내과 외래환자의 특정 진료서비스 요구의 분석 : 한 지방도시 종합병원의 사례 분석

Abstract

[한글]

외래 이용자 중에서 특정 진료서비스를 요구하는 환자의 빈도, 일반적 특성, 의료 비용과 서비스 결과를 구명하기 위해 한 지방도시에 위치한 400병상 규모의 종합병원 내과 외래에서 1988년 4월 13일부터 동년 5월 12일까지 1개월 동안 내원한 신환 중에서 검사를 시행한 이용자들을 대상으로 조사를 실시하여 다음과 같은 결과를 얻었다.

1. 신환 704명중에 특정 진료서비스를 요구한 환자수는 155명(22.0 %) 이었다.

2. 특정 진료서비스를 요구한 군과 요구하지 않은 군을 비교하면 성과 의료보험 가입 여부만이 통계학적으로 유의한 차이가 있었는데 요구하지 않은 군에서 여자가 많았으며 의료보험 가입자가 많았다. 또한 특정 진료서비스를 요구한 군에서 건강에 대한 관심도가

높았다. 진료결과는 특정 진료서비스를 요구한 군에 있어서 정상이 통계학적으로 유의하게 많았다

3. 특정 진료서비스를 요구한 군중에 주소가 있는 군과 주소가 없는 군은 특성 별로 통계학적으로 유의한 차이가 없었다. 주소가 없는 군에서 과거 병력이 높았으며 진찰후 양성소견이 낮았는데 이는 통계학적으로 유의하였으며 진료결과는 통계학적으로 유의한 차이가 없었다.

4. 특정 진료서비스 요구는 본인 스스로의 판단에 의한 경우가 가장 많았다.

5. 의료보험 가입자로 특정 진료서비스를 요구한 군중에 주소가 없으면서 진료결과가 정상인 군의 일인당 평균 진료비는 14,473원, 일인당 평균 조합부담금은 3,135뭔 이었다.

특정 진료서비스를 요구한 군에서 진료결과가 정상으로 통계학적으로 유의하게 높은 이유는 적절한 의료가 되지 않고 있다는 것을 반영해 주며 또한 이만큼 의료비가 효율적인 이용이 되지 못하는 것으로 생각된다.

이 연구는 한 병원을 대상으로 짧은 기간동안에 조사를 했다는 점과 진료 의사의 주관성을 배제할 수가 없었다는 점등 연구의 제한점이 있다.

앞으로 조사대상 및 보건지식 문항에 대한 충분한 고려와 진료서비스의 계절적인 차이가 있는지, 개원가의 특정 진료서비스 요구조사 대상과의 비교 및 의사의 적정진료 여부의 객관적인 통제 등을 고려한 노력이 계속되어야 하리라 생각된다.

[영문]

This research was conducted to Investigate the general characteristics, the medical care expenses and the medical service results of newly visited outpatients who made requests for diagnostic medical services based on self-judgement, at a department of Internal medicine of a 400 bed-sized general hospital, In a city, from April 13 to May 12, 1988.

The results of this research are summarized below:

1. Of the 704 new outpatients, there were 155 (22.0%) who made requests for diagnostic medical services based on self judgement.

2. In the comparison between the group that made requests for medical services and the group that did not, only the variables sex and having a medical insurance were statistically significant. Furthermore, in the group with requests for diagnostic medical services based on self-judgement ,there was a high degree of concern for health. The results of the medical examinations In the group above revealed a higher proportion of normal individuals, which was statistically significant .

3. Within the group that made requests for medical services, no statistical significance was found in terms of general characteristics between the group with medical complaints and without medical complaints .In the group without medical complaints there was a greater number of previous medical visits and less number of positive findings on examination and this was statistically significant. The medical examination results were not statistically significant

4. Most of those with requests for the diagnostic medical services were made based on self-judgement (decision).

5. Of those who had medical insurance and who made requests for medical services and were later found to be normal, the average medical cost was ￦l4,473 per person and the average insurance benefit was ￦3,135 per person.

The high degree of statistical significance in those who made requests for medical services and were later diagnosed as Being normal reflects the fact that appropriate medical services are not being utilized and, therefore, it is believed that medical costs also are not being efficiently used.

This research was conducted to Investigate the general characteristics, the medical care expenses and the medical service results of newly visited outpatients who made requests for diagnostic medical services based on self-judgement, at a

department of Internal medicine of a 400 bed-sized general hospital, In a city, from April 13 to May 12, 1988.

The results of this research are summarized below:

1. Of the 704 new outpatients, there were 155 (22.0%) who made requests for diagnostic medical services based on self judgement.

2. In the comparison between the group that made requests for medical services and the group that did not, only the variables sex and having a medical insurance were statistically significant. Furthermore, in the group with requests for

diagnostic medical services based on self-judgement ,there was a high degree of concern for health. The results of the medical examinations In the group above revealed a higher proportion of normal individuals, which was statistically significant .

3. Within the group that made requests for medical services, no statistical significance was found in terms of general characteristics between the group with medical complaints and without medical complaints .In the group without medical

complaints there was a greater number of previous medical visits and less number of positive findings on examination and this was statistically significant. The medical examination results were not statistically significant

4. Most of those with requests for the diagnostic medical services were made based on self-judgement (decision).

5. Of those who had medical insurance and who made requests for medical services and were later found to be normal, the average medical cost was ￦l4,473 per person and the average insurance benefit was ￦3,135 per person.

The high degree of statistical significance in those who made requests for medical services and were later diagnosed as Being normal reflects the fact that appropriate medical services are not being utilized and, therefore, it is believed that medical costs also are not being efficiently used.