한약첩약의 건강보험 급여화에 대한 한의사의 인식 및 수용의사가격 연구

Abstract

[한글]본 연구는 첩약의 건강보험 급여화에 대한 한의사의 인식 및 첩약보험급여화시 한의사의 수용의사가격에 대한 연구로 향후 첩약보험급여화에 대한 정책적 제안점을 찾아보고자 하였다.연구 대상은 2006년 5월 대한한의사협회에 등록된 전체 한의사로, 한의사 명부의 12,084명 중 E-mail이 파악된 한의사 8,463명에게 설문조사를 보내 설문에 응한 414명중 본 연구에 적합한 대답을 한 342명을 최종 분석 대상으로 하였다. 자료 분석은 빈도분석과 X2 test를 통해 첩약보험급여의 찬반과 일반적 특성, 진료 현황과의 관계를 파악하였고, 첩약보험급여의 찬성 및 반대의 이유와 선호하는 첩약보험급여의 형태에 대해 파악하였다. 그리고 급성상기도감염(감기)에 대한 현재첩약가격과 수용의사가격을 조사하고 한의사의 일반적 특성 및 진료현황과의 관계를 ANOVA를 통하여 분석하였다. 마지막으로 수용의사가격을 결정하는 사회·경제적 요인을 알아보기 위해 다중회귀분석을 실시하였다.연구 결과는 다음과 같다.첫째, 첩약보험급여화에 대해 조사된 한의사의 84.80%가 찬성하였고 보통 2.63%, 반대 11.40%, 모르겠다 1.17%로 조사되어 대부분의 한의사가 첩약보험급여에 찬성하는 것을 알 수 있었다. 한의사의 일반적 특성 및 진료현황과의 관계는 통계적으로 유의미한 차이가 없었다. 첩약보험급여의 찬성이유로는 ‘한의학이 치료의학으로 발전할 수 있다’, ‘환자들의 경제적 부담감소’, ‘환자의 한방진료 선택권 확대‘ 순으로 나타나 환자들의 높은 경제적 부담을 덜어주어 첩약을 보다 자유롭게 이용함으로써 한방진료가 더욱 대중화되기를 원하는 것으로 나타났다.둘째, 현재 급성상기도감염(감기)의 첩약치료시 하루 진료비로는 평균 17,252원, 중간값 15,000원으로 조사되어 기존 연구에 비해 보다 높게 나타났다. 또한 65세 이상의 급성상기도감염(감기)의 첩약보험급여시 수용의사가격으로는 평균 17,358원(±8342원), 중간값 15,000원으로 조사되었다. 한의사의 일반적 특성 및 진료현황에 따른 수용의사가격의 모형을 구축하여 다중회귀분석을 통해 분석한 결과, 현재의 첩약가격이 수용의사가격외의 다른 변수들은 수용의사가격을 결정하는 변수로 적합하지 않는 것으로 나타났고, 현재첩약가격의 계수의 값은 양(+)의 값을 보여 현재첩약가격보다 높은 수용의사가격을 보이는 것으로 나타났다.이러한 결과를 종합해볼 때 한의사들은 첩약보험급여에 대해서는 대부분 찬성하지만 실제 첩약보험급여시의 수용의사가격은 현재의 첩약가격보다 높은 것을 알 수 있었다. 따라서 첩약보험급여에 관한 정책 논의시 합리적인 첩약의 수가체계에 대해 깊은 연구가 필요할 것으로 보이며 또한 한의사들을 대상으로 첩약보험급여의 인식 재고를 위한 노력이 필요할 것으로 보인다.

[영문]This study, which is about the oriental medical doctor's opinion and their willingness to accept(WTA) when national publiic health care insurance pay for packed oriental herb, tried to find a policy proposition.The object of this study is whole oriental doctors who registered in the association of Korean Oriental Medicine on May of 2005. The final object of this study is 342 doctors who gave proper answers among 414 doctors who accepted the questionnaire among 8,463 doctors who were grasped their e-mail address among 12,084 doctors who registered in the association. Research material analysis was progressed by grasping the relation between the present condition of medical treatment and the general characteristic and the pros and cons of the wage of the insurance of packed oriental herb by frequency analysis and X²-Test and also grasping reasons of the pros and cons of the salary of the insurance of the packed oriental herb and preferred forms of it. Moreover, the price of the present packed oriental herb and willingness to accept was investigated about acute upper respiratory infections(common cold) and the relation of general characteristic as well as the present condition of the medical treatment was analyzed by 'ANOVA'. Finally, multiple rarity analysis was carried out to recognize the social ? economical primary factor, deciding the willingness to accept.The result of this study is like this.Number one, 84.80% of oriental doctors, who were investigated about the salarization of the insurance of the packed oriental herb, agreed, 2.63% of them were just alright, 11.40% of them opposed, 1.17% of them said that they don't know. According to this investigation, it was noticed that most of oriental doctors agreed to the salarization of insurance of packed oriental herb. There were statistically no meaningful differences in the relationship between the general characteristic of oriental doctors and the present condition of medical treatment. Representative reasons of the wage of the insurance of the packed oriental herb are like this; 'Oriental medicine can be developed as a treatment medicine', 'Decrease of the patient's economical burdensome' , 'Much wider selections of the patient's oriental medical treatment'. Those show that patients of the oriental medicine want that the oriental medical treatment becomes more popular by more free using of the packed oriental herb and that can lift the burden of their economical conditions.Number two, it was shown that one day fee of the treatment, when treatment of acute upper respiratory infections(common cold) by packed oriental herb, is much higher as this investigation; the average of fee is 17.252won, median is 15,000won. Moreover, it was investigated that the average of the willingness to accept is 17,358won(±8342won) and median is 15,000won when the wage of the insurance of the packed oriental herb is applied to acute upper respiratory infections(common cold) patients over 65 age. The result by multiple rarity analysis, which was analyzed by constructing the model of the willingness to accept related to the general characteristic of the oriental doctor and the present condition of the medical treatment, has shown that different variables of the present price of the packed oriental herb seems that it is not proper as a variable which decides the willingness to accept. In addition, the value of the coefficient of the price of the packed oriental herb has shown a positive value and this has shown the willingness to accept is higher than the present price of the packed oriental herb.Combined with these results, oriental doctors agree to the wage of the insurance of the packed oriental herb but it was noticed that the willingness to accept is more expansive than the price of the packed oriental herb when the real wage of insurance of packed oriental herb was applied. Consequently, when the policy about the wage of the insurance of the packed oriental herb is discussed, it is likely that detail researches are needed about a medical charge system of the reasonable packed oriental herb and it seems that more efforts for the recognizant reconsideration of the wage of the insurance of the packed oriental herb are essential as well. All of oriental doctors will be targeted to the efforts.