[논문]상용치료원 보유가 의료기관 종별 선택에 미치는 영향: 대형병원 환자집중현상 완화방안을 중심으로

김두리

doi:10.4332/kjhpa.2016.26.2.195

상용치료원 보유가 의료기관 종별 선택에 미치는 영향: 대형병원 환자집중현상 완화방안을 중심으로
The Effect of Having Usual Source of Care on the Choice among Different Types of Medical Facilities 원문보기

Health policy and management = 보건행정학회지, v.26 no.3, 2016년, pp.195 - 206

Abstract ▼ AI-Helper

Background: Concentration of patients to large hospitals is serious problem in Korea. The purpose of this paper is to propose appropriate policy direction to relieve concentration of patients to large hospitals. It is focused on evaluation of the possibility of family doctor system as a policy alternative to relieve concentration of patients to large hospital by empirically analyzing the effect of usual source of care (USC) on large hospitals medical care use. Methods: Korea Health Panel conducted 2009, 2012, 2013 by KIHASA (Korea Institute for Health and Social Affairs) and NHIS (National Health Insurance Service) was used for analysis. For dependent variables, first, the ratio of the amount of using large hospital to total amount of using medical care, and second, the amount of using large hospital are estimated. Independent variables are having an USC and type of USC. Panel analysis was done with above variables. Results: Main results are as follows. First, having an USC increases using large hospital. Second, having a domestic clinic type USC decreases using large hospital and ratio of using large hospital. Third, the effect of domestic clinic type USC is greater in older group, less income group, worse health status group, not having private insurance group, and having chronic disease group. Conclusion: These results show that family doctor program can be a policy alternative to relieve concentration of patients to large hospital. Nonetheless, primary care system in Korea is unsatisfied. It is recommended to reinforce primary care system and family doctor system to relieve concentration of patients to large hospitals.

주제어

질의응답

핵심어	질문	논문에서 추출한 답변
	World Health Organi-zation(WHO)을 정의하면?	이와 같은 대형병원 환자집중현상은 의료자원의 낭비, 의료의질 저하 등의 문제를 야기할 수 있으며, 특히 일차의료의 붕괴를 초래할 수 있다는 점에서 심각한 문제가 된다. World Health Organi-zation (WHO)는 ‘일차보건의료’라는 개념을 보건 및 사회경제분 야의 핵심 부분으로 보건의료체계의 중심적 기능을 담당하여 질병치료뿐 아니라 건강증진, 예방, 치료 및 재활 등의 서비스까지 통합된 보건의료제공체계라고 정의하고 있다[3]. 때문에 일차의료의 붕괴는 비단 일차의료 공급자뿐 아니라 지역사회 전체에까지 그 영향이 미칠 수 있다.
	대형병원의 환자집중현상은 어떤 문제를 초래하는가?	이와 같은 대형병원 환자집중현상은 의료자원의 낭비, 의료의질 저하 등의 문제를 야기할 수 있으며, 특히 일차의료의 붕괴를 초래할 수 있다는 점에서 심각한 문제가 된다. World Health Organi-zation (WHO)는 ‘일차보건의료’라는 개념을 보건 및 사회경제분 야의 핵심 부분으로 보건의료체계의 중심적 기능을 담당하여 질병치료뿐 아니라 건강증진, 예방, 치료 및 재활 등의 서비스까지 통합된 보건의료제공체계라고 정의하고 있다[3].
	대형병원 환자집중현상 완화정책의 목적은 의료이용량 자체의 감소가 아닌, 대학병원 의료 수요를 의료기관으로 이동시킨다는 것의 근거는 무엇인가?	한편 대형병원 환자집중현상 완화정책의 목적은 대형병원 의료 수요를 의원급 의료기관으로 이동시키는 것이지 의료이용량 자체의 감소가 아니라는 사실을 기억해야한다. 의료이용량이 감소할 경우 미충족의료가 발생할 수 있고, 상대적으로 취약계층이 우선적으로 미충족의료에 노출될 가능성이 높기 때문이다. 때문에 의원급 상용치료원의 대형병원 이용 감소효과가 잉여 의료를 감소시킨 것인지, 의료수요를 의원급 의료기관으로 이동시킨 것인지, 혹은 미충족의료를 발생시킨 것인지에 대한 고찰이 필요하다.

참고문헌 (35)

Health Insurance Review and Assessment Service. Medical care benefit statistics by provider types. Wonju: Health Insurance Review and Assessment Service; 2014.
Lee SS. Medical delivery system TF data. Sejong: Ministry of Health and Welfare; 2009.
World Health Organization. Primary health care: report of the International Conference on Primary Health Care, Alma-Alta, USSR 6-12 September 1978. Geneva: World Health Organization; 1978.
Nars pending issue paper, 2009
Sung NJ, Lee GO. Cognition of medical service quality by USC types and primary medicine function in Korea. Proceedings of the 6th Korea Health Panel Conference; 2014 Dec 12; Seoul, Korea. Sejong: Korea Institute for Health and Social Affairs; 2014.
Starfield B. Is primary care essential? Lancet 1994;344(8930):1129-1133.

상세보기
Lim HS, Lee JH, Choi YJ. The relationship between family doctor quality and hospitalization and use of emergency room. Proceedings of the 6th Korea Health Panel Conference; 2014 Dec 12; Seoul, Korea. Sejong: Korea Institute for Health and Social Affairs; 2014.
Chai YS, Lee JK, Park SS, Kim HJ, Kang IG, Kim HS, et al. Use of emergency medical services and characteristics of urgent and non-urgent adult patients according to the usual source of care: a Korea medical expenditure panel study. J Korean Soc Emerg Med 2015;26(2):129-137.
Kim JE, Chae SM, Lee JH. The effect of primary care on medical use and health behavior of chronic disease patient. Proceedings of the 6th Korea Health Panel Conference; 2014 Dec 12; Seoul, Korea. Sejong: Korea Institute for Health and Social Affairs; 2014.
Kim M, Kwon S. The effect of outpatient cost sharing on health care utilization of the elderly. J Prev Med Public Health 2010;43(6):496-504. DOI: http://dx.doi.org/10.3961/jpmph.2010.43.6.496.

원문보기 상세보기
Byun JN, Ghang HY, Lee HB. Differential cost-sharing and utilization of outpatients care by types of medical institutions. Korea Soc Policy Rev 2014;21(2):35-55. DOI: http://dx.doi.org/10.17000/kspr.21.2.201406.35.

상세보기
Kim HJ, Kim YH, Kim HS, Woo JS, Oh SJ. The impact of outpatient coinsurance rate increase on outpatient healthcare service utilization in tertiary and general hospital. Health Policy Manag 2013;23(1):19-34. DOI: http://dx.doi.org/10.4332/kjhpa.2013.23.1.019.

원문보기 상세보기
Park HK. Impact of increasing outpatient coinsurance rate of tertiary care hospitals on outpatient utilization [master's thesis]. Seoul: Yoensei University; 2011.
Andersen R. A behavioral model of families' use of health services. Chicago (IL): Center for Health Administration Studies, University of Chicago; 1968.
Ko SJ. The effect of USC on medical use and medical costs. Proceedings of the 6th Korea Health Panel Conference; 2014 Dec 12; Seoul, Korea. Sejong: Korea Institute for Health and Social Affairs; 2014.
Kim JY, Baek SM, Jung TY. Difference in differences analysis of USC effect. Proceedings of the 6th Korea Health Panel Conference; 2014 Dec 12; Seoul, Korea. Sejong: Korea Institute for Health and Social Affairs; 2014.
Weiss LJ, Blustein J. Faithful patients: the effect of long-term physicianpatient relationships on the costs and use of health care by older Americans. Am J Public Health 1996;86(12):1742-1747. DOI: http://dx.doi.org/10.2105/ajph.86.12.1742.

상세보기
Wasson JH, Sauvigne AE, Mogielnicki RP, Frey WG, Sox CH, Gaudette C, et al. Continuity of outpatient medical care in elderly men: a randomized trial. JAMA 1984;252(17):2413-2417. DOI: http://dx.doi.org/10.1001/jama.252.17.2413.

상세보기
Dietrich AJ, Marton KI. Does continuous care from a physician make a difference? J Fam Pract 1982;15(5):929-937.

상세보기
Pati S, Shea S, Rabinowitz D, Carrasquillo O. Does gatekeeping control costs for privately insured children? Findings from the 1996 medical expenditure panel survey. Pediatrics 2003;111(3):456-460. DOI: http://dx.doi.org/10.1542/peds.111.3.456.

상세보기
Phillips RL, Dodoo MS, Green LA, Fryer GE, Bazemore AW, McCoy KI, et al. Usual source of care: an important source of variation in health care spending. Health Aff (Millwood) 2009;28(2):567-577. DOI: http://dx.doi.org/10.1377/hlthaff.28.2.567.

상세보기
Weber EJ, Showstack JA, Hunt KA, Colby DC, Callaham ML. Does lack of a usual source of care or health insurance increase the likelihood of an emergency department visit?: results of a national population-based study. Ann Emerg Med 2005;45(1):4-12. DOI: http://dx.doi.org/10.1016/j.annemergmed.2004.06.023.

상세보기
You CH, Kwon YD. Factors influencing medical institution selection for outpatient services. J Korean Med Assoc 2012;55(9):898-910. DOI: http://dx.doi.org/10.5124/jkma.2012.55.9.898.

상세보기
Lee JC, Kim KH, Kim HN, Park YH. Factors associated with the hypertension outpatients' choice of healthcare providers in Korea. J Korean Med Assoc 2011;54(9):961-970. DOI: http://dx.doi.org/10.5124/jkma.2011.54.9.961.

상세보기
Cheong CL, Lee TJ. The effect of increase in coinsurance rate for tertiary hospital visits on the choice among different types of medical facilities stratified by income levels in Korea. Korean J Health Econ Policy 2015;21(1):103-124.
Huh JH, Joe YT. Activity limitations and health behaviors by socioeconomic status among the elderly Seoul population. J Korean Gerontol Soc 2008;28(1):87-104.
Kim HL. The relationship of socioeconomic position and health behaviors with morbidity in Seoul, Korea. Health Soc Welf Rev 2005;25(2):3-35.
Kim J, Oh J, Moon O, Kwon S. Quantitative and qualitative difference in the utilization of health care: based on the survey of Gwangju-Jeonnam residents. Korean J Health Policy Adm 2007;17(3):26-49. DOI: http://dx.doi.org/10.4332/kjhpa.2007.17.3.026.

원문보기 상세보기
Lee YJ. A equity in health care utilization by health status. J Korean Assoc Soc Policy 2010;17(1):267-290.
Rhim KH, Lee JH. Income-related inequality in medical care utilization by provider types. Korean J Health Econ Policy 2010;16(2):39-56.
Lee TJ. Medical cost and health insurance policy. Proceedings of the 7th Korea Health Panel Conference; 2015 Nov 26; Seoul, Korea. Sejong: Korea Institute for Health and Social Affairs; 2015.
Shin SH. The comparison on the characteristics of medical service consumers by type of treatment institution alternatives [dissertation]. Seoul: Yeonsei University; 2000.
Clark TS, Linzer DA. Should I use fixed or random effects? Polit Sci Res Methods 2015;3(02):399-408. DOI: http://dx.doi.org/10.1017/psrm.2014.32.

상세보기
Kim DR. The effect and determinant factors of use of big hospitals of mild cases. Proceedings of the 7th Korea Health Panel Conference; 2015 Nov 26; Seoul, Korea. Sejong: Korea Institute for Health and Social Affairs; 2015.
Lee JH. Korea USC situation and medical costs. Proceedings of the 7th Korea Health Panel Conference; 2015 Nov 26; Seoul, Korea. Sejong: Korea Institute for Health and Social Affairs; 2015.

저자의 다른 논문 :

표제어: PCR

동의어: Packet Collision Rate

용어 설명 출처 목록 (6)

용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format

연합인증