• 디지털융복합연구
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• 제13권10호
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• pp.425-436
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• 2015

본 연구는 우리나라의 고혈압 의료비의 지역별 변이와 지역의 사회학적, 의료공급, 건강행태 등의 변이 요인을 규명함으로써 이를 기반으로 지역별 고혈압 관리 사업 방안 마련에 기초자료를 제시하는 것이다. 이를 위해 전국 시 군 구 247개 지역을 대상으로, 2012년 지역별 의료이용 통계자료(국민건강보험공단), 지역사회건강조사(질병관리본부) 및 국토해양부 자료를 이용 분석하였다. 연구결과 전국 247개 시 군 구의 고혈압 건강보험진료비는 평균 6만2천원이었고 변동계수는 30.0으로 지역 간 높은 고혈압 의료비 변이를 보였다. 주요 변이 요인으로는 인구밀도, 유배우자율, 평균가구원수입, 인구십만명당병원수, 관외의료비비율, 월간음주율, 중증도이상신체활동실천율, 평생의사진단율 등으로 나타났다. 의사결정나무를 이용한 분석 결과 평생의사진단율, 평균가구원수입, 유배우자율, 인구십만명당병원수, 비만율, 월간음주율에서 유의한 차이가 있었다. 본 연구의 결과 고혈압 의료비의 지역 간 변이요인으로는 의료공급이나 인구사회학적 특성뿐만 아니라 건강행태에 있음을 확인하였고 이는 고혈압의료비 절감을 위한 지역보건사업 정책 결정에 참고가 될 수 있을 것이다.

• Industrial Engineering and Management Systems
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• 제13권4호
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• pp.449-453
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• 2014

Chronic diseases including hypertension and its complications are major sources causing the national medical expenditures to increase. We aim to predict the risk of hypertension complications for hypertension patients, using the sample national healthcare database established by Korean National Health Insurance Corporation. We apply classification techniques, such as logistic regression, linear discriminant analysis, and classification and regression tree to predict the hypertension complication onset event for each patient. The performance of these three methods is compared in terms of accuracy, sensitivity and specificity. The result shows that these methods seem to perform similarly although the logistic regression performs marginally better than the others.

• 한국직업건강간호학회지
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• 제21권3호
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• pp.209-220
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• 2012

Purpose: This study examined the influencing factors for metabolic syndrome and the annual medical expenditures of metabolic syndrome among public officials. Methods: The National Health Insurance data in 2009 were collected for 364,932 public officials and the heath examination results and annual medical expenditures were analyzed using PASW 18.0 program. Results: The prevalence of metabolic syndrome is 17.6%, and it was higher in male officials than that of females in all age groups. In men, the influencing factors for metabolic syndrome were: age, family history of stroke, cardiovascular disease, hypertension, and diabetes mellitus, smoking, alcohol consumption, exercise, and obesity. However, in women, health-related behaviors such as smoking, alcohol consumption and exercise did not affect metabolic syndrome. People who had metabolic syndrome showed significantly higher medical expenditures than those without metabolic syndrome. The odds ratios of having the highest quartile in medical expenditures were 1.372 (95% CI 1.252~1.504, p<.001) in women with metabolic syndrome and 1.213 (95% CI: 1.184~1.243, p<.001) in men. Conclusion: The results implied that health-related behaviors were associated with metabolic syndrome, and resulted in higher medical expenditures. In order not only to decrease the risk of metabolic syndrome but also reduce medical expenditures, nurses should plan health promotion strategies to educate public officials about healthy life strategies.

• Journal of Preventive Medicine and Public Health
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• 제55권1호
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• pp.60-67
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• 2022

Objectives: This study investigated the determinants of undiagnosed hypertension among Indonesian adults. Methods: This study involved an analysis of secondary data from the 2014 Indonesia Family Life Survey (IFLS) on 5914 Indonesian adults (≥40 years). The determinant variables examined in this cross-sectional study were education level, monthly per capita expenditures (PCE), whether the participant experienced headaches in the morning, and other general health variables. The outcome variable was undiagnosed hypertension, which was defined as participants with hypertension who had not received a hypertension diagnosis from a health professional and had never been prescribed medication for treating hypertension. The data were analyzed using logistic regression. Results: A total of 3322 participants (56.2%) were found to have undiagnosed hypertension. The odds ratios (ORs) and 95% confidence intervals (CIs) of undiagnosed hypertension were significantly higher among those who completed primary school or lower (OR, 1.60; 95% CI, 1.29 to 1.98), had low monthly PCE (OR, 1.28; 95% CI, 1.13 to 1.43), did not report experiencing headaches in the morning (OR, 1.97; 95% CI, 1.76 to 2.21), and reported a general health status of healthy (OR, 2.05; 95% CI, 1.82 to 2.30) than those who had a higher education level, had high monthly PCE, experienced headaches in the morning, and were unhealthy. Conclusions: Education level, monthly PCE, the experience of headaches in the morning, and general health status were associated with undiagnosed hypertension. The monitoring system for detecting undiagnosed hypertension cases must be strengthened. Health promotion is also necessary to reduce the prevalence of undiagnosed hypertension.

• 간호행정학회지
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• 제16권3호
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• pp.295-305
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• 2010

Purpose: This study was conducted to evaluate the economic efficiency of a community-based nursing care center to help policy makers determine whether or not to invest in similar facilities. Methods: The subjects were 101 elderly people over 65 years who participated in a health management program from February 1 to July 31, 2007. Direct cost was estimated with center operations cost, medical cost for out-patients and pharmacy cost. Indirect cost was measured by transportation cost. Direct benefit was calculated by saved medical cost for out-patients, saved pharmacy cost, saved transportation cost, and reducing hospital charges. Indirect benefit was estimated with prevention of severe complications. Economic efficiency was evaluated by cost-benefit ratio and net benefit. Results: Operating a community-based nursing care center was found to be cost-effective. Specifically, the cost of operating the center evaluated here was estimated at 135 million won while the benefit was estimated at 187 million won. Benefit-cost ratio was 1.38. Conclusion: The Community-based nursing care center that was described here could be a useful health care delivery system for reducing medical expenditures.

• Journal of Preventive Medicine and Public Health
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• 제53권6호
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• pp.455-464
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• 2020

Objectives: The distribution of hospitals in Korea is unbalanced in terms of accessibility. Many local public health centers (PHCs) exempt out-of-pocket payments (OOPs) based on local government laws to increase coverage. However, this varies across administrative regions, as many make this exemption for the elderly, while others do not. This study aimed to evaluate the effects of the OOP exemption at local PHCs among elderly individuals. Methods: This study used online data on Korean national law to gather information on individual local governments' regulations regarding OOP exemptions. Individual-level data were gathered from the 2018 Community Health Survey and regional-level data from public online sources. Results: The study analyzed 132 regions and 44 918 elderly people. A statistical analysis of rate differences and 2-level multiple logistic regression were carried out. The rate difference according to whether elderly individuals resided in areas with the OOP exemption was 1.97%p (95% confidence interval [CI], 1.07 to 2.88) for PHC utilization, 1.37%p (95% CI, 0.67 to 2.08) for hypertension treatment, and 2.19%p (95% CI, 0.63 to 3.74) for diabetes treatment. The regression analysis showed that OOP exemption had an effect on hypertension treatment, with a fixed-effect odds ratio of 1.25 (95% CI, 1.05 to 1.48). Conclusions: The OOP exemption at PHCs can affect medical utilization in Korea, especially for hypertension treatment. The OOP exemption should be expanded to improve healthcare utilization in Korea.

• 약학회지
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• 제57권5호
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• pp.369-375
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• 2013

Objective: Using the Korean Health Panel data (KHP) of 2008 and 2009, this paper analyzed the effect of antihypertension medication adherence on the changes in medical service utilization and medical expenditure in the next year. Method: Through a face-to-face interview survey, KHP has provided an extensive data on demographic characteristics, medical utilizations behavior, medical expenditure and health behaviors of the targeted households and their members since 2008. KHP is recognized as highly accurate regarding medical expenditure in that it makes the target households to record 'Health diary' whenever they use healthcare service, which could minimize their cognitive bias or memory distortion. The 2010 KHP data was based on the interview from 6,432 households and 19,697 household members. Two part model was used to explore the effects of medication adherence on medical use (logistic regression analysis) and medical expenditures (OLS). Result: Our study result demonstrated that the 74.7% of the patients who strictly adhere to their medication in both years, in 2008 and in 2009, were likely to use inpatient service in 2010. This shows the noncompliant patients were in fact use emergency service less than the compliant patients. Conclusion: Based on our analysis, this paper concludes that the high medication adherence of hypertensive patients could contribute to reduce the emergency service use. Therefore it is highly recommendable for the Korean government and the insurer, NHIS, to actively invest in developing education and promotion program to improve medication adherence among hypertensive patients.

• Journal of Preventive Medicine and Public Health
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• 제30권2호
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• pp.437-461
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• 1997

이 연구는 의료보험관리공단의 공 교 의료보험자료를 이용하여 1989년부터 1993년까지의 5년간의 60세이상의 노인의 의료이용과 진료비의 변화를 연령별, 성별, 의료 보험료 수준별 코호트를 구성하여 상병당으로 분석함으로써 좀 더 정확한 변화의 양상을 파악하고 예측을 하는데 연구의 목적이 있다. 연령별 연도별 입원 수진율은 연도별 입원수진율은 70-74세 군이 89년과 93년에 각각 1,000명당 117.3과 141.1로 가장 높았으며, 매년 증가하는 추세이다. 연령 코호트의 연도별 상병건수는 전체적으로는 5년 동안에 40.5%증가하였다. 성별 코호트의 연도별 상병건수는 남자 상병건수보다 여자가 많이 증가하였으며, 남자와 여자의 연평균 증가율은 각각 9.1%와 10.2%였다. 연령 코호트의 상병당 연도별 입원진료비의 변화는 전체적으로 보았을 때 5년간 총 진료비는 15.4%증가 하였다. 이 중 진료행위료의 증가가 21.5%로 가장 큰 폭으로 증가하였다. 의료 보험료 수준별 코호트의 상병당 입원진료비 변화는 보험료 수준이 낮은 군보다 높은 군에서 진료비가 높았으며, 보험료 수준별 코호트의 연도의 경과에 따라서 각종 진료비가 증가하였다. 재원기간은 0.08% 증가하여 거의 변화가 없었으며, 1991년을 기점으로 감소하는 경향이었다. 10대 다빈도 상병 중에서 가장 흔한 질병은 백내장이었다. 1993년의 10대 다빈도상병 중 1989년에 비하여 비율이 증가한 상병은 백내장, 뇌동맥 폐색이었으며, 감소한 질병은 폐결핵과 본태성 고혈압이었다. 전체 상병에서 10대 상병이 차지하는 비율은 30-35%였으며, 연령군별로는 차이가 없었다. 연령 코호트의 이용의료기관별 평균진료비 및 재원 기간은 전체적으로는 병원급 의료기관에서의 진료비 증가율이 가장 높았으며, 재원기간은 의료기관 종별에 관계없이 감소하였으며, 병원이 4.9% 감소하여 감소폭이 가장 켰다. 총 상병건수에서 고액진료건수가 차지하는 비율은 67.6% 증가하였고, 암환자건수는 8.9% 증가하였으며, 장기입원환자가 차지하는 비율은 오히려 1.2% 감소하였다. 총 진료비 규모는 62.2% 증가하였으며, 고액상병진료비가 차지하는 비율은 5년간 129.9% 증가하였고, 암환자 진료비는 68.5%, 장기입원환자의 진료비는 59.4% 증가하였다. 상병당 입원진료비 및 재원기간을 1989년 수가로 환산하여 변화 추이를 보면, 상병당 총 진료비는 매우 완만한 증가를 보이고, 약제비는 오히려 약간 감소하는 경향이었고, 진료행위료는 지속적으로 상승하는 추세였다. 재원기간은 완만하게 감소하는 양상을 보였다. 연령구간별로 구분하여 분석한 결과 진료비와 재원기간과는 연령에 관계없이 비슷한 상관계수를 보였으나, 의료보험료 수준과 연령구간별 진료비는 상관계수는 매우 작았으며, 연령군별로 큰 차이는 없었다. 시계열 분석 결과 향후 약제비는 매우 완만한 감소 추세를 보일 것이고, 진료행위료와 총 진료비는 지속적으로 증가할 것으로 예측되었으며, 재원기간은 13.0일로 변화가 없을 것으로 예측되었다. 이 연구에서는 진료행위료의 증가가 총 진료비의 상승을 주도하고 있는 것으로 생각된다. 이는 첨단 의료기기나 신기술의 도입에 의한 것으로 의료기관들의 서비스 다각화 전략과도 관련 있는 것으로 생각된다. 또한 의료이용량 즉 입원상병건수의 증가가 진료비 상승에 영향을 많이 미치는 것으로 판단되며 전체 인구 집단의 의료비 상승요인과는 다른 양상을 보일 수 있으므로 노인 인구에 대한 의료비 절감 대책은 다른 연령층과 구별하여 적용할 필요성이 있다고 볼 수 있다. 향후 노인 연령 군별 질병양상의 변화와 서비스량 및 변화에 대한 연구를 개인특성 자료나 의료기관의 특성 등과 연계하여 포괄적인 연구를 수행함으로써 노인입원 특성과 향후 노인의료 이용량과 진료비의 추이를 판단하고 이를 토대로 노인의료문제의 해결을 위한 방안을 마련할 수 있으리라 생각된다.

• 대한지역사회영양학회지
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• 제17권3호
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• pp.341-352
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• 2012

It is well established that excessive sodium intake is related to a higher incidence of chronic diseases such as hypertension, stroke, coronary heart disease, cardiovascular disease and gastric cancer. Although the upper limit of the current sodium intake guideline by WHO is set at 2,000 mg/day for adults, sodium intake of Koreans is well over 4,700 mg/capita/day implying an urgent need to develop and implement sodium intake reduction policy at the national level. This study investigated the cost-effectiveness of the sodium intake reduction policy, for the first time, in Korea. Analyses were performed using most recent and representative data on national health insurance statistics, healthcare utilization, employment information, disease morbidity/mortality, etc. The socioeconomic benefits of the policy, resulting from reduced morbidity of those relevant diseases, included lower medical expenditures, transportation costs, caregiver cost for inpatients and income losses. The socioeconomic benefits from diminished mortality included reductions in earning losses and welfare losses caused by early deaths. It is estimated that the amount of total benefits of reducing sodium intake from 4.7 g to 3.0 g is 12.6 trillion Korean Won; and the size of its cost is 149 billion Won. Assuming that the effect of sodium intake reduction would become gradually evident over a 5-year period, the implied rate of average return to the sodium reduction policy is 7,790% for the following 25 years, suggesting a very high cost-effectiveness. Accordingly, development and implementation of a mid-to-long term plan for a consistent sodium intake reduction policy is extremely beneficial and well warranted.