• 제목/요약/키워드: Dental Service Utilization

검색결과 44건 처리시간 0.026초

노인외래정액제 개선이 고령층의 의료이용에 미친 영향 (The Effects of the Revised Elderly Fixed Outpatient Copayment on the Health Utilization of the Elderly)

  • 김리현;이경민;이우리;유기봉
    • 보건행정학회지
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    • 제34권2호
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    • pp.196-210
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    • 2024
  • 연구배경: 2018년 1월 의원급(의원, 치과의원, 한의원) 노인외래정액제 개선안이 시행되었다. 정액진료비 상한금액인 1만 5,000원 이하 진료를 받은 경우의 본인부담금은 기존과 동일하다. 개선안은 정액진료비 상한금액인 1만 5,000원 초과 진료를 받은 경우의 본인부담금을 차등적으로 인하하였는데, 1만 5,000원 초과 2만 원 이하 구간의 본인부담금은 진료비의 30%에서 10%로, 2만 원 초과 2만 5,000원 이하 구간의 본인부담금은 진료비의 30%에서 20%로 인하하였다. 우리나라는 급격한 인구 고령화로 고령인구와 노인진료비가 빠르게 증가하고 있고, 노인빈곤율이 경제협력개발기구 회원국 중 가장 높다. 연구는 건강보험 지속 가능성 유지와 노인복지 향상을 위하여 노인외래정액제 개선이 고령층의 의료이용에 미친 영향을 종합적으로 확인하려고 한다. 방법: 연구는 한국의료패널 자료를 사용하여 노인외래정액제 개선 이후 고령층의 의료이용 변화를 추정하였다. 연구는 단절적 시계열 연구 중 구간별 회귀분석을 분석에 이용하였고, 진료비 구간별 및 의원 종류별 외래진료 횟수, 입원횟수 및 일수 변화는 포아송 구간별 회귀분석을, 외래 및 입원진료비 변화는 구간별 회귀분석을 이용하여 추정하였다. 구간별 회귀분석은 개입으로 인한 효과와 시간의 흐름에 따른 효과를 구분할 수 있게 해주어, 개입이 없더라도 발생했을 변화와 개입으로 인한 변화를 명확하게 추정할 수 있도록 해준다. 의료이용에 영향을 미칠 것으로 예상되는 성별, 연령, 교육수준, 소득, 배우자 유무, 장애 정도, 지역, 주관적 건강인식, 질병 및 손상으로 인한 일상생활 제한 여부, 응급 및 입원 수술 여부, 응급실 이용횟수, 만성질환 개수, 계절은 통제변수로 포함하였다. 결과: 노인외래정액제 개선 직후 본인부담 변화가 없던 의원, 한의원 진료비 1만 5,000원 이하 구간의 외래진료 횟수가 감소하였다. 그러나 본인부담이 감소한 의원 1만 5,000원 초과 2만 원 이하 구간과 한의원 2만 원 초과 2만 5,000원 이하 구간의 외래진료 횟수는 증가하였다. 치과의원의 외래진료 횟수 변화는 통계적으로 유의하지 않았다. 입원율은 노인외래정액제 개선 직후 감소하였지만, 이후 다시 증가하였다. 외래진료비 중 본인부담금은 노인외래정액제 개선 직후 감소하였다. 입원진료비와 외래와 입원진료비를 합한 총진료비는 노인외래정액제 개선 직후 감소하였다가 이후 다시 증가하였다. 결론: 분석결과를 통해 노인외래정액제 개선 이후 일시적인 의료이용 증가와 본인부담금 감소를 확인할 수 있었다. 총진료비 중 입원이 차지하는 비중이 외래보다 크기 때문에, 노인외래정액제 개선이 고령 환자의 의료비 부담 완화에 미친 영향은 매우 제한적이었다. 장기적으로 고령 환자의 의료비 부담 완화와 건강보험 지속 가능성 유지를 위해서는 본인부담 완화 정책과 질병 악화로 인한 입원을 예방하기 위한 만성질환 관리정책이 함께 이루어져야 할 것으로 보인다. 연구의 결과는 정책을 수립할 때 본인부담 변화가 고령층의 의료이용 행태에 미치는 영향에 대한 기초정보를 제공할 수 있을 것으로 기대된다.

한 농촌보건지소에서의 보건관리 실태에 관한 고찰 -수동면 보건지소의 조직과 인력을 중심으로- (A Study on Status of Health Care for Community Residents in a Rural Health Subcenter - With special Reference to Organization and Man Power of Su Dong Myun Health Subcenter -)

  • 위자형
    • 농촌의학ㆍ지역보건
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    • 제16권1호
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    • pp.3-9
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    • 1991
  • In order to find out status of health care for community residents with special reference to organization and man power in a rural health subcenter, a study was carried out, through analyzing the data, operated by health subcenter during 1973~1990 in a rural area, Su Dong-Myun, Nam Yang Ju-Gun, Kyung Gi-Do, Korea. The following results were obtained : l) The Number of Population in Su Dong-Myun is decreasing and household is increasing chronologically. 2) In 1989, the characteristics of population composition rate in Su Dong-Myun were shown : the groups of Age, 65 and over was high rate(9.8%) and 0~4 was low rate(5.3%) decreasing chronologically. 3) Since 1972, services of Su Dong-Myun health subcenter have been carried in the 3 functions(medical treatment, health care management and clerical work) with supports of Ewha Woman's University through the participation of community residents organization. 4) The Number of Su Dong-Myun health subcenter personnel in 1990 was 5 persons(public health doctor l, public health dentist l, health worker l, dental technician l and assistant nurse l) and of these, health worker who must have the huge charge of health care management, has been worked at Myun-office as a public official, in condition, decreased from 3 in 1980 to 2 in 1981 and from 2 to 1 in 1985. 5) Health service Activities of Su Dong Myun health subcenter obtained good results in it's achievement during 1975-1985, but since 1986, it has been in condition of lower stepping. 6) Since 1977, annual medical utilization rate showed decreasing tendency such as 900 per l,000 population in 1977, 846 in 1979, 723 in 1981, 343 in 1973 and 34l in 1987. 7) A proposal : (l) Organization of health subcenter must be unified and systematized by government, so that health subcenter can carry out primary health care for community residents through responsibilities and authorities. (2) Teaching programs in educational process must be reorganized, according to periodical request. considering relative importance to primary health care in health care needs of community residents.

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전북지역 양호교사의 업무수행과 자신감과 그에 영향하는 요인에 관한 연구 (A Study on the Factors of the school health Teachers' Self-confidence Affecting the School Nursing Activities in Jeonbuk Province)

  • 양경희
    • 지역사회간호학회지
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    • 제1권1호
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    • pp.582-594
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    • 1989
  • The purpose of this study is to analyze the factors affecting the school health teachers' self-confidence. This study was conducted with 87 school health teachers working in Jeonbuk province, from September to December, 1986, The results are follows; 1. Demographic characteristics of school health teachers 1) Age mean ; 34, range; 23-54 2) School Nursing experience mean; 11 years, range; 0-24 3) Clinical experience mean; 1.5 years, range: 0-13 2. Status of school health resources & nursing activities 1) Personnel resource school health teacher: pupils : 1 : 1,436 'classes=1:31 'general teacher=1:39 2) Budget Total school operating budget: School health budget : 100 : 4.2 (52.2 thousand Won) Half of the school health budget expend on medicine. 3) Clinic 80% of all schools have health clinic seperately. 71.32 of all schools have less than $35m^2$, 23.9%, $36-66m^2$. 4) Only 20% of all schools have organization for health 5) Average of clinic visitor for 1 year; 2,084 Major problem is on digestive system. And other problem: respiratory, skin, musculo - skeletal system, dental problem, etc... 6) Literal message for 1 year; 12 times. For health education (4), vaccination (3), examination of parasites (2), etc... 3. The degrees of the school health teachers' self-confidence 1) Program planning & evaluation; 2.9. 2) Clinic management; 2.8 3) Health education; 2.8 4) Management of school environment; 2.7 5) Health care services; 2.5. 6) Operating of school health organization; 2.3 4. Significances to self-confidence on school health nursing activities 1) Program planning & evaluation: home message (r=.228, p<.05) No. of clinic visitor (r=.220, p<.05) expending time for clinic management (r=.229, p<.05) religion (t: 2.5, p<.05) level of school (F=6.3, p<.005) 2) Clinic management: age of school health teacher (r=-.202, p<.05) school health experience (r=-.211, p<.05) salary step (r=.187, p<.05) expending time for clinic management (r=.315, p<0.1) marital status (t=3.97, p<.005) level of school (F=3,139, p<0.5) 3) Management of school environment: level of school (F=3.899, p<.05) expending time for clinic management (r=-,216, p<0.5) 4) Health care service: age of school health teacher (r=-.186, p<.05) marital status (t= 3.67, pH.005) 5) Health education: expending times for clinic management (r=-.252, p<05) level of school (F=5.343, p<.01) 6) Operating of health organization; age of school health teacher (r=-.258, p<.01)salary step (r=.188, p<.05) Based on the above results, the suggestions are as follows; 1. Need to raise ,appointment rate school health teacher. 2. Need to raise self-confidence on school health nursing activities through the inservice education or re-inforcement. 3. Need to secure adequate budget for school health. 4. Participation of school health teacher and support of school master for school health services are required. 5. Need for use the health clinic seperately, adequate facilities and free utilization by visitors.

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농촌(農村) 주민(住民)들의 의료필요도(醫療必要度)에 관(關)한 연구(硏究) (A Study Concerning Health Needs in Rural Korea)

  • 이성관;김두희;정종학;정극수;박상빈;최정헌;홍순호;라진훈
    • Journal of Preventive Medicine and Public Health
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    • 제7권1호
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    • pp.29-94
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    • 1974
  • Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.

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