산부인과 의사의 진료업무량 측정방법에 관한 연구

Abstract

[한글]

1977년 우리나라에 의료보험이 도입된 이후로 끊임없이 제기되어온 의료수가를 해결하기 위해서 그동안 여러가지 방안이 제시되어왔으나 그 때마다 정부의 강력한 통제로 인하여 오늘날까지 근본적인 해결을 보지 못하고 있다. 그러나 최근 관련학계에서 제기되고 있는 해결방안들은 매우 구체적이며, 정부에서도 공감대를 형성하고 있어 매우 고무적이다. 그 해결방안이란 포괄수가제(DRG)와 의사진료행위의 상대가치(RBRVS)로 요약할 수 있다.

특히 상대가치 개발을 위한 연구는 이미 내과와 외과를 상대로 연구가 이루어 진 상태인데 향후의 전체진료과목을 대상으로 연구를 진행하기 위하여 몇 가지의 방법론적인 문제점에 대하여 검토과정에 진입한 상태이다. 이에 본 연구는 설문지 개발에 필수적인 의사의 업무량 측정방법을 크게 두 가지로 나누어서 비교하여 보다 합리적인 방법을 제시하기 위해 시작되었다.

즉, 조사서비스를 전체업무를 기준으로 할 때와 조사서비스를 사전, 실제, 그리고 사후의 3단계로 세분화하여 분리측정하는 두 방법을 비교하는 것이다.

이를 위하여 본 연구에서는 두방법간의 분석대상의사의 특징과, 신뢰도 및 타당도, 업무량의 직접비교 그리고 미국의 연구와 비교 등을 실시하였다.

연구의 분석의 단위는 산부인과의사 개인이며 전국을 모집단으로 하고 측정방법별로 각각 300명씩의 표본을 선정하였다. 조사방법은 산부인과 자문위원회의에서 검토, 선정한 서비스항목들을 대상으로 설문지를 제작하였으며, 우편설문으로 실시하였다.

연구의 결과 두 측정방법들의 분석대상자간에는 통계적으로 유의한 차이는 없었으며, 나머지 분석결과는 모두 전체측정방법이 보다 합리적임을 제시하고 있다.

[영문]

We have never seen any method to cope basically with complicated situation and problems around medical reimbursement rates here in Korea since 1977 witnessed by the beginning of medical insurance and I bet government regulation should have been there.

By the way researchers concerned are beginning to propose some kinds of innovative, not to magics, and detailed ideas to government in these days. Those are Diagnosis-related group(DRG) and Resource-based relative value scale(RBRVS) or something. It is so encouraging that our government can come up with that and move.

In case of RBRVS research they have already been reaching even to the level of reviewing and revising methodology for its further development after naive pilot study on internal medicine and general surgery last year. For me, it was a fortune to be involved in that pilot study and happened to grasp the fact that there might be something different conditions between USA and Korea to apply the same method as we see in the economical application of international exchange-rates and it must be

vital to check so called 'total work approach' compared with 'intra-service work approach' before we expand our research to the whole medical fields as well.

When it comes to 'Intra-service approach', the physician's work is supposed to be divided into three sub-works by the name of intraservice work, of course, and pre & post service work. These subworks, again should be merged together to be pre-postwork subset through some statistical methods of the estimation process

applied by Dr. Hsiao's methodology in RBRVS development later on. But I didn't do that estimation process because I got real values for all of those surveyed items related to just one specialty, OB & GY. In other words, it was unneccessary for me to classify W/T(work per unit time) with cluster analysis or apply regression

method to project pre-post time in this paper.

To tell the truth, have I expanded this research to more than two specialties, it might be impossible. Anyway, in this paper I used some statistical comparison procedures relevant to demographic analysis, reliability & validity and correlation

analysis with American RVU(Relative value unit) between the total work and merged total work from intraservice work approach.

The unit of analysis was individual physicians of OB & GY and 300 physicians were selected for each approach by systemic random sampling method based on national population of OB & GY physicians in Korea. And also with the thankful help of Advisory committee under Korean Association of OB &GY, survey questionnaires were made and mailed to the subjects, two times.

Finally I could not find out any statistically available differences in demographic chracteristics between the two approaches except for the only variable 'Weekly consuming (average) time for non-insured patients', but in other sections

of analysis all showed 'Total approach' was not only more rational and statistically meaning than 'Intra-service approach' but also had considerable merits of time and cost containments. But I'm not sure about this paper's robustness. I'd rather strongly like to suggest further researches should be followed. In that case, the first thing would be a research of the influence of doctor's characteristics, especially 'frequency' on the rating of physician's work.