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공공병원과 민간병원의 운영성과에 관한 비교 분석

Other Titles
 Comparison of operational performance between public hospitals and private hospitals 
Authors
 이희원 
Issue Date
2004
Description
보건행정학과/박사
Abstract
[한글] 본 연구에서는 재무성과, 자원생산성, 그리고 진료특성으로 구분하여 공공병원과 민간병원의 운영성과를 비교 분석하였다. 대상병원 선정은 지리적 특성과 병상규모를 고려하여, 국립대학병원8개와 사립대학병원 12개, 지방공사의료원8개와 민간 2차병원 16개로 총 44개 병원을 분석대상으로 하였다. 재무성과 분석은 투입물과 산출물 간의 비율분석 방법을 채택하였으며, 자원생산성의 분석을 위해서는 자료포락분석을 채택하였고 진료특성을 분석하기 위하여 로지스틱 회귀분석 기법과 t-test를 사용하였다. 재무성과 분석의 결과, 비용대비 수익으로 측정한 수익성에서 민간병원이 공공병원보다 우위에 있었다. 비용구조에서는 공공병원과 민간병원 사이에 큰 차이가 없었고, 의료수익구조에서는 공공병원에서 의료급여환자의 수익이 민간병원에서보다 큰 비중을 차지하고 있었다. 자원생산성 분석의 결과, 공공병원이 자료포락분석 모든 모형에서 민간병원에 비해 우위에 있는 것으로 나타났다. 이는 공공병원이 민간병원에 비해서 투입된 인력에 비해 환자수가 절대적으로 많기 때문이다. 진료특성 분석의 결과, 공공병원은 민간병원에 비해 동일 질환군 내에서도 만성 질환자, 고령자 및 의료급여 환자를 많이 진료하는 것으로 나타났으며 이로 인해 평균 재원일수는 민간병원에 비해 길고, 총진료비는 적게 나타났다. 중증도를 보정한 동일질환에 대한 서비스량 비교에서는 민간병원이 공공병원에 비해 총진료비 및 평균재원일수, 일당진료비가 많았다. 즉, 민간병원이 공공병원에 비해 동일질환에 더 많은 진료서비스를 제공하고 있었다. 결론적으로, 공공병원은 민간병원에 비해 자원생산성은 높으면서도 재무성과가 민간병원에 비해 낮게 나타났으며, 그 원인을 다음 두 가지에서 찾을 수 있었다. 첫째, 공공병원은 민간병원에 비해 투입자원 대비 더 많은 환자를 진료하고 있지만 환자 구조에서 수익성이 낮은 의료급여환자의 비중이 높다. 두 번째, 공공병원은 민간병원에 비해 동일질환군 내에서 수익성이 낮은 만성질환자 및 고령환자의 비중이 높고, 보정을 거친 동일질환에 대해서도 민간병원에 비해 적은 양의 서비스를 제공하여 진료비 수익이 적다. 본 연구에서는 공공병원이 민간병원에 비해 재무성과는 낮지만, 의료급여환자의 진료와 수익성이 낮은 만성질환의 진료, 그리고 동일환자에 대한 적은 의료비 지출 등 어느 정도 사회적 역할을 수행하고 있음을 실증적으로 확인할 수 있었다.
[영문]Operational performance was compared between public hospitals and private hospitals by dividing the performance into financial performance, resource productivity, and medical characteristics. Considering the regional characteristics and number of beds, 44 hospitals were examined including 8 national university hospitals, 12 private university hospitals, 8 secondary public hospitals and 16 secondary private hospitals. Financial performance was analyzed by comparing the ratio of input and output. Resource productivity was analyzed using data envelopment analysis (DEA). Medical characteristics were analyzed using logistic regression analysis and t-test. According to the analysis of financial performance, the level of earnings measured by comparing the ratio of earning per cost was higher in private hospitals compared with public hospitals. No significant difference was present between public hospitals and private hospitals in cost structure. According to medical earnings structure, earnings from medical aids were larger in public hospitals compared with private hospitals. According to the analysis of resource productivity, public hospitals were better compared with private hospitals in all models of date envelopment analysis (DEA), because the absolute number of patients per the number of input personnel was higher in public hospitals compared with private hospitals. According to the analysis of medical characteristics, public hospitals treated more chronic patients, older people, and more medical aid patients even within the same disease group compared with private hospitals. Thus, compared with private hospitals, the average number of hospitalization was longer and total medical cost was lower in public hospitals. When the amount of service was compared by adjusting the severity within a same disease group, the total medical cost, average days of hospitalization, and medical cost per day were higher in private hospitals compared with public hospitals. In other words, more treatment services were provided at private hospitals for a same disease group compared with at public hospitals. In conclusion, public hospitals showed higher resource productivity and lower financial performance compared with private hospitals because of the following two reasons. Firstly, public hospitals treated more patients per input resource compared with private hospitals but more patients were on medical aid giving less earning according to patient structure. Secondly, compared with private hospitals, the number of patients with chronic diseases within a same disease group and older patients giving less earning to the hospital was higher in public hospitals. Furthermore, little medical services were provided within a same disease group after adjustment at public hospitals compared with private hospitals, giving less earnings from medical cost. The results of this study showed that financial performance was lower in public hospitals compared with private hospitals, and public hospitals play socal roles to certain extent through the treatment of patients on medical aid and patients with chronic diseases giving less earnings to the hospital and the placement of less medical cost per patient.
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Appears in Collections:
7. Others (기타) > Others (기타) > 5. Others
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/136775
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