보건행정학회지 (Health Policy and Management)

  • 제28권1호
  • /
  • Pages.35-47
  • /
  • 2018
  • /
  • 1225-4266(pISSN)
  • /
  • 2289-0149(eISSN)
한국보건행정학회 (Korean Academy of Health Policy and Management)
권호 표지
DOI QR코드

DOI QR Code

만성질환을 가진 노인의 의료경험과 미충족의료 인식

Medical Experiences and Unmet Health Care Perception among Elderly People with Chronic Disease

  • 민동후 (경희대학교 의과대학 예방의학교실) ;
  • 조정연 (서울대학교 보건대학원) ;
  • 김정길 (서울대학교 보건대학원) ;
  • 서수진 (서울대학교 보건대학원) ;
  • 김미경 (서울대학교 보건대학원) ;
  • 심은혜 (서울대학교 보건대학원) ;
  • 차유현 (서울대학교 보건대학원) ;
  • 김창엽 (서울대학교 보건대학원)
  • Min, Dong-Hoo (Department of Preventive Medicine, Kyunghee University College of Medicine) ;
  • Cho, Jung-Yeon (Graduate School of Public Health, Seoul National University) ;
  • Kim, Jeong-Gil (Graduate School of Public Health, Seoul National University) ;
  • Seo, Su-Jin (Graduate School of Public Health, Seoul National University) ;
  • Kim, Mi-Kyung (Graduate School of Public Health, Seoul National University) ;
  • Shim, Eun-Hye (Graduate School of Public Health, Seoul National University) ;
  • Cha, Yu-Hyun (Graduate School of Public Health, Seoul National University) ;
  • Kim, Chang-Yup (Graduate School of Public Health, Seoul National University)
  • 투고 : 2017.11.09
  • 심사 : 2018.01.29
  • 발행 : 2018.03.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: The purpose of this study is to elucidate the context of medical experience and the perception of unmet healthcare of elderly people with chronic diseases based on in-depth interview data. Methods: We carried out in-depth interviews with 10 elderly people with chronic diseases using semi-structured questionnaires based on literature review. The in-depth interview data were analyzed using thematic analysis; one qualitative research methodology, three core meaning categories, and four attributes associated with unmet healthcare were ultimately derived. Results: The context of the medical experience were based on the following three categories: (1) discomfort due to diseases and high medical needs, (2) the poor community medical environment and difficulties in accessing to metropolitan medical institutions, and (3) inconvenience caused by long waiting time and side effects of medicine. In addition, the elderly with chronic disease realized the unmet healthcare as (1) the availability related to the desired medical institutions at the right time, (2) the affordability related to their economic capacity, (3) the effectiveness of the medical services they experienced, and (4) the appropriateness related to receiving medical services in a pleasant environment. Conclusion: The perception of unmet healthcare among the elderly with chronic disease is the result of interaction of multi-level and multi-dimensional factors related with their medical experience.

키워드

참고문헌

  1. Shin YJ, Shon JI. The prevalence and association factors of unmet medical need: using the 1st and 2nd Korea welfare panel data. Health Soc Welf Rev 2009;29(1):95-122. DOI: https://doi.org/10.15709/hswr.2009.29.1.95.
  2. Donabedian A. Aspects of medical care administration: specifying requirements for health care. Cambridge (MA): Harvard University Press; 1973.
  3. Mun J, Kang M. The prevalence and predictors of unmet medical needs among the elderly living alone in Korea: an application of the behavioral model for vulnerable populations. Health Soc Welf Rev 2016;36(2):480-510. DOI: https://doi.org/10.15709/hswr.2016.36.2.480.
  4. Jeong GH, Oh YH, Kang EN, Kim JH, Seonu D, Oh MA, et al. Survey of the elderly in 2014: final report 14 Mar 2014-10 Dec 2015. Sejong: Ministry of Health and Welfare: 2014.
  5. Lee SY, Bae JY. A study on promoting the linkage between hospital care and community health services for the low-income elderly with chronic disease. Korean J Soc Welf Stud 2011;42(2):303-322. DOI: https://doi.org/10.16999/kasws.2011.42.2.303.
  6. Kim JG. Factors affecting the choice of medical care use by the elderly person. J Welf Aged 2008;(39):271-300.
  7. Macinko J, Starfield B. The utility of social capital in research on health determinants. Milbank Q 2001;79(3):387-427. https://doi.org/10.1111/1468-0009.00213
  8. Woo KS, Seo JH, Kim GS, Shin YJ. The effect of social capital, health risk behavior and health status on medical care utilization by the elderly. Korean J Health Policy Adm 2012;22(4):497-521. DOI: https://doi.org/10.4332/KJHPA.2012.22.4.497.
  9. Song KS, Lee JH, Rhim KH. Factors associated with unmet needs for health care. Korean Public Health Res 2011:37(1):131-140. https://doi.org/10.22900/KPHR.2011.37.1.011
  10. Huh S, Lee S. Unmet health care needs and associated factors among patients with hypertension and those with diabetes in Korea. Korean J Health Policy Adm 2011;21(1):1-22. DOI: https://doi.org/10.4332/KJHPA.2011.21.1.001.
  11. Bae JY. The study on the relationship between the burden of medical expenditures and health-related quality of life among the elderly with chronic diseases. J Soc Sci 2014;25(4):109-129. DOI: https://doi.org/10.16881/jss.2014.10.25.4.109.
  12. Song HY, Choi JW, Park EC. The effect of economic participatory change on unmet needs of health care among Korean adults. Health Policy Manag 2015;25(1):11-21. DOI: https://doi.org/10.4332/KJHPA.2015.25.1.11.
  13. Andersen R. A behavioral model of families' use of health service. Chicago (IL): Center for Health Administration Studies, University of Chicago; 1968.
  14. Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res 1974;9(3):208-220.
  15. Ahn YH, Kim NH, Kim CB, Ham OK. Factors affecting unmet healthcare needs of older people in Korea. Int Nurs Rev 2013;60(4):510-519. DOI: https://doi.org/10.1111/inr.12055.
  16. Kim J, Kim TH, Park EC, Cho WH. Factors influencing unmet need for health care services in Korea. Asia Pac J Public Health 2015;27(2):2555-2569. DOI: https://doi.org/10.1177/1010539513490789.
  17. Lee SE, Yeon M, Kim CW, Yoon TH. The association among individual and contextual factors and unmet healthcare needs in South Korea: a multilevel study using national data. J Prev Med Public Health 2016;49(5):308-322. DOI: https://doi.org/10.3961/jpmph.16.035.
  18. Jeong US, Park MJ. Factors affecting unmet medical care of the elderly with chronic illness. Proceedings of the 3rd Korea Health Panel Academic Conference; 2011 Dec 1; Seoul, Korea. Sejong: Korea Institute for Health and Social Affairs; 2011.
  19. Park MJ. The factors affecting unmet medical needs in elderly by using Korea health panel data 2011. J Korean Data Anal Soc 2014;16(2):1017-1030.
  20. Hwang BD, Choi R. The prevalence and association factors of unmet medical needs by age group in the elderly. Korean J Health Serv Manag 2015;9(1):81-93. DOI: https://doi.org/10.12811/kshsm.2015.9.1.081.
  21. Heo SI, Kim MG, Lee SH, Kim SJ. Policy options to tackle unmet health needs. Sejong: Korea Institute for Health and Social affairs; 2009.
  22. Cho MO, Jeong SY, Jeong GI. Health care seeking behavior among elderly with chronic diseases. Qual Res 2014;15(2):100-116. https://doi.org/10.22284/qr.2014.15.2.100.
  23. Ha JY, Yee OH, Son HM. Chronic disease in later life: a qualitative research. Qual Res 2011;12(1):11-24.
  24. Chung J, Cho JJ. Use of qualitative research in the field of health. J Korean Acad Fam Med 2008;29(8):553-562.
  25. Newacheck PW, Hughes DC, Hung YY, Wong S, Stoddard JJ. The unmet health needs of America's children. Pediatrics 2000;105(4 Pt 2):989-997.
  26. Cunningham PJ, Hadley J. Differences between symptom-specific and general survey questions of unmet need in measuring insurance and racial/ethnic disparities in access to care. Med Care 2007;45(9):842-850. DOI: https://doi.org/10.1097/MLR.0b013e318053678f.
  27. Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013;12:18. DOI: https://doi.org/10.1186/1475-9276-12-18.
  28. Allin S, Grignon M, Le Grand J. Subjective unmet need and utilization of health care services in Canada: what are the equity implications? Soc Sci Med 2010;70(3):465-472. DOI: https://doi.org/10.1016/j.socscimed.2009.10.027.
  29. Han KT, Park EC, Kim SJ. Unmet healthcare needs and community health center utilization among the low-income population based on a nationwide community health survey. Health Policy 2016;120(6):630-637. DOI: https://doi.org/10.1016/j.healthpol.2016.04.004.
  30. Hwang EJ, Kim YH, Eo YS, Kim HH, Song MK, Cho GY. The lived experience of the women suffering from rheumatoid arthritis. Qual Res 2002;3(1):1-14.
  31. Hur HK. Pain in patients with rheumatoid arthritis: focused on patients with rheumatoid arthritis. J Muscle Jt Health 1997;4(1):115-124.
  32. Eun Y. Chronic pain control in patients with rheumatoid arthritis. J Muscle Jt Health 1995;2(1):17-40.
  33. Joung EO, Kwon SB, Ahn OH. Coping with experiences in multiple chronic diseases in the rural elderly. J Korean Acad Community Health Nurs 2007;18(1):32-41.
  34. Korean Statistical Information Service. E-local index [Internet]. Daejeon: Statistics Korea; 2017 [cited 2018 Jan 12]. Available from: http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1YL0000.
  35. Lee TH, Gwak MY, Kim MJ, Shin HS, Lee TS, Hwang KS, et al. 2016 Medical vulnerability monitoring research: final report 11 May 2016-30 Nov 2016. Sejong: Ministry of Health and Welfare; 2016.
  36. Korea Centers for Disease Control and Prevention. 2015 Goseong-gun community health survey [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; 2016 [cited 2018 Jan 12]. Available from: https://chs.cdc.go.kr/chs/index.do.
  37. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3(2):77-101. DOI: https://doi.org/10.1191/1478088706qp063oa.
  38. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995;36(1):1-10. DOI: https://doi.org/10.2307/2137284.
  39. Kim DH. Perceived urban neighborhood environment for physical activity of older adults in Seoul: a multimethod qualitative study [dissertation]. Seoul: Seoul National University; 2016.
  40. Morse JM, Field PA. Qualitative research methods for health professionals. 2nd ed. Thousand Oaks (CA): Sage Publications; 1995.
  41. Sandelowski M. The problem of rigor in qualitative research. ANS Adv Nurs Sci 1986;8(3):27-37. DOI: https://doi.org/10.1097/00012272-198604000-00005.
  42. Marshall EG, Wong ST, Haggerty JL, Levesque JF. Perceptions of unmet healthcare needs: what do Punjabi and Chinese-speaking immigrants think?: a qualitative study. BMC Health Serv Res 2010;10:46. DOI: https://doi.org/10.1186/1472-6963-10-46.
  43. Katz MH, Cunningham WE, Mor V, Andersen RM, Kellogg T, Zierler S, et al. Prevalence and predictors of unmet need for supportive services among HIV-infected persons: impact of case management. Med Care 2000;38(1):58-69. DOI: https://doi.org/10.1097/00005650-200001000-00007.
  44. Lin L, Brown KB, Yu F, Yang J, Wang J, Schrock JM, et al. Health care experiences and perceived barriers to health care access: a qualitative study among African migrants in Guangzhou, Guangdong province, China. J Immigr Minor Health 2015;17(5):1509-1517. DOI: https://doi.org/10.1007/s10903-014-0114-8.
  45. Goins RT, Williams KA, Carter MW, Spencer M, Solovieva T. Perceived barriers to health care access among rural older adults: a qualitative study. J Rural Health 2005;21(3):206-213. DOI: https://doi.org/10.1111/j.1748-0361.2005.tb00084.x.
  46. Khan NF, Evans J, Rose PW. A qualitative study of unmet needs and interactions with primary care among cancer survivors. Br J Cancer 2011; 105 Suppl 1:S46-S51. DOI: https://doi.org/10.1038/bjc.2011.422.
  47. Yun H, Lee SI. Primary care and health care reform in Korea. Sejong: Korean Development Institute; 2012.
  48. Choi YJ, Ko BS, Cho KH, Lee JH. Concept, values, current status and prospect of primary care in Korea. J Korean Med Assoc 2013;56(10):856-865. DOI: https://doi.org/10.5124/jkma.2013.56.10.856.
  49. Jeong MG. Problems and development of primary care in Korea. Seoul: People's Health Institute; 2016.
  50. Park SB, Cho KH, Lee SH, Choi YE, Kim TJ, Lee JW, et al. Development of management system model through analyzing medical use of patients with multiple chronic diseases and pilot study, clinical care guideline development. Goyang: National Health Insurance Service Ilsan Hospital; 2015.
  51. Jung YH. Analysis of multiple chronic diseases of the elderly: focusing on outpatient use. Sejong: Korea Institute for Health and Social Affairs; 2013.