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가계지출 보건의료비의 구조변화와 결정요인 분석

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 The study on the structural changes and determinants of household health care expenditure 
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가계지출 보건의료비는 의료이용에 있어 매우 중요한 요인이므로 본 연구에서는 통계청에서 실시한 도시가계조사 자료를 이용하여 가계지출 의료비의 변화 추세, 구조 및 결정요인 등에 대한 분석을 시도해 보고자 하였으며 주요 결과는 다음과 같다.

첫째, 보건의료비가 가계지출에서 차지하는 구성비는 지속적으로 증가하였으며, 가계지출 의료비의 증가율이 동기간 가계지출보다 크게 증가하였다.

둘째, 가계지출 의료비의 세부항목별 변화 추이를 살펴보면, 의료서비스 비용의 증가에 비해 의약품비, 의료용품기구 비용, 그리고 건강보험료의 증가가 상대적으로 높은 것으로 나타났다. 의료서비스 비용을 세무항목별로 살펴보면, 외래나 입원진료비에 비해 한방진료비가 크게 증가한 것으로 나타났다.

셋째, 가계지출 보건의료비는 가구원수, 가계지출, 가구주의 연령이 증가할수록 증가하였으며, 가구주의 직업이 생산직인 가구에 비해 사무직인 가구와 무직인 가구가 많았으며, 일반 가구에 비해 맞벌이 가구가, 가구주가 여성인 가구가, 가구주의 직업이 생산직인 가구에 비해 자영업인 가구의 보건의료비 지출이 적었다. 넷째, 가계지출대비 보건의료비는 가구주의 연령이 증가할수록 증가하였고, 가구주의 교육수준이 중학교 이하인 가구가, 가구주의 직업이 자영업인 가구가 많은 것으로 나타났으며, 가계지출이 증가할수록 감소하였으며, 일반 가구에 비해 맞벌이 가구가, 가구주가 여성인 경우의 가계지출대비 보건의료비가 적은 것으로 나타났다.

다섯째, 연령과 가구원수를 보정한 가계지출 보건의료비의 가계지출 탄력도는 0.8006으로 1보다 작은 것으로 나타났다.

본 연구의 결과를 바탕으로 다음과 같은 몇 가지 제언을 하고자 한다. 첫째, 적정부담, 적정급여를 통한 건강보험의 보장성 강화가 시급하다. 둘째, 향후 의료용품 및 기구, 의료장비 및 기기에 대한 수요가 지속적으로 증가될 것으로 전망되므로 이에 대한 정부 차원의 육성 및 지원대책이 필요하다. 셋째, 노인 의료비 및 노인들의 의료 접근성에 대한 대책이 조속히 마련되어야 할 것이다.

[영문]To the extent that household health expenditure is one of critical factors in medical utilization, this study was attempted to analyze the trend, structure and determinants of household health expenditure on the basis of the data from the urban household survey carried out by National Statistical Office.

The important findings of this study were as follows:

First, it was found that the proportion of health expenditure in household expenditure continued to increase and the increase rate of household health expenditure was remarkably higher than that of household expenditure over the same period.

Second, as a result of examining the transitions of detailed components of household health expenditure, it was revealed that the expenditure of drugs, the expenditure of medical supplies and devices, and the premium of health insurance showed relatively high increase rate, compared to the expenditure of medical services. As a result of looking into the detailed components of medical service expenditure, it was identified that the expenditure of oriental medicine increased remarkably, compared to that of ambulatory or admission treatment.

Third, household health expenditure increased in proportion to the number of households, household expenditure and the age of householder, and was higher in the households whose householders'' occupation corresponded to office workers or jobless persons, rather than production workers. In addition, lower health expenditure appeared in the households that corresponded to dual-income family rather than single-income family, and whose householders are female or self-employed workers rather than male or production workers.

Fourth, health expenditure to household expenditure increased with the increased age of householder, was especially higher in the households whose householders had academic background equivalent to or less than completing the middle school course or were self-employed, and decreased with increased household expenditure. Lower health expenditure to household expenditure was observed in the households that corresponded to dual-income family rather than single-income family and whose householders were female rather than male.

Finally, the income elasticity of household health expenditure with the ages and number of households controlled was 0.8006.

Based on the above findings, the researcher makes following suggestions:

First, it is required to strengthen the coverage of health insurance through reasonable premiums and benefits as soon as possible. Second, as it is expected that the demand for medical supplies, devices and equipments will continue to increase, the governmental policies to promote and support them are necessary. Lastly, it is pressing to establish appropriate measures for the medical expenditure of the elderly and their access to medical services.
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