• Journal of Hospice and Palliative Care
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• 제18권3호
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• pp.219-226
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• 2015

목적: 본 연구에서는 가정호스피스 완화의료에 대한 국민의 인식을 파악하고 이 인식과 관련된 요인을 확인하고자 한다. 방법: 2014년 8월 19일부터 30일까지 2010년도 인구센서스를 기반으로 제주도를 제외한 전국에 거주하는 만 20세 이상 성인 남녀 1,500명을 대상으로 온라인 설문조사를 실시하였다. 결과: 가정호스피스 완화의료를 인지하고 있는 대상자는 15.9%였고, 가정호스피스 완화의료 이용 의향이 있는 대상자는 61.3%였다. 가정호스피스 완화의료 인지도에 영향을 미치는 요인이 거주지역, 종교 및 민간보험 가입여부이다. 서울, 광주/전라, 부산/울산/경남에 거주하는 대상자의 가정호스피스 완화의료 대한 인지도는 인천/경기에 거주하는 대상자에 비해 높았다. 종교를 보유한 대상자의 가정호스피스 완화의료 인지도는 종교를 보유하지 않은 대상자에 비해 유의하게 높았으며, 민간보험 가입자의 가정호스피스 완화의료 인지도는 민간보험 미가입자에 비해 높았다. 결론: 가정호스피스 완화의료를 활성화하기 위해서는 호스피스에 대한 국민과 의료진의 인식 개선 방안을 마련해야 한다. 또한 요양기관과 지역사회 보건소가 일정 요건을 갖춘 호스피스 완화의료팀을 구성하여 가정을 방문하여 돌봄을 제공할 수 있는 시스템을 구축하여 법제화하고, 이를 건강보험 수가에 적용하는 방안을 적극적으로 검토해야 한다. 또한, 요양기관과 보건소가 가정호스피스 제공이 어려운 지역에서는 호스피스 전문간호사 중심의 가정 방문 호스피스 센터 설치에 대한 고민도 필요한 시점이다.

• 한국노년학
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• 제31권2호
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• pp.259-276
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• 2011

다른 사람의 도움을 받아야 하는 노인도 적절한 재가서비스를 받으면서 가능한 오래 가정에 머물 수 있다면 그들의 삶의 질을 향상시키고 비용을 절감할 수 있다고 알려져 있다. 이 연구는 노인장기요양보험제도를 시행한 후, 재가서비스 이용자가 시설서비스로 전환하여 입소하는 것에 대한 결정요인을 살펴보고자 한 종적 연구이다. 이 연구는 장기요양급여 이용자와 주수발자를 대상으로 한 '2009년 노인장기요양서비스 만족도 조사' 자료를 활용하였다. 이 연구의 분석대상자는 총 1,230명으로, 이들은 시도별, 장기요양등급별, 의료보장형태별로 비례할당으로 추출된 것이다. 종속변수는 연구대상자가 재가서비스를 이용하다가 시설로 입소하는 데까지 걸린 시간이고, 이것은 노인장기요양급여DB를 연계하여 파악하였다. 또한 이 연구는 Cox Proportional Hazard Model을 이용하여 hazard ratio를 산출하였다. 연구결과에 의하면, 다른 변수들을 보정한 후에도 이용자가 골절을 앓고 있는 경우에는 시설에 입소할 확률이 유의하게 높은 것으로 나타났다. 또한 통계적으로 유의하지는 않았지만 저하된 인지기능의 항목수가 많을수록 시설에 입소할 확률이 높은 것으로 나타났다. 이러한 영향요인들을 감안하여 향후에는 이용자의 욕구를 충족시키는 재가서비스 이용체계를 구축하고 보완하는 정책개발이 필요하다.

• 보건행정학회지
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• 제19권2호
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• pp.51-70
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• 2009

Background : Previous studies have reported that enhanced continuity of care prevented a sudden worsening in progress among chronic disease patients, and as a result was favorable for efficient spending of health care funds. This study aims to estimate the continuity of care of Korean with diabetes and to identify factors affecting the continuity of care. Methods : This study used the Korean National Health Insurance Claims Database which includes E11 (ICD-10) as a primary or secondary disease as of 2006. Study population is 1,160,725 type 2 diabetics (20-84 years). Continuity of Care Index (COC), Modified, Modified Continuity Index (MMCI), and Most Frequent Provider Continuity (MFPC) were used as indexes of continuity of care. Results : The continuity of care in the study population was $0.94{\pm}0.10$ as calculated by MMCI, $0.91{\pm}0.16$ as calculated by MFPC and $0.86{\pm}0.23$ as calculated by COC. The lower continuity of care was shown in the patients who were female, 65 and over years old, Medical Aid recipients, 13 times or more visitors, hospital users as main attending medical institution, patients experienced hospitalizations or comorbidities. Conclusion : The continuity of care for adult patients with type 2 diabetes was high in Korea, and showed variation according to patients' characteristics. This result provides empirical evidence for policymakers to develop or strengthen programs for managing patients showing low continuity of care.

• 치위생과학회지
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• 제23권2호
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• pp.154-168
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• 2023

Background: Legal regulations and fees have been established in Korea to provide visiting oral health care services to individuals with long-term care insurance (LTCI). However, beneficiaries of this service are very limited. Therefore, to improve the Korean system we propose a comparative analysis with the Japanese system. Methods: This study is a descriptive analysis based on secondary data, such as statistics, laws, and service record forms from Korea and Japan. The most recent institutional documents were obtained through a Google search. The variables investigated were financial resources of LTCI, co-payment structure, monthly limit of LTCI benefits, care levels of LTCI, service providers, service costs, contents of service, and the number of cases of service. Results: In both Korea and Japan, LTCI is financed through a combination of taxes and insurance premiums. However, the monthly limit for receiving LTCI services in Japan is about 2.4 times higher than in Korea. Visiting medical and dental treatment is also possible in Japan. Furthermore, nursing staff can provide daily oral health care services according to dental hygienists' instruction unlike Korea. Oral health care services in Korea are focused on oral hygiene and prevention of oral diseases, while Japan additionally provides oral function screening, patient education for oral health management, and training for nursing staff to enhance oral function, eating, and swallowing of the patients. Conclusion: We concluded that the possibility of visiting dental treatment, differences in monthly limit of LTCI benefits, oral function assessment and guidance, as well as collaboration with other healthcare professionals contributed to the difference in the frequency of utilization of visiting oral health care services between Korea and Japan.

• 보건행정학회지
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• 제31권4호
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• pp.508-517
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• 2021

Background: After the first case of coronavirus disease 2019 (COVID-19) in January 2020, Korea has experienced three waves in 2020. This study aimed to analyze changes in health care utilization according to the period of the 1st to 3rd waves of the COVID-19 pandemic. Methods: We analyzed 3,354,469,401 national health insurance claims from 59,104 medical facilities between 2017 and 2020. Observed-to-expected ratios (O:E ratio) with data from 2017 to 2019 as expected values and data from 2020 as observed values were obtained to analyze changes in medical utilization. T-test was used to test whether the difference of observed and expected values was statistically significant. Results: In 2020, the O:E ratio was 0.894, indicating a decrease in health care utilization overall during the pandemic. The O:E ratio of the 1st wave was 0.832, which was lower than those of the second (0.886) and third (0.873) waves. Health care utilization decreased relatively more among outpatient, women, children and adolescents, and health insurance patients. And health care utilization decreased more in small medical facilities and in Daegu and Gyeongbuk during the first wave. During the pandemic, the O:E ratios of respiratory diseases were 0.486-0.694, while chronic diseases and mental diseases were more than 1.0. Conclusion: Health care utilization decreased during the COVID-19 pandemic overall, and there were differences by COVID-19 waves, and by the characteristics of patients and medical facilities. It is necessary to understand the cause of changes in health care utilization in order to cope with the prolonged COVID-19 pandemic.

• Journal of Preventive Medicine and Public Health
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• 제24권4호
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• pp.485-495
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• 1991

This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discouraging the use of tertiary care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131 (3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care utilization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.

• 보건행정학회지
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• 제24권4호
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• pp.349-356
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• 2014

Background: This study aimed to explore factors associated with the non-use of beneficiaries of long-term care insurance services for the elderly in Jeollanam-do Province by analyzing a dataset obtained from National Health Insurance Service. Methods: The study sample consists of 1,663 individuals who were evaluated as eligible for long-term care insurance services in Jeollanam-do Province during the period of July 1, 2008 through June 30, 2009. As a dependent variable, the non-use of the service was defined as one when a beneficiary had used it once or more times during one year after he or she was evaluated as eligible and as zero otherwise. A proportion analysis was conducted to describe characteristics of study sample. Chi-square tests were used to compare general characteristics between beneficiaries who had used the services and those who had not used them. Multiple logistic regressions were performed by three models including additional sets of explanatory variables such as socio-demographic characteristics, health conditions, and economic status. Results: Main results are summarized as follows. The proportion of beneficiaries who had not used the service was 14.5% of all beneficiaries. According to the results from the model using all explanatory variables, the factors associated with the non-use of the services were residence location, dwelling place, type of desired service, level of care needs, and instrumental activities of daily life limitations. Conclusion: In particular, regarding the type of desired service, the cash benefit showed a high likelihood of the non-use of the service; it had an odds ratio (OR) of 50.212 (95% confidence interval [CI], 24.00-105.04) compared with home service. In case of dwelling place, a hospital showed also a high likelihood of the non-use with an OR of 20.71 (95% CI, 10.12-42.44) compared with home.

• 보건행정학회지
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• 제31권2호
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• pp.173-179
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• 2021

Background: In Korea, the length of stay and medical expenses incurred by medical aid patients are increasing at a rate faster than the national health insurance. Therefore, there is a need to create a management strategy for each type of hospitalization to manage the length of stay of medical aid patients. Methods: The study used data from the 2019 National Health Insurance Claims. We analyzed the factors that affect the length of stay for 186,576 medical aid patients who were hospitalized for more than 31 days, with a focus on the type of hospitalization in long-term care hospitals. Results: The study found a significant correlation between gender, age, medical aid type, chronic disease ratio, long-term care hospital patient classification, and hospitalization type variables as factors that affect the length of hospital stay. The analysis of the differences in the length of stay for each type of hospitalization showed that the average length of stay is 291.4 days for type 1, 192.9 days for type 2, and 157.0 days for type 3, and that the difference is significant (p<0.0001). When type 3 was 0, type 1 significantly increased by 99.4 days, and type 2 by 36.6 days (p<0.0001). Conclusion: A model that can comprehensively view factors, such as provider factors and institutional factors, needs to be designed. In addition, to reduce long stays for medical aid patients, a mechanism to establish an early discharge plan should be prepared and concerns about underutilization should be simultaneously addressed.

• 보건행정학회지
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• 제21권4호
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• pp.527-540
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• 2011

Some patients tend to visit tertiary hospitals instead of non-tertiary hospitals for minor illnesses, which is a chronic problem within the Korean health care delivery system. In order to reduce the number of patients with minor severity diseases unnecessarily utilizing the tertiary medical services in Korea, the Ministry of Health and Welfare raised the outpatient co-insurance rate for the tertiary hospitals in July, 2009. Another increase in the prescription drug co-insurance rate by the general and tertiary hospitals is scheduled to take place in the second half of 2011. An increase in copayments may discourage the utilization rate of medical services among the underprivileged or patients who require complicated procedures. This study aims to analyze the diabetic patients' utilization rates of tertiary hospitals according to the Comorbidity score. Diabetic patients' data was gathered from the Health Insurance Claims Records in the Health Insurance Review & Assessment Service between 2007-2009. Comorbidity scores are measured by the Charlson Comorbidity Index and the Elixhauser Index. Chi-square and logistic regressions were performed to compare the utilization rates of both insulin-dependents (n=94,026) and non-insulin-dependents (n=1,424,736) in tertiary hospitals. The higher Comorbidity outcomes in the insulin-dependent diabetic patients who didn't visit tertiary hospitals compared to those who did, was expected. However, after adjusting the gender, age, location, first visits and complications, the groups that scored >=1 on the comorbidity scale utilized the tertiary hospitals more than the O score group. Non-insulin-diabetic patients with higher Comorbidity scores visited tertiary hospitals more than patients who received lower grades. This study found that patients suffering from severe diabetes tend to frequently visit the tertiary hospitals in Korea. This result implied that it is important for Korea to improve the quality of its primary health care as well as to consider a co-insurance rate increase.

• 한국노년학
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• 제29권3호
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• pp.917-933
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• 2009

본 연구는 새롭게 도입된 노인장기요양보험제도 체계 내에서 공적보호서비스(시설보호서비스와 재가보호서비스)를 이용하게 되는 요인과 두 서비스유형간의 선택을 결정하게 되는 요인을 밝히고자 한다. Andersen의 행동모델에 기반하여 노인장기요양서비스 이용형태를 결정하는 소인요인과 자원요인, 욕구요인의 영향을 검증하는 연구모형을 구성하였으며, 노인장기요양보험 2차 시범사업의 서비스 이용권리가 있는 요양 1~3등급의 노인 5,497명의 서비스 이용자료와 개인적 특성 자료를 활용하여 다항 로지스틱 회귀분석을 실시하였다. 주요 분석결과는 다음과 같다. 첫째, 서비스 이용의 본인부담금을 나타내는 소득수준에 따라 서비스 이용형태에 차이가 나타났다. 국민기초생활보호대상자, 일반소득계층, 차상위계층의 순으로 서비스 이용이 높았으며, 재가보호서비스에 비해 시설보호서비스의 이용이 높게 나타났다. 둘째, 군지역에 비해 대도시와 중소도시가 시설보호서비스 또는 재가보호서비스를 이용할 확률이 높으며, 특히 중소도시의 경우 재가보호서비스보다는 시설보호서비스 이용이 높은 것으로 나타났다. 셋째, 요양 1~2등급이 3등급에 비해 시설보호서비스 또는 재가보호서비스 이용이 높으나, 등급에 따른 서비스 이용 유형간 차이는 나타나지 않았다. 넷째, 일상생활수행능력(ADL), 수단적 일상생활수행능력(IADL), 인지기능과 문제행동의 기능이 나쁠수록 시설보호서비스 이용이 높으며, 재가보호보다는 시설보호를 이용하는 것으로 나타났다. 그러나 간호처치영역은 기능상태가 나쁠수록 서비스 이용이 적고, 재활영역의 기능상태는 통계적 유의미성을 나타내지 못하였다. 이와같은 연구결과를 통해 현 노인장기요양보험제도의 본인부담금의 조정과 지역별 균형적인 서비스인프라 구축의 필요성을 제기하며, 또한 요양등급판정체계의 재검증의 필요성을 제기하는 바이다.