[논문]한국의 의료기관 외래진료 민감질환 입원율: 의료이용 효율성 지표로의 활용 가능성?

정건작; 김진경; 강혜영; 신의철

doi:10.4332/kjhpa.2016.26.1.4

한국의 의료기관 외래진료 민감질환 입원율: 의료이용 효율성 지표로의 활용 가능성?
Hospital Admission Rates for Ambulatory Care Sensitive Conditions in South Korea: Could It Be Used as an Indicator for Measuring Efficiency of Healthcare Utilization? 원문보기

Health policy and management = 보건행정학회지, v.26 no.1, 2016년, pp.4 - 11

정건작 (가톨릭대학교 의과대학 예방의학교실) , 김진경 (건양대학교 병원경영학과) , 강혜영 (연세대학교 약학대학) , 신의철 (가톨릭대학교 의과대학 예방의학교실)

Abstract ▼ AI-Helper

Background: Hospital admissions for ambulatory care sensitive conditions (ACSCs), which are widely used as an indicator of poor access to primary care, can be used as an efficiency indicator of healthcare use in countries providing good access to health care. Korea, which has a national health insurance (NHI) system and a good supply of health care resources, is one such country. To quantify admission rates of ACSC and identify characteristics influencing variation in Korean health care institutions. Methods: By using NHI claims data, we computed the mean ACSC admission rate for all institutions with ACSC admissions. Results: The average ACSC admission rate for 4,461 institutions was 1.45%. Hospitals and clinics with inpatient beds showed larger variations in the ACSC admission rate (0%-87.9% and 0%-99.6%, respectively) and a higher coefficient of variation (7.96 and 2.29) than general/tertiary care hospitals (0%-19.1%, 0.85). The regression analysis results indicate that the ACSC admission rate was significantly higher for hospitals than for clinics (${\beta}=0.986$, p<0.05), and for private corporate institutions than public institutions (${\beta}=0.271$, p<0.05). Conclusion: Substantial variations in ACSC admission rates could suggest the potential problem of inefficient use of healthcare resources. Since hospitals and private corporate institutions tend to increase ACSC admission rates, future health policy should focus on these types of institutions.

주제어

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문제 정의

In this regard, this study quantifies the ACSC admission rate for individual health care institutions in Korea to provide important insights into the potential problem of the inefficient use of healthcare resources in the context of ACSC admissions. In addition, the study identifies the factors influencing variation in ACSC admission rate across health care institutions to provide important policy implications.
In this regard, this study quantifies the ACSC admission rate for individual health care institutions in Korea to provide important insights into the potential problem of the inefficient use of healthcare resources in the context of ACSC admissions. In addition, the study identifies the factors influencing variation in ACSC admission rate across health care institutions to provide important policy implications.

제안 방법

5% of all admissions in an acute care hospital in Italy [25]. Finally, the conditions included in KACSCs differed from those in the US version of ACSCs or in country-specific ACSCs because we modified the list of KACSCs to reflect the patterns of ACSC treatment in Korea.
The level of care and the ownership type had significant coefficients, further demonstrating the effects of organizational characteristics on the ACSC admission rate. The ACSC admission rate was higher for those institutions providing a high level of care (i.
We took the natural log of the ACSC admission rate to reduce the effects of out liers. To prevent missing values assigned t o institutions with no ACSC admissions as a result of the log transformation, we added 1% to the ACSC admission rate before taking the natural log. We analyzed the data by Stata ver.

대상 데이터

Major data source of the study was the national health insurance (NHI) claims data in 2004. Study subjects include health care institutions that have filed any inpatient or outpatient insurance claims of KACSCs as a primary diagnosis in 2004. We initially identified a total of 4,469 institutions but excluded those with only inpatient claims for ACSC cases (n=8).
We considered these institutions as outliers because health care institutions are not likely to treat all ACSC cases through inpatient care. Thus, the final sample included 4,461 institutions.

성능/효과

59) forgeneral/tertiary care hospitals (Table 2). Clinics and hospitals showed large variations in the ACSC admission rate (0%-87.9%and 0%-99.6%, respectively) and high CV values (7.96 and 2.29, respectively). However, general/tertiary care hospitals showed small variations and a low CV value (0%-19.
Its implication is not straightforward to tell whether this is high enough to bring an attention because of the following reasons. First, no objective criterion has been proposed to judge how high the ACSC admissions rate is problematic. Second, we cannot compare the result directly with the rates for other countries because the ACSC admission rate for other countries is typically calculated based on a unit of analysis such as the geographic region (e.
However, we found substantial variations in the ACSC admission rate across the health care institutions, which indicate the possible overuse of inpatient services for ACSCs. The regression analysis results indicate that organizational characteristics were a significant predictor of variations in the ACSC admission rate. The results of stepwise modeling verify the regression results.
The result of the present study supports the potential problem of inefficient use of health care resources of Korean health care system, which can be characterized as NHI scheme with fee-for-service reimbursement system, lack of gate keeping, primary and secondary care co-located, and lack of organizational barrier. It is hard to conclude which characteristics of the Korean healthcare system are attributable to the problem.

후속연구

It is hard to conclude which characteristics of the Korean healthcare system are attributable to the problem. However, it is hoped that the result of this study can be utilized to emphasize the need for an appropriate health policy to improve the efficient use of healthcare resources in Korea.
First, because of limited access to patient-level data from NHI records, we employed demographic and socioeconomic characteristics of residents in regions where health care institutions were located as proxies for population factors. Second, for the same reason, we could not control for differences in the patient case-mix across institutions in the multivariate analysis, which otherwise would have increased the validity of the findings.
8% confidence interval), indicating that the variation is not natural or random variation, but special cause variation (Figure 1) [20,21]. Thus, the cause of the variation would be worth for further investigation.

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