의료보험 가입자의 보험료 납입액과 수혜액 및 의료이용정도에 관한 연구

Abstract

[한글]

제1종 의료보험을 통한 단위조합내 의료보험 가입자들의 계층간 소득재분배 효과를 보기 위하여 서울 시내에 위치하고 있는 한 일종의료보험조합 가입자 1,558명, 768세대를 대상으로 보험료 납입액과 수혜액 및 이용정도와의 관계를 조사하였다.

조사자료는 1977년 7월 1일부터 1979년 6월 30일까지 만 2년간 지정 의료기관의 진료비 청구서를 이용하였다.

세대 및 개인을 단위로 조사하였으며 수혜액대 수혜기대치의 비와 수혜액대 평균수혜액의 비를 이용하여 소득재분배 효과를 측정하였다.

연구결과는 다음과 같다.

1. 수혜약대 수혜기대치의 비는 고소득층은 1보다 적고 중간계층 및 저소득층은 1보다 커 소득재분배 효과가 나타났으나 실제 혜택은 중간 계층이 제일 많이 받았다.

2. 세대당 수혜액대 평균수혜액의 비는 등급이 높을수록 높아 세대당 수혜의 동등성을 나타내지 못하였다.

3. 의료보험 이용율은 세대당으로는 등급이 높을수록 이용율이 높았으며 개인별로는 중간등급이 다른 등급보다 약간 높았다.

Relationship between the amount of the premium and benefits and utilization of

enrollees in a Health Insurance Cooperatives

Cho, Woo Hyun

Graduate School of Health Science and Management, Yonsei University

(Directed by Professor Kim, Il Soon)

This study attempts to assess the effect of the 1st class health insurance

program to the income redistribution among the participants in a unit helath

insurance cooperatives.

One health insurance cooperatives, located in Seoul, with 1558 members and 768

households was selected for this purpose. The relationships between amount of

premium payed and benefits from the cooperatives were compared.

Necessary data were obtained from the bills submitted to the health insurance

cooperatives by the contracted medical institutions from 1st January 1977 to 30th

June 1979. Households and individuals were the unit of the assessment. The

indicators measuring income redistribution effect were the ratios between the

benefit and the mean benefit.

The major findings were :

1. The ratio between the benefits and the expected benefits were lower than 1 in

the high income level and greater than 1 in the middle and lower income groups.

This fact imply that the income redistribution effect was shown in the studied

group. It was also shown that the middle income groups received the greatest

benefit, and then the lower income group.

2. The ratio between the benefit and the mean benefit of the households in the

higher standard income grade, were found to be higher. This means that the equity

of the benefits of households were not achieved by the policy of the health

insurance plan.

3. The health insurance utilization rates of the higher standard income group,

measured by the household unit, were higher, and by the individual unit, the same

rates of the middle income group were higher than other group.

[영문]

This study attempts to assess the effect of the 1st class health insurance program to the income redistribution among the participants in a unit helath insurance cooperatives.

One health insurance cooperatives, located in Seoul, with 1558 members and 768 households was selected for this purpose. The relationships between amount of premium payed and benefits from the cooperatives were compared.

Necessary data were obtained from the bills submitted to the health insurance cooperatives by the contracted medical institutions from 1st January 1977 to 30th June 1979. Households and individuals were the unit of the assessment. The indicators measuring income redistribution effect were the ratios between the benefit and the mean benefit.

The major findings were :

1. The ratio between the benefits and the expected benefits were lower than 1 in the high income level and greater than 1 in the middle and lower income groups.

This fact imply that the income redistribution effect was shown in the studied group. It was also shown that the middle income groups received the greatest benefit, and then the lower income group.

2. The ratio between the benefit and the mean benefit of the households in the higher standard income grade, were found to be higher. This means that the equity of the benefits of households were not achieved by the policy of the health insurance plan.

3. The health insurance utilization rates of the higher standard income group, measured by the household unit, were higher, and by the individual unit, the same rates of the middle income group were higher than other group.