도시지역의료보험 및 의료전달체계 실시가 일 삼차진료기관에 미친 영향

Abstract

[한글]

이 연구는 1989. 7. 1부터 실시된 도시지역의료보험 및 의료전달체계 실시가 의료기관에 미친 영향을 파악하기 위하여 일 삼차진료기관에서 1988년 10월부터 1989년 3월과 1987년10월부터 1990년 3월까지 행해진 의료이용량과 진료수입을 중심으로 비교하는 방법을 통하여 얻어진 결과는 다음과 같다.

1. 외래이용자는 의료전달체계실시전에 비해 8.8% 감소되었는데 그중 초진이용자는 26.1% 재진이용자는 5.1%감소하였다. 이를 의료전달체계 적용군과 의료전달체계예외군으로 나누어 볼 때 적용군에서는 초진 재진 공히 감소되었고 예외군에서는 증가하였다. 특히 가정의학과의 경우 배에 가깝게 증가하여 1차진료전문의를 육성할려는 정책에 긍적적인 결과를 보였다.

2. 입원이용자는 의료전달체계실시전에 비해 2.8% 증가되었다. 진료과별로는 특별한 점은 발견되지 않았으나 의료보험 종별로는 의료보험관리공단 가입자들이 더 감소하였다.

3. 입원이용자의 평균재원기간에는 변화가 없었으나 의료전달체계 적용군에서는 감소하고 예외군에서는 증가하는 현상을 보였다.

4. 응급실이용환자의 입원이 22.8% 증가하였다.

5. 진료수입은 입원이 14.8% 외래가 17.O% 증가하였다.

6. 비급여부분수입은 별 변화가 없었다.

이상과 같은 결과를 볼 때 3차진료기관의 외래이용환자수는 감소하여 의료전달체계실시가 직접적으로 영향을 미쳤음을 알 수 있고 앞으로 연구대상 병원을 좀 더 많이 선정하여 의료기관등급별로 심층적 분석과 충분한 기간을 두고 계속 비교 연구가 이루어져야 할

것으로 생각된다.

[영문]

The aim of this study examine the infuence of urban regional insurance and the medical delivery system after July 1. 1989.

The sample of this study was a third class medical institution and its degree of medical utilization and medical income are compared in this study from October 1988 to March 1989 and from October 1989 to March 1990. The results were as follows.

1. The number of outpatient was reduced by a total 8.8% after execution of the medical delivery system, among them, first - visit patients were reduced by 26.5% and second-visit patients are reduced by 5.1%. When the medical delivery system was divided into applied and execeptive groups, the applies group of the medical delivery system showed a decrease in both first- visit and second- visit patients and the exceptive group showed an increase both. Especially, in case of, Family medicine increase tow times in exceptive group's patients therefore ,the policy of

rearing about first medical specialist except to show positive results.

2. The number of inpatients was increased more than 2.8% after execution of the medical delivery system each part of clinic dose not find any specialty but in sort of medical insurance, The number of beneficiaries of Korea Medical Insurance Corporation, was more decreased than those of other medical insurance.

3. The average length of hospital stay did not change, although the applied group of the medical delivery system decreased and the exceptive group of medical delivey system increased.

4. The number of inpatients for medical utilization of the emergency room increased 22.8%.

5. Medical care income increased in 14.8% of inpatients and 17.0% of outpatients.

6. Uncovered insurance fees scarcely changed.

As the same above results, the number of utilization of the third medical institution decreased, execution of medical delivery system was received the effect directly.

The hospital for this study do not select much and a comparative studs does not execute in classification of medical institution. I think that a continuing comparative examination should be accomplished in the future.