• 한국콘텐츠학회논문지
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• 제13권2호
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• pp.378-389
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• 2013

본 연구는 주성분분석을 활용하여 1995-2009년 동안의 보건의료비 지출을 소득수준별로 일인당 지출, 민간부문 지출, 공공부문 지출 및 총지출로 구분하여 사회후생 증대 효과를 분석하였다. 분석결과에 의하면 소득수준별 보건의료비 지출의 사회후생 증대효과는 세계전체 소득과 우리나라의 경우 부문별 지출에 따라 편차가 크고, 중간소득 국가에서 가장 크게 나타났으며, 고소득 국가, 저소득 국가, EU 국가 및 OECD 국가는 낮은 수준의 유사한 형태를 보이고 있다. 한편, 보건의료비 지출을 부문별로 살펴보면 일인당 지출은 소득수준과 무관하게 사회후생 증대효과가 낮은 것으로 나타났고, 민간부문 지출은 부문별 지출 중에서 사회후생 증대효과가 가장 크게 나타났다. 공공부문 지출과 총지출의 경우 중간소득 국가가 크게 나타났으며 소득수준별로 편차가 큰 특징을 나타내고 있다. 결과적으로 보건의료비 지출의 효율성을 제고하여 사회후생 증대에 기여할 수 있는 방안을 모색하는 것이 가장 중요한 현안이라 하겠다. 이를 위해서는 무엇보다도 보건의료비 지출이 공공성의 특성을 벗어나 시장기능에 의한 자원배분을 할 수 있는 제도적 지원 방안이 모색되어야 할 것이다.

• 보건행정학회지
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• 제24권1호
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• pp.47-55
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• 2014

Background: Korea is considered to have an integrative health system where both western medicine and Korean (traditional) medicine are officially recognized and provided. Although Korean medicine has been covered by National Health Insurance over 20 years, equity in the utilization of Korean medical care has rarely been examined. Methods: We examined medical care utilization and expenditure of outpatient Korean medicine using panel fixed effects model to remove selection bias. Then we compared it with pooled ordinary least square (OLS) model. This study used Korea Health Panel data, which provides accurate information on out-of-pocket health care payment, including non-covered medical services. Results: Principal findings indicate that the frequency of the utilization of Korean medicine is related with unobservable individual choices different from western medicine, so the panel fixed effect model is appropriate. But pooled OLS model is better fitted for the expenditure of Korean medicine, after controlling for western medical care expenditure. After adjusting for the selection bias, socioeconomic status (income, education) was significantly associated with the expenditure of Korean medicine, but not with the frequency of the utilization of Korean medicine. Conclusion: This study shows that expenditure of Korean medicine utilization is inequitable across socioeconomic groups, which implies that health insurance coverage of Korean medicine is not sufficient.

• 한국사회정책
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• 제25권1호
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• pp.99-123
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• 2018

본 연구는 노인장기요양보험 인정자 중에서 사망한 자의 임종 관련 의료비를 분석함으로써, 향후 임종 관련 의료비의 효율적 관리방안과 양질의 임종관리 제공방안을 모색하는데 목적이 있다. 본 연구에서 활용한 자료는 건강보험 및 노인장기요양보험 급여이용자료, 통계청 사망원인 통계자료이며, 2008년 7월 1일부터 2012년 12월 31일까지 장기요양 인정등급을 받고 같은 기간 내 사망한 자 총 271,474명을 최종 분석대상자로 하였다. 연구결과 대상자는 여성(60.6%), 75세 이상(74.7%)이 다수를 차지했고, 대부분이 2개 이상의 질환을 보유하고 있었으며, 특히 고혈압(44.3%), 치매(42.3%), 뇌졸중(29.9%) 등 비율이 높았다. 사망원인은 순환기계질환(29.8%), 암(15.3%), 선천성 기형, 변형 및 염색체 이상(14.7%) 등의 순이었고, 사망장소로는 의료기관(64.4%), 자택(22.0%), 사회복지시설(9.2%) 순이었다. 대상자의 등급인정 이후 사망까지 소요시간은 평균 516.2일이었고, 대상자 중 99.3%는 사망 전 1년간 건강보험 또는 장기요양보험 급여를 이용하였다. 특히, 1인당 평균 총 급여비는 사망한 달에 가까워질수록 규모가 커져, 사망 전 12개월 보다 사망 전 1개월에 3배 이상 높아졌다. 또한, 사망 전 1개월간 대상자의 31.8%는 연명치료 범위에 해당하는 치료를 받은 것으로 나타났다. 향후 장기요양 인정자의 임종 관련 불필요한 의료이용 감소 및 효율적 의료관리를 위해 건강보험과 장기요양보험 급여의 통합적 임종관리 전달체계 확립과 호스피스 등 임종케어의 적극적 도입을 제안한다.

• 보건행정학회지
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• 제22권2호
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• pp.207-224
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• 2012

This study estimates the total health expenditure of ambulatory dental care and explores the factors related to disbursements. The study used two waves of a 2008 Korea Health Panel (KHP) survey, of which each wave is composed of 7866 households and 24,659 persons. The KHP includes missing expanses of reimbursement data of the National Health Insurance (NHI), such as out-of-pocket, drugs, and private health insurance. The study estimates total monthly ambulatory dental expenditure and the sub-special categories of dental care. For influential factors analyses, the study exploits log-linear model with age, gender, education, job, equivalence income, the status of chronic diseases, means-tested benefit recipients, private insurance, and the composite deprivation index as independent variables. The total monthly outpatient health spending is estimated to be 102,468 won per household, and for dental, each household spends 31,115 won per month. Older age, means-test recipients, non-regular workers are more likely to spend less money on dental care, whereas private insurers, high income, and those who live in less deprived areas are more likely to spend more money for dental services. From the study we found that the KHP data are more suitable to estimate the total amount of health care markets, especially when the NHI coverage is low, such as for dental care in Korea.

• 보건행정학회지
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• 제19권3호
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• pp.125-141
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• 2009

The purpose of this study was to examine the role of provider practice patterns in the difference in health expenditure between the two types of patients: Health Insurance and Medical Aid type 1. The study used the outpatient claim data for all Medicaid and health insurance patients of hypertension who received medical services from 8,454 primary care physicians during the first half of 2006. The data were stratified by patient's gender and age for the two groups of patients who received care from the same physician. The dependent variables were the differences in medical expenditure per case, patient days per case and medical expenditure per patient day between Medicaid patients and health insurance patients. Empirical results showed that physician characteristics, such as physicians under age 50, greater proportion of pediatric Medicaid patients, lower proportion of new Medicaid patients and the greater number of comorbidity of Medicaid patients are associated with the greater difference between the two types of patients (i.e., greater expenditure of Medicaid patients relative to health insurance patients). This study shows that factors associated with provider practice patterns need to be taken into account in Medicaid policy.

• 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.

• 보건교육건강증진학회지
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• 제7권2호
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• pp.78-88
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• 1990

The subject of this study is to review the practical approaches of Home Care Services. Included is a brief overview of its nature, providers of Home Care Services, recent history of Home Care Services, and the impact of the national movement toward cost containment in health care. The data used in this study are obtained from the Elderly Program of the Medical Services and other data on the Home Care Services in Japan. With the growing elderly population in Japan, it is to be expected that the medical care expenditure for this sector will continue to increase. With the aim of keeping expenditure for medical care within reasonable bounds, it is essential that this increasing expenditure on the elderly be used effectively. With the Health and Medical Services Law for the Aged was enforced, therefore, remuneration for medical treatment of the elderly and what is known as the staff placement standard at hospital for the elderly were rationalized. In addition to rationalization from the point of view of medical care supply, it is necessary to guarantee the appropriate treatment within the community and at home for those elderly who are bedridden but not in need of hospital care. For this it is required that Home Care Services, such as health services like visiting guidance by public health nurse in hospital of Health Center. So that the elderly can feel secure in receiving treatment within the community and at home, allowances for guidance on leaving hospital and for intermittent nursing and guidance thereafter are to be newly introduced. Home care Services in one aspect of comprehensive health care, it is comprised of health services provided to individuals and families in their homes. Its purposes include promoting, maintaining and restoring health, specifically maximazing independent functioning and minimizing the disabling effects of illness, including terminal illness. Services appropriate to the needs of clients and their families are planned, coordinated, and delivered by providers organized for the delivery of home health care through the use of contractual arrangement, employed staff, or a combination of the two.

• 보건행정학회지
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• 제15권1호
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• pp.30-56
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• 2005

This paper used two threshold approaches to measure the equity in urban households' out-of-pocket payments for health care from 1997 to 2002, which developed by Wagstaff and van Doorslaer. One approach used catastrophic health expenditure, which means that payments exceed a 'pre-specified proportion' of total consumption expenditures or ability to pay and the other used impoverishment that they did not drive households into poverty. Indicies for 'catastrophic expenditure' captured intensity as well as its incidence and also the degree of which catastrophic payments occur disproportionately among poor households. Measure of poverty impact also captured both intensity and incidence. The methods applied with data on out-of-pocket payments from the Urban Household Expenditure Survey Incidence and intensity of catastrophic payments - both in terms of total household consumption as well as ability to pay - increased between 1997 and 2002, and that both incidence and intensity of 'catastrophic expenditure' became less concentrated among the poor, but more concentrated in 2001 than in 1997. The incidence and intensity of the poverty impact of out-of-pocket payments increased between 1997 and 2002. Health security system may not have provided financial protection against catastrophic health expenditure to low-income households, because of high user fee policy not considering income level. The policies alleviating catastrophic health payments among the poor need to be more developed, and two threshold approaches further evaluated on our policy context.

• 보건의료산업학회지
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• 제12권2호
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• pp.89-99
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• 2018

Objectives : To compare the degree of achievement of Universal Health Coverage (UHC) among 39 developing countries in Africa and to investigate the correlation between health care financing and the UHC index. Methods : For data, 14 UHC indexes were used in 2015 supplied by the World Health Organization (WHO). In addition, this study used a 10% of threshold point corresponding to the catastrophic health expenditures and a 25% of threshold points as a health care financing index. Results : It was found that there were significant difference among Least Low Developed Countries (LLDCs), Other Low Income Countries (Other LICs), Lower Middle Income Countiies (LMICs), Upper Middle Income Countires (UMICs) to compare the average value by nation on the UHC index. This study showed that the UHC index of LLDCs was lowest, but the average value was higher as it moved towards LMICs and UMICs. In addition, it was found that there was an average value difference among the groups like LLDCs, Other LICs, LMICs and UMICs. As a result of comparison, it was found that the spending of household health expenditure increased as LLDCs moved towards UMICs when the burden of household health expenditure was 25%. Conclusions : This study aimed to compare the UHC indexes of African nations and to investigate the correlation between the degree of spending of total expenditure on health and burden of household health expenditure and UHC, and its effect.

• International Journal of Contents
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• 제8권3호
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• pp.52-56
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• 2012

This study examines whether the infant mortality rate and life expectancy at birth are affected by health care expenditure in Korea. It can be provisionally concluded that the infant mortality rate tends to be affected by the health system itself in the long-run, whereas life expectancy at birth is immediately affected by health-related facilities such as the number of physicians and number of hospital beds in the short-run. Therefore, the health-related system should be well established to improve the infant mortality rate. On the contrary, physical capital such as life-prolonging medical technologies has to be accumulated to improve life expectancy at birth.