• 대한예방한의학회지
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• 제24권2호
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• pp.31-41
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• 2020

Background : The introduction of policies expanding the coverage of uninsured Korean Medicine (KM) services have requires an understanding of the following components of the service : current financial expenses, degree of financial burden on the patient, and financial effect of the coverage expansion. Objectives : This study aims to determine the annual trend of outpatients' characteristics and the category of out-of-pocket spending in KM. Methods : This study uses data from the Korea Health Panel to analyze use of KM in the Korean population. Using the user characteristics and behavior drawn from the Korea Health Panel data, out-of-pocket spending trends of KM were analyzed by year. The diagnosis and prescription of out-of-pocket spending were also analyzed. Results : The proportion of patients receiving uninsured medical treatment and the number of uninsured medical treatment in outpatient clinics have increased. However, the average out-of-pocket spending per person and out-of-pocket spending per visit are consistent or have decreased. Meaningful trends are the increase of R00-R99 (unclassified symptoms) and the decrease of K00-K93 (digestive system disease) and J00-J99 (respiratory system disease). Conclusions : Expansion of KM medical service and insurance is influenced by uninsured medical treatment of KM. Hence, research to increase medical treatment categories for out-of-pocket spending or explore diseases where KM diagnosis has been proven effective should be further developed.

• 문화기술의 융합
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• 제3권2호
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• pp.21-30
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• 2017

본 연구는 뇌혈관질환자의 년간 총직접비용에 대하여 조사하였다. 본 연구를 위하여 2012년 한국의료패널 조사자 중 2012년 한 해 동안 뇌혈관질환으로 응급, 입원, 외래서비스를 1건 이상 이용하였다고 응답한 265명을 대상으로 하였다. 뇌혈관질환자 일반사항은 2012년에 한국의료패널 응답자 중 뇌혈관질환으로 응급, 입원, 외래서비스를 이용한 응답자의 비율이다. 연구방법은 응급, 입원, 외래서비스의 평균의료비와 가중평균을 적용하여 직접비용을 산출한 후 년간 총직접비용을 산출하였다. 연구결과는 뇌혈관질환자가 1인당 연 평균 본인부담 의료비 지출액은 약 561,934원이고, 남성은 669,557원, 여성은 448,696원이다. 건강보험 가입자의 경우 뇌혈관질환으로 인한 1인당 본인부담액은 평균 634,459원이고 의료급여 수급자는 160,236원이었다. 뇌혈관질환자가 265명의 연 평균 총직접비용은 약 162,165,690이고, 남성은 193,223,955원, 여성은 129,486,685이다. 건강보험가입자의 경우 뇌혈관질환으로 인한 1인당 총직접비용은 평균 183,095,125원이고 의료급여 수급자는 46,241,705원이었다. 가구소득별로 보면, 가구 소득 3분위에 속한 환자는 672,268원으로 가장 높게 나타났으며, 5분위에 속한 환자는 108,970,650원 으로 뇌혈관질환자의 총직접비용이 가장 낮았다.

• International Journal of Advanced Culture Technology
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• 제9권1호
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• pp.16-21
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• 2021

As the average age of national veterans has increased from 69 years old(2011) to 71 years old(since 2015) over the past five years, the overall medical service cost of veterans has increased by about 20%. The main cause of this phenomenon is 'ultra-aging', which accounts for 67% of veterans, while the proportion of health insurance patients aged 70 or older is 9%. Therefore, it is judged that the analysis of the trend of use of medical services at veterans hospitals in each region that is in charge of severe medical services of national veterans can serve as an opportunity to seek countermeasures for the severe medical system of national veterans. First of all, based on the details of major medical expenses (hospitalization, outpatient, pharmaceutical expenses) by region for the last 10 years(2010-2019), data significance was performed through a chi-square test, and the Central Veterans Hospital and Non-Central Veterans Hospital using EXCEL. 'Expected frequency' was calculated by year. By applying the CHITEST(observation frequency, expected frequency) function again, the p-value(p<0.05) was calculated, and the profit bias of each region's veterans hospital could be determined. The specific research method is for the last 10 years(2010-2019) for state-sponsored patients_outpatient treatment income, state-sponsored patients_hospitalization income, exempt patients_outpatients at the Central Veterans Hospital, Busan Veterans Hospital, Gwangju Veterans Hospital, Daegu Veterans Hospital, and Daejeon Veterans Hospital. A one-way analysis of variance was conducted to verify the significance of the difference between group averages on the status of 5 medical revenues of veterans hospitals in each of the 5 regions, including medical treatment income, reduced patients_hospitalization income, and reduced patients_medicine expenses. It was found to be significant(p<0.05) at all levels, including region and type. Finally, the bias in the profit structure of regional veterans hospitals was the highest in 2017(p=0.0004) and the lowest in 2013(p=0.0349). In addition, in the profit structure of the Veterans Hospital, the year in which the'regional' variable worked the most was 2019, and the year with the least affected was 2010. The order of the former is Jungang(=31,674,713), Busan(=12,314,614), Gwangju(=11,957,038), Daegu(=10,168,015), and Daejeon(=6,991,034), and the order of the latter is Jungang(=57,868,791), and Busan(=19,183,194). Gwangju(=17,904,712), Daegu(=15,656,034), and Daejeon(=14,377,395). In conclusion, the profit bias of veterans hospitals repeatedly raced the lowest(p=0.01986) and highest(p=0.03499) for the past five years(2010-2014) year by year, with the 'regional' variable being the most in the veterans hospital's profit structure It was identified as a major influence factor. On the other hand, for the last 5 years (2015-2019), the influence factors of the'regional' variable every year were in 2015(p=0.02015), 2016(p=0.01741), 2017(p=0.00045), and 2018(p=0.00394). in 2019(p=0.00227), a significant difference was confirmed at a very low level.

• 한국임상약학회지
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• 제13권1호
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• pp.5-12
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• 2003

Influenza virus is a major cause of respiratory infection in the epidemic season. Especially, the elderly with underlying health problems are at increased risk for complications of influenza. The objective of this study was to investigate that influenza vaccination can reduce the hospital admission rate related to the respiratory diseases. This study was a retrospective study of two age groups, who are the healthy children aged 6 months to 9 years (n=237) and the adults aged over 20 years with respiratory disease (n=327). The vaccinated groups were compared to the controls that were matched in sex and age. The children were vaccinated in winter season of 1995-96 and the adults were vaccinated in 1996-97. The efficacy of influenza vaccine was evaluated with the number of outpatient visits in children group, the admission rate and the mean admission days in both children and adult group. As results, there were not significant differences between the vaccinated and the control group of children. In the elderly over 61 years, however, the influenza vaccination can reduce the admission rate $(8.9\%\;vs.\;25.6\%,\;p<0.05)$ and the mean admission days (1.3 vs. 3.8 days, p<0.05) compared to the control. In conclusion, influenza vaccination can effectively reduce the events related to respiratory infection in the elderly than the children. The elderly should be recommended for influenza vaccination.

• 한국병원경영학회지
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• 제20권2호
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• pp.39-56
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• 2015

This study calculated the potential customer satisfaction improvement index (PCSI index) and average satisfaction coefficient (ASC) by categorizing quality attributes based on the Kano analysis for medical service quality. This study seeks to suggest ways to increase the efficiency of medical business management by determining priority to improve after applying the indexes to IPA. To achieve such purposes, this study conducted a survey on 150 outpatients of a premium general hospital and 200 workers in four different sections in the same hospital. As a result of the analysis, there was a difference in the awareness of service quality to improve patient satisfaction between the outpatients and workers. Therefore, the focus should be put on those items deemed important by the patients rather than those that the workers called attention to in order to effectively improve service quality. Along with efforts to alleviate or eliminate inconveniences experienced by patients, it is necessary to provide training programs for workers on customer reception and management such as delivering services with a kind manner and giving explanations in a proper and professional manner and exhibiting the right attitude.

• 한국콘텐츠학회논문지
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• 제21권3호
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• pp.314-323
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• 2021

이 연구의 목적은 국내거주 건강보험 가입 외국인의 국적 및 자격유형별 의료이용현황을 분석하는 것이다. 2018년 건강보험 가입 외국인 중 보험료 결측인원을 제외한 1,058,886명을 분석대상으로 선정하였다. 분석결과, 의료를 한 번이라도 이용한 사람은 822,267명으로, 의료이용률은 약 78%임을 확인할 수 있었다. 이용 인원 수가 많은 국가는 중국, 베트남, 미국 순이었다. 1인당 총 진료비는 입원과 외래에 관계없이 미국이 가장 높았다. 자격유형별로는 지역가입자의 1인당 진료건수, 외래진료비, 입원진료비가 가장 높았으며, 1인당 입원 일수는 직장피부양자가 가장 높았다. 마지막으로 중국인과 지역가입자는 다른 그룹에 비해 납부한 보험료 대비 많은 혜택을 누리고 있음을 확인할 수 있었다. 이 연구는 외국인 건강보험 당연적용제도 시행 이전 자료를 사용함으로 인해 현재 상황을 정확히 보여주고 있지 못하지만, 추후 변화에 대한 비교분석을 위한 기초자료를 만들었다는 점에 그 의의가 있다.

• 한국노년학
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• 제31권4호
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• pp.1247-1263
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• 2011

현재 우리나라가 경험하고 있는 급속한 인구고령화 현상은 노년층 사이의 만성질환 및 의료서비스 이용의 증가로 연결된다. 의료서비스 이용은 궁극적으로 서비스 소비자들의 삶의 만족도에 영향을 준다. 하지만 노년기의 의료서비스 이용이 삶의 만족도에 미치는 영향이나 만성질환의 유무에 따라서 의료서비스 이용이 삶의 만족도에 미치는 영향이 상이한지에 대해서는 알려진 바가 많지 않다. 본 연구는 노년기 의료서비스 이용이 삶의 만족도에 미치는 영향에 대해서 살펴보고, 의료서비스 이용이 삶의 만족도에 미치는 영향이 만성질환 유무에 따라서 상이한지를 살펴보고자 한다. 이러한 목적을 달성하기 위해서 한국복지패널 3차년도 조사에 참가한 65세 이상 노인 3,944명을 대상으로 구조방정식(Structural Equation Modeling)과 다중집단 구조방정식분석(Multi-Group SEM)을 하였다. 관련변수들을 통제한 상태에서 주요결과는 다음과 같다. 노인 전체적으로는 외래서비스 이용이 많을수록 삶의 만족도 수준은 낮고, 입원일수가 많을수록 삶의 만족도 수준이 높은 반면, 건강검진 서비스 이용수준은 만족도와 유의한 관련성이 없었다. 하지만 의료서비스가 만족도에 미치는 영향은 만성질환의 유무에 따라서 상이하였다. 만성질환이 있는 사람들은 입원서비스 이용 수준이 삶의 만족도에 영향을 주지 않는 반면, 없는 사람들은 입원일수가 많을수록 삶의 만족도가 높았다. 질병이 있는 사람들은 건강 검진서비스 수준이 삶의 만족도에 영향을 미치지 않는 반면, 질병이 없는 사람들은 건강검진 서비스를 많이 받은 사람들의 만족도 수준이 낮았다. 외래서비스 이용이 만족도에 미치는 영향은 질명유무에 따라서 차이가 없었다. 이러한 결과는 노년기 의료서비스 이용이 삶의 만족도에 영향을 준다는 것과 의료서비스 이용이 만족도에 주는 영향이 만성질환이 있는 노인들과 없는 노인들 사이에 차이가 있을 수 있다는 점을 보여준다. 연구 결과를 토대로 이론적 실천적 함의에 대해서 논의하고 향후 연구의 방향에 대해서 제안하였다.

• 보건행정학회지
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• 제30권4호
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• pp.460-466
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• 2020

Background: The purpose of this study is to analyze whether there is a change in patterns of medical use among those likely to be converted their health insurance qualifications when the family support rule is alleviated. There is no empirical analysis that converting health insurance qualification will affect the increase in medical use. Methods: For analysis, data were extracted from the national health insurance eligibility and medical care database. To identify analysis targets similar to that of medical aids' characteristics among health insurance coverage, we compared income, property level, and medical use patterns through basic statistical analysis and used a difference-in-difference (DID) analysis to estimate the net effect of changes in medical use following the change of qualifications. Results: The main results are as follows. The results show that those who are under the 5% income group (1st income group) of health insurance coverage are the most similar to the medical aids group. DID analysis shows that changes in the medical use of people who maintain their national insurance qualification and who are not. As a results, the number of hospitalized days of converting group was reduced by 3.5 days while outpatient days were increased by 1.8 days. Conclusion: As a result, there was not much difference in the patterns of medical use for the under 5% income group who are likely to be eligible for expanded medical aids when the family support rule is alleviated. In addition, more than 30% of them are in arrears with their health insurance premiums, causing inconvenience in using medical services. These findings suggest the need of abolishing the criteria obligated to support family, and great efforts should be made to contribute to non-paid poor and remove their medical blind spot.

• 한국병원경영학회지
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• 제12권3호
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• pp.1-19
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• 2007

This study focused on finding the variation of medical service utilization and medical payments of the patients died by three, cancers, stomach, breast, and colon cancer. 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 slays, 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. The data of the patients died by cerebrovascular diseases and cancer in 2004 were selected. To select the dead by cerebrovascular diseases and cancer in 2004, were matched the 2004 reimbursement data of all medical institutions to the data of funeral fee payment by the National Health Insurance Corporation from January 2004 to May 2005 for the death in 2004. The results of the analysis were as follow. The variation of medical service utilization of the dead by cancers were not small in Korea. The current study found that the variation of medical care utilization was influenced by the factors of suppliers, such as types and locations of medical institutions and the factors of users, 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. The results of the study suggested that tile factors of suppliers and utilizers should he reviewed to reduce the under use and over use expressed by variations of medical service utilization. The processes of care, effective communication and management system should be investigated for the equity of medical service utilization. Additionally, prospective payment could he recommended to reduce the high variation of medical service Use. To find the variation caused by under use and over use, further study need to control the severity of diseases, socio-economic status of the users and the system factors.

• KDI Journal of Economic Policy
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• 제30권2호
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• pp.99-128
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• 2008

민간보험은 공적보험과 보완적인 관계를 형성함에도 불구하고 우리나라의 민간보험은 소득계층에 따른 접근성 차이로 인한 사회적 불평등, 도덕적 해이로 인한 공적보험 재정악화 등의 우려를 낳고 있다. 그러나 이에 관한 실증적 분석은 그간 이루어지지 못하여 정책적인 방향을 정립하는 데 장애가 되어 왔다. 본 연구는 건강보험공단, 심사평가원, 민간보험사, 행정자치부 주민등록세대정보 등의 관련 정보를 종합하여 이에 대한 실증분석을 시도했다. 그 결과, 우리나라의 민간보험 가입률은 전 국민의 64%에 달하고 있으며, 고소득층과 저소득층 간에 민간보험 가입률의 차이가 나타나지 않았다. 이는 공적보험의 보장성이 미흡한 상황에서 저소득층 역시 갑작스런 의료지출에 대비하고 있으며, 민간보험이 의료접근성의 계층화를 초래하지 않고 있다는 것을 시사한다. 또한 민간보험 가입자는 평균적으로 미가입자에 비해 의료이용량이 높지 않았으며, Two-Part Model을 통해 다양한 변수를 통제했을 경우에도 동일한 결과가 나타났다. 연령대에 따른 차이로 미루어 이러한 결과는 노동시장과 연관된 한시적인 성격일 것으로 추측되나, 현재로서는 민간보험 가입에 따른 도덕적 해이가 강하게 나타나고 있다는 근거는 발견되지 않았다.