학술논문
의료급여 수급 여부가 예방가능한 입원에 미치는 영향: 한국의료패널조사를 중심으로
The Effect of Medical aid Benefit on Preventable Hospitalization: Analysis of the Korean Medical Panel Survey
The Effect of Medical aid Benefit on Preventable Hospitalization: Analysis of the Korean Medical Panel Survey
Document Type
Article
Author
Source
보건경제와 정책연구(구 보건경제연구) / Korean Health Economic Review. Dec 31, 2021 27(4):1
Subject
Language
Korean
ISSN
1738-7302
Abstract
이 연구에서는 한국의료패널 조사자료를 이용해 의료급여 수급자와 건강보험 가입자의 의료 이용 현황을 비교하고, 의료급여 수급 여부가 예방가능한 입원에 미치는 영향을 분석하였다. 2016-2018년 3개 연도에 대한 불균형패널데이터를 활용했으며 두 그룹의 건강위험을 유사하게 맞추기 위해 성, 연령, 장애유무, 동반상병지수를 활용한 성향점수매칭을 통해 수급자와 건강보험 가입자를 1:3으로 매칭하여, 최종 분석대상 관측치는 5,648(의료급여 1,412, 건강보험 4,236)이었다. 예방가능한 입원은 외래의료민감질환으로 인한 입원으로 정의했다. 분석 결과, 의료급여 군에서 외래방문 횟수, 입원율, 연간입원일수가 유의하게 높았으며, 예방가능한 입원율 역시 유의하게 높았다. 회귀분석을 통해 소인성 요인, 가능 요인, 필요 요인을 보정한 후에도, 의료급여 수급자에서 예방가능한 입원이 통계적으로 유의하게 높은 것으로 나타났다. 소득하위 20% 및 만성질환자군 내에서도 동일한 양상이 나타났으며, 다만 당뇨환자 내에서는 의료급여 수급여부가 예방가능한 입원에 유의미한 영향을 미치지 않았다. 추가적으로, 의료급여와 경제적 이유로 인한 미충족의료 경험 사이의 교호작용은 음의 방향으로 나타났는데 이러한 조절효과는 의료급여자의 치료 지연 등과 관련이 있을 수 있다. 이 연구는 의료급여군에서 예방가능한 입원이 더 많이 발생하는 상황을 분석함으로써, 의료급여 수급자에게 제공되는 일차의료의 질이 개선될 필요가 있음을 실증적으로 보여주었다는 데에 의미가 있다
In this study, we analyzed the impact of the medical aid benefit on preventable hospitalization using the Korea Medical Panel 2016-2018. We adopted propensity score matching method using gender, age, disability, and co-morbidity indices to focus on the effects of medical aid benefits under similar health risks, and the final participants were 5,648 (1,412 Medical aid, 4,236 National Health Insurance). Preventable hospitalization was defined as hospitalization due to Ambulatory Care Sensitive Conditions (ACSCs). The analysis results showed that the number of outpatient visits, hospitalization rate, annual hospitalization days, and preventable hospitalization rate were significantly higher in the medical aid group. Panel regression showed that preventable hospitalization was significantly higher among the medical aid group, even after adjusting predisposing, enable, and need factors. We found the same pattern within the lower 20% of income level and patients with chronic conditions, but not in the diabetic patients. Additionally, the unmet healthcare needs for economic reasons attenuated the effect of medical aid, in which preventable hospitalization was increasing. Assuming that preventable hospitalization due to ACSCs represent the quality of primary care, medical aid recipients are not guaranteed the quality of care, even though they use more outpatient services. This study is meaningful in that it demonstrated the necessity of improving the quality of health care in the medical aid group based on empirical analysis.
In this study, we analyzed the impact of the medical aid benefit on preventable hospitalization using the Korea Medical Panel 2016-2018. We adopted propensity score matching method using gender, age, disability, and co-morbidity indices to focus on the effects of medical aid benefits under similar health risks, and the final participants were 5,648 (1,412 Medical aid, 4,236 National Health Insurance). Preventable hospitalization was defined as hospitalization due to Ambulatory Care Sensitive Conditions (ACSCs). The analysis results showed that the number of outpatient visits, hospitalization rate, annual hospitalization days, and preventable hospitalization rate were significantly higher in the medical aid group. Panel regression showed that preventable hospitalization was significantly higher among the medical aid group, even after adjusting predisposing, enable, and need factors. We found the same pattern within the lower 20% of income level and patients with chronic conditions, but not in the diabetic patients. Additionally, the unmet healthcare needs for economic reasons attenuated the effect of medical aid, in which preventable hospitalization was increasing. Assuming that preventable hospitalization due to ACSCs represent the quality of primary care, medical aid recipients are not guaranteed the quality of care, even though they use more outpatient services. This study is meaningful in that it demonstrated the necessity of improving the quality of health care in the medical aid group based on empirical analysis.