Analysis of Factors which Affect the Medical Utilization Fee after an Increase of Health Insurance Benefits for Patients with Serious Illnesses

According to a research analysis of the factors which affect the medical utilization fee after an increase of health insurance benefits for patients with serious illnesses based on 225 patients over 6 months, both before and after the increase of benefits, from January, 1st, 2005 to June 30th, and also from January, 1st, 2006 to June 30th. In terms of genders, 67.8% of males were affected, whereas only 32.2% of females were effected, a much higher rate of men than women. Men also had higher rates before and after the increase of benefits. Out of 5 categories related to medication and treatment, radiation testing was the most expensive at about 5,300,000, operation fees were 590,000, and costs of other testing approximately 200,000 with the least expensive category being 120,000 for medication. By looking at the relationship between the fees and increase of benefits, medication was a hospital charge (p<0.01), injection fees were hospital charges (p<0.01), operation fees were hospital charges (p<0.01). Medication fees (p<0.01) and injection fees (p<0.01) were found to be related.

건강보험 중증질환 급여확대 전후에 따른 진료비 차이에 관한연구

본 연구는 급여 확대 전 2005년 1월 1일부터 6월 30일까지 6개월간과 확대 후 2006년 1월 1일부터 6월 30일까지 6개월간 총 255명을 조사대상으로 하여 건강보험 중증질환 보험급여 확대에 따른 진료비 증감 요인을 파악한 결과 다음과 같다. 성별로는 남자 67.8%, 여자 32.2%로 여자보다 남자가 높은 분포를 보였으며, 확대 전 후 또한 여자보다 남자가 높은 분포를 보였다. 투약 및 처치에 따른 진료비 5항목 중에서 방사선료가 530만원대로 가장 많았고, 시술료 59만원, 기타검사료 20만원 순이었으며, 투약료가 12만원선으로 가장 낮았다. 급여확대 후에 따른 진료비와의 상관관계를 보면, 투약료는 입원료(p<0.01)와, 주사료는 입원료(p<0.01) 및 투약료(p<0.01)와 시술료는 입원료(p<0.01), 투약료(p<0.01) 및 주사료(p<0.01)와 정상관관계를 보였다.