한국경제지리학회지 (Journal of the Economic Geographical Society of Korea)

  • 제26권3호
  • /
  • Pages.289-309
  • /
  • 2023
  • /
  • 1226-8968(pISSN)
  • /
  • 2713-9115(eISSN)
한국경제지리학회 (The Economic Geographical Society of Korea)
권호 표지
DOI QR코드

DOI QR Code

보건의료 서비스의 공간적 불균등 분포 변이에 대한 연구: 1995년부터 2021년까지 초기진료기관을 대상으로

Evolution of Healthcare Service Disparities: A Case Study of Primary Care Services in Korea, 1995-2021

  • Hyun Kim (Department of Geography and Sustainability, University of Tennessee) ;
  • Yena Song (Department of Geography, Chonnam National University)
  • 투고 : 2023.09.21
  • 발행 : 2023.09.30
⟨ 이전 논문 다음 논문 ⟩

초록

우리나라의 국민건강보험은 빠른 시간에 보편적 의료시스템을 정착시키는데 큰 기여를 했다. 하지만 연령대에 따른 의료서비스의 차이는 지속되고 있으며, 내과, 가정의학과, 소아청소년과와 같은 핵심의료 서비스에서 이러한 불평등이 존재하는 것은 큰 우려를 불러일으킬 수 밖에 없다. 진료기관 접근에 대한 불평등은 연령대만이 아니라 지역, 특히 도시와 농촌 사이에도 크게 나타나고 있다. 본 연구는 1995년부터 2021년까지 초기진료기관의 분포를 이용하여 변화하는 경제환경 속에서 의료서비스의 공간적 불평등이 어떻게 변화되어 왔는지를 살핀다. 다양한 불평등 지수와 공간통계분석의 결과를 토대로 볼 때, 1997년 IMF 경제위기, 2008년 금융위기, 그리고 2020년의 COVID-19 공중보건 위기를 겪으며 불평등이 심화 확대된 것을 확인할 수 있었다. 또한 초기의료기관의 불균등 분포에 큰 변화가 온 시기도 밝혀낼 수 있었는데, 이러한 변화에는 유소년이나 전체 인구 분포보다는 고령인구의 분포가 큰 역할을 하고 있었다. 본 연구결과는 인구와 의료서비스의 공간적 분포를 통합적으로 고려하여 핵심적인 의료자원의 불평등을 해소하기 위한 노력이 절실히 필요하다는 것을 강조한다. 특히 이러한 노력은 미래의 경제적 충격에도 적절한 수준의 의료 서비스를 지속할 수 있는 기반이 될 수 있을 것이다.

While South Korea's universal healthcare system has garnered attention in public health, the issue of inequality in healthcare service provision among different age groups has incessantly become a significant concern. The focus of this concern is primarily on essential healthcare services, encompassing fundamental aspects of healthcare such as internal medicine, family medicine, and pediatric and adolescent care. This inequality is not limited to differences among age groups (both junior and senior demographics) but also extends to potential disparities in healthcare services based on geographic location, particularly in urban and rural contexts. This paper aims to investigate disparities in primary healthcare service resources in South Korea's evolving economic landscape between 1995 and 2021. We utilize a set of inequality indices with a spatial perspective through geographic cluster analysis. The findings reveal that concerns about inequality have been amplified during various economic events, including the IMF crisis in 1999, the global financial crisis in 2008, and the COVID-19 pandemic in 2020. These years are identified as significant phases that have contributed to manifesting spatial disparities in primary healthcare provisions, with a particular emphasis on the senior-aged population rather than junior or all population groups. Our findings underscore the pressing need to address the unequal distribution of essential healthcare resources as part of preparedness for potential economic impacts, requiring a comprehensive consideration of the interconnected nature of demographic and spatial dimensions in healthcare services.

키워드

참고문헌

  1. Alaimo, L. S., Nosova, B. and Salvati, L., 2023, "Did COVID-19 enlarge spatial disparities in population dynamics? A comparative, multivariate approach for Italy," Quality & Quantity (2023). DOI:10.1007/s11135-023-01686-9 
  2. Anderson, G. V., 1989, "Universal health care coverage in Korea," Health Affairs 8(2), pp.24-34.  https://doi.org/10.1377/hlthaff.8.2.24
  3. Borrell, L. N. and Talih, M., 2011, "A symmetrized Theil index measure of health disparities: An example using dental caries in U.S. children and adolescents," Statistics in Medicine 30(3), pp.277-290.  https://doi.org/10.1002/sim.4114
  4. Chea, H. and Kim, H., 2020, "Examining spatial disparities of obesity: Residential segregation and the urban-rural divide," The Professional Geographer 72(2), pp.206-218.  https://doi.org/10.1080/00330124.2019.1676800
  5. Cheng, L., Yang, M., De Vos, J. and Witlox, F., 2020, "Examining geographical accessibility to multi-tier hospital care services for the elderly: a focus on spatial equity," Journal of Transport and Health 19, 100926. 
  6. Costa, R. N. and Perez-Duarte, S., 2019, "Not all inequality measures were created equal. The measurement of wealth inequality, its decompositions, and an application to European household wealth," European Central Bank Statistics Paper Series 31. 
  7. Daniels, N., 2001, "Justice, health, and healthcare," The American Journal of Bioethics 1(2), pp.2-16.  https://doi.org/10.1162/152651601300168834
  8. De Hann, J. and Sturm, J.-E., 2017, "Finance and income inequality: A review and new evidence," European Journal of Political Economy 50, pp.171-195.  https://doi.org/10.1016/j.ejpoleco.2017.04.007
  9. Getis, A. and Ord, J. K., 1992, "The analysis of spatial association by use of distance statistics," Geographical Analysis 24(3), pp.189-206.  https://doi.org/10.1111/j.1538-4632.1992.tb00261.x
  10. Goda, T., 2018, "The global concentration of wealth," Cambridge Journal of Economics 42(1), pp.95-115.  https://doi.org/10.1093/cje/bex020
  11. Guindo, L. A., Wagner, M., Baltussen, R., Rindress, D., van Til, J., Kind, P. and Goetghebeur, M. M., 2012, "From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decisionmaking," Cost Effectiveness and Resource Allocation 10, 9. 
  12. Hawthorne, T. L. and Kwan, M. P., 2012, "Using GIS and perceived distance to understand the unequal geographies of healthcare in lower-income urban neighborhoods," The Geographical Journal 178(1), pp.18-30.  https://doi.org/10.1111/j.1475-4959.2011.00411.x
  13. Hsu, M., Anen, C. and Quartz, S. R., 2008, "The right and the good: Distributive justice and neural encoding of equity and efficiency," Science 320(5879), pp.1092-1095.  https://doi.org/10.1126/science.1153651
  14. Jeong, H.-S. and Niki, R., 2012, "Divergence in the development of public health insurance in Japan and the Republic of Korea: A multiple-payer versus a single-payer system," International Social Security Review 65(2), pp.51-73.  https://doi.org/10.1111/j.1468-246X.2012.01428.x
  15. Joo, K., Kim, H., Lee, S. and Min H., 1996, "A comparative study on medical utilization between urban and rural Korea," Korean Journal of Preventive Medicine 29(2), pp.311-330. 
  16. Kim, H., Lee, K., Lee, Y. and Song, Y., 2021, "Restaurants' survival in the era of COVID-19 - A case study of Seoul," Journal of the Korean Geographical Society 56(1), pp.35-51.  https://doi.org/10.22776/KGS.2021.56.1.35
  17. Kreng, V. B. and Yang, C.-T., 2011, "The equality of resource allocation in health care under the National Health Insurance System in Taiwan," Health Policy 100(2-3), pp.203-210.  https://doi.org/10.1016/j.healthpol.2010.08.003
  18. Kwon, S., 2009, "Thirty years of national health insurance in South Korea: Lessons for achieving universal health care coverage," Health Policy and Planning 24(1), pp.63-71.  https://doi.org/10.1093/heapol/czn037
  19. Lee, S. M., 2019, "Essential health care," Journal of the Korean Medical Association 62(4), pp.231-237.  https://doi.org/10.5124/jkma.2019.62.4.231
  20. Liu, D., Kwan, M.-P., Huang, J., Kan, Z., Song, Y. and Li, X., 2022, "Analyzing income-based inequality in transit nodal accessibility," Travel behavior and Society 27, pp.57-64.  https://doi.org/10.1016/j.tbs.2021.11.005
  21. Lu, J. R., Leung, G. M., Kwon, S., Tin, K. Y. K., Van Koorslaer, E. and O'Donnell, O., 2007, "Horizontal equity in health care utilization evidence from three high-income Asian economies," Social Science and Medicine 64(1), pp.199-212.  https://doi.org/10.1016/j.socscimed.2006.08.033
  22. Manz, K. M. and Mansmann, U., 2021, "Inequality indices to monitor geographic differences in incidence, mortality and fatality rates over time during the COVID-19 pandemic," PLOS ONE 16(5), e0251366. 
  23. Ministry of Health and Welfare, 2023, Announcement of essential healthcare support measures, https://www.mohw.go.kr/eng/nw/nw0101vw.jsp?PAR_MENU_ID=1007&MENU_ID=100701&page=5&CONT_SEQ=374922 (last accessed: 2023/09/01). 
  24. Ministry of the Interior and Safety, Local data, https://localdata.go.kr (last accessed: 2022/05/27) 
  25. National Health Insurance Service, 2021, National health insurance statistical yearbook, NHIS.
  26. Neutens, T., 2015, "Accessibility, equity and health care: Review and research directions for transport geographers," Journal of Transport Geography 43, pp.14-27.  https://doi.org/10.1016/j.jtrangeo.2014.12.006
  27. OECD, 2013, Crisis squeezes income and puts pressure on inequality and poverty. OECD Publishing, Paris. 
  28. O'Malley, A. S., Rich, E. C., Maccarone, A., DesRoches, C. M. and Reid, R. J., 2015, "Disentangling the linkage of primary care features to patient outcomes: A review of current literature, data sources, and measurement needs," Journal of General Internal Medicine 30, pp.576-585.  https://doi.org/10.1007/s11606-015-3311-9
  29. Ord, J. K. and Getis, A., 1995, "Local spatial autocorrelation statistics: Distributional issues and an application," Geographical Analysis 27(4), pp.286-306.  https://doi.org/10.1111/j.1538-4632.1995.tb00912.x
  30. Persad, G., Wertheimer, A. and Emanuel, E., 2009, "Principles for allocation of scarce medical interventions," The Lancet 373(9661), pp.423-431.  https://doi.org/10.1016/S0140-6736(09)60137-9
  31. Piketty, T., 2014, Capital in the Twenty-First century. Cambridge: Harvard University Press. 
  32. Shi, L., Starfield, B., Politzer, R. and Regan, J., 2002, "Primary care, self-rated health, and reductions in social disparities in health," Health Services Research 37(3), pp.529-550.  https://doi.org/10.1111/1475-6773.t01-1-00036
  33. Song, S. O., Jung, C. H., Song, Y. D., Park, C.-Y., Kwon, H.-S., Cha, B. S., Park, J.-Y., Lee, K.-U., Ko, K. S. and Lee, B.-W., 2014, "Background and data configuration process of a nationwide population-based study using the Korean National Health Insurance System," Diabetes and Metabolism Journal 38, pp.395-403.  https://doi.org/10.4093/dmj.2014.38.5.395
  34. Song, Y. and Kim, H., 2015, "Evolution of subway network systems, transport accessibility and change of urban landscape: A longitudinal approach," International Journal of Applied Geospatial Research 6(2), pp.53-76.  https://doi.org/10.4018/ijagr.2015040104
  35. Statistic Korea, Population statistics, http://kostat.go.kr (last accessed: 2023/07/01) 
  36. Stensrud, M. J. and Valberg, M., 2017, "Inequality in genetic cancer risk suggests bad genes rather than bad luck," Nature Communications 8, 1165. 
  37. Strange, K. C., Miller, W. L. and Etz, R. S., 2023, "The role of primary care in improving population health," Milbank Quarterly 101(S1), pp.795-840.  https://doi.org/10.1111/1468-0009.12638
  38. Tao, Z. and Cheng, Y., 2019, "Modelling the spatial accessibility of the elderly to healthcare services in Beijing, China," Environment and Planning B 46(6), pp.1132-1147.  https://doi.org/10.1177/2399808318755145
  39. The World Health Organization, 1946, Constitution of the World Health Organization. 
  40. Theil, H., 1967, Economics and information theory. Amsterdam: North Holland. 
  41. Wang, F., 2012, "Measurement, optimization, and impact of health care accessibility: a methodological review," Annals of the Association of American Geographers 102(5), pp.1104-1112.  https://doi.org/10.1080/00045608.2012.657146
  42. Watanabe, R. and Hashimoto, H., 2012, "Horizontal inequity in healthcare access under the universal coverage in Japan; 1986-2007," Social Science and Medicine 75(8), pp.1372-1378.  https://doi.org/10.1016/j.socscimed.2012.06.006
  43. Waters, H. R., 2000, "Measuring equity in access to health care," Social Science and Medicine 51(4), pp.599-612.  https://doi.org/10.1016/S0277-9536(00)00003-4
  44. Ye, H., and Kim, H., 2014, "Measuring spatial health disparity using a network-based accessibility index method in a GIS environment: A case study of Hillsborough County, Florida," International Journal of Geospatial and Environmental Research 1(Article 2). 
  45. Yin, C., He, Q., Liu, Y., Chen, W. and Gao, Y., 2018, "Inequality of public health and its role in spatial accessibility to medical facilities in China," Applied Geography 92, pp.50-62.  https://doi.org/10.1016/j.apgeog.2018.01.011
  46. Zhang, T., Xu, Y., Ren, J., Sun, L. and Liu, C., 2017, "Inequality in the distribution of health resources and health services in China: Hospitals versus primary care institutions," International Journal for Equity in Health 16, 42.