. 2010 national health insurance statistical yearbook [Internet]. Seoul: National Health Insurance Corporation, 2012.
  15. Ministry of Health and Welfare. Basic plan for re-setting role and function of medical providers [Internet]. Seoul: Ministry of Health and Welfare, 2011.
  16. Yoo CH, Kwon YD. Factors influencing medical institution selection for outpatient services. J Korean Med Assoc 2012;55(9):898-910. https://doi.org/10.5124/jkma.2012.55.9.898
  17. Cho SJ, Chung SH, JY Oh. Differences between diabetic patients' tertiary hospital and non-tertiary hospital utilization according to comorbidity score. Korean J Health Policy Adm 2011;21: 527-540. https://doi.org/10.4332/KJHPA.2011.21.4.527
  18. Lee JC, Kim KH, Kim HN, Park YH. Factors associated with the hypertension outpatients' choice of healthcare providers in Korea. J Korean Med Assoc 2011;54:961-970. https://doi.org/10.5124/jkma.2011.54.9.961
  19. Lee JC, Kim KH, Kim HN, Kim NS. Factors associated with diabetes outpatient use of tertiary or general hospitals as their usual source of care in Korea. J Korean Med Assoc 2012;55: 1215-1225. https://doi.org/10.5124/jkma.2012.55.12.1215
  20. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005;43:1130-1139. https://doi.org/10.1097/01.mlr.0000182534.19832.83
  21. Dominick KL, Dudley TK, Coffman CJ, Bosworth HB. Comparison of three comorbidity measures for predicting health service use in patients with osteoarthritis. Arthritis Rheum 2005;53:666-672. https://doi.org/10.1002/art.21440
  22. Park YH. The Characteristics and utilization factors of tertiary hospital inpatients: evidence from Korea Health Panel (2008-2011). The Korean Journal of Health Service Management 2014;8(3):13-25. https://doi.org/10.12811/kshsm.2014.8.3.013
  23. Kim HJ, Kim YH, Kim HS, Woo JS, Oh SJ. The impact of outpatient coinsurance rate increase on outpatient health care service utilization in tertiary and general hospital. Korean J Health Policy Adm 2013;23(1):19-34. https://doi.org/10.4332/KJHPA.2013.23.1.019
  24. Shin SM, Kim ES, Lee HW. Self-perception of the amount of medical aid use of outpatient over users in Korea. Korean J Health Policy Adm 2009;19:21-35. https://doi.org/10.4332/KJHPA.2009.19.2.021