• 한국산학기술학회논문지
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• 제16권11호
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• pp.7463-7473
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• 2015

본 연구는 장기요양 1등급 건강보험가입자를 대상으로 장기요양서비스 이용자와 미이용자의 의료비 지출 차이를 비교하고, 의료비 지출에 미치는 영향 요인을 규명해 보고자 시도하였다. 연구 대상은 건강보험가입자로 2009년 1월 1일부터 12월 31일까지 1등급 판정을 받은 21,213명 전수를 대상으로 국민건강보험공단의 장기요양급여, 건강보험급여 자료를 활용하였다. 연구결과 2007년부터 2009년의 연간 총 진료비 변화량의 경우 서비스 이용자에 비해 미이용자는 5,337천원 증가하였으며, 연간 요양병원 진료비 변화량은 5,449천원 증가하였다. 연간 총 입원일 변화량의 경우 서비스 이용자에 비해 미이용자는 87.31일 증가하였으며, 요양병원 입원일 변화량은 79.47일 증가한 것으로 나타났다. 이 같은 결과는 장기요양 서비스 미이용자의 의료이용, 특히 요양병원의 의료이용이 높게 나타남에 따라 미이용자에 대한 적정의료와 요양서비스 지원 정책을 통해 장기요양과 의료서비스의 효율적 연계가 필요로 된다.

• 대한간호학회지
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• 제42권7호
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• pp.928-935
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• 2012

Purpose: The current study was done to identify individual- and group-level factors associated with health care service utilization among Korean medical aid beneficiaries by applying multilevel modeling. Methods: Secondary data analysis was performed using data on health care service reimbursement and medical aid case management progress from 15,948 beneficiaries, and data from 229 regions were included in the analysis. Results: Results of multilevel analysis showed an estimated intraclass correlation coefficient (ICC) of 18.1%, indicating that the group level accounted for 18.1% of the total variance in health care service utilization, and that beneficiaries within the region are more likely to share common features with regard to health care service utilization. At the individual level, existence of disability and types of medical aid beneficiaries showed a significant association, while, at the group level, social deprivation index, and the number of beneficiaries and case managers within the region showed a significant association with health care service utilization. Conclusion: The significant influence of group level variables in health care service utilization found in this study indicate a need for group level approaches, such as policy change and/or promotion of community awareness.

• 보건행정학회지
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• 제10권3호
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• pp.1-18
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• 2000

This study was conducted to find medical care utilization pattern and to examine the affecting factors on medical facilities utilization using Andersen's medical care service behavioral model. Three hundreds and five public officials with detected disease through the health examination in 1998 were surveyed using self-administered questionnaire. And 230 data were available and analyzed. The results of this study were summarized as follows: Among variables of predisposing factors, knowledge for disease, confidence about periodic health examination program in health insurance, and the attitude toward medical utilization in the usual showed significant relations with the medical utilization. Other variables were not related with the medical utilization. Variables of enabling factors did not show significant relations with the medical utilization. Recognition of family members for detected disease had significant relations with the medical utilization. Among variables of need factors, absence caused by detected disease was significantly related with the medical utilization. The number of non-occupational diseases detected, but untreated people were 75(32.6%) of total subjects, mainly because detected diseases seemed insignificant to them. With multiple logistic regression analysis, the significant variables having an effect on the medical facilities utilization were 'knowledge for disease', 'attitude toward medical utilization in the usual', 'recognition of family members for detected disease' and 'experience of absence caused by detected disease'. On considerations of above findings, counselling for detected disease and its treatment, health education for individuals and program for family support promotion are needed for health management of public officials with diseases detected in health examination.

• Journal of Preventive Medicine and Public Health
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• 제21권2호
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• pp.419-430
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• 1988

This study was performed in a rural community, Kanghwa county which was introduced to a regional medical insurance pilot program in 1982. The purposes of this study were, firstly, to observe the changes in ambulatory care utilization in the three years 1982, 1983 and 1987 : secondly, to analyse factors which convert perceived medical care needs to effective medical care demand. During the three periods, a serial interview survey was performed to determine the changes in medical utilization before and after the regional medical insurance program implementation. The number of subjects was 3,356 persons in the year 1982, 3,705 in 1983 and 2,745 in 1987. The results of the study were as follows : 1. Total ambulatory care utilization rates per 100 persons during a 2-week period were 23.6 in the year 1982, 21.8 in 1983, and 29.3 in 1987; and physician visit rates were 6.1 in 1982, 11.7 in 1983, and 14.9 in 1987. Thus, compared to the total utilization rate there was a definite increase in physician visit, and during the study periods there was a decrease in drug store visits whereas an increase in hospital or clinic visits was noticed. 2. The rates of effective demand for medical care need were 70.7% in 1982, 70.5% in 1983 and 75.9% in 1987 : and the rates of patients who visited physicians were 20.2% in 1982, 42.8% in 1983 and 35.6% in 1987. Thus, physician visits increased sharply by introducing the medical insurance program, but after the latent medical care demands were fulfilled, there was a slight decrease in the physician visits. 3. The number of acute symptoms and the number of chronic symptoms were common determinants of total ambulatory care utilization and physician visits. Besides the medical care need factors, age in 1982, sex and accessibility in 1983, and accessibility in 1987 were statistically significant determinants of the total utilization ; sex and accessibility in 1983, and education in 1987 were also statistically significant determinants of the physician visit. 4. For persons with perceived acute symptoms during the 2-week periods, accessibility in total utilization and age in physician visits were common discriminating factors of ambulatory care utilization in the three years, and education and income were also statistically significant variables. For persons with perceived chronic symptoms, occupation and income were statistically significant discriminating variables commonly observed in total utilization and physician visits.

• 한국산학기술학회논문지
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• 제15권11호
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• pp.6746-6755
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• 2014

본 논문은 기초생활보장수급자를 대상으로 장기요양서비스 이용 여부가 의료 이용에 미치는 영향을 파악하기 위한 서술적 연구이다. 연구 대상은 장기요양 1등급 판정을 받은 기초생활보장수급자 5,834명을 대상으로 하였다. 기초생활보장수급자의 의료 이용에 미치는 영향을 다중회귀분석으로 분석한 결과 2007-2009년 총 진료비 변화량을 설명하는 $R^2$은 22.6%이었으며, 장기요양 서비스 이용자에 비해 미이용자는 8,297,329원 증가하였다(${\beta}=.29$, p< .001). 입원일 변화량의 $R^2$은 22.4%이었으며, 서비스 이용자에 비해 미이용자는 119.013일 증가하였다(${\beta}=.33$, p< .001). 총 진료비와 입원일 변화량에 영향을 미치는 요인은 장기요양서비스 이용 여부, 수발자 여부, 2009년 일상생활수행능력, 간호처치, 재활기능이 유의한 영향을 미치는 것으로 나타났다. 따라서 장기요양 서비스 미이용자의 의료 이용이 높게 나타남에 따라 미이용자에 대한 적정 의료와 요양서비스 이용을 지원할 수 있는 정책 마련이 필요로 된다.

• Journal of Preventive Medicine and Public Health
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• 제23권2호
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• pp.185-193
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• 1990

The purpose of this study is to observe the pattern of change in medical care utilization over time in early years of insurance coverage. The source of data is the benefit records file of a voluntary medical insurance society for covering the four-year period, from 1982 to 1985. The measure of medical care utilization used in this study is the age-sex standardized percentage of the enrollee who have visited a physician over total analytical population during a three-month period. For six cohorts by the year of enrollment ($1979{\sim}1984$), the relationship between the utilization and duration of insurance coverage was examined controlling for the calender year and season. In the analysis, logistic multiple regression and residual analysis were employed. It was observed that medical care utilization rapidly increased during the early stage of insurance coverage, and after then increased at a slower rate over time to become almost stable in about twenty months.

• 보건의료산업학회지
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• 제8권3호
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• pp.49-61
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• 2014

Due to the rapid population's aging, the life span's expansion and social & cultural characteristics, the standards of age classes in senescence are changed. Thus, this study aimed to identify the influential factors on health care utilization in the elderly by age class, and targeted 2,937 adults in their ages over 55 years old from the Korea Health Panel's 2009 Yearly Integrated Data. This study investigated the target health care utilization in the elderly in relation with the gender, the education level, the health-care insurance type, the income, the current job state, the chronic disease. In order to analyze the influential factors on health care utilization in the elderly, the multiple linear regression analysis was conducted to the data. As the results from this study, Concerning the influential factors on the health care utilization, the income, the subjective health state, the chronic disease and the regularly meals for the young-old influenced. Concerning the influential factors on the health care utilization, the subjective health state for the old. Concerning the influential factors on the health care utilization, the subjective health state, the income for the older-old influenced. Concerning the influential factors on the health care utilization, the education level, the spouse, the economic activity and the drinking oldest-old influenced. Therefore, it will need to provide systemic health-care & medical services, to develop health-care & medical programs and the health-care & medical policies and to execute them according to the age classes in senescence.

• Journal of Preventive Medicine and Public Health
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• 제24권3호
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• pp.265-278
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• 1991

This study was to examine the effects of insurance coverage on the utilization of public health institutions and to identify the factors associated with the utilization. The data were obtained from household interview surveys conducted twice in Hwachun Gun, Kangwon Do. The time period covered in the first survey was December $17{\sim}31$, 1987, before the implementation of regional medical insurance for the self-employed, and that of the second survey was January 28 $\sim$ Febuary 11, 1990, after its implementation. Major findings emerged from the analysis can be summarized as follows (1) Medical care utilization of rural people markedly increased after they were covered by medical insurance. The insurance coverage increased the utilization of public health institutions as well, and this increase was mainly attributable to the utilization by chronically ill patients. (2) Between 1987 and 1990, the proportion of the utilization of public health institutions over whole medical care utilization decreased. But the proportion increased for chronically ill patients covered by regional medical insurance during the same time span. (3) The results of logistic regression suggested that the rural self-employed utilized public health institutions at an increased rate after they were covered by medical insurance. It was also indicated that the increase resulted from the utilization by chronically ill patients. (4) The relative importance of public health institutions for rural medical care decreased after the implementation of regional medical insurance. But considering that the utilization of public health institutions by chronically ill patients increased after insurance coverage, attention should be directed to improving the capability of public health institutions to control chronic degenerative diseases.

• Journal of Preventive Medicine and Public Health
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• 제46권5호
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• pp.237-248
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• 2013

Objectives: The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea. Methods: We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners. Results: The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010. Conclusions: We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.

• 보건의료산업학회지
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• 제13권4호
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• pp.179-190
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• 2019

Objectives: This study aimed to investigate the mediating effects of health promotion behaviors on the correlation between self-perceived health and medical care utilization among older adults. Methods: This study used data from a. Data were analyzed with frequency analysis, descriptive statistics, Pearson's correlation coefficient, and hierarchical multiple regression. Mediation analysis was performed according to the Sobel test. Results: The self-perceived health and some health promotion behaviors in older adults had a statistically significant effect on medical care utilization. Only the nutritional management of health promotion behaviors had a mediating effect on the relation between the self-perceived health and medical care utilization of older adults. Conclusions: The nutritional management of older adults was confirmed as an important factor to health promotion and prevention. This study was meaningful in that it identified the political directions for establishing health care policy for the older adults.