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건강진단 검사의 비용 - 효과분석 : 고혈압 진단을 중심으로

Other Titles
 Cost-effectiveness analysis of hypertension screening test. 
Authors
 박은철 
Issue Date
1989
Description
보건학과/석사
Abstract
[한글]

공무원 및 사립학교 교직원 의료보험공단의 피보험자 건강진단중 고혈압 진단을 대상으로 건강진단 채제내에서 검사의 효율성을 비용-효과분석으로 비교하고자 건강진단 대상자 총 906,554명중 이단계 층화 무작위 추출한 49,983명의 건강진단 결과자료를 이용하여분석하였다 . 고혈압 건강진단 검사의 효율성 향상을 위하여 설정된 검사항목 조합의 조정, 진단기준의 조정, 대상집단의 연령별 구분 적응의 세가지 대안을 발견자 일인당 검사비로 평가하여 다음의 결과를 얻었다.

현재 고혈압 건강진단으로 발견되는 사람은 대상자의 1.2%인 590명이었으며 고혈압을진단하는데 소요되는 발견자당 검사비는 30,833.0원이었다. 검사항복중 고혈압 진단에 있어 가장 감수성이 낮은 검사는 안정검사로 2차 건강진단에서 이를 제외하므로써 발견자당 검사비 는 28,098.2원이었다. 가장 효율적인 검사 조합은 1차 및 2차 건강진단 검사에서 혈압측정 만을 실시하는 경우로 발견자당 검사비가 기존 검사비의 79.2%인 24,408.7원이었다. 고혈압 진단기준을 현 기준보다 높이는 대안의 적용은 발견자당 검사비를 3.7%-6.7% 증가시켰으며 39세 이하 연령층의 발견자당 검사비는 170,582.9원이었으며, 40-59세 연령층의 검사비는 20,032,7원이었고, 60세 이상 연령층은 8,675.3원이었다.

이들 결과를 종합하여 효율성과 현실성을 감안하여 제시한 대안은 2차 건강진단에서 안정검사를 제외하고 건강진단의 대상자를 40세이상으로 국한하여 실시하는 것으로 이로 인해 발견자당 검사비는 15,222.4원이 되며 총 검사비의 54.9%를 절감시킬 수 있다. 그런데

이 연구는 건강진단의 궁극적인 효과인 질병력이나 사망력의 감소를 측정하지 않았다는제한점이 있다.

[영문]

To evaluate the costs and effectiveness of the hypertension screening program of Korea Medical Insurance Corporation, the records of screening examination were used. The sample size was 49,983 of 906,554 insured to the Coporation by two stage stratification random sampling. The alternatives for efficiency of screening program which were devised into three category: modification of screening test package, application of other hypertension diagnostic criteria, and selective approach of tested groups by age, were evaluated to costs per patients detected.

The results of this study were as follows:

In hypertension screening system the costs per patients detected were Won 30,883.0. The most non-sensitive test for hypertension detection was ophthalmoscopy, that was examined during second stage of screening. If ophthalmoscope examination was excluded, non-detected patient was only one person which was 0.17% of detected person and costs per patients detected were Won

28,098.2. The Host efficient modification of screening test package was only measurement of blood pressure through first and second stage of screening. The costs per patients detected of this modification were Won 24,408.7. The application of other diagnostic critera which were more restricted criteria, increased the costs per patients detected to 3.7%-6,7%. The costs per patients detected less than 39 years old were Won 170,582.9, 40 to 59 years old Won 20,032.7, greater than 60 years old Won 8,675.3.

The conclusion was that alternative suggested in the aspects of efficiecy and practical acception excluded ophthalmoscope examination of second stage screening and restricted to persons greater than 40 years old for the target population. The application of this alternative decreased 54.9% of screening costs and costs per patients detected were Won 15,222.4.

This study had the limitation that the measurement of effectiveness was not ultimate goal of screening such as decreasing morbidity and mortality, but disease detection as short-term objectives.
Appears in Collections:
1. College of Medicine (의과대학) > Others (기타) > 2. Thesis
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/137594
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