• 보건행정학회지
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• 제34권1호
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• pp.38-47
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• 2024

연구배경: 한국의 소아청소년 인구는 최근 10년간 288만 명 감소하였으며 전례 없는 초저출산으로 더욱 감소할 것으로 예상되고 있다. 여기에 코로나19 팬데믹 영향으로 소아청소년과 의원의 수익은 크게 감소하여 폐업이 증가하고 있는 실정이다. 본 연구는 아동인구 감소로 인한 소아청소년과 의원의 수익 악화가 폐업에 실질적으로 영향을 주었는지 분석하였다. 방법: 2011-2022년 건강보험심사평가원의 요양기관현황신고, 건강보험청구자료와 통계청의 주민등록인구현황 자료를 이용하여 2012-2022년 소아청소년과와 그 외 진료과(내과, 이비인후과, 가정의학과) 의원의 연도별 자료를 구축하였다. 종속변수를 폐업 여부로 하였고, 지역의 인구 특성 및 경쟁 정도를 반영하는 변수(전년 대비 아동인구 감소 여부, 허핀달-허쉬만지수 등)와 기관 특성 변수(전년 대비 수익 감소 여부, 연간 수익 등)가 폐업에 영향을 주는지 분석하였다. 기술통계, 카이제곱분석을 실시하였으며 일반화추정방정식(generalized estimating equations, GEE)을 사용하여 변수별 오즈비를 추정하였다. 결과: 소아청소년과 의원의 폐업률은 2.66%-7.04%로 내과·이비인후과·가정의학과 1.81%-2.47%와 비교했을 때 지속적으로 높았으며 코로나19 팬데믹 시기에 7.04%로 가장 높았다. 3개 진료과와 소아청소년과의원의 기관당 진료비 격차는 2012년 126백만 원에서 2019년 245백만 원으로 더 커졌다. GEE 분석결과, 낮은 수익, 전년 대비 수익 감소는 소아청소년과의 폐업을 증가시키는 주요 요인이었으며 수익 관련 변수 보정 후 소아청소년 인구 감소 자체는 폐업을 증가시키지 않는 것으로 분석되었다. 지역 내 동일 진료과 의원 수가 많거나 독과점이 있는 경우 3개 진료과(내과·이비인후과·가정의학과) 의원의 폐업은 증가하였으나 소아청소년과 의원의 폐업에는 영향을 주지 않는 것으로 나타나 차이가 있었다. 결론: 아동인구가 감소하는 상황에서 수익 감소는 소아청소년과 의원의 폐업을 증가시키는 주요 요인이 분명하다. 추후 소아청소년 진료체계를 안정적으로 유지시키기 위한 적극적인 방안이 모색되어야 한다.

• 한국임상약학회지
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• 제25권4호
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• pp.280-285
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• 2015

Objectives: To suggest direction for improving policies by understanding current management of narcotics or psychotropic drugs and analyzing their distributions and usage. Method: We conducted a comparison analysis between health insurance claims and the amount supplied to health care institutions for narcotics or psychotropic drugs through health insurance claims data and drug distribution supply data from 2010 to 2012 collected from Korea Pharmaceutical Information Service Center (KPIS). Furthermore, we carried out literature investigation and online search to comprehend the current management of narcotics drugs in Korea. Results: The amount supplied to medical institutions for all drugs in 2012 was 19.4 trillion won, which increased from 19.5 trillion in 2011 by 0.54%. For narcotic drugs, the amount supplied was 318.4 billion won in 2011 and increased to 335.1 billion won by 5.3% in 2012, which exceeded the rate of increase for the amount supplied for all drugs. The proportion of amount claimed in the total amount supplied to medical institutions for all drugs was 60.5% in 2012, whereas the proportion of amount claimed for narcotic drugs was 55.6%, which showed that narcotic drugs were used relatively less within health insurance. Furthermore, management of the current domestic distribution supply data focuses on manufacturing and medical institution supply stages. Conclusion: Hereafter, the management of narcotics or psychotropic drugs needs to be improved by reinforcing active monitoring in optimal prescription and usage in patients by collecting and analyzing information on drug usage of patients.

• 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.

• 한국병원경영학회지
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• 제13권4호
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• pp.46-75
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• 2008

Main objective of this study is to investigate the factors that affect the reduction and recovery rate of hospital health insurance review departments of Korean tertiary hospitals, general hospitals and hospitals. A nationwide mail survey was conducted through structured questionnaire for chiefs and members of health insurance review departments of 178 hospitals, and data from 1,064 respondents were utilized in the final analysis. Major findings are as follows: 1) Monthly average reduction rate of surveyed hospitals was 1.18% for inpatients and 0.56% for outpatients. Also, average recovery rates from protests were 45.7% and 53.6%, respectively. 2) Average ages of health insurance review department employees were 41.5 for chiefs and 34.9 for members, and their average working period was 6.64 years. 69.1% of the respondents felt stress in their jobs, and they suggested 'communication problems with doctors' along with 'heavy workloads' as major reasons for the stress. 3) Reduction rates decreased and recovery rates increased when separate member in charge was assigned to each medical department, when health insurance review departments periodically provided medical parts with related education, and when the members participated in various committees.

• 대한의사협회지
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• 제61권11호
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• pp.687-698
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• 2018

Inappropriate antibiotic use significantly contributes to antibiotic resistance, resulting in reduced antibiotic efficacy and an increased burden of disease. The objective of this study was to investigate the characteristics of prescribers whose antibiotics use was high and to explore factors affecting the use of antibiotics by medical institutions. This study analyzed the National Health Insurance claims data from 2015. Antibiotic prescription data were analyzed in terms of the number of defined daily doses per 1,000 patients per day, according to the World Health Organization anatomical-therapeutic-chemical classification and methodologies for measuring the defined daily dose. We investigated the characteristics of prescribers and medical institutions with high antibiotic use. Multivariate regression analyses were performed on the basis of characteristics of the medical institution (number of patients, type of medical institution [hospital or clinic], age of the physician, etc.). The number of patients and number of beds were found to be significant factors affecting antibiotic use in hospitals, and the number of patients, region, and medical department were significant factors affecting antibiotic use at the level of medical institutions. These findings are expected to help policy-makers to better target future interventions to promote prudent antibiotic prescription.

• 보건행정학회지
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• 제27권1호
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• pp.30-38
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• 2017

Background: This study aims to analyze the behavioral changes of healthcare providers and influencing factors after the reviewer unification of auto insurance medical benefit claims by an independent review agency. Methods: The comparison data were collected from the second half of 2013 and the same period of 2014. The key indicators are the number of admission days, the number of outpatient visits, inpatient ratio, inpatient medical expenses, and outpatient medical expenses. Results: Four indicators (number of admission days, number of outpatient visits, inpatient ratio, and outpatient medical expenses) showed statistically significant drops, while one indicator (inpatient medical expenses) showed no significant change. Conclusion: The reviewer unification of auto insurance medical benefit claims by an independent review agency showed significant reduction in cost and patient days.

• 보건행정학회지
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• 제29권2호
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• pp.130-137
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• 2019

The fee-for-service system is used as the main payment system for health care providers in Korea. It has been argued that it can't reflect differences in the medical practice costs across regions because the fee schedule is calculated based on the average cost. So, some researchers and providers have disputed that there is need for adopting geographic practice cost index (GPCI) used in the United States for the Medicare program for the elderly to the fee-for-service payment system. This study performed to identify whether the difference in the practice costs among regions exists or not and to examine the feasibility of applying GPCI to Korea payment system. For this purpose, we calculated modified-GPCI and examined considerations to introduce GPCI in Korea. First we identified available data to calculate GPCI. Second, we made applicable GPCI equations to Korea payment system and computed it based on four types of regions (metropolitan, urban, suburban, and rural). We also categorize the regions based on the availability of the medical resources and the capability of utilizing them. As a result, we found that there wasn't any significant difference in the GPCI by regional types in general, but the indices of rural areas (0.91-0.98) was relatively low compared to the indices of other regions (0.96-1.07). Considering the need to use GPCI floor, the pros and cons of using GPCI, and the concern of the regional imbalance of resources, the introduction of GPCI needs to be carefully considered.

• 보건행정학회지
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• 제20권2호
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• pp.128-143
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• 2010

Objectives : This study aims to estimate the oral antihyperglycemic medications adherence among ambulatory care with adult type 2 diabetes patients and to identify factors affecting the medication adherence in Korea. Methods : This study used the Korean National Health Insurance Database. Study population was 40,082 patients who were 20 years of age or older and first diagnosed with type 2 diabetes (ICD-10: E11) in 2004. The patients were followed up for two years in order to measure adherence with oral antihyperglycemic medications. The level of medication adherence was measured by the medication possession ratio (MPR). Results : The average MPR in the study population was 49.5%. The appropriate adherence rate (MPR$\geq$80%) was 29.4% and showed variation according to the characteristics of individual patients. Multiple logistic regression analysis revealed that the odds of appropriate adherence increased with female (OR:1.21, CI:1.14-1.27), older age, increasing ambulatory care visits, health insurance (OR:1.53, CI:1.33-1.76), decreasing ambulatory care providers, using a specialized general hospital as their main attending medical institution (OR:10.08, CI:8.96-11.33), having co-morbidity, using polytherapy (OR:1.07, CI:1.01-1.13). Conclusions : The medications adherence for patient with type 2 diabetes is low in Korea, and shows variation according to the characteristics of patients. For proper management of diabetes, health care policy is expected to be enacted to improve medications adherence continuously. In particular, more intensive management is needed for patients with low medications adherence. Also, health care policy makers need to develop the program to induce health care utilization by a patient to be more concentrated with the same provider.

• 보건의료산업학회지
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• 제11권1호
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• pp.27-42
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• 2017

Objectives : This study analyzes the characteristics of hospital organization structures, insurance claims reviews and assessment tasks and their effects on hospitals in Pusan. Methods : The data for this study were collected through interview and self-administered surveys in 109 hospitals. The study included only - hospitals with a minimum of 50beds and excluded those providing only dental, psychiatric, or long-term care. Results : The findings of this study state that the number of beds has an influence on the organizitional structure. Conclusions : Hospital managements should seek human resources management(the insurance claims reviewer and evaluator) schemes that take into account the characteristics of the medical institution. In addition, insurance claims review and assessment tasks in hospitals require considerable knowledge and experience, and hospitals should be equipped with staff that have the relevant expertise. Therefore, to further deepen knowledge, comprehensive training should be continuously carried out in order to produce specialists in claims review and assessment.

• 한국임상약학회지
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• 제18권2호
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• pp.124-131
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• 2008

The impacts of guideline for digestives on physicians' prescription of GI medication Clinical practice guidelines provide benefits to physicians, patients, and researchers. It also helps doctors to make decisions in medical services. In many countries, practice guidelines lead to activities of quality improvement and are developed using evidence based methods. This research was to assess the impacts of Korean Medical Association's guideline for digestives on the change of physicians' behavior. This study was progressed as one-group pre-test post-test quasi-experimental design using health insurance claims data. The unit of analysis was institution. Data was analyzed using paired t-test for change of prescription rate before and after the distribution of practice guidelines. And the multiple regression analysis was performed to examine the independent impact of the guideline on the prescribing rate of GI medication. Prescription rates of GI medication per claim by medical institution increased significantly, 1.98%point (from 50.27% to 52.25%) and multivariate regression analysis showed significant increase in the prescription rate of GI medication after the distribution of guideline (p<0.001). In conclusion, the distribution of guideline for digestive might not have the effects on the change in provider's behavior. Furthermore, to activate the use of practice guideline, it would be necessary to educate the contents to physicians as well as to develop practice guideline.