• Journal of Preventive Medicine and Public Health
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• 제35권4호
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• pp.340-350
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• 2002

Objectives : To evaluate the annual visit days, the annual prescription days and the medical costs of hypertensive patients. Methods : The medical insurance records of 40,267 incident patients with the diagnostic code of hypertension from September 1998 through August 1999 in Daegu city were reviewed. Results : The proportion of the most proper medical care pattern group (Group VIII) who visited for 6-15 days with 240 prescription days or more a year was only 6.2%. The proper care group (Group IX) who visited for more than 16 days with 240 prescription days or more a year was 9.3%. The overall proper care group (Group VIII+IX) was therefore 15.5%. The proportion of the insufficient care group (Group I, IV) in both the number of visiting days and prescription days was 57.4%. The mean prescription day of the most proper group (Group VIII) was 29 days; the mean annual medical expenses,453,587won; the mean annual amount paid by patients, 218,013won; and mean medical expenses per prescription day, 1,483won. The proportion of the overall proper care group (Group VIII+IX) was significantly higher in adults aged 50-59, those who were enrolled in industrial workers health insurance as well as government employees and private school teachers health insurance, and those who made a higher contribution per month (p<0.01). According to the type of medical facilities, the proportion of the most proper medical care pattern group was highest in the general hospitals (9.3%) but the overall proper care group was higher in the public health centers (22.1%) and private clinics (17.1%). Conclusions : The management system of hypertension should be reinforced urgently. Therefore, it is necessary to develop guidelines including the number of visiting days per year and prescription days per visit day, and make the system provide medical facilities to more properly care for hypertensive patients.

• 지역사회간호학회지
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• 제26권3호
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• pp.278-291
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• 2015

Purpose: This study was conducted to examine differences in health care utilization and related costs between before and after the introduction of the designated doctor system, and to find out factors making the differences. Methods: Data were collected from 200 medical aid beneficiaries having one or more chronic diseases, registered in the designated doctor system during the year of 2012, and the relationship between the use of health services and claimed medical expenses was analyzed through paired t-test and multiple regression analysis using the SPSS 18.0 program. Results: There was a decrease in the number of total benefit days and the number of outpatient and medication days, but some cases showed an increase after the designation of medical institution. In general, hospital stay increased after the introduction of the system. However, the number of medical institutions utilized was reduced in most cases after designation. Conversely, medical expenses increased in most cases after the designation of medical institution. Conclusion: These results suggest that a detailed scheme to designate medical institutions should be made in consideration of the seriousness of illness and classification of medical institutions not only for the beneficiaries' enhanced health but for the effective management of medical aid fund.

• 한국산학기술학회논문지
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• 제21권9호
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• pp.199-209
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• 2020

본 연구는 다문화 구성원의 의료만족도에 영향을 미치는 요인을 파악하고 이에 대한 통합적 이해를 바탕으로 다문화 구성원의 의료서비스 개선 및 보건의료 지원 사업에 필요한 기초자료를 제공하기 위한 서술적 조사연구이다. 연구 자료는 경기도 A시 소재의 외국인 근로자 센터와 다문화 센터 이용자 301명을 대상으로 2019년 9월1부터 11월30일까지 수집하였으며 수집된 자료는 t-test, ANOVA, Multiple linear regression으로 분석하였다. 의료진, 의료환경, 진료비용에 대한 만족도를 살펴보면 의료진에 대한 만족도의 평균은 3,65로 가장 높았고, 의료환경의 평균은 3.55, 진료비용의 평균은 3.08순으로 나타났다. 의료진에 대한 만족도에 영향을 주는 요인은 나이와 건강보험이었으며, 이에 대한 설명력은 28%로 나타났다. 의료환경에 대한 만족도는 나이와 직업이었으며, 이에 대한 설명력은 17%로 나타났다. 진료비용에 대한 만족도는 다문화 형태, 교육수준, 직업이었으며, 이에 대한 설명력은 33%로 나타났다. 이상의 결과로 다문화 구성원의 건강문제를 해결하고 보건의료 향상을 위해서는 다문화 구성원의 건강상태 및 건강행위와 관련된 보건의료이용실태 및 만족도를 살펴보고 의료이용 만족도를 높일 수 있는 전략과 프로그램을 개발하고 제공하여야 한다.

• Journal of Preventive Medicine and Public Health
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• 제34권1호
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• pp.28-34
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• 2001

Objectives : To investigate the changing pattern of medical utilization claims following the economic crisis in Korea. Methods : The original data consisted of the claims of the 'Medical insurance program of self-employees' between 1997 and 1998. The data was selected by medical treatment day ranging between 8 January and 30 June. Medical utilizations were calculated each year by the frequency of claims, visit days for outpatients, length of stay for inpatients, total days of medication, and the sum of expenses. Results : The length of stay as an inpatient in 1998 was decreased 4.7 percent in comparison to 1997. However, inpatient expenses in 1998 increased 10.8 percent as compared to 1997. Inpatient hospital claims in 1998 increased 6.2 percent over 1997, although general hospital inpatient claims in 1998 decreased 3.3 percent in comparison to 1997. The outpatient claim frequency decreased 7.3 in 1998 percent as compared to 1997 Outpatient visit days of in 1998 were decreased 8.5 percent in comparison to that recorded in 1997. Outpatient claim frequencies of 'gu region' in 1998 decreased 10.5 percent comparison to that in 1997, but 'city and gun region' decreased less than 'gu region'. Conclusions : Medical utilization in 1998 deceased in relation to 1997 Medical utilization by outpatients decreased more than that of inpatients. Medical utilization by 'gu region' decreased mere than the other regions.

• 보건행정학회지
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• 제21권3호
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• pp.397-413
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• 2011

Purpose: The purpose of this study is to examine the relationship between the income level and the healthcare utilization by health insurance type in all cancer patients in year 2005. Methods: The target population was cancer patients with health insurance who used healthcare as a diagnosis code (C00-C97) from January 1 to December 31 of 2005. The Korea Central Cancer Registry Center's Cancer Patient Registry Data, the list of cancer patients of the National Health Insurance Corporation, and the claim data of the Health Insurance Review & Assessment Service were used. The I was the wealthiest, followed by II, III, IV. The V was the poorest in this study. For the analysis, the $x^2$-test, ANOVA (and Kruskal-Wallis test), and regression were used. Results: Outpatient and hospitalization medical expenses, and outpatient visit days of cancer patients with self-employed health insurance were highest in I (p<.001, respectively), and the hospitalization days were the highest in II (p<.001, respectively). Outpatient and hospitalization medical expenses, and outpatient visit and hospitalization days of cancer patients with occupational health insurance were the highest in I (p<.001, respectively). Outpatient and hospitalization medical expenses, and outpatient visit and hospitalization days in cancer patients were higher in I compared to V, and higher in II and III, IV compared to V (p<.001, respectively). Conclusion: Supporting plan for cancer patients' outpatient healthcare utilization are necessary. Moreover, we should make specialized strategy for low income cancer patients with self-employed health insurance when we develop quality improvement policy for inpatient service.

• 보건행정학회지
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• 제33권3호
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• pp.273-294
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• 2023

Background: Most developed countries are working to improve their universal health coverage systems. This study investigates regional disparities in unmet healthcare needs and their causes in South Korea. Additionally, it compares the unmet healthcare needs rate in South Korea with that of 33 European countries. Methods: The analysis incorporates information from 13,359 adults aged 19 or older, using data from the Korea Health Panel. The dependent variables encompass the experience of unmet healthcare needs and the three causes of occurrence: "burden of medical expenses," "time constraints," and "lack of care." The primary variable of interest is the region of residence, while control variables encompass 14 socio-demographic, health, and functional characteristics. Multivariable binary logistic regression analysis, accounting for the sampling design, is conducted. Results: The rate of unmet healthcare needs in Korea is 11.7% (95% confidence interval [CI], 11.0%-13.3%), which is approximately 30 times higher than that of Austria (0.4%). The causes of unmet healthcare needs, ranked in descending order, are "lack of care," "time constraints," and "burden of medical expenses." Predictive probabilities for experiencing unmet healthcare needs and each cause differ significantly between regions. For instance, the probability of experiencing unmet healthcare needs due to "lack of care" is approximately 10 times higher in Gangwon-do (13.5%; 95% CI, 13.0%-14.1%) than in Busan (1.3%; 95% CI, 1.3%-1.4%). The probability due to "burden of medical expenses" is approximately 14 times higher in Seoul (4.1%; 95% CI, 3.6%-4.6%) compared to Jeollanam-do (0.3%; 95% CI, 0.2%-0.4%). Conclusion: Amid rapid sociodemographic transitions, South Korea must make significant efforts to alleviate unmet healthcare needs and the associated regional disparities. To effectively achieve this, it is recommended that South Korea involves the National Assembly in healthcare policy-making, while maintaining a centralized financing model and delegating healthcare planning and implementation to regional authorities for their local residents-similar to the approaches of the United Kingdom and France.

• 보건행정학회지
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• 제2권2호
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• pp.221-237
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• 1992

The reasons for cost inflation in medical insurance expenditure are classified into demand pull inflation and cost push inflation. The former includes increase in the number of beneficiaries and utilization rate, while the latter includes increase in medical insurance fee and the charges per case. This study was conducted to analyze sources of increases of expenditure in medical insurance demonstration area by the period of 1982-1987 which was earlier than national health insurance and the period of national health insurance(1988-1990). The major findings were as follows: Medical expenditure in these areas increased by 9.4%(15.1%) annually between 1982 and 1990 on the basis of costant price(current price) and for this period, the yearly average increasing rate of expenses for outpatient care[10.5%(15.8%)] was higher than that of inpatient care [7.3%(12.6%)]. Medical expenditure increased by 6.3%(8.9%) annually between 1982 and 1987, the period of medical insurance demonstration, while it increased by 10.7%(18.9%) after implementing national health insurance(1988-1990). Medical expenditure increased by 35.9%(45.9%) between 1982 and 1987. Of this increase, 115.2%(92.1%) was attributable to the increase in the frequencies of utilization per beneficiary and 61.0%(68.1%) was due to the increase in the charges per case, but the expenditure decreased by 76.2%(60.2%) due to the reduction in the number of beneficiaries. Beteen 1988 and 1990, the period of national health insurance, medical expenditure increased by 21.2%(41.4%). Of this increase, 87.5%(46.4%) was attributable to the increase in the frequencies of utilization per beneficiary and 52.4%(73.4%) was due to the increase in the charges per case, and of the increase in the charges per case, 69.6%(40.8%) was attributable to the increase in the days of visit per case. Medical expenses per person in these areas increased by 78.2%(89.0%) between 1982 and 1987. Of this increase, 76.6%(69.1%) was attributable to the increase in the frequencies of utilization per beneficiary and 23.4%(30.9%) was due to the increase in the charges per case. For this period, demand-pull factor was the major cause of the increase in medical expenses and the expenses per treatment day was the major attributable factor in cost-push inflation. Betwee 1988 and 1990, medical expenditure per person increased by 31.2%(53.1%). Of this increase, 60.8%(37.2%) was attributable to the demand-pull factor and 39.2%(62.8%) was due to the increase in the charges per case which was one of cost-push factors. In current price, the attributalbe rate of the charges per case which was one of cost-push factors was higher than that of utilization rate in the period of national health insurance as compared to the period of medical insurance demonstration. In consideration of above findings, demand-pull factor led the increase in medical expenditure between 1982 and 1987, the period of medical insurance medel trial, but after implementing national health insurance, the attributable rate of cost-push factor was increasing gradually. Thus we may conclude that for medical cost containment, it is requested to examine the new reimbursement method to control cost-push factor and service-intensity factor.

• 한국산학기술학회논문지
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• 제17권8호
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• pp.407-414
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• 2016

본 연구의 목적은 일 지역 내 소재 요양병원에 입원하고 있는 일당정액제 환자의 입원일수 및 진료비 특성을 파악하고, 요양병원 입원일수 및 입원진료비 관련 현황을 분석하여, 향후 요양병원의 입원진료에 대한 적정성 방안을 찾기 위해 필요한 기초자료를 제공하는 것이다. 본 연구의 대상은 2014년 1월부터 12월까지 1년 간 대전, 충남, 충북, 세종 소재 요양병원 입원 환자가 건강보험심사평가원에 청구한 월별 청구자료 중 요양병원 1일당 정액수가제에 해당하는 44,037건이었다. 분석결과 연구대상자의 일반적 특성과 주 진단명 상위 15위 간의 정준상관분석 결과 7개의 정준함수가 도출되었으며, 그 중 6개의 정준함수가 통계적으로 유의한 것으로 나타났고(p<0.001), 정준함수 1에서는 카이제곱 값이 5955.49이고 자유도가 98일 때 p<0.001 수준에서 유의하게 나타났다. 본 연구에서는 지역사회 내 보건 복지서비스를 확대하면 사회적 입원을 줄일 수 있을 것으로 판단된다. 보건 복지서비스의 확대는 고령의 노인들에 대한 삶의 질을 향상시킬 수 있으며, 아울러 요양병원 입원일수를 단축시키고 총 진료비를 절감시켜 증가 일로에 있는 국민의료비의 지출 감소에도 기여할 것으로 판단된다.

• 자원ㆍ환경경제연구
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• 제29권2호
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• pp.113-144
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• 2020

다양한 대기질 관측 자료는 우리나라의 대기 오염이 지속적으로 개선되고 있음을 보여 준다. 하지만 일반 시민들은 최근 대기 오염 상태가 심각하며, 이로 인한 경제적 부담이 증가하였다고 인식한다. 본 연구는 이러한 인지와 관측된 자료의 차이 그리고 의료 비용 및 소비 지출에 대한 경제학적 쟁점을 세 가지로 분석하였다. 첫째, 검색량 분석과 시군구 단위 대기 오염 물질 농도 변화의 비교 분석을 통해 인지와 관측된 자료의 불일치를 확인하였다. 둘째, 의료경제모형을 이용하여 대기 오염과 의료비 지출의 이론 모형을 도출하고, 계량경제모형을 통해 대기 오염의 개선에 따른 의료 비용 감소를 실증하였다. 셋째, 소비 지출 분석을 통해 우리나라의 대기 오염에 의한 경제적 부담 증가는 소비 지출 항목에 의존하고 있음을 확인하였다. 본 연구의 결과는 우리나라 대기 오염의 사회경제적 영향을 분석 시, 분석항목에 따른 과대추정의 가능성과 대기 오염의 개선과 관련한 역해석의 문제가 있을 수 있음을 보여준다. 또한 본 연구의 결과는 대기질 관리의 보다 엄격한 기준 적용의 필요성, 방어적 소비재에 대한 사회취약층에 대한 고려 그리고 대기 오염 관련 정보의 접근성 향상 및 신뢰성 회복이 필요하다는 정책적 함의를 가진다.

• 대한물리치료과학회지
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• 제4권2호
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• pp.421-432
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• 1997

To find out the actual status of treatment of physically handicapped who were stayed of home, 320 physically handicapped persons were selected among total 6,264 physically handicapped registered in Taejon city, surveyed from January 1st to March 30, 1997. Following are the results ana lysed of collected data from 201 samped persons. 1. For the cause of physically handicapped, 36.3% was congenital, 26.9% was cerebralvascular acciednt(CVA). and 14.9% was infectious diseases and others in that orders. The must frequest cause of below 20 years age group was congenital cause, but that of $20{\sim}30$ years age group and $40{\sim}50$ years age group were accident and CVA repectively. 30.0% of respondents caused by infection and others earned household living expenses. Household living expenses were higher among the respondents caused by congenital cause but those were lowest in the accidental couse group. Handicap durations were longer in the accidental cause group and infections and others group than the congenital cause group and CVA group. 2. 54.7% of studied handicapped were under treatment. But 36.3% of them were stopped treatment, and 8.9 % of them answered not treated. Most handicapped, coused by congenital and CAV, were under treatment, but most of them caused by accidental and others were stopped treatment. 3. For the medical facilities, 54.5% of them utilized welfare facility, but 25.5% utilized general hospital and 20.0% of them utilized oriental medical hospital and health centers. Congenital cause group frequently selected welfare facility for the treatment facility. But accidental cause group frequently seleced general hospitals and CVA gruop frequently selected oriental medical hospital and others. The medical cost of welfare facility, oriental medical hospitals and others were lower than that of general hospitals. 4. The proportions of under treatment were higher among yonger age higher monthly living expenses group shorter handicapped duration groups, congenital cause group and handicap grade II group. But that of stop treatment were higher among congenital cause group, infectious and others cause group, and handicap grade I & then III group. 5. For the feelings satisfacion about medical treatment, only 35.3% of under treated group responed satisfation. 55.5% of them responded so-so, but 9.1 % responed dissatisfaction. The proportion of satisfaction was higher among shorter handicap duration group.