보건학과/석사[한글]
공·교 의료보험에서 시행중인 피보험자 건강진단을 수검받은 검진군과 수검받지 않은 비검진군의 의료이용 크기와 진료비 지출액을 비교 분석하기 위하여 본 연구를 시행하였다. 연구대상은 의료보험 관리공단 피보험자중 1984년도와 1986년도 건강진단을 2회 모두
수검받은 670,015명과 2회 모두 수검받지 않은 4,674명을 연구 대상으로 정하고 비검진군과 검진군을 1:3으로 짝지어 18,696명의 표본을 뽑아 1985년 1일부터 86년 12월 31 일까지 의료이용 크기와 진료비 지출액을 비교하였다.
분석은 변수별 분포상황을 보기 위해 X**2 검정을, 의료이용 크기와 진료비 지출을 비교하기 위해서 군간의 변수별 비교는 t검정을, 군내 변수별 비교는 단순분류 분산분석 (one-way ANOVA)을, 두 군간의 변수별 비교는 이중분류 분산분석 방법(two-way ANOVA)을 하였다. 연구결과는 아래와 같다.
1. 1인당 평균 수진률은 검진군이 2.5회, 비검진군이 2.1회 였고, 진료기간은 검진군이 15.2일, 비검진군이 19.1일 이었다.
2. 1인당 평균 총진료비는 검진군이 48,600원, 비검진군이 77,500원 이었고, 보험급여비는 검진군이 32,500원, 비검진군이 53,700원 이었다.
3. 1인당 평균 외래 진료횟수는 검진군이 2.3회, 비검진군이 1.8 회 였고, 1인당 평균 입원진료횟수는 검진군이 0.04회, 비검진군이 0.09회 였다.
4. 1인당 평균 병원이용횟수는 검진군이 0.68회, 비검진군이 1.00회 였고, 1인당 평균 의원이용횟수는 검진군이 1.63회, 비검진군이 0.90회 였다.
5. 질환별 1인당 평균 수진률은 폐결핵은 검진군이 2.2회, 비검진군이 3.2회, 본태성 고혈압은 검진군이 2.2회, 비검진군이 2.4회, 당뇨병은 검진군이 2.6회, 비검진군이 2.7회, 간질환은 검진군이 2.0회, 비검진군이 3.0회 였다.
6. 질환별 1인당 평균 진료기간은 폐결핵은 검진군이 37.4일, 비검진군이 69.6일, 본태성 고혈압은 검진군이 30.6일, 비검진군이 42.9일, 당뇨병은 검진군이 28.9일, 비검진군이 43.6일, 간질환은 검진군이 26.4일, 비검진군이 60.3일 이었다.
7. 질환별 1인당 평균 총진료비는 폐결핵은 검진군이 71,000원 비검진군이 180,400원, 본태성 고혈압은 검진군이 50,600원, 비검진군이 108,300원, 당뇨병은 검진군이 91,600원, 비검진군이 182,800원, 간질환은 검진군이 99,000원, 비검진군이 196,800원 이었다.
8. 질환별 1인당 평균 보험급여비는 폐결핵은 검진군이 45,400원, 비검진군이 123,800원, 본태성 고혈압은 검진군이 31,000원, 비검진군이 69,500원, 당뇨병은 검진군이 65,300원, 비검진군이 114,500원, 간질환은 검진군이 65,800원, 비검진군이 126,400원 이었다.
이상의 결과를 종합하면 검진군과 비검진군의 의료이용 횟수와 진료비 지출에 차이가 있었으며, 그 차이는 반드시 검진의 효과로 볼 수는 없으나 예방사업의 효과와 일치하는 결과를 얻었다. 따라서 예방사업의 효과를 보다 객관적으로 평가하기 위해서는 체계적이
고 구체적인 측정방법의 개발과 새로운 연구가 필요하다.
[영문]
This is a study of comparison on medical care utilization rates, costs, patterns and types of medical care facilities between the two groups who received and did not receive the regular physical examination required by Health Insurance for Government and Private School Employees from January 1, 1985 to December 31 ,1986. The differences in medical care utilization rates and costs for the four diseases such as pulmonary tuberculosis, essential hypertension, diabetes mellitus and liver
diseases were also compared.
A total of 4,674 insureds in the non-examined group and 14,022 insureds in the examined group were studied. The samples of the two groups were taken by matching sex, age and income. Statistically significant variables were identified by X**2
test, which in turn entered t-test, one-way and two-way ANOVA between the two groups.
The results of this study are summed up as follows:
1. The average medical care utilization rates per insured person for two years were 2.5 times in the examined group and 2.1 times in the non-examined group. The average total treatment periods per insured person for two years were 15.2 days in the examined group and 19.1 days in the non-examined group.
2. The average total medical care costs per insured person for two years were W48,600 in the examined group and W77,500 in the non-examined group. The average costs for the insurer's share per insured person for two years were W32,500 in the examined group and W53,700 in the non-examined group.
3. The average out-patient utilization rates per insured person for two years were 2.3 times in the examined group and 1.8 times in the non-examined group. The average in-patient utilization rates per insured person for two years were 0.04 times in the examined group and 0.09 times in the non-examined group.
4. The average hospital utilization rates per insured person for two years were 0.68 times in the examined group and 1.00 times in the non-examined group. The average clinic utilization rates per insured person for two years were 1.63 times in the examined group and 0.90 times in the non-examined group.
5. The average medical care utilization rates of the four diseases per insured person for two years, between examined and non-examined groups were 2.2 times and 3.2 times in pulmonary tuberculosis, 2.2 times and 2.4 times in essential hypertension, 2.6 times and 2.7 times in diabetes mellitus and 2.0 times and 3.0 times in viral hepatitis, chronic liver disease and cirrhosis, respectively.
6. The average total treatment periods of the four diseases per insured person for two years, between examined and non-examined groups were 37.4 days and 69.6 days in pulmonary tuberculosis, 30.6 days and 42.9 days in essential hypertension, 28.9 days and 43.6 days in diabetes mellitus and 26.4 days and 60.3 days in viral hepatitis, chronic liver disease and cirrhosis, repectively.
7. The average total medical care costs for the four diseases per insured person for two years, between examined and non-examined groups were W71,000 and W18O,400 in pulmonary tuberculosis, W5O,600 and W1O8,300 in essential hypertension, W9l.600 and Wl82,800 in diabetes mellitus and W99,600 and Wl96,800 in viral hepatitis, chronic liver disease and cirrhosis, respectively.
8. The average costs for the insurer's share of the four diseases per insured person for two years, between examined and non-examined groups were W45,400 and Wl23,800 in pulmonary tuberculosis, W3l,000 and W69,500 in essential hypertension,
W65,300 and Wll4,500 in diabetes mellitus and W65,800 and Wl26,400 in viral hepatitis, chronic liver disease and cirrhosis, repectively.
All results showed statistically significant differences between the two groups in medioal care utilization. While these findings were not necessarily resulted from the preventive measure, but they showed positive outcomes usually resulted
from the successful prevention programs. Further studies for objective evaluation of preventive effects, development of systematic and valid instrument to measure the effects are needed to prove real effects of the program.prohibitio
