진료의뢰 여부에 따른 의료 이용 비교

Abstract

[한글]이 연구는 진료의뢰협력센터를 경유한 환자군(ARC 경로군)과 그 외의 경로를 경유한 환자군(일반경로군)의 의료이용 특성 및 진료비 특성을 파악하고자 하였다.연구대상은 서울시내 소재한 A종합전문병원의 2005년 6월부터 12월까지 외래를 방문한 신환환자 총 44,336명(ARC 경로군 5,694명, 일반군 38,642명)으로 하였고, 분석은 SPSS Window 12.0 Program을 사용하였다.연구결과는 다음과 같다.첫째, 내원경로와 인구학적 특성에서는 ARC 경로군에서는 40대가 21.69%로 가장 많이 차지한 반면, 일반 경로군에서는 60대 이상이 19.84%로 가장 많아 통계적으로 관련이 있는 것으로 나타났으며, 지역과 내원경로의 교차 분석결과 ARC 경로군과 일반 경로군에서 서울(병원근처) 의뢰 비율이 높았다.희귀난치성 질환 분포는 내원경로와 상관없이 비슷한 분포를 보였으며, 통계적으로 유의한 관련은 없었다.둘째, 다빈도 10대 진단명 분포는 ARC 경로군에서는 협심증이 1위였으며, 일반 경로군에서는 관절장애가 1위였다. 10대 진단명중 암관련 진단명을 살펴보면 ARC 경로군은 위암, 유방암, 간암, 직장암이 분포된 반면 일반경로군에서는 간암, 위암만 선정되었다.셋째, 외래 내원횟수는 일반 경로군보다 ARC 경로군이 통계적으로 많았으며, 부도율 또한 ARC 경로군이 일반 경로군보다 통계적으로 높았다.넷째, 연구기간 동안의 외래 전체수익은 ARC 경로군이 일반 경로군보다 통계적으로 유의하게 많았으며, 외래 방문당 수익에 있어서도 ARC 경로군이 일반경로 군에 비해 유의하게 높았다. 외래 방문당 세부항목 수익에 있어서는 주사료, 검사료, 영상진단 방사선치료료에서 ARC 경로군이 일반 경로군보다 유의하게 높았다.다섯째, 연구기간 동안의 입원 전체 수익은 일반 경로군이 ARC 경로군보다 통계적으로 유의하게 많았으며, 입원일당 수익에 있어서도 일반 경로군이 ARC 경로군보다 유의하게 높았다.세부항목별 수익에 있어서는 처치수술료 및 마취료는 일반 경로군이 ARC 경로군보다 유의하게 높았으며, 검사료는 ARC 경로군이 일반 경로군보다 유의하게 높았다. 투약조제료, 주사료, CT진단료를 제외한 모든 항목에서 두 군 간에 유의한 차이를 보였다.본 연구는 내원경로별에 따른 진료이용 행태 및 진료비 특성을 분석하여, 진료의뢰협력센터의 CRM(Customer Relation Management) 구축의 기반으로 활용하는데 의의가 있으나, 일개 병원을 연구대상으로 시행한 분석으로 추후 연구 대상병원을 확대하여 연구할 필요가 있다고 생각한다.

[영문]The purpose of this study was to comparatively analyze differences of medical service uses and their costs between the patients' group (ARC path group) referred from Diagnosis Referral Cooperative Center and the other patients' group (ordinary path group).For this purpose, the researcher set as population those 44,336 new outpatients who had come to 'A' general specialized hospital for the period from June through December, 2005, and thereby, classified 5,694 ones into ARC path group and 38,642 ones into ordinary path group. The collected data were analyzed using the SPSS Windows 12.0 program.The results of this study can be summarized as follows;First, in view of paths and demographic variables, those outpatients in their 40's accounted for most (21.69%) of the ARC group, while those in their 60's accounted for most (19.84%) of the ordinary path group; such a difference was statistically significant. As a result of tabulating regions and paths, it was found that the ratios of having been referred from the Seoul center (near the sample hospital) were higher in both groups.On the other hand, distribution of the rare obstinacy diseases was similar between two groups, suggesting no significant difference between them.Second, in view of top 10 diseases diagnosed, stenocardia ranked top among the ARC path group, while joint trouble was rated first among the ordinary path group. In terms of cancer-related diseases among the top 10 diseases, the ARC path group patients were suffering primarily from stomach cancer, breast cancer, liver cancer and rectum cancer, while the ordinary path group ones were suffering from liver and stomach cancers mostly.Third, ARC path group patients had visited the hospital significantly more frequently than the ordinary path group, and the ratio of non-performing reservations was significantly higher in the former group.Fourth, the entire hospital revenues for the period of this study were significantly higher from ARC path group than from ordinary path group, and the revenue per outpatient was also significantly higher from the ARC path group. To break down, the medical services incurring more revenues per outpatient from the ARC path group were injection, health checks, CT and radioactive treatment.Fifth, the revenues coming from hospitalized treatments were significantly higher from ordinary path group than from ARC path group, and the revenues per day of hospitalization were significantly higher from the ordinary path group.To break down, revenues coming from treatments & surgeries and anesthesia were significantly higher from the ordinary path group, while revenues from health checks were higher from the ARC path group. Namely, differences of revenues were significant in all medical services but medication & prescription, injection and CT.This study may well be significant in that it analyzed the patterns shown in outpatients' uses of medical services and their medical costs depending on their paths leading to a hospital and thereby, provided for some data useful to construction of a CRM (Customer Relation Management) system by Diagnosis Referral Cooperative Center, but its results may not as well be generalized due to its small sample size (a single hospital). So, it is hoped that this study will be followed by future studies which will use a larger sample to test the results of this study.