정신신체의학 (Korean Journal of Psychosomatic Medicine)

한국정신신체의학회 (Korean Psychosomatic Society)
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조현병 환자의 동반 만성신체질환 현황 및 총 의료비용에 관한 연구

Chronic Physical Comorbidities and Total Medical Costs in Patients with Schizophrenia

  • 이상욱 (국립정신건강센터) ;
  • 이예린 (경희대학교 의과대학 예방의학교실) ;
  • 오인환 (경희대학교 의과대학 예방의학교실) ;
  • 유빈 (국립정신건강센터) ;
  • 구애진 (국립정신건강센터) ;
  • 김유석 (국립정신건강센터)
  • Lee, Sang-Uk (National Center for Mental Health) ;
  • Lee, Ye-rin (Department of Preventive Medicine, School of Medicine, Kyung Hee University) ;
  • Oh, In-Hwan (Department of Preventive Medicine, School of Medicine, Kyung Hee University) ;
  • Ryu, Vin (National Center for Mental Health) ;
  • Goo, Ae-Jin (National Center for Mental Health) ;
  • Kim, You-Seok (National Center for Mental Health)
  • 투고 : 2017.11.28
  • 심사 : 2018.04.22
  • 발행 : 2018.06.30
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초록

연구목적 본 연구에서는 조현병 환자의 만성신체질환 유병현황을 확인하고, 총 의료비용에 미치는 영향을 제시하고자 하였다. 방 법 2014~2015년 건강보험심사평가원 자료를 활용하였으며, 자료의 정확성을 높이기 위하여 조현병 및 만성신체질환은 주/부상병으로 동일 상병을 3회이상 진단받은 경우만 해당 질환으로 분류하였다. 총 의료비용은 보건의료체계적 관점으로 보험자의 비용과 함께 본인부담비용을 포함하였다. 결 과 조현병 환자의 24.5%는 1개, 17.3%는 2개, 23.4%는 3개이상의 만성신체질환을 가지고 있는 것으로 나타났으며, 만성신체질환의 1~5순위는 만성위염/위식도역류질환이 27.3%, 알레르기가 19.5%, 고혈압이 13.2%, 만성요통이 11.0%, 당뇨병이 10.6%로 위장간질환 및 알레르기 질환, 대사성 질환뿐만 아니라 근골격계 질환의 유병률도 높게 나타났다. 2014년에 진단받은 조현병 환자의 2015년 총 의료비용은 약 1조 8백억원이었으며, 총 의료비용에 영향을 미치는 요인으로는 성별, 연령, 만성신체질환의 수, 건강보험여부로 나타났다. 결 론 조현병 환자의 만성신체질환의 문제를 해결하기 위한 접근방법은 단순히 개별 질환을 중심으로 치료하기 보다는 조현병 환자의 다양한 신체 질환을 동시에 치료 및 관리할 수 있는 새로운 형태의 진료체계에 대한 모델 개발이 필요할 것이다.

Objectives : This study tried to explore the prevalence of chronic physical diseases in patients with schizophrenia and its effects on total medical costs. Methods : The Health Insurance Review and Assessment Service data in 2014-2015 was employed. Only the injuries and diseases, identically diagnosed 3 times or more as a major or minor injury and disease, were classified into chronic physical diseases to improve data accuracy. Total medical costs included out-of-pocket and insurer's costs from health care system perspective. Results : It was shown that 24.5%, 17.3% and 23.4% of schizophrenia patients had one, two and three or more chronic physical diseases, respectively. There was a high prevalence of not only metabolic, but also musculoskeletal, diseases in those patients. The amount of 2015 total medical costs of patients with schizophrenia in 2014 was about 1.08 trillion won. The factors affecting the costs included sex, age, number of chronic physical diseases, and health insurance status. Conclusions : It is considered that clinical practice guidelines based on personal diseases may not sufficiently solve the problems for comorbidities in schizophrenia patients. Accordingly, it should be required to develop models for new types of medical systems capable of treating and caring varied illnesses at the same time.

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