• 사회복지연구
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• 제43권2호
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• pp.319-344
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• 2012

본 연구는 2010년 국민건강영양조사 원자료를 이용하여 의료이용 형평성지수인 집중지수와 Hiwv지수를 성별, 연령, 지역의 하위집단에 따라 집단 간 차이(Between)에 의한 부분과 집단 내부의 불평등(Within)에 의한 부분, 그리고 잔여 부분(R)으로 분해하였다. 본 연구의 분석결과는 다음과 같다. 첫째, 외래이용 횟수에서 남녀의 집단 간 차이가 Hiwv지수에 미치는 영향은 0으로 나타났다. 반면 외래비용에서는 Hiwv지수 .1035 중 여성들의 집단 내부불평등이 .0441을 설명하고 있어 빈곤여성들의 의료서비스 저이용이 의료이용 형평성에서 중요한 문제가 됨을 알 수 있었다. 둘째, 외래이용 횟수 형평성에 연령집단의 차이는 크게 영향을 미쳤는데, 미세한 양이지만 Hiwv지수 -.0107에서 대부분인 -.0085을 설명하고 있다. 셋째, 외래비용의 Hiwv지수에는 집단 내부의 불평등 특히, 노년층의 내부 불평등이 .0253을 설명하여 설명력이 크게 나타났다. 넷째, 외래비용의 Hiwv지수에 지역의 내부 격차(Within)가 가장 크게 영향을 미쳐서 Hiwv지수 .1035 중 .0569를 설명하였으며, 이 중 대부분인 .0535를 도시지역의 불평등이 설명하였다. 분석결과를 종합하면 분석된 집단범주 중 외래이용 횟수의 형평성에 가장 크게 영향을 미치는 집단은 연령집단이었으며, 외래비용에서는 집단 간 격차보다 집단 내부의 불평등이 더 크게 영향을 미치는 것으로 나타났다. 빈곤여성일수록, 빈곤노인일수록, 도시빈민일수록 기대비용에 못 미치는 외래진료비를 지출하고 있음을 나타냈는데, 이들에 대한 의료비지원 정책이 요구된다고 하겠다.

• 보건행정학회지
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• 제17권3호
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• pp.26-49
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• 2007

The purpose of this study is to analyze the equity of health care utilization by income groups in terms of both quantity and quality of care, which is measured by expenditure, type of care, and type of health care institutions. Equity in health care utilization is measured by HIwv index, based on the survey of 1,480 Gwangju-Jeonnam residents. Health care utilization in terms of the probability and quantity of outpatient and inpatient care show equitable or pro-poor inequitable distribution, whereas the distribution of health care expenditure, which can account for the quality of care, is pro-rich inequitable, implying that the better off tend to use more expensive medical care. In terms of the types of care, simple visits for basic care show equitable distribution, whereas the distribution of the utilization of traditional tonic medicine, comprehensive health examination, CT, MRI, and ultrasound is pro-rich inequitable. Utilization of general hospitals and traditional health institutions show pro-rich inequitable distribution, hospitals and dental care institutions equitable, and physician clinics and public health centers pro-poor inequitable.

• 도시과학
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• 제8권1호
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• pp.51-58
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• 2019

본 연구의 목적은 노인들의 응급의료이용에 영향을 주는 요인들을 알아보고 의료접근의 형평성을 조사하는 데 있다. 2014년 한국의료패널조사 자료를 사용하여 기술분석과 로지스틱회귀분석이 행하여졌으며 인터뷰에 참여했던 1,313명의 노인들이 표본으로 선정되었다. 연령, 성별, 교육수준 등의 인구변수들이 응급의료이용의 중요한 결정요인이었다. 의료요구는 노인 계층 간 응급의료이용의 차이를 충분히 설명하지 못한 걸로 나타났으나 건강상태는 응급의료서비스를 사용하는 노인들의 중요한 결정요인이었다. 의료비지출은 응급의료서비스이용의 계층 간 차이를 개선하지 못했으나 응급의료이용의 중요한 예측요인으로 남았다. 한국에서 의료개혁은 의료요구를 가진 노인들이 효과적인 진료혜택을 받을 수 있도록 전국민 응급의료 보장을 확대하는 방향으로 계속 이루어져야 한다. 앞으로 연구도 75세 이상의 교령노인과 여성 및 교육수준이 낮은 노인, 그리고 높은 의료비 지출을 하는 노인과 같은 인구계층들에게 혹시 있으지 모르는 의료접근의 장애들을 허무는 방향으로 이루어질 필요가 있다.

• 보건행정학회지
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• 제5권2호
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• pp.155-172
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• 1995

This study is an empirical analysis on the equity in the delivery of heatlh care under the Korean Medical Insurance Corporation System. The purposes of this study are to find out effects of income on the health care utiliztion and measure the income-related inequity in the distribution of health care. This study was carried out based on the fact that the health insurance program has been organized to achieve the equity objective, "equal treatment for equal needs". Of 41, 828 insured persons who had been diagnosed in the 1993 Health Screening Test and utilifzation data from 1, January 1993 through 31, December 1993 were derived from the Benefit Managment File. Inequity was measured by means of I) share approach, ii) standardization concentration curve approach, iii) inequity index, iv) test for inequity. The major findings were as follows : 1. The expenditure shares of the top two quintile groups exceeded their morbidity shares, whereas the opposite was true of the bottom three quintile groups, Which showed a positive HI$_{LG}$ inequity index, suggesting the presence of some inequity favoring the rich group. 2. Compared with other residential areas, the rural area showed the highest positive HI$_{LG}$ irrespective of need indicatior applied. 3. Standardized expenditure concentration indices adjusted by age, gender and need structure were also found to be positive, and therefore still indicated that there has been inequity favoring the rich after the standardization. 4. The Loglikelihood Ratio (LR) test for the statistical significance of income-related inequity of medical care utilization was carried out using the logistic regression model. The resulting loglikelihood ratio test statistic value was 176, which did exceed the 0.5 percent critical value of the chi-square distribution with 28 degrees of freedom, which is 50.993. Therefore, the null hypothesis of no income-related inequity of medical care utilization was rejected at the 99.5 percent confidence level. 5. The Regression based F-test has been carried out for analyzing the income-related inequity of medical expenditure in terms of age, gender, morbidity indicators as explanary variables. The hypothesis of the absence of income-relate inequity was rejected for all need indicators at the 95% confidence level.nce level.

• 보건행정학회지
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• 제29권3호
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• pp.288-302
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• 2019

Background: The one-person households (OPH) are rapidly increasing and vulnerable to socioeconomic and health problems. Because it is predicted to be inequitable to health care utilization, we would like to find out about the equity of health care utilization of the OPH by comparison with the multi-person households (MPH). Methods: This study followed the theoretical framework of Wagstaff and van Doorslaer (2000), O'Donnell and his colleagues (2008), where the horizontal inequity index is the difference between the concentration indices of actual health care utilization and health care needs. This study employed the 9th Korea Health Panel survey, and a total of 10,807 cases were analyzed. Health care needs were measured by age, sex, subjective health status, chronic disease count, Charlson's Comorbidity Index, limitation of activities, and disability. Results: Compared with the MPH, there were pro-poor inequities in hospitalization, emergency utilization, hospitalization out-of-pocket payments, and pro-rich inequities in outpatient out-of-pocket payments for the OPH. The decomposition of the concentration index revealed that chronic disease count made the largest contribution to socioeconomic inequality in outpatient utilization. Age, health insurance, economic activities, and subjective health status also proved more important contributors to inequality. The variables contributing to the hospitalization and emergency utilization inequity were age, education, Charlson's Comorbidity Index, marital status, and income. Conclusion: Because the OPH was more vulnerable to health problems than the MPH and there were pro-poor inequities in medical utilization, hospitalization, and emergency costs, it is necessary to develop a policy that can correct and improve the portion of high contribution to medical utilization of the OPH.

• 보건행정학회지
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• 제13권3호
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• pp.104-128
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• 2003

Equity in health care has taken priority in the Korean government's policy agenda after the government-led national health insurance achieved universal coverage in 1989 along with the final inclusion of the self-employed as beneficiary. The purpose of this study is to examine the extent to which there exists difference or inequality in the utilization of health care, especially cancer inpatient services among income classes. We analysed the utilization of cancer inpatient services of residents in Jeju Island for a year of 2000, using the national health insurance data for qualification of beneficiaries and utilization of health care. The independent variable are 10 income classes based on the national health insurance fee imposed on each household for a year of 2000. The dependent variables of this study are an amount of cancer inpatient health care utilization measured by cancer admission days and cancer treatment costs. Also, cancer inpatient health care utilization is analysed by three categories divided into utilization in medical care institutions (1) within Jeju Island, (2) outside Jeju Island, and (3) all within and outside Jeju Island. We measured concentration index of cancer inpatient health care utilization. This analysis showed negative concentration index within Jeju Island and positive outside Jeju Island, and positive in all within and outside Jeju Island. This results suggest inequality against the relatively poor income groups in utilization of cancer inpatient health care services. Especially, inequity of cancer inpatient health care would be more serious in Jeju Island of Korea, considering that lower income groups reportedly have higher incidence rates in most of cancer and thus use more health services.

• 보건행정학회지
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• 제2권1호
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• pp.167-203
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• 1992

The effects of regional health insurance on access to ambulatory care are examined in this paper. Access is measured as use-disability ratios. The data are collected in a household interview survey at Hwachon county before and after the introduction of regional health insurance. Before the introduction of regional health insurance, low-income class has less contacts with physicians than high-income class. This disparity in accessibility among economic classes is reduced with the health insurance coverage, but not removed, even after adjusting for health need.

• 한국병원경영학회지
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• 제14권1호
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• pp.36-61
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• 2009

This study focused on finding the variation of medical service utilization, paths of medical service utilization and medical payments of the patients died by cerebrovascular diseases. For this study, data of the one-year episodes of the health insurance subscribers died in 2004 were selected. The frequency of medical visits, the lengths of stays, the days of outpatient visits, the total period of medical services and the total medical payments were compared by the characteristics of the suppliers and utilizers. This study is useful in reviewing the equity of medical service utilization because it analyzed variance in utilization by episodes. In oder to collect accurate data of the patients died by cerebrovascular diseases in 2004 the 2004 reimbursement data of all medical institutions were matched to the data of funeral fee payment by the National Health Insurance Corporation from January 2004 to May 2005. The major results of the study are as follows. The variation of medical service utilization of cerebrovascular diseases was influenced by supplier factors suppliers, such as types and locations of medical institutions and user factors such as sex and age. It was suspected that the reimbursement by fee-for-service contributed to the variation quite a lot, but we could not compare the variation between the different reimbursement systems in Korea. On the basis of analyzing results this study suggests that the factors of suppliers and utilizers should be reviewed to reduce the under use and over use expressed by variations of medical service. The processes of care, effective communication and management system should be investigated for the equity of medical service utilization and also. alternative medical services would be recommended to reduce the high medical payment. Additionally to find other causes of variation further in depth study controling the severity of diseases, socio-economic status of the users and the system factors is required.

• 지역사회간호학회지
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• 제12권3호
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• pp.589-599
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• 2001

The purpose of this study was to analyze the relation amongst health status, health care costs. health service utilization among the low income elderly who were 60 years of age or older, earning a half of the average Korean family income. The cross-sectional descriptive survey research we conducted used families randomly sampled nationwide. The data were collected from July 12 to August 7, 1999 and the total sample was 1.259 household members (421 households). These were the major findings. 1. As for the health status. 72.4% of respondents fell ill in the last 1 month; 54% of respondents had chronic disease. 2. As for the health care cost. the cost of hospitalization and the medical treatment were 1.069,000 won and 226.000won. respectively. 59.3% of respondents experienced a burden from the monthly health care expenses. 3. As for the health service utilization for the last 3months. 28.5% of respondents didn't utilize the health service. In addition, 22.2% of respondents gave up a medical treatment because of economic situation (88.8%). 4. The statistically significant determinants of health service utilization are old age, female, living with a spouse, unemployed state, medicare, and more days sick. 5. It is shown conclusively that equity and efficacy of the health care policy are to be considered for lower income older adult.

• 보건행정학회지
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• 제6권1호
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• pp.110-143
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• 1996

The purpose of this study is to assess the extent of inequality in health outcomes and the distribution of health services according to health need under National Health Insurance System in Korea. For the empirical analysis, data were collected through an interview survey during one month of October, 1994. Interview were conducted with a total of 10, 875 of the employees and the self-employed selected through cluster, systematic sampling. The major findings of this research are as follows: 1. The analysis of the differentials in morbidity rates by socio-economic group showed that health inequality in the pro-higher groups existed in all self-reported morbidity indicators. 2. The findings of the conventional use measures showed that the lower socio-economic groups had more ambulatory and inpatient services than the higher groups. In contrast to the level of the medical care utilization, however, the higher socio-economic groups were more likely to use the high-quality source of care in terms of their treatment place compared to the lower groups. 3. By using the need-based use measures, the results were different from each use-disability ration indicator. Using the use-disability ration measured by physician visits per 100 restricted-activity days in the population, it was found that there was no evidence favoring the higher socio-economic groups. In contrast, the use-disability ration based on physician visits per a chronic patient in one year displayed that there was remarkable relative difference by income group as well as the evidence of the pro-higher income groups. 4. The results of logistic regression analysis and two-stage estimation method indicated that although the utilization is significantly affected by type and duration of insurance coverage, the use or nonuse of service and the volume of physician care consumed is determined by health need and demographic characteristics rater than economic status. In sum, these findings suggest that physician service is equitably distributed according to health need under national health insurance system in Korea. As there were some evidences of inequality including the differential in physician visits of chronic patients by income group, however, the government should strengthen the activities to guarantee the equity of health services utilization.