Changes in health care utilization patterns in a rural area by the introduction of health care delivery system and health insurance
醫療傳達體系 및 醫療保險 導入이 農村住民의 醫療利用度 및 醫療理容樣相에 미치는 影響을 알아 내고저 實驗的 模型을 設定하여 硏究하였다.
硏究地域으로는 京畿道 江華郡 4個面을 選擇하였다. 4個面中 1個面에는 醫療傳達體系만을 導入하고 1個面에는 醫療傳達體系 導入과 同時에 醫療保險 加入을 誘導하였으며 對照群 2個面에는 새로운 醫療傳達體系나 醫療保險을 導入하지 않았다.
資料蒐集은 實驗事業 導入前後 2次에 걸쳐서 實施하였다. 事前調査는 實驗事業 導入前인 1975年 11月에 3,037名으로부터 事後調査는 導入後 2年이 경과한 1977年 11月에 3,733名으로부터 施行하였다. 1, 2次 調査 모두 같은 方法으로 面接調査하여 醫療必要度 및 醫療理容에 관한 事項을 蒐集하였다.
醫療傳達體系 導入群, 醫療保險 加入群 및 對照群間에 實驗事業 導入前後 醫療利用率 및 醫療利用樣相을 比較 考察하여 다음과 같은 結果를 얻었다.
1. 事前調査에서는 皮調査者의 13.4%가 2週동안 急性疾患을 앓았으며 慢性疾患 有病率이 24.2% 인데 비해 事後調査에서는 2週동안 急性疾患 發生率 12.2%, 慢性疾患 有病率 21.4%로 事前調査에서보다 감소된 경향을 보여주었다.
2. 住民의 醫師訪問回數로 測定된 醫療利用率은 醫療傳達體系 導入群에서 導入前 年間 1人當 0.6回로부터 導入後 1.1回로 增加되었으나 對照群에서 역시 같은 시기에 0.5回로부터 1.3回로 增加되어 비슷한 추세를 보였다. 事後調査에서 醫療保險 加入群의 醫療利用率은 年間 1人當 1.6回로서 같은 시기에 調査된 對照群, 醫療傳達體系 導入群의 醫療利用率보다 높았다.
3. 月間 家口收入에 따른 醫療利用率을 事後調査에서 보면 對照群의 境遇 高所得群이 低所得群보다 높은 醫療利用率을 보인데 반해 醫療傳達體系 導入群이나 醫療保險 加入群에서는 月間 家口收入에 관계없이 平準化된 醫療利用率을 보였다.
4. 家口主 敎育程度別 醫療利用率은 對照群에서는 敎育程度가 높을수록 利用率이 增加하는 不均衡을 보였으나 醫療傳達體系 導入群이나 醫療保險 加入群은 平準化된 醫療利用率을 보였다.
5. 對照群에서는 버스타는 道路와의 距離가 멀수록 현저히 醫療利用率이 감소하였으나 醫療傳達體系 導入群이나 醫療保險 加入群에서는 遠距離地域에서도 比較的 높은 醫療利用率을 보였다.
6. 疾病 自覺者中 醫師利用率은 事後調査에서 事前調査에서보다 約 2倍 더 增加되었으며 事後調査에서 醫療保險 加入群이 12.2%로 가장 높은 率을 보였다.
7. 實驗事業群의 治療處別 醫療利用樣相을 對照群과 比較한바 醫療傳達體系 導入群에서는 藥局 利用은 별 變化가 없었고 醫師利用 部分이 약간 증가하고 其他 治療處 즉 한약방등에서의 治療率이 감소하였다. 이에 반해 醫療保險 加入群에서는 藥局利用, 其他利用이
줄고 相對的으로 醫師利用이 增加되어 33.1%나 되었다.
以上의 結果를 綜合해 볼 때 韓國 農村地域에 醫療傳達體系만을 導入했을때는 醫療均霑은 이룰 수 있으나 醫療擴大에는 별로 影響을 미치지 못하고 醫療傳達體系와 醫療保險을 同時에 導入할 때 비로소 醫療擴大 및 均霑을 모두 達成할 수 있다는 結論을 내릴 수 있다.
To measure the changes in health care utilization patterns by the introduction of health care dalivery system and health insurance, a field experimental study model was designed. Four myuns in Kang Wha gun were cohsen for the experiment. Health
care delivery system only was introduced to one Myun and health insurance program as well as health care delivery systems was introduced to another myun. Two myuns out of 4 myuns were selected as control. In order to compare the utilization
patterns and rates before and after the experiment, two health interview surveys in two year interval were conducted: one in November 1975 from 3,037 persons and another one in November 1977 from 3,733 persons.
The following results were obtained.
1. The incidence rates of self-reported acute diseases for the past 2 weeks were 13.4% before the program(1975) and 12.2% after the program(1977). The prevalence rates of self-reported chronic diseases were 24.4% in 1975 and 21.4% in 1977.
2. In the area the health care delivery system only was introduced, the physician visits per person per year increased from 0.6 in 1975 to 1.1 in 1977(after the program). In the control area also, physician visits per person per year increased
from 0.5 in 1975 to 1.3 in 1977. The group health insurance was introduced showed the highest physician visits after the program(1.6 visits per person per year).
3. While the Medical care utilization rate of the lower-income family group was significantly lower than that of the higher-income family group in the control area, the rates in the areas where the health care delivery system and health insurance were introduced showed even between low and high income groups.
4.In the control area, physician visits of the groups with highly educated head of household were higher than that of groups with less educated head of household. The rates, however, were similar regardless of educational levels of head of household in the experimental areas.
5. In the control area, the longer the distance from the resident village to the bus road, the lower the rates of physician visits. Even though those groups lived in an area inconvenient to transportration, the rates for physician visits
increased in the experimental group.
6. The treatment rates by physician among diseased persons for the past 2 weeks after the experiment were two times higher than that before the experiment. The health insurance program group showed the highest rate, 12.2%.
7. Medical care utilization patterns of the experimetal area by sources of treatment among the treated patients were compared with that of control area. In the area the health care delivery system was introduced the physician utilization was increawed, while patients treated at the drugstore remained at a nearly
constant. In the group the health insurance and the health care delivery system were introduced, patients treated at a drugstore or by other sources were significantly decreased and the rate treated by physician was increased.
With the above results, the following conclusions were drawn:
The introduction of health care delivery system only contributed equal distribution of medical care among different socieconomic classes but affects only slightly to the rate for physician care and visits.
The introduction of a health care delivery system and an appropriate financing mechanism together improve both distribution and utilization of medical care.