• 보건행정학회지
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• 제5권1호
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• pp.31-58
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• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• 보건행정학회지
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• 제9권4호
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• pp.120-139
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• 1999

The objectives of this study were to examine the utilization patterns of oriental medical care and to discover problems in its delivery. The data for this study were collected from a questionnaire survey mailed out from March 10 to April 9 1999 to 6.346 oriental medical clinic. The questionnaires were then distributed to two patients in each clinics. Of these questionnaires. 670 were completed and returned. The major statistical methods used for the analysis were the t-test. ANOVA, and x$^2$-test. The major findings are as follows: 1. Respondents reported visiting oriental doctors twice as often as they visited western doctors(All those completing the survey received the questionnaire at oriental medical clinics). 2. The number of reported visits to oriental physicians according to among gender, age, marital status, education, income and residence. Males, married respondents, the elderly and the residents of rural areas visited oriental physicians more frequently than females, singles, younger respondents and urbanites. Those people belonging to the middle income class and middle education level also more frequently visited oriental physicians. 3. There are several factors that restrict the utilization of oriental medical care, such as the limitation of the scientific diagnostic instrument use commonplace reliance upon western medical techniques, and the perception of high price for oriental medical care. It is very important to focus oriental medical care onto the fields of acupuncture, circulatory system disease, musculoskeletal system ailments, etc. to improve the utilization of oriental medical care. Other policies for the improvement of oriental medical care include the standardization of price, quality and quantity of oriental medicine.

• 보건행정학회지
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• 제27권2호
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• pp.128-138
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• 2017

Background: The purpose of this study is to analyze the effects of differential coinsurance policy on prescription drug coverage of outpatients by types of medical institutions. Methods: In this study, we used a sample cohort database of the National Health Insurance Service and frequency analysis and marginal logistic regression model using generalized estimating equation were used for statistical analysis. Results: The summary on the major research is followed. First, about 16% of patients who used only tertiary or general hospital due to 52 ambulatory care sensitive conditions before policy implementation moved to hospitals and clinics. However, about 57% of them still use tertiary or general hospital. Second, the factors influencing the utilization of hospitals and clinics after the implementation of the policy were gender, age, and income level. As a result, the policy is effective to reduce the medical use of outpatient mental patients in tertiary or general hospital, but the effect is not significant. Conclusion: Therefore, in order to achieve the purpose of the policy for establishing the health care delivery system, it is necessary to adjust the co-payment so as to feel the burden on the co-payment when the outpatient for 52 ambulatory care sensitive conditions is used at the tertiary or general hospital.

• 한국콘텐츠학회논문지
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• 제17권11호
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• pp.435-445
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• 2017

본 연구는 단순 의료이용의 차이를 확인하거나 제한적인 의료필요와 의료이용지표를 활용하여 의료이용의 형평성을 연구한 선행연구의 한계를 극복하기 위하여 수행되었다. 구체적으로 의료필요지표로 활동제한여부, 만성질환이환여부와 수, 주관적 건강상태를 활용하였고 의료이용지표로 외래와 입원, 응급이용횟수와 진료비를 활용하였다. 아울러 의료필요를 고려한 의료이용의 형평성을 분석하기 위하여 집중지수와 집중곡선, Le Grand계수를 활용하였다. 주요 분석결과, 첫째 단순한 의료이용 집중정도로 볼 때 저소득층의 의료이용량이 고소득층에 비해서 많은 것이다. 특히, 저소득층 입원이용이 외래나 응급이용에 비해서 크게 많았다. 둘째, 저소득층에게 의료필요가 집중된 것으로 나타났다. 즉, 저소득층의 건강상태가 좋지 않은 것이다. 셋째, 의료필요를 고려한 의료이용의 형평성을 확인하기 위하여 Le Grand계수를 산출하였다. 의료필요를 고려하더라도 고소득층의 의료이용량이 많았다. 즉, 단순한 양적인 의료이용은 저소득층의 이용이 많았지만, 의료필요를 고려한 의료이용횟수는 고소득층이 많은 것이다. 또한, 전체진료비는 활동제한여부와 만성질환수를 고려했을 때는 고소득층의 의료이용이 많았으며 주관적 건강상태와 만성질환이환여부를 고려하였을 때는 저소득층의 의료이용이 많았다. 따라서 대체로 저소득층이 건강상태에 비해 의료이용을 충분히 하지 못하는 것을 알 수 있었다. 한편, 저소득층의 주관적 건강상태와 만성질환이환여부 관련 의료필요에 비해 의료비지출이 많았는데 이는 저소득층이 스스로의 건강상태와 만성질환이환에 대한 인식을 소극적으로 함으로써 의료필요가 과소평가된 것이 원인으로 사료된다.

• 대한한의학회지
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• 제32권1호
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• pp.97-108
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• 2011

Objective: This study aimed to analyze the utilization of Oriental medical services and its determinants among the elderly. Method: Data from a Korean longitudinal study of aging was used. Regression analysis was used to find the determinants of the utilization of medical care. Results: People with low education and low income were more likely to use Oriental medical services. Determinants of using Oriental health service were sex, marriage, income, subjective health condition, activity restriction due to pain, and chronic disease. Among them, only subjective health condition and activity restriction due to pain were significant determinants of frequency of and expenditure on Oriental medical services. Especially, activity restriction due to pain was a significant factor in the use of Oriental medical services, but not in the use of Western medical services. Conclusion: Treatment related to pain was closely associated with Oriental medical services. These treatments need to be developed with scientific and clinical evidence.

• 보건행정학회지
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• 제23권4호
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• pp.387-396
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• 2013

Background: The purpose of this study was to analyze the association between areas of Korea Train Express (KTX) region and external medical service use in Korean society using spatial statistical model. Methods: The data which was used in this study was extracted from 2011 regional health care utilization statistics and health insurance key statistics from National Health Insurance Corporation. A total spatial units of 229 districts (si-gun-gu) were included in this study and spatial area was all parts of the country excepted Jeju, Ulleungdo island. We conducted Kruskal-Wallis test, correlation, Moran's I and hot-spot analysis. And after, ordinary linear regression, spatial lag, spatial error analysis was performed in order to find factors which were associated with external medical service use. The data was processed by SAS ver. 9.1 and Geoda095i (windows). Results: Moran's I of health insurance patients' external medical service use was 0.644. Also, population density, Seoul region, doctor factors positively associated with health insurance patients' external medical service. In contrast, average age, health care organization per 100 thousand were negatively associated with health insurance patients' external medical service use. Conclusion: The finding of this study suggested that health insurance patient's external medical service use correlated for seoul region in korea. The study results imply the need for more attention medical needs in the region (si-gun-gu unit) for health insurance patients of seoul region. It is important to adapt strategy to activation of primary health care as well as enhancing public health institution for prevent leakage of patients to other areas.

• 한국응급구조학회지
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• 제17권1호
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• pp.21-39
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• 2013

Purpose : The purpose of this study is to provide the basic data to improve pre-hospital phase emergency care for acute myocardial infarction (AMI) patients by analyzing AMI patients' clinical characteristics and emergency care situations. Methods : Data were collected through medical records of 385 AMI patients including ambulance records of 107 AMI patients transferred to the emergency medical center for three and a half years. Results : Regarding emergency care for AMI patients in pre-hospital phase, 47% of the care revealed moderate level or higher, and appropriateness of pre-hospital phase emergency care for cardiopulmonary complaints practiced by paramedics showed statistically significant improvement in recent years (p<.001). The time from onset of symptom to ballooning intervention by 119 emergency services was shorter than that in other cases. However, emergency care by paramedic was mainly basic life support. Conclusion : Since prognosis of AMI shows vast differences depending on prompt detection and medical intervention, cooperation between pre-hospital and in-hospital phase is highly required. 119 paramedics should be trained focusing on the accurate assessment and emergency care, and medical direction should be activated. In addition, regulation on 12-lead EKG, cardiac enzyme analysis, use of analgesics and thrombolytic agents should be legally implemented.

• 지역사회간호학회지
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• 제25권3호
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• pp.159-169
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• 2014

Purpose: The purpose of this study was to evaluate the effectiveness of case management for patients with hypertension on their health status and medical service utilization. Methods: This study was a secondary analysis of data collected for a larger study of chronic disease management in 2008 using the National Health Insurance Corporation database. A total of 12,944 patients who received case management for hypertension were included in this analysis. The subjects of case management were classified into subgroups, namely, over-use, under-use, and non-use groups according to the amount of medical service utilization. To compare the medical service utilization, a control group was selected randomly. The data were analyzed through descriptive statistics, McNemar test, and ANOVA. Results: All the subgroups displayed significant differences in blood pressure, self-management, social support, and their characteristics of medical service utilization. The total medical expense of the under-use and non-use groups increased after case management. However, there was no decrease in the medical expense of the over-use group. Conclusion: This finding suggests that there is a need to re-examine why patients overuse medical services and to supplement specific strategies for encouraging appropriate medical service utilization, and enhancing case management efforts for the over-use group.

• Journal of Preventive Medicine and Public Health
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• 제25권1호
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• pp.53-63
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• 1992

There are increasing interest and need for information on health care consumer with the significance of hospital marketing and strategic planning being increasingly emphasized. This study was conducted to investigate the criteria for selection of medical facilities according to the characteristics of health care consumer by the types of medical services on a sample of 1,500 population aged 20 years and above. Major findings are as follows ; 1. When considering the criteria for selection of medical facilities into two factors, namely, quality or convenience factors, convenience factor was the major contributor for outpatient and dental services whereas it was quality factor for inpatient services. 2. Females and those residing in large cities selected medical facilities based on convenience factor in the outpatient services. In the case of inpatient service, persons who considered their present health status to be good and whose ages were 50 years old and above choose medical facilities based on quality factor. 3. Persons who considered medical facilities to be profit-making tended to choose medical facilities based on convenience factor for outpatient services. There were no differences in the cases of inpatient and dental services. 4. There was no significant difference on the criteria for selection of medical facilities according to the decision maker for selection or trust on medical facilities. On the use of health service information, selection of medical facilities was based on quality factor for those who made more use of the information in the cases of outpatient and dental services. 5. Analysis using the logistic regression model on the criteria for the selection of medical facilities with the characteristics of health care consumer as independent variables was performed. The selection of medical facilities was significantly related with residential area, sex, and use of information on medical facilities for outpatient services and with age, average monthly income, and perception of health status for inpatient services. For dental services significant association with residential area and use of information on medical facilities was seen. The results of this study, despite some limitations, can be used as baseline data for marketing and strategic planning of hospital management.

• KDI Journal of Economic Policy
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• 제33권1호
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• pp.125-148
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• 2011

인터넷과 같은 정보기술의 눈부신 발전으로 인해 환자들의 보건의료정보에 대한 접근성이 매우 향상되었다. 이는 곧 환자들이 당면하고 있는 보건의료정보의 비대칭 문제, 즉 의료서비스 공급자에 비해 적은 양의 정보를 보유함으로 인해 의료서비스 소비에 있어 그 효율성이 침해될 수 있다는 기존의 주장이 갖고 있는 타당성에 한계가 있음을 지적할 수 있는 변화라고 할 수 있다. 따라서 이러한 변화를 감안해 볼 때, 환자들의 정보비대칭 문제에 있어 핵심적인 사항은 환자들이 획득한 많은 의료정보를 그들의 합리적인 의료서비스 소비를 위해 어떻게 활용하느냐 하는 것으로 정리할 수 있다. 이러한 맥락에서 의료서비스 공급자인 의사가 환자들과의 효과적인 의사교환을 통해 보건의료정보에 대한 환자들의 이해와 효율적인 활용을 도와주고자 노력하는 것은 환자의 의료서비스 소비의 효율성을 증진함에 있어 매우 중요한 역할을 담당할 것으로 생각할 수 있다. 이에 본 논문은 의사-환자 간 의료서비스 소비에 대한 이론모형 구축을 통해 우선 환자의 비효율적인 의료서비스 이용이 그들의 정보 문제, 즉 의료서비스의 치료효과에 대한 오해에서 비롯됨을 밝혔으며, 두 번째로 의사가 이러한 환자의 정보문제를 해결하기 위해 충분한 노력을 투입했을 때 환자의 의료서비스 소비에 있어 파레토 효율성이 증대됨을 보였다. 아울러 정책적 관점에서 의사들로 하여금 환자를 상대로 한 충분한 의사교환을 유도하기 위한 정책방안으로 의사의 지불보상체계가 잘 작동함을 보였다. 즉, 환자의 진료비에 대한 의사의 책임 부분을 증가시킴으로 인해 의사의 진료상의 노력이 충분히 증가함을 이론적으로 입증할 수 있었다.