최근 5년간의 보건의료자원개발예산 투자 분석 : 재특·농특예산을 중심으로

Abstract

[한글]

이 연구는 보건의료자원개발에 관한 국가보건의료정책의 흐름과 예산정책 및 집행결과의 정책적 함의를 거시적으로 파악하고자 최근 5년간 민간병원과 공공보건기관의 병상확충 및 기능보강을 위해 투입된 보건복지부소관 예산을 시계열적으로 분석하고, 형평성 및

효율성 측면에서 병원별 병상수와 병상이용률의 변화 추이를 재특·농특재원으로 늘어난 병상과 비교분석하여 다음과 같은 결과를 얻었다.

첫째, 보건복지부소관 일반회계 예산 증가율은 1996년에 19.5%로 정부 예산 증가율을 앞서고 있으며, 재특 및 농특회계 예산의 정부예산에 대한 구성비도 매년 증가 추세를 보이고 있다. 보건의료자원개발을 위한 재정지원의 연도별 추이에 있어서 공공보건기관의 시설개선 및 기능보강을 위한 일반회계 예산은 농특회계가 1994년 신설되면서 삭감되었다가 1996년에 일부 도시지역의 보건소를 지원하기 위해 다시 재편성 되었다. 또한 민간의

노인치매전문요양병원을 신축하기 위한 예산이 1996년과 1997년에 편성되었다. 보건복지부소관 재특회계 예산은 주로 민간병원의 병상확충을 위해 편성되었으며 1997년에는 전문병원 신·증축과 정신요양병원 전환을 위한 예산이 추가로 편성되었다. 또한 농특회계 예산은 45.9%가 공공보건기관 지원에 편성되었고 나머지 54.5%는 민간병원의 금융지원을 위해 편성되었다.

둘째, 병원급이상 병원 총병상에서 3년간의 순증가병상 대비 재원융자 증가병상 분율은 80.5%이며 재원융자 병상의 31.1%가 6대 도시에, 33.6%가 경인대권과 경남대권에 분포하였다. 또한 총병상수의 시군별 분포 추이를 보면 1996년에는 시지역 93.3%, 군지역 6.7%

로 지역간의 편재 현상은 1993년에 비해 더 심해졌으며 재원융자 병상의 82.3%가 시지역에, 17.7%가 군지역에 분포하였다.

셋째, 병원 및 종합병원의 경우 3년간의 순증가병상 대비 재원융자 증가병상 분율의 시도별 분포는 전라남도(445.7%), 경상북도(321.0%), 광주광역시(199.7%), 충청북도(196.8%) 등이 100%이상으로, 이 지역의 1996년 병상이용률은 평균보다 낮은 추세였다. 연도별 병상이용률은 전국 평균과 6대도시 평균 모두에서 매년 감소하는 추세를 보여주었다. 정신병원의 경우 재원융자에 의한 시도별 순증가병상 구성비가 높은 경상남도, 경기도, 부산광역시의 1996년 정신병원의 병상이용률은 다른 병원과 비교하여 상대적으로 높았다.

한방병원의 경우 재원융자 증가병상의 55.3%가 6대 도시에, 43.5%가 경인대권에 분포하였으나 경인대권의 경우 1996년 병상이용률이 전국의 평균 병상이용률보다 낮았다. 또한 한방병원의 평균 병상이용률의 감소 폭은 다른 병원보다 상대적으로 큰 편이었다.

이상의 결과로 볼 때 민간병원과 공공보건기관의 병상확충 및 기능개선을 통해 의료이용의 형평성을 제고하고자 추진한 재특·농특사업은 효율성을 고려하지 않고 병상확충을 하였기 때문에 병원의 시군간 편재현상을 가중시키는 결과를 초래하였다고 생각된다. 따라서 민간병원 병상의 형평성 및 효율성을 높일 수 있도록 재원융자에 대한 정책적 방향의 재 모색이 필요할 것으로 생각한다

[영문]

This study aims to comprehensively grasp the trend of National health policy on the exploitation of medical and health resources and to find out what implications the current budget policy and its effect would give for setting up and enforcing the health policy hereafter.

For these purposes, I did a diachronic analysis of the budget under the jurisdiction of the Health and Welfare Affairs, which has been invested with the aim of increasing the number of sickbed of private hospitals as well as of strengthening the function of both private hospitals and public health organizations for the recent five years. And I, also, compared the change in the sickbed number of each of medical facilities and its sickbed occupancy rate with the increased sickbed number through the Special financial resources from the national treasury loans and those from the farming and fishing villagers' tax. The results are as follows:

In the first place, the increasing rate of the budget of general account under the jurisdiction of the Health and Welfare Affairs(which is 19.5% in 1996) is higher than that of National budget, and the component ratio of the Special financial resources from the national treasury loans and the farming and fishing villagers' tax to National budget has risen steadily every year. According to the annual change in National financial support for the purpose of exploiting medical and health resources, the budget of general account to improve the facilities of public health organizations and to strengthen their function was abolished in 1994, when the Special financial resources from the farming and fishing villagers' tax were newly-set up. But it was recompiled again with the view of supporting the Health Centers in some urban areas in 1996. Also, in 1996 and 1997, the budget for building private dementia hospitals was

drawn up. The budget of the Special financial resources of the national treasury loans was made up mainly to increase the sickbeds of the private hospitals and in 1997, the another budget items were newly drawn up for the construction and extension of special purpose hospitals and the conversion of mental nursing homes into mental nursing hospitals. The 45.9% of the budget of the Special financial resources from the farming and fishing villagers' tax was assigned to public health organizations and the rest, 54.1%, to private hospitals.

Secondly, in all hospitals, except such as tuberculous, leprous, and dental hospital, the rate of the sickbed number increased by financing to the total increased sickbed number for the last three years is 80.5%. The 31.1% of the former was given out to six large cities and the 33.6% of it was alloted to Seoul, Inchon and Kyoungki Area and Southern Kyoungsang Area. And the annual change in the allotment of the total sickbed number to each of cities and counties shows that there was more serious regional unbalance in 1996(urban area: 93.3%; county area: 6.7%) than in 1993. Moreover, the 82.3% of the sickbed number increased by financing was in urban area and the 17.7% of it was in county area.

Finally, in hospitals and general hospitals, the rate of the sickbed number increased by financing to the increased sickbed number for the last three years in each of cities and Provinces is as follows: 445.7% in Southern Cheonla Province; 321.0% in Northern Kyoungsang Province; 199.7% in Kwangju Extensive City; 196.8% in Northern Chungchong Province. Although they are all over 100%, the 1996 sickbed occupancy rate of these areas was lower than the average. The annual average rate of the whole country and six large cities has diminished. In Southern Kyoungsang Province, Kyoungki Province and Pusan Extensive City, the component rate of the sickbed number of mental hospitals

increased by financing is higher than any other areas. And also the occupancy rate is relatively high in comparison with other hospitals. In Chinese medicine hospitals, the 55.3% of the sickbeds increased by financing was alloted to six large cities and the 43.5% was to Seoul, Inchon and Kyoungki Area. But the 1996 sickbed occupancy rate of this Area is lower than the national average rate. The average sickbed occupancy rate of Chinese medicine hospitals, compared with that of other kind of hospitals, was reduced to a very high degree.

As we can see in the above results, the project of the Special financial resources from national treasury loans and from the farming and fishing villagers' tax (which was originally intended to achieve the equity of medical services through increasing

the sickbed number of private hospitals and reinforcing the function of both private hospitals and public health organizations), in effect, has resulted in the aggravation

of the regional maldistribution primarily because the project increased the sickbed without considering its efficiency.

Conclusively, to improve the equity of the sickbed number of private hospitals and the efficiency in running the sickbeds of private hospitals, I believe that it's necessary to review the current financial policy critically and to establish the

directionality of the future financial policy.