의료보험 실시후 2년간의 진료양상의 변화 : 서울시내 의료기관 입원환자를 중심으로

Abstract

[한글]

의료보험 실시후 2년간 보험환자에 대한 진료양상의 변화를 파악하고자, 서울시내 의료기관에서 1979년 3월1일부터 5월 31일까지와 1980년 같은 기간중에 의료보험관리공단에 청구한 입원진료 수가청구명세서중 급성충수염과 정상분만으로 진단된 청구명세서를 대상으로, 재원기간, 입원비, 진료내역 각 항목의 비용 및 진료내역 각 항목의 입원비중 차지하는 구성비율을 질병별 의료기관별로 연도에 따라 조사하였다.

분석대상자료는 정상분만이 590건으로 1979년, 1980년 각각 289건과 301건이었으며, 급성충수염이 203건으로 각 연도에 92건과 111건이었다.

각 년도에 제공된 의료의 양을 동일조건으로 비교하기 위해 1979년의 수가를 1980년 수가로 환산하여 수가를 표준화 하였으며 연도별 차이를 통계학적으로 검증하였다.

연구결과는 다음과 같다.

1. 각 질병의 의료기관별 평균 재원일수는 연도에 따라 유의한 차이가 없었다.

2. 각 질병의 의료기관별 평균 입원비는 연도에 따라 유의한 차이가 없었으나 의원급에서는 오히려 1980년에 감소하였다.

3. 각 질병의 의료기관별 각 진료내역의 비용은 1979년에 비해 1980년에 감소하는 항목이 증가하는 항목보다 많았으며 급성충수염보다 정상분만에서 변화가 있는 항목이 많았다.

정상분만의 경우 총 진료행위료는 대부분 의료기관에서 1980년에 유의하게 감소하였으며 총 약제료는 대부분 변화가 없었으나 대학병원에서만은 1980년에 유의하게 감소하였다. 총진료행위료의 감소는 주로 검사료, 처치료 및 이학요법료의 감소로 인한 것이었으며

대학병원에서 총 약제료의 증가는 투약료의 증가에 기인했다.

4. 각 진료내역이 입원비중 차지하는 구성비율의 연도에 따른 변화는 비용의 변화와 유사하였으나 정상분만의 경우 주사료가 차지하는 구성비율이 전 의료기관에서 증가한 것이 특징이었다.

구성비율로 볼 때 총 약제료는 증가하는 양상을, 총 진료행위료는 감소하는 양상을 나타냈다. 총 약제료의 증가는 주로 투약 및 주사시의 약품료의 증가에 기인하였으며, 총 진료행위료의 감소는 검사료, 처치료 및 이학요법료의 감소에 기인했다.

5. 1980년 입원비중 가장 구성비율이 높은 진료내역은 급성충수염에서 주사료이었으며, 정상분만에서는 대학병원의 경우 주사료, 기타 의료기관에서는 처치료이었다.

이상과 같은 진료양상의 변화에 각 빌병에 대한 진료수가청구명세서의 심사기준이 큰 영향을 미친 것으로 판명되었다.

[영문]

To identify the changes in professional care patterns after the introduction of medical insurance in Korea, Professional care in hospitals and clinics of two succeeding years were compared.

The hospitals and clinics selected for this study were those which located in Seoul city. Hospitals were classified into 3 categories: University hospital, general hospital and hospital.

The diseases selected for this study were acute appendicitis and normal delivery.

They were selected because their disease courses are considered to be fairly stable.

The variables used for this study were length of stay, total hospital costs, costs of each components of cares.

The information used for this study was obtained from the official forms requested by the medical facilities to the Korea Medical Insurance Corporation.

The two periods studied were 3 months of each year from March 1st to May 31st of 1979 and 1980.

The total number of normal delivery studied was 289 in 1979, 301 in 1980 respectively and the acute appendicitis was 92 and 111 respectively.

In order to compare the quantity of medical care between 2 study periods the insurance price scores of 1979 were converted to prices of 1980. For statistical test of difference between 2 periods T-test and Welch's test were used.

The result of the study were briefly summarized in below.

1. No significant difference was observed in the average length of stay of both disease between two study periods in all types of hospitals.

2. No significant difference was observed in the average total hospital costs of both diseases in all types of hospital, but in the private clinic the average clinic costs was rather decreased significantly in 1980.

3. More cost decrease were seen than cost increase in 1980 in all types of facilities. More cost changes by items were seen in acute appendicitis than in normal delivery between two study periods.

The total hospital costs can be devided into 2 portions: charges for drug and material and for physician.

In normal delivery, costs for physician's charges was significantly decreased in almost all the hospitals and costs for drug and material were not changed significantly in all the hospitals in 1980. In the University hospitals, however, the costs for drug and material were increased significantly in 1980.

The cost decrease for physician's charge were mainly due to the decrease in the costs of laboratory test, treatment and physical therapy.

The increase in the costs for the drug and material in the university hospitals was mainly due to the increase in the costs for drugs for oral administration and injection.

4. The proportion of components of medical care in the hospital has not been changed significantly, however, the cost for injection in normal delivery was characteristically increased in 1980 in all hospitals studied.

In general the proportion of the costs for drug and material was tended to increase and the costs for physician was tended to decrease in 1980.

The increase in the costs for drug and material were considered to be due to increase in the cost for drugs for oral administration and injection.

The decrease in the costs for physician were due to decrease in the costs of laboratory test, treatment and physical therapy.

Above mentioned changes in hospital and clinic care patterns were considered to be mostly influenced by the review criteria set by the Korea Medical Insurance Corporation for the assessment of the fee request made by clinics and hospitals.