Korea Journal of Hospital Management (한국병원경영학회지)

Korean Society of Hospital Management (한국병원경영학회)
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Effects of Usual Source of Care by Patients with Diabetes on Use of Medical Service and Medical Expenses

당뇨병 환자의 상용치료원 보유가 의료이용 및 의료비에 미치는 영향

  • Lee, So Dam (Health Insurance Review and Assessment Service) ;
  • Shin, Euichul (Department of Preventive Medicine, Catholic University College of Medicine) ;
  • Lim, Jae-Young (Department of Food and Resource Economics, Korea University) ;
  • Lee, Sang Gyu (Graduate School of Public Health, Yonsei University) ;
  • Kim, Ji Man (Graduate School of Public Health, Yonsei University)
  • 이소담 (건강보험심사평가원) ;
  • 신의철 (가톨릭대학교 의과대학 예방의학교실) ;
  • 임재영 (고려대학교 식품자원경제학과) ;
  • 이상규 (연세대학교 보건대학원) ;
  • 김지만 (연세대학교 보건대학원)
  • Received : 2017.01.04
  • Accepted : 2017.08.03
  • Published : 2017.09.30
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Abstract

Purposes: Diabetes is a metabolic disorder that requires continuous care in order to prevent complications, as it can impose a critical burden on families and society due to various complications, including terminal renal failure, non-traumatic lower extremity amputation, and adult blindness. The usual sources of care are "specified private clinics, public health centers, or other facilities to visit when ill or when health-related advice is needed". These usual sources of care offer preventative services, have a high overall satisfaction rate in terms of public health care, and decrease the inpatient rates and medical costs of medical aid recipients. This study analyzed the current status of diabetic patients over 20 years of age based on their possession of a usual source of care, and the effects of this possession on the frequency of their medical service usage and its costs. Methodology: Based on data from the 7th Korea Health Panel, a Tobit analysis was used to analyze the different factors that can affect the frequency of medical service usage and its costs for diabetic patients with and without a usual source of care. Findings: The medical costs of diabetic patients with a usual source of care decreased in terms of inpatient, and the outpatient visits and inpatient costs of the group with a usual source of care in the form of a mainly-visiting doctor decreased more than those of the group with a mainly-visiting medical institution only. Practical Implications: Having a usual source of care can increase the treatment continuity, leading to reduced inpatient, and having a mainly-visiting doctor as the usual source of care further increases the treatment continuity. Based on these results, a new policy is needed to increase and strengthen diabetic patients? possession of a usual source of care.

목적: 상용치료원(usual source of care)은 아프거나 건강문제에 대한 조언이 필요할 때 주로 방문하는 특정 개인의원, 보건소, 혹은 기타 장소로, 상용치료원 보유는 예방서비스를 제공을 더 받게 되며, 보건의료에 대한 전반적인 만족도가 높고, 입원율을 감소시키며 의료급여자의 의료비를 감소시킬 수 있다. 이 연구에서는 당뇨병을 보유하고 있는 20세 이상을 대상으로 상용치료원 보유 여부에 따른 대상자의 현황을 파악하고, 의료이용 횟수 및 의료비의 차이와 이에 영향을 미치는 특성을 분석하였다. 방법: 이 연구는 제7차 한국의료패널 자료를 이용하였다. 상용치료원 보유여부에 따른 의료이용 횟수와 의료비를 비교하기 위해 분산분석을 실시하였으며, 상용치료원 유형에 따른 의료이용 횟수와 의료비용에 영향을 미치는 요인을 파악하기 위해 Tobit 분석을 수행하였다. 결과: Tobit 분석결과, 상용치료원을 보유한 경우 보유하지 않은 경우보다 외래의료비는 증가했으나 입원의료비는 감소하였다. 상용치료원을 보유한 경우 보유하지 않은 경우보다 외래이용횟수와 입원횟수가 증가했으나 통계적으로 유의하지 않았다. 함의: 지속적이고 포괄적인 의료서비스가 제공되는 상용치료원을 당뇨병 환자들이 보유하게 되면, 외래 예방서비스의 이용을 통해 장기적으로 입원의료비의 감소를 기대할 수 있을 것이다.

Keywords

References

  1. Kim JG. The impact of family type on health behavior of elderly people. J Welf Aged 2011;51: 35-55.
  2. WHO. Noncommunicable diseases country profiles 2011. Geneva, Switzerland: World Health Organization; 2011.
  3. International Diabetes Federation (IDF). IDF Diabetes, 5th edition. Brussels, Belgium: International Diabetes Federation; 2011.
  4. Korean Diabetes Association. Korean diabetes fact sheet 2015. Seoul, Korea: Korean Diabetes Association, 2015.
  5. UK prospective diabetes study group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998;317(7160):703-713. https://doi.org/10.1136/bmj.317.7160.703
  6. The diabetes control complications trial research group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329(14):977-986. https://doi.org/10.1056/NEJM199309303291401
  7. Park IB, Baik SH. Epidemiologic characteristics of diabetes mellitus in korea: current status of diabetic patients using Korean Health Insurance Database. Korean Diabetes J 2009;33(5):357-362. https://doi.org/10.4093/kdj.2009.33.5.357
  8. Lim JH, Oh CS. Medical care utilization status and quality of life in diabetes mellitus patients. J Digit Policy Manag 2013;11(10):609-618.
  9. Diabetes care analysis-savings estimate [Internet]. 2005 [cited 2 october 2015]. Available from: http://www.hci3.org/sites/default/files/files/files/Guide_BTE-Diabetes.pdf.
  10. Kim MY, Kim JH, Choi I-K, Hwang IH, Kim SY. Effects of having usual source of care on preventive services and chronic disease control: a systematic review. Korean J Fam Med 2012; 33(6):336-345. https://doi.org/10.4082/kjfm.2012.33.6.336
  11. Xu KT. Usual source of care in preventive service use: a regular doctor versus a regular site. Health Serv Res 2002;37(6):1509-1529. https://doi.org/10.1111/1475-6773.10524
  12. Weiss LJ, Blustein J. Faithful patients: the effect of long-term physician-patient relationships on the costs and use of health care by older Americans. Am J Public Health 1996;86(12): 1742-1747. https://doi.org/10.2105/AJPH.86.12.1742
  13. Ettner SL. The timing of preventive services for women and children: the effect of having a usual source of care. Am J Public Health 1996;86(12): 1748-1754. https://doi.org/10.2105/AJPH.86.12.1748
  14. Ettner SL. The Relationship between continuity of care and the health behaviors of patients: does having a usual physician make a difference? Med Care 1999;37(6):547-555. https://doi.org/10.1097/00005650-199906000-00004
  15. Liaw W, Petterson S, Rabin DL, Bazemore A. The impact of insurance and a usual source of care on emergency department use in the United States. Int J Family Med. 2014;2014:842847.
  16. Donahue K, Fryer GE, Phillips R, Green L. The importance of usual source of care for patients with cardiovascular-related conditions. Academy for Health Services Research Annual Meeting; June 10-12, 2001; Atlanta, Ga 2001.
  17. DeVoe JE, Fryer GE, Phillips R, Green L. Receipt of preventive care among adults: insurance status and usual source of care. Am J Public Health 2003;93(5):786-791. https://doi.org/10.2105/AJPH.93.5.786
  18. Korean Institute for Health and Social Affairs, National Health Insurance Service. In-depth analysis of medical utilization on Korea using Korean Health Panel Survey, 2012.
  19. Kim KM, Jeon HS, Lee JH. Having a physician rather than a place as a usual source of care would be better - from 2012 Korea Health Panel Data. J Korean Med Sci 2017;32(1):4-12. https://doi.org/10.3346/jkms.2017.32.1.4
  20. Ko SJ. In-depth analysis of medical utilization in Korea using Korean Health Panel Survey(KHPS). Seoul, Korea: Korea Institute for Health and Social Affairs, 2012.
  21. Kim JY, Kim HY, Kim HY, Min KW, Park SW, Park IB, et al. Current status of the continuity of ambulatory diabetes care and its impact on health outcomes and medical cost in Korea using National Health Insurance database. Diabetes Metab J 2006;30(5):377-387.
  22. Kim Jh, Chu SK, Moon JR, Song MS, Kim SE. Health behaviors of diabetic and non-diabetic subjects across age groups. Korean J Health Educ Promot 2010;27(3):13-22.
  23. Nam SM, Yu HY, Lee MY, Koh JH, Shin JY, Shin YG, et al. Alcohol consumption, liver enzymes, and prevalence of metabolic syndrome in korean adult men. Diabetes Metab J 2007;31(3): 253-260.
  24. Bloom G, Standing H, Lloyd R. Markets, information asymmetry and health care: Towards new social contracts. Soc Sci Med 2008;66(10): 2076-2087. https://doi.org/10.1016/j.socscimed.2008.01.034
  25. KIM ES. Medical care utilization and its determinants of industrial workers with diabetes mellitus detected through periodic health examination program. Daegu, Korea: Graduate School of Public Health, Kyungpook National University; 2007.