• Safety and Health at Work
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• 제9권4호
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• pp.462-467
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• 2018

Background: This study was conducted to investigate the effects of work on medical expenditures by the elderly. Methods: Data pertaining to individuals aged 65 or older collected by the Korean Health Panel 2008-2013 were used. The effects of work on medical expenditures were analyzed in a panel tobit model adjusted for several variables of demographic factors, socioeconomic factors, and health factors for health care. Data were also analyzed based on age groups (65-74, $75{\leq}$), type of work (waged or self-employed), and working time (daytime work or night time work). Results: Among the elderly older than 65 years, 34-37% were workers. Work among the elderly reduced medical expenditures relative to nonworking elderly. Specifically, medical expenditures were lower in individuals older than 75 years, as well as among those who were self-employed insured and had medical aid insurance and those who exercised. However, medical expenditures were higher among females, married individuals, those with a higher household income, and those with a chronic disease. Elderly wageworkers showed reduced medical expenditures than nonworking elderly and elderly daytime workers did. Conclusion: The elderly population's work, especially wage work and daytime work, reduced medical expenditures relative to no work. These results provide valuable information for policymakers by indicating that work was associated with lower medical expenditures than no work. If elderly work is to be encouraged, it is necessary to provide a variety of high-quality wage work.

• 한국보건간호학회지
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• 제31권1호
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• pp.5-18
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• 2017

Purpose: This study was conducted to suggest a method for financial projection of health insurance expenditures that reflects future changes in demographic structure. Methods: Using data associated with the number of patients and health insurance cost per patient, generalized linear models (GLM) were fitted with demographic explanatory variables. Models were constructed separately for individual medical departments, types of medical service, and types of public health insurance. Goodness-of-fit of most of the applied GLM models was quite satisfactory. By combining estimates of frequency and severity from the constructed models and results of the population projection, total annual health insurance expenditures were projected through year 2060. Results: Expenditures for medical departments associated with diseases that are more frequent in elderly peoples are expected to increase steeply, leading to considerable increases in overall health insurance expenditures. The suggested method can contribute to improvement of the accuracy of financial projection. Conclusion: The overall demands for medical service, medical personnel, and relevant facilities in the future are expected to increase as the proportion of elderly people increases. Application of a more reasonable estimation method reflecting changes in demographic structure will help develop health policies relevant to above mentioned resources.

• 보건행정학회지
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• 제23권2호
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• pp.132-144
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• 2013

Background: The purpose of this study was to analyze the medical expense change and influencing factors after introducing longterm care insurance system. The study period was 2 years before and after introduction of the system. Methods: We analyzed data collected from two divided group lived in Incheon. Four hundred and eighty-five elderly who received long-term care wage for one year were selected for experimental group. For control group, 1,940 elderly were selected by gender and age stratified random sampling. Difference-In-difference analyses was used for evaluating policy effectiveness. Also multiple regression analyses were conducted to identify the factors associated with total medical expenditures. The control variables were demographic variables, economic status, diseases, and medical examination variables. Results: Difference-in-difference analyses showed that total average medical expenses among long-term patients has decreased by 61.85%. Of these, the hospitalization expenses have decreased by 91.63% and the drug expenses have increased by 31.85%. Multiple regression analyses results showed that total average medical expenses among long-term patients have significantly decreased by 46.5% after introducing the long-term care insurance. The hospitalization expenses have significantly decreased by 148.5%, whereas the drug expenses have increased by 53.6%. And outpatient expenses have increased by 10.4%, but the differences were not statistically significant. Conclusion: The results showed that total medical expenses and hospitalization expenses have decreased after introducing the long-term care insurance. These results could support the opinion that the health insurance spending among long-term patients will be reduced gradually by long-term care insurance through changing medical demand.

• 지역사회간호학회지
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• 제32권1호
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• pp.95-106
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• 2021

Purpose: The purpose of this study is to investigate the association between unmet healthcare needs due to financial reasons and catastrophic health expenditures. Methods: This study used secondary data from the 2014~2015 Korean Health Panel survey. The subjects of this study were 21,495 people aged 20 or older, and of them, there were 16,227 people aged 20 to 64 and 5,268 people aged 65 or older, which were surveyed between 2014 and 2015. The association between unmet healthcare needs due to financial reasons and catastrophic health expenditures was analyzed through logistic regression. Results: In 2015, 1.7% of people aged 20~64 years and 7.9% of those aged 65 or older experienced unmet healthcare needs due to financial reasons. In the 20~64 age group, people who repeatedly experienced catastrophic health expenditures (=10%,=20%) were less likely to experience unmet healthcare needs due to financial reasons than those who did not experience catastrophic health expenditures for two years (OR=0.50, OR=0.41). However, in the 65-or-older group, people who repeatedly experienced catastrophic health expenditures (=20%) were more likely to experience unmet healthcare needs due to financial reasons than those who did not experience catastrophic health expenditures for two years (OR=1.68). Conclusion: A greater percentage of the elderly repeatedly faced both catastrophic health expenditures and unmet healthcare needs due to financial reasons compared to the non-elderly.

• Journal of Preventive Medicine and Public Health
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• 제47권6호
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• pp.327-335
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• 2014

Objectives: Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated. Methods: Suicides motivated by non-illness-related factors were identified using the investigator's note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status. Results: Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women. Conclusions: Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.

• Human Ecology Research
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• 제53권3호
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• pp.309-318
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• 2015

This study investigates to investigate the ageing effect on household demand for clothing, food, housing and medical care commodities in Korea using a demand system model. The cross-sectional and time-series data from Statistics Korea on urban household expenditures and age projection analyzed household demands of consumption commodities. The household head age and elderly population ratio were employed for proxy variables of ageing. Ageing variable elasticities of commodity demands were estimated. Study results show that ageing variables significantly influenced on a household demand for commodities; clothing and food consumption decreases; however, housing and medical care consumption increases with ageing. The elasticities of total consumption expenditures and price variables were estimated in the demand analysis; these two variables significantly impacted almost all of the household consumption for the studied commodities. This study provides an opportunity to examine how ageing influences household consumption for clothing, food, housing and medical care commodities as Korean society experiences a rapid ageing. It is also meaningful that this study conducted a quantitative measuring of the household demands for commodities that was different from past research on the household consumption expenditures for commodities.

• Journal of Preventive Medicine and Public Health
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• 제30권2호
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• pp.437-461
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• 1997

이 연구는 의료보험관리공단의 공 교 의료보험자료를 이용하여 1989년부터 1993년까지의 5년간의 60세이상의 노인의 의료이용과 진료비의 변화를 연령별, 성별, 의료 보험료 수준별 코호트를 구성하여 상병당으로 분석함으로써 좀 더 정확한 변화의 양상을 파악하고 예측을 하는데 연구의 목적이 있다. 연령별 연도별 입원 수진율은 연도별 입원수진율은 70-74세 군이 89년과 93년에 각각 1,000명당 117.3과 141.1로 가장 높았으며, 매년 증가하는 추세이다. 연령 코호트의 연도별 상병건수는 전체적으로는 5년 동안에 40.5%증가하였다. 성별 코호트의 연도별 상병건수는 남자 상병건수보다 여자가 많이 증가하였으며, 남자와 여자의 연평균 증가율은 각각 9.1%와 10.2%였다. 연령 코호트의 상병당 연도별 입원진료비의 변화는 전체적으로 보았을 때 5년간 총 진료비는 15.4%증가 하였다. 이 중 진료행위료의 증가가 21.5%로 가장 큰 폭으로 증가하였다. 의료 보험료 수준별 코호트의 상병당 입원진료비 변화는 보험료 수준이 낮은 군보다 높은 군에서 진료비가 높았으며, 보험료 수준별 코호트의 연도의 경과에 따라서 각종 진료비가 증가하였다. 재원기간은 0.08% 증가하여 거의 변화가 없었으며, 1991년을 기점으로 감소하는 경향이었다. 10대 다빈도 상병 중에서 가장 흔한 질병은 백내장이었다. 1993년의 10대 다빈도상병 중 1989년에 비하여 비율이 증가한 상병은 백내장, 뇌동맥 폐색이었으며, 감소한 질병은 폐결핵과 본태성 고혈압이었다. 전체 상병에서 10대 상병이 차지하는 비율은 30-35%였으며, 연령군별로는 차이가 없었다. 연령 코호트의 이용의료기관별 평균진료비 및 재원 기간은 전체적으로는 병원급 의료기관에서의 진료비 증가율이 가장 높았으며, 재원기간은 의료기관 종별에 관계없이 감소하였으며, 병원이 4.9% 감소하여 감소폭이 가장 켰다. 총 상병건수에서 고액진료건수가 차지하는 비율은 67.6% 증가하였고, 암환자건수는 8.9% 증가하였으며, 장기입원환자가 차지하는 비율은 오히려 1.2% 감소하였다. 총 진료비 규모는 62.2% 증가하였으며, 고액상병진료비가 차지하는 비율은 5년간 129.9% 증가하였고, 암환자 진료비는 68.5%, 장기입원환자의 진료비는 59.4% 증가하였다. 상병당 입원진료비 및 재원기간을 1989년 수가로 환산하여 변화 추이를 보면, 상병당 총 진료비는 매우 완만한 증가를 보이고, 약제비는 오히려 약간 감소하는 경향이었고, 진료행위료는 지속적으로 상승하는 추세였다. 재원기간은 완만하게 감소하는 양상을 보였다. 연령구간별로 구분하여 분석한 결과 진료비와 재원기간과는 연령에 관계없이 비슷한 상관계수를 보였으나, 의료보험료 수준과 연령구간별 진료비는 상관계수는 매우 작았으며, 연령군별로 큰 차이는 없었다. 시계열 분석 결과 향후 약제비는 매우 완만한 감소 추세를 보일 것이고, 진료행위료와 총 진료비는 지속적으로 증가할 것으로 예측되었으며, 재원기간은 13.0일로 변화가 없을 것으로 예측되었다. 이 연구에서는 진료행위료의 증가가 총 진료비의 상승을 주도하고 있는 것으로 생각된다. 이는 첨단 의료기기나 신기술의 도입에 의한 것으로 의료기관들의 서비스 다각화 전략과도 관련 있는 것으로 생각된다. 또한 의료이용량 즉 입원상병건수의 증가가 진료비 상승에 영향을 많이 미치는 것으로 판단되며 전체 인구 집단의 의료비 상승요인과는 다른 양상을 보일 수 있으므로 노인 인구에 대한 의료비 절감 대책은 다른 연령층과 구별하여 적용할 필요성이 있다고 볼 수 있다. 향후 노인 연령 군별 질병양상의 변화와 서비스량 및 변화에 대한 연구를 개인특성 자료나 의료기관의 특성 등과 연계하여 포괄적인 연구를 수행함으로써 노인입원 특성과 향후 노인의료 이용량과 진료비의 추이를 판단하고 이를 토대로 노인의료문제의 해결을 위한 방안을 마련할 수 있으리라 생각된다.

• 보건행정학회지
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• 제32권3호
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• pp.282-292
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• 2022

Background: Aging societies face social problems of increased medical expenses for older adults due to increased geriatric diseases. This study aims to analyze the relationship between the state change of multiple chronic conditions (MCC) and out-of-pocket medical expenses in the elderly aged 60 or older. Methods: The 2014-2018 Korean Longitudinal Study of Aging data were used for 2,202 elderly people. Four status change groups were established according to the change in the number of chronic diseases. The association between the change of MCC and the out-of-pocket medical cost was analyzed using the generalized estimating equation model analysis. Results: The average out-of-pocket total medical costs were 1,384,900 won for participants with MCC and 542,700 won for those without MCC, which was a statistically significant difference (p<0.0001). Compared to the reference group (simple chronic disease, SCD→SCD), the change in multiple chronic conditions significantly increased the total out-of-pocket medical expenses in MCC→MCC and SCD→MCC groups (MCC→MCC: 𝛽=0.8260, p<0.0001; SCD→MCC: 𝛽=0.6607, p<0.0001). Conclusion: In this study, it was confirmed that the prevalence of MCC increased with age, and the out-of-pocket medical cost increased in the case of MCC. Continuity of treatment can be achieved for patients with MCC, and the system and management of treatment for MCC are required to receive appropriate treatment.

• 대한물리치료과학회지
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• 제8권1호
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• pp.735-744
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• 2001

After providing the purpose, scope and methods of present study in the first chapter. the second chapter discusses a theoretical overview on the social implication of medical expenditure and the medical insurance program for the aged population. In conclusion, to realize the reduction of aged population's medical expenditures, some possible plans are conceivable. Firstly, the payment level of medical insurance should be upgraded and the insurance coverage in oriental medicine treatment and the drug-store protection program need to be implemented. Secondly, the medical facilities and man-power have be expanded for the sake of reducing the social and geographical distances the aged population has to overcome to receive the medical benefits. Thirdly, the expansions of medical services for the home-stay aged are all the more required. Finally, a wide range of programs needs to be augmented to promote health for the aged population.

• Journal of Preventive Medicine and Public Health
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• 제57권1호
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• pp.65-72
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• 2024

Objectives: Protecting people against financial hardship caused by illness stands as a fundamental obligation within healthcare systems and constitutes a pivotal component in achieving universal health coverage. The objective of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran, over the period of 2013 to 2019. Methods: Data were obtained from 7 annual national surveys conducted between 2013 and 2019 on the income and expenditures of Iranian households. The prevalence of CHE was determined using a threshold of 40% of household capacity to pay for healthcare. A binary logistic regression model was used to identify the determinants influencing CHE. Results: The prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. In all the years analyzed, the extent of CHE occurrence among rural populations exceeded that of urban populations. Living in an urban area, having a higher wealth index, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of CHE (p<0.05). Conversely, the use of dental, outpatient, and inpatient care, and the presence of elderly members in the household, are associated with an increased probability of facing CHE (p<0.05). Conclusions: Throughout the study period, CHE consistently exceeded the 1% threshold designated in the national development plan. Continuous monitoring of CHE and its determinants at both household and health system levels is essential for the implementation of effective strategies aimed at enhancing financial protection.