• 보건행정학회지
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• 제34권2호
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• pp.196-210
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• 2024

연구배경: 2018년 1월 의원급(의원, 치과의원, 한의원) 노인외래정액제 개선안이 시행되었다. 정액진료비 상한금액인 1만 5,000원 이하 진료를 받은 경우의 본인부담금은 기존과 동일하다. 개선안은 정액진료비 상한금액인 1만 5,000원 초과 진료를 받은 경우의 본인부담금을 차등적으로 인하하였는데, 1만 5,000원 초과 2만 원 이하 구간의 본인부담금은 진료비의 30%에서 10%로, 2만 원 초과 2만 5,000원 이하 구간의 본인부담금은 진료비의 30%에서 20%로 인하하였다. 우리나라는 급격한 인구 고령화로 고령인구와 노인진료비가 빠르게 증가하고 있고, 노인빈곤율이 경제협력개발기구 회원국 중 가장 높다. 연구는 건강보험 지속 가능성 유지와 노인복지 향상을 위하여 노인외래정액제 개선이 고령층의 의료이용에 미친 영향을 종합적으로 확인하려고 한다. 방법: 연구는 한국의료패널 자료를 사용하여 노인외래정액제 개선 이후 고령층의 의료이용 변화를 추정하였다. 연구는 단절적 시계열 연구 중 구간별 회귀분석을 분석에 이용하였고, 진료비 구간별 및 의원 종류별 외래진료 횟수, 입원횟수 및 일수 변화는 포아송 구간별 회귀분석을, 외래 및 입원진료비 변화는 구간별 회귀분석을 이용하여 추정하였다. 구간별 회귀분석은 개입으로 인한 효과와 시간의 흐름에 따른 효과를 구분할 수 있게 해주어, 개입이 없더라도 발생했을 변화와 개입으로 인한 변화를 명확하게 추정할 수 있도록 해준다. 의료이용에 영향을 미칠 것으로 예상되는 성별, 연령, 교육수준, 소득, 배우자 유무, 장애 정도, 지역, 주관적 건강인식, 질병 및 손상으로 인한 일상생활 제한 여부, 응급 및 입원 수술 여부, 응급실 이용횟수, 만성질환 개수, 계절은 통제변수로 포함하였다. 결과: 노인외래정액제 개선 직후 본인부담 변화가 없던 의원, 한의원 진료비 1만 5,000원 이하 구간의 외래진료 횟수가 감소하였다. 그러나 본인부담이 감소한 의원 1만 5,000원 초과 2만 원 이하 구간과 한의원 2만 원 초과 2만 5,000원 이하 구간의 외래진료 횟수는 증가하였다. 치과의원의 외래진료 횟수 변화는 통계적으로 유의하지 않았다. 입원율은 노인외래정액제 개선 직후 감소하였지만, 이후 다시 증가하였다. 외래진료비 중 본인부담금은 노인외래정액제 개선 직후 감소하였다. 입원진료비와 외래와 입원진료비를 합한 총진료비는 노인외래정액제 개선 직후 감소하였다가 이후 다시 증가하였다. 결론: 분석결과를 통해 노인외래정액제 개선 이후 일시적인 의료이용 증가와 본인부담금 감소를 확인할 수 있었다. 총진료비 중 입원이 차지하는 비중이 외래보다 크기 때문에, 노인외래정액제 개선이 고령 환자의 의료비 부담 완화에 미친 영향은 매우 제한적이었다. 장기적으로 고령 환자의 의료비 부담 완화와 건강보험 지속 가능성 유지를 위해서는 본인부담 완화 정책과 질병 악화로 인한 입원을 예방하기 위한 만성질환 관리정책이 함께 이루어져야 할 것으로 보인다. 연구의 결과는 정책을 수립할 때 본인부담 변화가 고령층의 의료이용 행태에 미치는 영향에 대한 기초정보를 제공할 수 있을 것으로 기대된다.

• 한국병원경영학회지
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• 제14권2호
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• pp.1-20
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• 2009

The purpose of this study is to find the determinant variables to make profitability in regional public hospitals. The data come from financial statements and annual reports of 34 regional public hospitals for five years (from year 2003 to year 2007). The T or F-test and hierarchical multiple regression analysis are used. The dependant variables are the profitability indicators, ordinary income to total asset and operating margin to gross revenue, and the independent variables are general characteristics, diagnosis and treatment patterns, financial and public benefits. The findings of this study are summarized as follows. First, Variables affecting the profitability indexes revealed from DEA results is the bed occupancy rate, number of hospitalized patients to outpatients, ratio of first medical examination for outpatients, number of daily patients per medical specialist, labor cost per patient and managerial expenses per patient. Second, the ordinary income to total asset representing the asset usage performance is affected by the average hospitalized days, bed occupancy rate, labor cost per patient and ratio of patients with medical insurance coverage. Third, the operating martin to gross revenue obtained from the actual operations of hospitals has its significance with the bed occupancy rate, number of hospitalized patients to outpatients, managerial expenses per patient and public benefit indicator. This study has some restriction not to use pannel data analysis, although it used data for five years. Accordingly, various additional studies should be done to supplement such problems.

• 동의신경정신과학회지
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• 제29권3호
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• pp.135-144
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• 2018

Objectives: The purpose of this study was to analyze the medical cost for patients with vertigo and to examine associations between chronic vertigo and mental disorder using 2014 Health Insurance Review & Assessment Service-National Patients Sample (HIRA-NPS). Methods: We analyzed sociodemographic characteristics, medical cost and medical care use pattern for vertigo patients. We used hierarchical multiple logistic regression analysis to examine odds ratio between chronic vertigo and mental disorder. Results: A total of 46,502 people and 118,504 claims data were identified for vertigo cases. Characteristics of vertigo patients have significant differences on proportion of female patients (68.36%), patients' average age (54.98) and proportion of medical assistance (5.76%) compared with non-vertigo patients. Results revealed that Korean medicine are one of frequent methods among total treatments for vertigo patients. Total days of medical care and total costs are 2.78 days and 111,362 won, respectively, and days for outpatients in Korean medical care (mean: 2.26 days) are more than those (mean: 5.05 days) in Western medical care. There is significant difference relative to sex between acute vertigo and chronic vertigo. The odds ratio between chronic vertigo and mental disorder is estimated as 1.34, that means risk of becoming chronic is 34% higher for vertigo patients with mental disorder. Conclusions: This study assessed socio-demographic characteristics, medical care use and expenses related to vertigo, and estimated associations between chronic vertigo and mental disorder. Findings provide a basis for economic evaluation studies on vertigo patients and development of clinical practice guidelines for vertigo patients with mental disorder.

• 보건행정학회지
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• 제3권1호
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• pp.84-101
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• 1993

The current method of rate adjustment is based on the evaluation of the financial performance of hospitals. The method has the disadvantages such as too complicated, expensive process as well as low reliability due to small sample size. This study, therefore, develops a new model for the rate adjustment with the use of the composite index. In addition to that, it examines the validity of the model by comparing the result of the new method with that of the conventional method. The idea of the new model comes from the Medicare Economic Index(MEI) on which physician fees for the Medicare patients are adjusted periodically in the United States. Medical costs are classified into three groups : labor costs, materials and other expenses. Labor costs are subdivided into physicians and other personnels. Materials are subdivided into drugs and others. Other expenses are subdivided into 5 items. Macro economic indices are selected for each cost item in order to reflect the cost inflation during the specific period. Then the composite index which integrate all items according to the ration of each item in the total costs is calculated. The result from the application of empirical data to the new model is very similar to that of the current method. Furthermore, this method is very simple and also to easy to get social concensus. This model can be replaced the current method based on the analysis of the financial performance for the adjustment of medical fees.

• Journal of Preventive Medicine and Public Health
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• 제7권1호
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• pp.211-222
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• 1974

The survey was carried out on 1,031 primary school children for about 1 month, from June 1, to June 30, 1974, for the purose of understanding indirectly scio-medical status of a remote rural area, reflecting health status of primary school children. The summarized results were as follows: 1) The average age of surveyed children according to school year by sex was older in girls than in boys. The entrance in school at suitable age was peaked as 80.9% in boys of 5th school year and 72.4% in girls of 3rd school year, and also sunk 68.8% in boys of 2nd school year and 58.7% in girls of 1st school year. 2) Prevalence rate according to W.H.O. diseases classification during last a month and a year. a) During last month: The diseases of respiratory system remarked the highest 101.1 in boys and 116.6 in girls. The next were diseases of digestive system (24.2 in boys and 32.1 in girls), The girls were higher than boys in prevalence rate. b) During last year: The diseases of diegestive system ranked the highest 133.0 in boys and next, the diseases of respiratory system (108.6 in boys). c) Present illness: Number of code III ranked the highest 129.2 and next XII(127.3) in boys but inverted in girls such as XII(144.9) and III(116.7) and also, Number of code XVII was prevalenced twice in boys than in girls. d) Chief complaints by sex: Abdominal pain ranked the highest 71.2 per 1,000 population and next headache (34.7) in boys but headache ranked the heighest 88.5 and next abdominal pain (63.3) in girls. e) Water drinking habit: Number of code IX was higher in habit of raw water drinker than in habit of boiled water drinker and healthy children were higher in boiled water habit group than in raw water habit group. The diseases of respiratory system were the highest 124.74 in girls and next, the diseases of digestive system (52.3 in girls). According to school year, healthy children were increased to higher grades. 3) Average sick day per total surveyed children and patient during last month and last year. a) Per surveyed 1,031 children was 0.28 days during last month and 0.98 days during last year. And also per patient was 1.78 days during last month and 3.22 days during last year. b) Average sick day was higher in girls than in boys during last month, but inverted during last year. 4) Average absented day per total surveyed children and patient during last month and last year. a) Per surveyed 1,031 children were 0.43 days during last month and 3.81 days during last year (omitted 1st school year). b) Per absented children were 2.0 days during last month and 7.10 days during last year. c) Per absented children were 8.16 days in boys and 3.17 days in girls. 5) Utilization of medical facilities: The drug-store was consulted 91.2% of the total utilized boys and girls. The strengthening of medical facilities and medical care activities in health subcenter is urgently required 6) Medical Expenses by period and sex: a) Average medical expenses per surveyed 1,031 children were 35.95 won, per patient were 298.04 won during last month. b) Average medical expenses per survey children (omitted 1st school year) were 80.56 won, per patient were 243.98 won and per treated patient were 318.87 won during last year. c) Medical expenses were higher in boys than in girls. 7) Rohrer index by sex, present illness and school year. a) Average Rohrer index was 129.8 in boys and 126.2 in girls. b) Average Rohrer index was increased for 1st school year to 2nd school year and thereafter falling down step by step by school year. c) Under 151-160 Rohrer index number of code III was the highest and above 151-160 Rohrer index of code XII was peaked.

• 대한물리치료과학회지
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• 제4권2호
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• pp.421-432
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• 1997

To find out the actual status of treatment of physically handicapped who were stayed of home, 320 physically handicapped persons were selected among total 6,264 physically handicapped registered in Taejon city, surveyed from January 1st to March 30, 1997. Following are the results ana lysed of collected data from 201 samped persons. 1. For the cause of physically handicapped, 36.3% was congenital, 26.9% was cerebralvascular acciednt(CVA). and 14.9% was infectious diseases and others in that orders. The must frequest cause of below 20 years age group was congenital cause, but that of $20{\sim}30$ years age group and $40{\sim}50$ years age group were accident and CVA repectively. 30.0% of respondents caused by infection and others earned household living expenses. Household living expenses were higher among the respondents caused by congenital cause but those were lowest in the accidental couse group. Handicap durations were longer in the accidental cause group and infections and others group than the congenital cause group and CVA group. 2. 54.7% of studied handicapped were under treatment. But 36.3% of them were stopped treatment, and 8.9 % of them answered not treated. Most handicapped, coused by congenital and CAV, were under treatment, but most of them caused by accidental and others were stopped treatment. 3. For the medical facilities, 54.5% of them utilized welfare facility, but 25.5% utilized general hospital and 20.0% of them utilized oriental medical hospital and health centers. Congenital cause group frequently selected welfare facility for the treatment facility. But accidental cause group frequently seleced general hospitals and CVA gruop frequently selected oriental medical hospital and others. The medical cost of welfare facility, oriental medical hospitals and others were lower than that of general hospitals. 4. The proportions of under treatment were higher among yonger age higher monthly living expenses group shorter handicapped duration groups, congenital cause group and handicap grade II group. But that of stop treatment were higher among congenital cause group, infectious and others cause group, and handicap grade I & then III group. 5. For the feelings satisfacion about medical treatment, only 35.3% of under treated group responed satisfation. 55.5% of them responded so-so, but 9.1 % responed dissatisfaction. The proportion of satisfaction was higher among shorter handicap duration group.

• 디지털융복합연구
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• 제13권11호
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• pp.267-276
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• 2015

본 연구는 우리나라 종합병원의 경영실적을 흑자와 적자로 구분하여 안정성, 성장성, 활동성, 생산성, 원가지표, 진료실적과 수익성 간의 인과관계를 규명하고자 하였다. 또한 연구결과를 바탕으로 병원의 수익성 제고와 효율적인 경영방안을 모색하는데 유용한 기초자료를 제공하는데 그 목적이 있다. 조사기간은 종합병원 경영실적을 파악할 수 있는 2013년을 평가기준으로 하였으며, 총 147개의 종합병원을 조사대상으로 선정하였다. 결과을 보면, 흑자병원과 적자병원간의 재무실적과 진료실적에서는 유의한 차이 나타났으며, 흑자병원일수록 재무실적과 진료실적이 더 높은 비율을 나타냈다. 또한 병원의 수익성에 영향을 미치는 요인으로는 인건비율, 관리비율, 재료비율이 중요요인으로 나타났다. 앞으로 병원 수익성을 높이기 위해서는 진료수익을 증대하는 것도 중요하지만 인건비, 관리비를 줄이기 위한 효율적인 비용절감전략이 요구된다 할 수 있다.

• 보건행정학회지
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• 제27권1호
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• pp.47-55
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• 2017

Background: This study purposed to analyze the effects of metabolic syndrome on the total medical charge of patients. Methods: 2013 National Health Insurance Service sample research database (eligibility database, medical database, and health examination database) was used for this study. Gamma regression was applied to analyze the effects of metabolic syndrome on the total medical charge and logistic regression was used to determine the probability of medical charge which was higher than the third quartile. Sociodemographic characteristics (age and household income), health behavior factors (smoking, drinking, exercise, and body mass index), and disease related factors (family history and metabolic syndrome) were included as the independent variables. Results: people who had metabolic syndrome spent more medical expenses than those without metabolic syndrome both in man and woman group. The standard regression coefficient was 0.09 (p< 0.001) in man with metabolic syndrome and 0.16 (p< 0.001) in woman. In addition, woman with metabolic syndrome spent more than the third quartile of medical charge. The odds ratios was 1.04 (p= 0.16) for man with metabolic syndrome and 1.18 (p= 0.013) for woman. Conclusion: people with metabolic syndrome spent more medical charge, so it will need to consider policy interventions for preventing the incidence and management of metabolic syndrome in Korean people.

• 대한예방한의학회지
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• 제18권1호
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• pp.43-52
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• 2014

This study was conducted to analyze if there is a difference between the head hospital and branch hospital by comparing the profitability and operating expenses to patient revenue of oriental medicine hospitals affiliated with universities in order to find whether opening branch hospitals is an appropriate method to increase profitability. Profit indices used for the comparison of head hospital and branch hospital include ratio of operating profit on medical revenue, net-income on medical revenue, net profit to total assets, and operating profit to total assets; and cost indices included ratio of labor costs, material costs and administrative costs. In comparison of profit indices of head hospitals and branch hospitals, head hospitals displayed negative(-) in all four profit index averages while branch hospitals displayed positive(+), showing that branch hospitals have higher profitability. In particular, in the case of head hospitals, ratio of net profit to total assets was -13.6%, while that of branch hospitals was 12.9%, which was higher than 3.1%, the average of Korean oriental medicine hospitals in 2011. As a result of difference analysis between groups of head hospitals and branch hospitals, profit indices of ratio of operating profit on medical revenue, net-income on medical revenue, and ratio of net profit to total assets were found to vary by hospitals, but there was no statistically significant difference between head hospitals and branch hospitals(p<0.1). Only the ratio of operating profit to total assets of head hospitals and branch hospitals indicated significant difference between the two groups, showing that ratio of operating profit to total assets of branch hospitals is larger than that of head hospitals. Meanwhile, the cost indices of ratio of labor costs, material costs and administrative costs in the difference test results did not show significant difference between the head hospital and branch hospital(p<0.1). Thus, it cannot be said that a certain oriental medicine hospital's profitability is high or low depending on whether it is head hospital or a branch as profitability varies depending on the management environment of the hospital. Therefore, oriental medicine hospitals affiliated with universities would need to make efforts to increase their profitability as an individual hospital rather than focusing on whether they are head hospital or a branch.

• 대한한의학회지
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• 제42권4호
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• pp.133-149
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• 2021

Objectives: To lay the foundation for future research into Korean Medicine treatment for Rotator Cuff repair surgery patients by analyzing Korean Medical and Western Medical service utilization and treatment duration. Methods: Data sampling was performed on 2015's HIRA patient data (confidence level of 97%) to analyze patients' Korean Medical and Western Medical service usage tendency. Sampled groups were divided into two groups: i) Patients who completed their treatment within five months after the rotator cuff surgery (termination group), ii) Patients who were treated for more than five months after the surgery (continuation group). Then the patients' Korean Medical and Western Medical service usage tendency was investigated and information of these patients are arranged. Results: Out of 1,453,486 patients who were gathered for sampling, 2,461 patients in total had gone through rotator cuff repair surgery. The termination group had 517 patients and the continuation group had 541 patients. The proportion of patients who visited a Korean Medicine clinic was lower in the termination group than the continuation group. Conclusion: The continuation group received more treatments (both in Western Medicine and Korean Medicine) and spent more on medical expenses compared to the termination group. Further research is highly recommended for more efficient Western Medicine and Korean Medicine treatments and reduced medical expenditure.