• 보건행정학회지
• /
• 제34권1호
• /
• pp.48-58
• /
• 2024

연구배경: 이 연구는 충청남도 지역 및 환자의 특성과 관외 의료기관 이용과의 연관성을 분석한 연구이다. 충청남도 지역에 거주하는 입원 및 외래 환자들을 통해 도내 진료권을 분석하고, 수도권 및 대전권 의료기관에 대한 관외 의료이용 양상을 파악하여 도내 의료전달체계 개선 및 건강보험 재정 안정 도모를 위한 충청남도 의료정책 사업의 근거적 자료 제공을 목적으로 한다. 방법: 이 연구는 건강보험 코호트 DB 2.0 2016-2019년 자료를 활용하였다. 수집된 원시 자료 중 환자의 거주지가 충청남도 지역이면서, 이용한 요양기관이 상급종합, 종합병원, 병원, 의원인 환자로 한정하였고, 최종적으로 2,570,439건(입원=43,309, 외래=2,527,130)의 자료를 추출하였다. 먼저, 분석대상자의 일반적 특성을 파악하기 위해 각 변수별로 기술통계를 실시하였고, 충청남도 지역 및 환자의 특성과 관외 의료기관 이용과의 연관성을 파악하기 위해 다변량 로지스틱 회귀분석 및 다항 로지스틱 회귀분석을 실시하였다. 또한 관외 의료기관 이용에 따른 입원 및 외래 환자의 진료 1건당 의료비 차이를 파악하기 위해 심사결정 후 건강보험 총요양급여비용을 자연로그값으로 변환하여 분석하였다. 결과: 분석결과, 충청남도 지역 거주 환자들은 충남권, 대전권, 수도권 순으로 의료기관을 많이 이용하였고, 입원 및 외래 환자 모두 천안, 아산 거주 환자들에 비해 모든 권역에서 관외 의료기관을 더 많이 이용하였다. 특히 공주, 부여, 천안(odds ratio [OR], 72.931) 및 계룡, 논산, 금산(OR, 116.817) 거주 입원 환자는 대전권 의료기관 이용과 매우 높은 연관성을 나타냈다. 또한 충청남도 지역 거주 환자들은 충남권 의료기관에 비해 수도권(외래=17.01%, 입원=22.11%)과 대전권(외래=16.63%, 입원=15.41%) 의료기관에서 더 많은 의료비를 지불하였다. 결론: 이 연구는 충청남도 지역 거주 환자들의 관외 의료이용 양상을 분석하고 관련 시사점을 제공하였다. 향후 지역 의료기관과 서비스에 대한 신뢰도 및 만족도와 환자의 주진단과 같은 요인들을 고려한 연구가 추가적으로 진행되어야 하며, 연구결과를 바탕으로 합리적인 의료의 지역화와 의료공급 효율성 및 건강보험 재정 건정성 확보를 위한 정책사업의 기초 자료로 활용되기를 고대한다.

• 보건행정학회지
• /
• 제25권3호
• /
• pp.185-196
• /
• 2015

Background: Issues concerning with the classification accuracy of Korean Outpatient Groups (KOPGs) have been raised by providers and researchers. The KOPG is an outpatient classification system used to measure casemix of outpatient visits and to adjust provider risk in charges by the Health Insurance Review & Assessment Service in managing insurance payments. The objective of this study were to refine KOPGs to improve the classification accuracy and to evaluate the refinement. Methods: We refined the rules used to classify visits with multiple procedures, newly defined chemotherapy drug groups, and modified the medical visit indicators through reviews of other classification systems, data analyses, and consultations with experts. We assessed the improvement by measuring % of variation in case charges reduced by KOPGs and the refined system, Enhanced KOPGs (EKOPGs). We used claims data submitted by providers to the HIRA during the year 2012 in both refinement and evaluation. Results: EKOPGs explicitly allowed additional payments for multiple procedures with exceptions of packaging of routine ancillary services and consolidation of related significant procedures, and discounts ranging from 30% to 70% were defined in additional payments. Thirteen chemotherapy drug KOPGs were added and medical visit indicators were streamlined to include codes for consultation fees for outpatient visits. The % of variance reduction achieved by EKOPGs was 48% for all patients whereas the figure was 40% for KOPGs, and the improvement was larger in data from tertiary and general hospitals than in data from clinics. Conclusion: A significant improvement in the performance of the KOPG was achieved by refining payments for visits with multiple procedures, defining groups for visits with chemotherapy, and revising medical visit indicators.

• 한국산학기술학회논문지
• /
• 제16권3호
• /
• pp.1920-1927
• /
• 2015

본 연구는 뇌졸중 환자의 작업치료 보험수가를 분석하고자 실시하였다. 연구대상자는 2010년 뇌졸중 유병자 중에서 의료기관에 입원하거나 외래로 작업치료를 받은 사람을 대상으로 하였으며, 작업치료 검사비용은 건강보험심사평가원의 2010년 보험청구자료를 주자료원으로 분석하였고, 작업치료의 종류는 2010년 작업치료보험수가를 토대로 구분하여 분석하였다. 연구결과 작업치료를 받은 인원은 입원의 경우 전문재활치료료가 가장 많았고 외래는 신경계기능검사료가 가장 많았다. 작업치료 비용은 전문재활치료료가 253억원으로 가장 많았으며, 병원종별 이용건수는 상급종합 및 종합병원이 18만건으로 가장 많았으나 총비용은 요양병원이 104억으로 가장 많았다. 보험종별로는 의료보험이 40만건으로 의료급여보다 많았으며 평균비용은 의료급여가 6만 1,626원으로 의료보험보다 더 많았다. 지역별 작업치료 이용건수와 비용은 서울과 경기가 가장 많았다. 본 연구는 전국 뇌졸중 환자의 자료를 이용하여 작업치료 비용을 분석한 최초의 연구라는 점에서 의의가 있으며 연구 결과는 향후 보험수가 개선에 필요한 기초자료로 활용될 수 있을 것이다.

• Journal of Preventive Medicine and Public Health
• /
• 제43권1호
• /
• pp.35-41
• /
• 2010

Objectives: In Korea, the top 10% of Medical Aid recipients represent nearly 60% of total payment, with the costs for those disabled for over 365 days representing approximately 30% of total payment. The purpose of this study was to compare Medical Aid use of the disabled with non-disabled recipients, and to identify contributing factors to the total payment in the top 2% of recipients identified as Medical Aid overusers. Methods: Subjects (n=2,211) selected were ${\geq}18$-years-of-age and received >1000 days of co-payment-free type I Medical Aid. Case managers (n=200) conducted interviews in December 2006, and collected data from Health Insurance Review & Assessment Service. Amounts over the 9 months from January September 2006 were analyzed descriptively and using Chi-square, ANCOVA, and robust multiple linear regression. Results: Disabled individuals (mean age 61.3 years) composed 36.6% of subjects; 44.8% of the disabled were male. On a monthly basis per capita, the disabled group averaged 10.5 outpatient days, total payment of 523,000 Korean Won(￦), inpatient payment of ￦359,000, and outpatient payment of ￦183,000. All values exceeded the monthly average for non-disabled individuals. Contributing factors were identified as male gender (￦82,000), elementary school or lower educational level (￦64,000), residence in a small city (￦82,000), lack of family support (￦61,000), kidney disability (￦673,000), intellectual disability (￦151,000), and multiple disabilities (￦119,000). Conclusions: The identification of contributing factors to Medical Aid use by those defined as disabled supports the adoption of comprehensive alternative policies such as strengthening of education and consultation services, provision of alternative facilities, and promotion of self-care.

• 한국병원경영학회지
• /
• 제21권1호
• /
• pp.32-42
• /
• 2016

This study is conducted to estimate economic ripple effects of subsidiary services of hospitals. Using the Input/Output Analysis, this study analyzes production inducement effect, added value inducement effect, and labor inducement effect. Also, it assesses potential economic effects of the subsidiary services of which the scope is expanded as the government's proposed in 2014. Data regarding hospital subsidiary services and economic effects are obtained from the hospitals' financial statements on the National Tax Services and the Bank of Korea. The major results of this study are summarized as follows; subsidiary service profits of hospitals are 466 billion won and rent profits of hospitals are 152 billion won. Of these, the rate of subsidiary service profits in tertiary hospitals is about 66% of total subsidiary service profits. Producement inducement effect of subsidiary services of hospitals is higher than that of total industry, service industry and medical service industry. Added value inducement effect of subsidiary services of hospitals is higher than that of total industry, manufacturing industry, service industry and medical service industry. Job position inducement effect of subsidiary service in hospitals is higher than that of total industry, service industry and medical service industry. Also, employment inducement effect of subsidiary service in hospitals is higher than that of total industry and medical service industry. The results may suggest that subsidiary services revenue in medical institutions contribute to improving operating profits. Facing with intense market competition and pressures to control health care costs, hospitals may need to determine whether subsidiary services help boost their profitability and improve customer satisfaction.

• 한국임상보건과학회지
• /
• 제2권2호
• /
• pp.126-132
• /
• 2014

Purpose. Because traditional statistics approach had limitations in learning future forecasting and major factors causing occupational injuries in each industry, this paper develops a model forecasting and evaluating occupational injury rate by using a system dynamics model through the analysis of the industry injury statistics and the project for industry injury prevention. Method. The model of this paper consists of 12 total models such as a model of employees, of industrial disaster victims, of injury rate, etc.; In the analysis of firm size, it is classified and developed according to 12 groups on the basis of the number of employees, and in the analysis of industrial classification, it is done according to 10 total business fields such as manufacturing business, construction one, etc. Results. This paper suggests the methodology which forecasts industry injury rate by business field and size on the basis of developed model, and evaluates an industry injury prevention project from various angles. Conclusions. This paper deduced problem through the analysis of an industry injury by business fields and a comparative analysis of foreign cases, and analyzed to affect industry injury prevention by industry. And it also analyzed actual condition of industry injury, and did a difference in the level of safety consciousness according to the general characteristics of workers and occupational safety and health education related characteristics. In result, this paper suggests that analyzing occupational injury related factors, a safety budgetary allocation, and industry injury related factors can reduce illness costs such as employees' injury and medical care, and also assist cost for a disability.

• Korean Journal of Acupuncture
• /
• 제30권1호
• /
• pp.21-26
• /
• 2013

Objectives : The purpose is to introduce the recent large-scale clinical researches for safety, efficacy and effectiveness of acupuncture in Germany. Results : In 2000, the German Federal Committee of Physicians and Health insurer proposed that large research initiatives on acupuncture, Acupuncture Model Projects(Modellvorhaben Akupunktur), could be conducted by health insurance companies for several pain that acupuncture is syndromes to justify the insurance-based reimbursement. Accordingly, 4 clinical researches were carried out; the Acupuncture Safety and Health economics studies(ASH), the Acupuncture Randomised Trial(ART), the Acupuncture in Routine Care studies(ARC), and the German Acupuncture trial(GERAC). Meanwhile, ASH is a prospective observational study for safety and costs. ART and GERAC are composed of RCTs for efficacy. ARC includes 6 pragmatic RCTs with additional non-randomized cohort study for effectiveness. We investigated the papers related to them and discussed about the outcomes. The researches showed that acupuncture is effective in practice for several chronic conditions such as migraine, tension-type headache, chronic low back pain, osteoarthritis of knee, dysmenorrhea, and allergic rhinitis. Based in part on them, the German health authorities decided that acupuncture would be included into routine reimbursement by social health insurance funds for chronic low back pain and chronic osteoarthritis of the knee in 2006. Conclusions : The German clinical researches may suggest the clues for establishing the evidence of acupuncture treatment.

• 한국식품영양학회지
• /
• 제28권4호
• /
• pp.717-727
• /
• 2015

Although the NutriPlus program has shown considerable evidence of enhancing users' nutritional status, the budget does not cover all eligible mothers and children. This study aimed to conduct a cost-benefit analysis of the NutriPlus program to assess its economic efficiency. 53 families with 79 users in the NutriPlus program at Daejeon Dong-gu Health Center participated in this study with informed consent. The costs and benefits were estimated from both the administrator's and users' perspectives. We converted the time cost into Korean currency based on the minimum wage in 2014. The value of nutrition education and service (B2), estimated by contingency valuation method (CVM), was counted as an economic benefit. 6 families (11.3%) were recipients of national medical care and 22 families (41.5%) paid 10% of the food package cost by themselves. The total cost was \7,450,167 and the total benefit was \12,402,239. The budget for the health center (C1+C2+C3+C4) was \5,984,381 a month. Time and transportation cost for receiving nutrition education (C6) differed significantly according to the economic status of families. Household food consumption increase (C4-B4) was 40,379 in the poverty group, which was four times more than in the other groups. The net benefit (B-C) was \4,852,172 and the B/C ratio was 1.66. Therefore, the NutriPlus program is beneficial in the economic aspect as well as in the nutritional aspect. If the enhancement of nutritional status was also considered, the total benefit would be even higher. These results confirm the legitimacy of a secure budget for the NutriPlus program. And we suggest expanding its budget to cover more eligible individuals to improve people's health and welfare.

• 의료법학
• /
• 제19권2호
• /
• pp.139-171
• /
• 2018

「의료사고 피해구제 및 의료분쟁 조정 등에 관한 법률」(이하 '의료분쟁조정법'이라 한다)에서는 보건의료인이 충분한 주의의무를 다하였음에도 불구하고 분만 중 불가항력적으로 발생한 의료사고에 대하여 국가가 예산의 범위 안에서 그 피해자에게 보상하도록 하고 있다(의료분쟁조정법 제46조). 지금까지 의료사고 피해자가 소송을 통해서만 피해회복을 기대할 수 있었던 것에 비한다면 획기적인 법률이라 할 수 있다. 그런데, 이러한 의료사고보상사업에 드는 비용의 100분의 30은 보건의료기관개설자 중 분만 실적이 있는 자가 부담하고 있는 바(의료분쟁조정법 시행령 제21조), 이 분담금 부과 조항이 분만 과정에서의 산모·신생아 사망 등의 사고가 의사의 과실이 없이 불가항력적으로 발생했음에도, 의사들에게 책임을 묻는 것은 아닌지 문제가 되어 왔다. 그러나 최근 헌법재판소에서 분담금 부과와 관련한 의료분쟁조정법법 제46조 제3항 중 '보건의료기관개설자의 범위' 및 '보상재원의 분담비율' 부분에 대하여 합헌 결정을 내린 바 있다(헌법재판소 2018. 4. 26. 선고 2015헌가13 결정, 이하 '이 사건 결정'이라 한다). 이 사건 결정에서는 법률유보원칙 및 포괄위임입법금지원칙에 의하여만 판단하였으나, 본고에서는 실질적인 판단도 가미하였다. 이 사건 분담금운 과잉금지원칙에 비추어 보더라도 보건의료기관개설자들의 재산권을 침해하지 않는 점을 논증하였다. 불가항력 의료보상제도의 분담금 부과가 민사책임의 중요 원칙인 과실책임원칙에 거스르는 측면이 존재한다. 그러나 의료사고보상사업은 의료사고 피해자를 위한 국가정책으로 합리성이 있으며, 동시에 의료분쟁의 조기종결 효과로 의료계 역시 이익을 얻는 측면이 분명 존재한다. 분담금의 납부를 통한 보상재원의 확충은 이러한 의료사고보상제도를 빠르게 정착시킴으로서 분만과정에서 발생한 의료사고 피해자의 고통과 오해를 경감시키고 의료인의 안정적 진료환경 구축에 큰 도움이 될 것이다.

• Safety and Health at Work
• /
• 제3권1호
• /
• pp.17-21
• /
• 2012

Objectives: Asbestos-related diseases (ARDs) have increased globally over the decades, causing an economic burden and increased health care costs. It is difficult to predict the risk of development of ARDs and of respiratory disability among workers with a history of asbestos exposure. Blood based biomarkers have been reported as promising tools for the early detection of malignant mesothelioma. This study investigated whether serum soluble mesothelin-related peptide (SMRP) would reflect severity of disablement in compensable ARDs. Methods: SMRP levels were measured in a cohort of 514 asbestos-exposed subjects. Severity of ARDs was assessed by a Medical Authority comprising four specially qualified respiratory physicians. Severity of ARDs and SMRP levels were compared. Results: Mean (standard deviation) serum SMRP level in the population with compensable ARDs (n = 150) was 0.95 (0.65) nmol/L, and was positively associated with disability assessment (p = 0.01). Mean SMRP level in healthy asbestos-exposed subjects was significantly lower than those with pleural plaques (p < 0.0001) and in subjects with ARDs who received compensation (p < 0.01). Conclusion: This study indicates that serum SMRP levels correlate with severity of compensable ARDs. Serum SMRP could potentially be applied to monitor progress of ARDs. Further prospective work is needed to confirm the relationship between SMRP and disability assessment in this population.