노인전문병원 입원환자의 의료비에 관한 연구

Abstract

[한글]

이 연구는 노인전문요양병원을 표방하는 병원에 입원한 299명의 환자를 대상으로 포괄적 기능상태를 평가하고, 입원기간 동안의 의료비를 조사하였다.이 연구 과정의 첫번째는 노인전문병원에 입원한 환자들의 일반적 특성 및 포괄적 기능상태를 조사하였으며, 둘째는 노인전문병원에 입원한 기간동안 지불한 환자의 월평균 의료비를 조사하였다. 마지막으로는 환자의 복합질환과 일상생활동작을 중심으로 의료비를 비교하여 노인전문병원 입원환자의 의료비를 분석하고자 하였다. 환자 기능상태 조사는 2007년 9월 1일부터 10월31까지 노인전문병원에 입원 중인 환자를 대상으로 해당병원의 간호사가 실시하였으며, 조사기준은 요양병원 포괄수가제 시범사업중 환자기능상태는 일상생활동작 지표를 이용하여 설문조사를 하였다. 의료비용은 급여 본인부담금을 포함한 보험급여 범위의 비용 뿐 만이 아니라 간병비 등 임의본인부담금의 영역도 함께 조사하였다.주요 연구 결과는 다음과 같다.1. 남자의 월평균 총진료비는 2,315,647원, 여자는 2,167,666원 이었으며, 환자부담비용은 남자, 여자 각각 965,488원, 1,002,080원 이었으나 성에 따른 비용의 차이는 통계학적으로 유의하지 않았다.2. 연령별 월평균 총진료비는 65세 이전이 2,240,335원, 65~69세 2,274,531원, 70~74세 2,553,193원,75~79세 2,580,807원, 80~84세 1,771,075원, 85세 이후 1,663,848원이었으나 나이에 따른 총진료비와 환자부담비의 차이는 통계학적으로 유의하였다.3. 복합질환수에서는 1가지 질환자의 월평균 총진료비가 1,949,593원, 2가지 2,182,694원, 3가지 2,419,098원, 4가지 이상 1,903,574원이었다. 총진료비, 환자부담비용에서 복합질환수에 따라 차이가 통계학적으로 유의하였다.4. 일상생활동작 중 식사하기, 체위변경하기, 옮겨앉기, 화장실 사용하기의 총진료비는 모두 통계학적으로 유의하였으며, 환자부담비에서는 체위변경하기를 제외한 나머지 변수만 통계학적으로 유의하였다.5. 의료비간 관련성을 알아보기 위하여 성, 연령 등을 통제한후 총진료비와 주요변수간의 관련성을 알아본 결과 질환수는 각 비용과 통계적으로 유의한 관련성이 있었으며, 일상생활동작중 화장실 사용하기만 총진료에서 통계적으로 유의한 관련성이 있었다.우리나라의 노인전문병원에 입원하는 환자 대부분이 필요한 서비스보다는 다른 사회경제적인 요인에 의해서 서비스 제공병원을 선택하고 있다.급속한 노인인구의 증가로 인해 노인의 의료이용이 증가하게 되어 이것이 결국 보험재정의 고갈 및 사회적 비용부담의 주된 원인 되었다. 노인 및 노인을 부양하는 가족들 역시 간병비 등 환자가 부담하는 의료비를 많다고 인식하고 있다. 이 연구는 단면연구이긴 하나, 향후 요양병원 포괄수가제 적용시 이용될 환자기능상태 조사 도구를 사용하여 개인별 의료비용을 조사하였기에 추후 연구의 기초가 될 수 있을 것이다.

[영문]This study was examined to evaluate the comprehensive functioning states of 300 patients who were hospitalized at the specialized hospitals for senior citizens and to investigate health care utilization expenses during their hospitalization. This study has been completed through several steps and steps are following:1. Find patients’ general characteristics and comprehensive functioning states.2. Examine monthly average medical expenses during the hospitalization.3. Analyze medical expenses by comparing each cost of the comprehensive functioning states and complex disease ones.The survey, which was on patients’ comprehensive functioning states, was performed by the nurses, who have taken care of long-term elderly patients in senior hospitals, from September 1 through October 31, 2007. The standard of this survey was used from ADL scores in pilot project of long-term care insurance in Health Insurance Review & Assessment Service. The health care utilization expense was included not only insurance payment from patient but also voluntary patient's payment such as caring fee.The results of the study are following:1. The total cost of male medical expenses was 2,315,647 Won and of female medical expenses was 2,167,666 Won. Although patient's-payment expenses were 965,488 Won for male and 1,002,080 Won for female, difference of costs between genders was not significant statistically.2. There were differences in costs between monthly average medical expenses among each age of people.A. People who are younger than 65 years old: 2,240,335 WonB. People who are 65-69 years old: 2,274,531 WonC. People who are 70-74 years old: 2,553,193 WonD. People who are 75-79 years old: 2,580,807 WonE. People who are 80-85 years old: 1,771,075 WonF. People who are older than 85 years old: 1,663,848 WonThe difference in total medical expenses and patient’s-payment expenses between ages was significant statistically and worth to be investigated more.3. There was also difference in medical expenses depends on number of diseases.A. Patient who has one disease: 1,949,593 WonB. Patient who has two diseases: 2,182,684 WonC. Patient who has three diseases: 2,419,098 WonD. Patient who has four or more diseases: 1,903,574 WonExpenses depends on number of diseases was significant statistically in both total medical expenses and patient’s-payment expenses.4. The total medical costs for the ability of daily activities, such as self-eating, changing position, moving to one place to another and self-voiding, have statistic significance. However, in the patient's payment expenses, position change was not significant.5. Under the regulation of genders and ages, only number of disease was related to both total medical expenses and patient’s-payment expenses. Also, among the ability of daily activities, self-voiding was just significant statistically in total medical expenses.Based on examination, most old patients intend to choose their hospitals according to the social economic factor, such as hospitalization expenses or their economic ability, rather than services that they really need. In addition, because of rapid increase of senior population, cost of seniors' medical expenses has been also increased and that became the major cause of exhaustion of medical insurance finance and the social sharing of cost. Also, related practical studies are required for people because not only senior patients but also their family members have felt the medical expenses, such as nursing fees, are way too high. Even though this study has some limitations, this investigation of patients' functioning states and the cost of medical expenses could be the framework for more studies.