보건의료의 성과를 증진시키기 위해서는 의료서비스의 과다이용을 억제하고, 효과적인 의료서비스이지만 과소 이용되고 있는 의료서비스는 이용을 장려해야 한다는 합리적 의료이용에 관한 논의가 지속되고 있다. 비응급 환자의 응급의료서비스 이용은 의료서비스의 과다이용으로 간주될 수 있다. 이에 이 연구는 국내 성인 전체 및 경증질환 환자의 응급실 다방문 여부에 따른 의료비 및 의료이용 차이를 확인하는 것을 목적으로 시행되었다. 연구의 자료원은 2016년 건강보험심사평가원 전체환자표본자료이며, 연간 1회 이상 응급실에 방문한 경험이 있으며, 응급실 방문 건 내 사망하지 않은 만 20세 이상 성인 118,921명을 대상으로, 1:3 ...
보건의료의 성과를 증진시키기 위해서는 의료서비스의 과다이용을 억제하고, 효과적인 의료서비스이지만 과소 이용되고 있는 의료서비스는 이용을 장려해야 한다는 합리적 의료이용에 관한 논의가 지속되고 있다. 비응급 환자의 응급의료서비스 이용은 의료서비스의 과다이용으로 간주될 수 있다. 이에 이 연구는 국내 성인 전체 및 경증질환 환자의 응급실 다방문 여부에 따른 의료비 및 의료이용 차이를 확인하는 것을 목적으로 시행되었다. 연구의 자료원은 2016년 건강보험심사평가원 전체환자표본자료이며, 연간 1회 이상 응급실에 방문한 경험이 있으며, 응급실 방문 건 내 사망하지 않은 만 20세 이상 성인 118,921명을 대상으로, 1:3 성향점수매칭을 통해 응급실 다방문군 4,090명, 응급실 비다방문군 12,270명을 선정하여 분석하였다. 의료비 및 의료이용 당 의료비에 대해서는 로그 치환하여 다중선형회귀분석을, 의료이용 횟수에 대해서는 음이항 회귀분석을 시행하였으며, 방문한 응급실의 의료기관 종별로 층화분석도 시행하였다. 추가적으로 40-50대 급성상기도감염 환자 3,160명을 추출하여 위와 동일한 방법으로 분석하였다. 연구 결과, 응급실 다방문군의 외래 의료비, 외래 방문횟수 당 의료비, 외래 방문횟수, 입원 의료비, 입원일당 의료비, 입원일수, 응급의료를 포함한 총 의료비가 비다방문군에 비해 유의하게 높았고(β=0.1288, P=0.0004; β=0.0930, P=0.0004; β=0.0729, P=<.0001; β=0.9180, P=<.0001; β=0.5163, P=<.0001; β=0.4653, P=<.0001; β=0.4287, P=<.0001), 40-50대 급성상기도감염 환자를 추출하여 분석한 결과, 외래 방문횟수에서 응급실 다방문군이 비다방문군에 비해 유의하게 낮았으며(β=-0.2742, P=0.0077), 방문 응급실 유형별로 층화했을 때, 병원급 응급실 다방문군의 외래 방문횟수가 비다방문군에 비해 유의하게 낮았다(β=-0.3532, P=0.0104). 이 연구에서는 응급실을 자주 방문하는 성인 환자가 전반적으로 외래 및 입원 서비스 이용이 많다는 것을 확인하였다. 또한, 경증질환인 급성상기도감염으로 병원급 응급실을 외래 진료처럼 이용하는 환자가 있음을 실증적으로 확인하였다. 비응급 환자의 응급의료서비스 과다이용으로 인한 의료재정 낭비를 감소시키고, 응급상황의 환자들이 적절한 시기에 의료서비스를 받을 수 있도록 국민들의 인식개선 및 일차 의료기관의 역할 강화가 필요하다.
보건의료의 성과를 증진시키기 위해서는 의료서비스의 과다이용을 억제하고, 효과적인 의료서비스이지만 과소 이용되고 있는 의료서비스는 이용을 장려해야 한다는 합리적 의료이용에 관한 논의가 지속되고 있다. 비응급 환자의 응급의료서비스 이용은 의료서비스의 과다이용으로 간주될 수 있다. 이에 이 연구는 국내 성인 전체 및 경증질환 환자의 응급실 다방문 여부에 따른 의료비 및 의료이용 차이를 확인하는 것을 목적으로 시행되었다. 연구의 자료원은 2016년 건강보험심사평가원 전체환자표본자료이며, 연간 1회 이상 응급실에 방문한 경험이 있으며, 응급실 방문 건 내 사망하지 않은 만 20세 이상 성인 118,921명을 대상으로, 1:3 성향점수매칭을 통해 응급실 다방문군 4,090명, 응급실 비다방문군 12,270명을 선정하여 분석하였다. 의료비 및 의료이용 당 의료비에 대해서는 로그 치환하여 다중선형회귀분석을, 의료이용 횟수에 대해서는 음이항 회귀분석을 시행하였으며, 방문한 응급실의 의료기관 종별로 층화분석도 시행하였다. 추가적으로 40-50대 급성상기도감염 환자 3,160명을 추출하여 위와 동일한 방법으로 분석하였다. 연구 결과, 응급실 다방문군의 외래 의료비, 외래 방문횟수 당 의료비, 외래 방문횟수, 입원 의료비, 입원일당 의료비, 입원일수, 응급의료를 포함한 총 의료비가 비다방문군에 비해 유의하게 높았고(β=0.1288, P=0.0004; β=0.0930, P=0.0004; β=0.0729, P=<.0001; β=0.9180, P=<.0001; β=0.5163, P=<.0001; β=0.4653, P=<.0001; β=0.4287, P=<.0001), 40-50대 급성상기도감염 환자를 추출하여 분석한 결과, 외래 방문횟수에서 응급실 다방문군이 비다방문군에 비해 유의하게 낮았으며(β=-0.2742, P=0.0077), 방문 응급실 유형별로 층화했을 때, 병원급 응급실 다방문군의 외래 방문횟수가 비다방문군에 비해 유의하게 낮았다(β=-0.3532, P=0.0104). 이 연구에서는 응급실을 자주 방문하는 성인 환자가 전반적으로 외래 및 입원 서비스 이용이 많다는 것을 확인하였다. 또한, 경증질환인 급성상기도감염으로 병원급 응급실을 외래 진료처럼 이용하는 환자가 있음을 실증적으로 확인하였다. 비응급 환자의 응급의료서비스 과다이용으로 인한 의료재정 낭비를 감소시키고, 응급상황의 환자들이 적절한 시기에 의료서비스를 받을 수 있도록 국민들의 인식개선 및 일차 의료기관의 역할 강화가 필요하다.
Proper medical care utilization, which involves reducing overused unnecessary medical services and increasing underused effective medical services, is widely under discussion around the world. Frequent visits to the emergency department of non-emergency patients could be regarded as overusing unnece...
Proper medical care utilization, which involves reducing overused unnecessary medical services and increasing underused effective medical services, is widely under discussion around the world. Frequent visits to the emergency department of non-emergency patients could be regarded as overusing unnecessary medical services. Thus, this study aimed to examine the association of frequent visits to the emergency department with outpatient and inpatient medical service utilization among Korean adults and, additionally, among similar-aged patients with acute mild diseases. Data from the 2016 National Patient Sample from the Health Insurance Review and Assessment Service (2016 HIRA-NPS) were used in this study. First, 118,921 individuals aged 20 or older, those who had visited the emergency department at least once in a year, and those who had not been dead during the emergency department visit were selected. Subsequently, a total of 16,360 individuals (frequent user group: 4,090; infrequent user group: 12,270) were selected according to 1:3 propensity score matching. Individuals who had visited the emergency department three times or more in a year were defined as the frequent user group. A multiple linear regression was used to examine the association between frequent visits to the emergency department and medical care expenditure, which was log-transformed to meet the normality assumption. A negative binomial regression was performed to examine the association between frequent visits to the emergency department and the number of outpatient and inpatient visits. Subgroup analysis stratified by the hospital type of the emergency department was also performed. In addition, 3,160 individuals aged 40 to 59 years and whose main sick code had been acute upper respiratory infections (ICD-10 code: J00-J06) when they had visited the emergency department were selected, and the same statistical analyses were conducted. Frequent users of the emergency department had significantly higher outpatient expenditure, outpatient expenditure per day, number of outpatient visits, inpatient expenditure, inpatient expenditure per day, admission days, and total medical care expenditure (β=0.1288, P=0.0004; β=0.0930, P=0.0004; β=0.0729, P=<.0001; β=0.9180, P=<.0001; β=0.5163, P=<.0001; β=0.4653, P=<.0001; and β=0.4287, P=<.0001, respectively), compared to infrequent users. Among patients aged 40 to 59 years with acute upper respiratory infections, the frequent user group had a significantly lower number of outpatient visits than did the infrequent user group (β=-0.2742, P=0.0077). According to the subgroup analysis, frequent users of the hospital emergency department had a significantly lower number of outpatient visits (β=-0.3532, P=0.0104). Frequent users of the emergency department used more outpatient and inpatient services. On the other hand, there were patients with mild diseases who used the hospital emergency department rather than using outpatient clinic services. Thus, it is necessary to improve the public perception of and strengthen the role of primary medical institutions in order to reduce the wastage of national medical finances caused by the excessive use of emergency medical services by non-emergency patients as well as to provide medical services to emergency patients at the appropriate time.
Proper medical care utilization, which involves reducing overused unnecessary medical services and increasing underused effective medical services, is widely under discussion around the world. Frequent visits to the emergency department of non-emergency patients could be regarded as overusing unnecessary medical services. Thus, this study aimed to examine the association of frequent visits to the emergency department with outpatient and inpatient medical service utilization among Korean adults and, additionally, among similar-aged patients with acute mild diseases. Data from the 2016 National Patient Sample from the Health Insurance Review and Assessment Service (2016 HIRA-NPS) were used in this study. First, 118,921 individuals aged 20 or older, those who had visited the emergency department at least once in a year, and those who had not been dead during the emergency department visit were selected. Subsequently, a total of 16,360 individuals (frequent user group: 4,090; infrequent user group: 12,270) were selected according to 1:3 propensity score matching. Individuals who had visited the emergency department three times or more in a year were defined as the frequent user group. A multiple linear regression was used to examine the association between frequent visits to the emergency department and medical care expenditure, which was log-transformed to meet the normality assumption. A negative binomial regression was performed to examine the association between frequent visits to the emergency department and the number of outpatient and inpatient visits. Subgroup analysis stratified by the hospital type of the emergency department was also performed. In addition, 3,160 individuals aged 40 to 59 years and whose main sick code had been acute upper respiratory infections (ICD-10 code: J00-J06) when they had visited the emergency department were selected, and the same statistical analyses were conducted. Frequent users of the emergency department had significantly higher outpatient expenditure, outpatient expenditure per day, number of outpatient visits, inpatient expenditure, inpatient expenditure per day, admission days, and total medical care expenditure (β=0.1288, P=0.0004; β=0.0930, P=0.0004; β=0.0729, P=<.0001; β=0.9180, P=<.0001; β=0.5163, P=<.0001; β=0.4653, P=<.0001; and β=0.4287, P=<.0001, respectively), compared to infrequent users. Among patients aged 40 to 59 years with acute upper respiratory infections, the frequent user group had a significantly lower number of outpatient visits than did the infrequent user group (β=-0.2742, P=0.0077). According to the subgroup analysis, frequent users of the hospital emergency department had a significantly lower number of outpatient visits (β=-0.3532, P=0.0104). Frequent users of the emergency department used more outpatient and inpatient services. On the other hand, there were patients with mild diseases who used the hospital emergency department rather than using outpatient clinic services. Thus, it is necessary to improve the public perception of and strengthen the role of primary medical institutions in order to reduce the wastage of national medical finances caused by the excessive use of emergency medical services by non-emergency patients as well as to provide medical services to emergency patients at the appropriate time.
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