의약분업 전후 의료기관과 약국의 외래이용변화

Abstract

[한글]

의약분업 이전에 의료기관에서 진료와 투약이 함께 이뤄졌던 것과는 달리 의약분업 이후 외래이용자들은 의료기관과 약국을 이중방문해야 하는 일대 의료이용에 개혁이 일어났다. 이에 본 연구에서는 의약분업이 각 의료기관의 외래이용량에 얼마나 많은 영향을 주었는지를 분업지역과 예외지역을 구분하여 기관별 평균방문횟수의 변화를 살펴보았고, 외래다빈도 질환 중 감기, 고혈압, 관절염, 당뇨 4개 질환을 선정하여 각 질환별로 평균방문횟수의 변화를 보고자 하였다. 자료는 1998년과 2001년도 전국단위로 조사된 국민건강영양조사자료를 활용하였다.

분업이후 약국평균방문횟수가 분업지역에서는 59%, 예외지역에서는 156% 증가하였고, 의원은 분업지역에서 11% 감소하였으나, 예외지역에서는 48% 증가하면서, 예외지역의 평균방문횟수가 분업지역의 평균방문횟수를 초과하였다. 병원은 분업지역에서는 감소하였고, 예외지역에서는 증가하였으며, 종합병원은 분업지역과 예외지역 모두 감소하였다. 종합전문요양기관에서는 분업지역이 증가하였고, 예외지역에는 변화가 없었으며, 분업대상에서 제외된 한방병의원은 분업지역과 예외지역 모두 증가하였다. 보건기관은 분업지역, 예외지역 모두 감소하였다.

외래다빈도 질환별로 살펴본 결과, 약국에서는 급성질환인 감기보다는 만성질환인 고혈압, 관절염, 당뇨의 평균방문횟수 증가가 뚜렷했고, 분업지역과 예외지역을 구분하여 살펴보면, 평균연령이 높은 예외지역 만성질환 환자들의 평균방문횟수 증가가 분업지역보다 크게 나타났다. 의원 또한 약국과 유사한 결과를 보였다. 약국과 의원을 중심으로 봤을 때, 예외지역의 약국과 의원의 평균방문횟수 증가가 분업지역의 평균방문횟수를 초과하여 증가하였다. 그 이유는 만성질환 환자들의 평균방문횟수가 예외지역에서 급격히 증가함으로 분업지역의 평균방문횟수를 초과한 것으로 보인다. 의약분업 대상에서 제외된 한방병의원의 방문횟수 증가는 분업이후 의료기관과 약국을 중복이용해야 하는 불편함을 덜기 위하여 한방병의원으로 이동한 환자들의 영향으로 생각되며, 또한 보건기관의 방문횟수의 감소세가 뚜렷한 것을 보아 의약분업 이후 본인부담금의 증가로 인한 저소득층이나 취약계층의 환자들이 의료를 포기하거나 의료이용을 줄일 수 있을 것으로 추정 할 수 있다. 이 문제 또한 해결해 나가야 할 하나의 정책과제라 생각된다.

[영문]While medical institutions executed medical examination as well as medical prescription before the separation of dispensary from medical practice, day-patients need visit both medical institutions and pharmacy after the separation of dispensary from medical practice. And it was an innovation in the medical area. This paper researched what influences the separation of dispensary from medical practice had on quantity of outpatients’ use of medical institution. This paper examined changes of outpatients’ average visit-frequency in each medical institution after dividing districts of pharmacy-clinic-separation and exceptional districts. Finally, this paper selected 4 kinds of disease such as flu, hypertension, arthritis, glycosuria among outpatients’ diseases showing a high visit-frequency in medical institutions, then, examined changes outpatients’ average visit-frequenc! y by each disease. Data used were nationwide materials about national public health and nutrition that were made in 1998 and 2001.

After the separation of dispensary from medical practice, districts of pharmacy-clinic-separation showed 59%-rise of average pharmacy-visit-frequency, exceptional districts showed 156%-rise of average pharmacy-visit-frequency, and districts of pharmacy-clinic-separation showed 11%-drop of average dispensary-visit-frequency, exceptional districts showed 48%-rise of average pharmacy-visit-frequency, as a result, average visit-frequency in exceptional districts was above that in districts of pharmacy-clinic-separation. In case of clinic, districts of pharmacy-clinic-separation showed a drop, while exceptional districts showed a rise. In case of general hospital, both districts of pharmacy-clinic-separation and exceptional districts showed a drop. In case of special sanatorium, districts of pharmacy-clinic-separation showed a rise, while exceptional districts showed no change! s. In case of herb medical institution that didn’t apply the separation of dispensary from medical practice, both districts of pharmacy-clinic-separation and exceptional districts showed a rise. In case of public health center, both districts of pharmacy-clinic-separation and exceptional districts showed a drop.

The examination of outpatients’ diseases showing a high visit-frequency in medical institutions proved that pharmacy-visit-frequency noticeably rose in chronic diseases like hypertension, arthritis, glycosuria, rather than acute diseases like flu. The examination by dividing districts of pharmacy - clinic - separation and exceptional districts told that average visit-frequency increased in exceptional districts where the number of chronic invalids whose average age is higher is larger more than in districts of pharmacy-clinic-separation. Clinics showed outcomes similar with pharmacies. In case of clinic and pharmacy, increases of average pharmacy-visit-frequency and average clinic - visit-frequency in exceptional districts were above those of average visit-frequencies in districts of pharmacy-clinic-separation. The reason was that average visit-frequency of chronic patients no! ticeably rose in exceptional districts. Rise of herb medical institution-visit-frequency, which was excluded from the separation of dispensary from medical practice, was because of many patients who moved from medical institutions and pharmacies to herb medical institutions after separation of dispensary from medical practice, for the purpose of saving cumbersome labor of double-visits. Also, the clear drop of public health center-visit-frequency told that the rise of self-charge rate made patients of small-income or lower class’s patients give up medical case or reduce medical-care-use. This question is also one of policy-tasks to be settled down in the future.