목적: 상용치료원(usual source of care)은 아프거나 건강문제에 대한 조언이 필요할 때 주로 방문하는 특정 개인의원, 보건소, 혹은 기타 장소로, 상용치료원 보유는 예방서비스를 제공을 더 받게 되며, 보건의료에 대한 전반적인 만족도가 높고, 입원율을 감소시키며 의료급여자의 의료비를 감소시킬 수 있다. 이 연구에서는 당뇨병을 보유하고 있는 20세 이상을 대상으로 상용치료원 보유 여부에 따른 대상자의 현황을 파악하고, 의료이용 횟수 및 의료비의 차이와 이에 영향을 미치는 특성을 분석하였다. 방법: 이 연구는 제7차 한국의료패널 자료를 이용하였다. 상용치료원 보유여부에 따른 의료이용 횟수와 의료비를 비교하기 위해 분산분석을 실시하였으며, 상용치료원 유형에 따른 의료이용 횟수와 의료비용에 영향을 미치는 요인을 파악하기 위해 Tobit 분석을 수행하였다. 결과: Tobit 분석결과, 상용치료원을 보유한 경우 보유하지 않은 경우보다 외래의료비는 증가했으나 입원의료비는 감소하였다. 상용치료원을 보유한 경우 보유하지 않은 경우보다 외래이용횟수와 입원횟수가 증가했으나 통계적으로 유의하지 않았다. 함의: 지속적이고 포괄적인 의료서비스가 제공되는 상용치료원을 당뇨병 환자들이 보유하게 되면, 외래 예방서비스의 이용을 통해 장기적으로 입원의료비의 감소를 기대할 수 있을 것이다.
목적: 상용치료원(usual source of care)은 아프거나 건강문제에 대한 조언이 필요할 때 주로 방문하는 특정 개인의원, 보건소, 혹은 기타 장소로, 상용치료원 보유는 예방서비스를 제공을 더 받게 되며, 보건의료에 대한 전반적인 만족도가 높고, 입원율을 감소시키며 의료급여자의 의료비를 감소시킬 수 있다. 이 연구에서는 당뇨병을 보유하고 있는 20세 이상을 대상으로 상용치료원 보유 여부에 따른 대상자의 현황을 파악하고, 의료이용 횟수 및 의료비의 차이와 이에 영향을 미치는 특성을 분석하였다. 방법: 이 연구는 제7차 한국의료패널 자료를 이용하였다. 상용치료원 보유여부에 따른 의료이용 횟수와 의료비를 비교하기 위해 분산분석을 실시하였으며, 상용치료원 유형에 따른 의료이용 횟수와 의료비용에 영향을 미치는 요인을 파악하기 위해 Tobit 분석을 수행하였다. 결과: Tobit 분석결과, 상용치료원을 보유한 경우 보유하지 않은 경우보다 외래의료비는 증가했으나 입원의료비는 감소하였다. 상용치료원을 보유한 경우 보유하지 않은 경우보다 외래이용횟수와 입원횟수가 증가했으나 통계적으로 유의하지 않았다. 함의: 지속적이고 포괄적인 의료서비스가 제공되는 상용치료원을 당뇨병 환자들이 보유하게 되면, 외래 예방서비스의 이용을 통해 장기적으로 입원의료비의 감소를 기대할 수 있을 것이다.
Purposes: Diabetes is a metabolic disorder that requires continuous care in order to prevent complications, as it can impose a critical burden on families and society due to various complications, including terminal renal failure, non-traumatic lower extremity amputation, and adult blindness. The us...
Purposes: Diabetes is a metabolic disorder that requires continuous care in order to prevent complications, as it can impose a critical burden on families and society due to various complications, including terminal renal failure, non-traumatic lower extremity amputation, and adult blindness. The usual sources of care are "specified private clinics, public health centers, or other facilities to visit when ill or when health-related advice is needed". These usual sources of care offer preventative services, have a high overall satisfaction rate in terms of public health care, and decrease the inpatient rates and medical costs of medical aid recipients. This study analyzed the current status of diabetic patients over 20 years of age based on their possession of a usual source of care, and the effects of this possession on the frequency of their medical service usage and its costs. Methodology: Based on data from the 7th Korea Health Panel, a Tobit analysis was used to analyze the different factors that can affect the frequency of medical service usage and its costs for diabetic patients with and without a usual source of care. Findings: The medical costs of diabetic patients with a usual source of care decreased in terms of inpatient, and the outpatient visits and inpatient costs of the group with a usual source of care in the form of a mainly-visiting doctor decreased more than those of the group with a mainly-visiting medical institution only. Practical Implications: Having a usual source of care can increase the treatment continuity, leading to reduced inpatient, and having a mainly-visiting doctor as the usual source of care further increases the treatment continuity. Based on these results, a new policy is needed to increase and strengthen diabetic patients? possession of a usual source of care.
Purposes: Diabetes is a metabolic disorder that requires continuous care in order to prevent complications, as it can impose a critical burden on families and society due to various complications, including terminal renal failure, non-traumatic lower extremity amputation, and adult blindness. The usual sources of care are "specified private clinics, public health centers, or other facilities to visit when ill or when health-related advice is needed". These usual sources of care offer preventative services, have a high overall satisfaction rate in terms of public health care, and decrease the inpatient rates and medical costs of medical aid recipients. This study analyzed the current status of diabetic patients over 20 years of age based on their possession of a usual source of care, and the effects of this possession on the frequency of their medical service usage and its costs. Methodology: Based on data from the 7th Korea Health Panel, a Tobit analysis was used to analyze the different factors that can affect the frequency of medical service usage and its costs for diabetic patients with and without a usual source of care. Findings: The medical costs of diabetic patients with a usual source of care decreased in terms of inpatient, and the outpatient visits and inpatient costs of the group with a usual source of care in the form of a mainly-visiting doctor decreased more than those of the group with a mainly-visiting medical institution only. Practical Implications: Having a usual source of care can increase the treatment continuity, leading to reduced inpatient, and having a mainly-visiting doctor as the usual source of care further increases the treatment continuity. Based on these results, a new policy is needed to increase and strengthen diabetic patients? possession of a usual source of care.
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문제 정의
Based on the 2012 Korea Health Panel survey data, this study set out to examine the medical service usage and medical costs of diabetic adults over 20 years of age according to their possession of a USC. The subject characteristics were then compared, and the difference in the distribution of medical service usage and medical costs was analyzed.
The Korea Health Panel has been conducted annually since 2008. It contains comprehensive information about medical visit types and costs and the factors affecting them. Therefore, it served as an in-depth data source for this study.
Therefore, this study evaluated the major factors affecting the outpatient visits, inpatient, and medical costs of diabetic patients with a USC based on a Korea Health Panel dataset representative of the Korean population.
제안 방법
The study subjects were classified into three groups: has a mainly-visiting doctor, has a mainlyvisiting medical institution only, has neither a mainly-visiting medical institution nor a mainlyvisiting doctor. A simple statistical analysis including a frequency analysis and percentage was then conducted to evaluate the distribution of the study subjects based on the sociodemographic characteristics, self-reported health status, medical security, and private insurance of each group. An analysis of variance was conducted to compare the differences in the average frequency of medical service usage and average medical costs based on whether the subjects had a USC or not.
A simple statistical analysis including a frequency analysis and percentage was then conducted to evaluate the distribution of the study subjects based on the sociodemographic characteristics, self-reported health status, medical security, and private insurance of each group. An analysis of variance was conducted to compare the differences in the average frequency of medical service usage and average medical costs based on whether the subjects had a USC or not. Frequency analysis was performed for USC possession status of patients with diabetes and in order to simply analyze difference by each feature for medical service using frequency and medical expenses based on USC possession status of patients with diabetes, KruskalWallis was performed.
Frequency analysis was performed for USC possession status of patients with diabetes and in order to simply analyze difference by each feature for medical service using frequency and medical expenses based on USC possession status of patients with diabetes, KruskalWallis was performed. In order to analyze an effect of USC possession status of patients with diabetes on medical service using frequency and medical expenses after considering an effect of other features, Tobit analysis was performed. The tobit analysis is designed to estimate linear relationships between variables when there is censored in the dependent variable.
In this study, the variables related to diabetes and the USC were selected based on previous studies about the effects of having a USC on medical visits and their costs[19] and the factors of diabetes prevalence[21,22]. In order to evaluate the medical service usage and its cost depending on the possession of a USC, the medical service usage, frequency of medical service usage, and costs were selected as dependent variables. Sociodemo-graphic characteristics including the gender, age, marital status, medical security, private insurance, and health behavior, and the medical institution types (the USC type) were selected as independent variables.
In this study, the variables related to diabetes and the USC were selected based on previous studies about the effects of having a USC on medical visits and their costs[19] and the factors of diabetes prevalence[21,22]. In order to evaluate the medical service usage and its cost depending on the possession of a USC, the medical service usage, frequency of medical service usage, and costs were selected as dependent variables.
The Korea Health Panel is a survey conducted by the Korea Institute for Health and Social Affairs and the National Health Insurance Service. It includes detailed information about the individual, the socioeconomic characteristics of the household, and the medical visits and costs of around 8,000 households and household members from 350 nation-wide enumeration districts extracted as a representative sample of the population using a 2-level proportionate probability stratified sampling and cluster sampling method. The Korea Health Panel has been conducted annually since 2008.
Based on the 2012 Korea Health Panel survey data, this study set out to examine the medical service usage and medical costs of diabetic adults over 20 years of age according to their possession of a USC. The subject characteristics were then compared, and the difference in the distribution of medical service usage and medical costs was analyzed. Furthermore, the different factors that could affect the medical service usage and medical costs according to the possession of a USC were analyzed.
This study encompassed different variables that affect the medical service usage and medical expenditure of diabetes patients, using Korea Health Panel data representative of the nationwide population to analyze subdivided groups of USC users, including those with a mainly-visiting doctor and a mainly-visiting medical institution. Nonetheless, the study presented certain restrictions.
This study is considered beneficial in that it used systematically-collected data representative of the nationwide population from the Korea Health Panel to allow for proper generalization of the research results. Moreover, due to certain restrictions, there has been scarce research on the different factors that can affect the medical service usage and medical costs of diabetic patients according to the possession of a USC.
대상 데이터
After excluding those who had responded "not applicable to USC" in the USC survey, 555 final subjects were chosen.
The 2012 Korea Health Panel collected data from 15,872 people. This study selected 599 adults over 20 years of age with diabetes (ICD-10 E10~E14) as its subjects. After excluding those who had responded "not applicable to USC" in the USC survey, 555 final subjects were chosen.
This study used data from the 7th Korea Health Panel. The Korea Health Panel is a survey conducted by the Korea Institute for Health and Social Affairs and the National Health Insurance Service.
성능/효과
This seems to have sprung from the lack of information at the time of the survey, and the operational definition of the USC needs to be accurately explained to the participants. Second, reporting biases may have appeared for the dependent variables, as the frequency of medical service usage and the out-of-pocket expenditure were reported from memory. Third, the severity of the diabetic patientsʼ condition was not taken into account.
05). Smoking-wise, current smokers had a lower frequency of medical service usage than former smokers, and a better self-reported health status decreased the frequency of medical service usage (p˂0.05).
The control factors for the frequency of medical service usage showed that in terms of sociodemographic variables, male subjects had a higher frequency of usage of all types of medical services but a lower inpatient rate than female subjects. Age-wise, the frequency of medical service usage was significantly lower in the younger age groups (p˂0.
However, the continuity of medical service usage, which is a similar concept to the USC, has been studied. The results have shown that a higher continuity of outpatient usage led to decreased inpatient rates and medical costs. However, contradicting studies[19,20] about medical visits and the medical cost expenditure of chronic disease patients with a USC showed that having a USC increased outpatient visits and medical costs.
Table 4 shows the effects of the possession of a USC on the medical costs. The results show that the outpatient costs were higher in the group with a USC than in the group without it, but that their inpatient costs were reduced with statistical significance (outpatient p˂0.01, inpatient p˂0.01). Moreover, the outpatient and inpatient medical costs were lower in the group with a mainly-visiting doctor as their USC than in that with a mainly-visiting medical institution only.
This increase in diabetes-related medical costs deepens the burdens of health insurance, medical aid funds, and personal budget. Therefore, the study showed that if the possession of a USC were promoted to provide consistent and comprehensive care in order to control diabetes, the medical costs of inpatient could be reduced by offering outpatient preventative services.
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