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장애여부에 따른 미충족 의료경험 차이

Other Titles
 Differences in Experience of Unmet Healthcare Needs According to Disability Status in Korea 
Authors
 김헌면 
College
 연세대학교 보건대학원 
Department
 보건정책관리 
Degree
석사
Issue Date
2020
Abstract
Background: In our society, the number of incidences of disabilities due to senile disease is increasing due to the aging of population, and the population with disabilities due to various diseases and accidents, which may be both congenital causes and acquired disorders, continues to rise. According to the Disability Welfare Act, 15 types of disabilities and severities are classified to provide policy support, but experiences of unmet healthcare needs have occurred due to various medical accessibility problems according to the characteristics and types of disabilities. Such repeated experiences of unmet healthcare needs exacerbate the current disease or cause secondary medical problems, deteriorating the quality of life and increasing the burden more medical support and medical expenses, To amend the current situation systematic medical management attention for the disabled is required. Recently, researches on unmet healthcare needs have increased, but not only were comparative studies between the disabled and non-disabled people and the number of comparison targets insufficient, comparative studies by disability types were also rare. Therefore, this study compared the experiences of unmet healthcare needs in the disabled, the vulnerable class in our society, to the non-disabled, and looked at the differences. By doing so, this study aimed to strengthen the equity in the policy for the disabled and to find a way to improve the quality of life for the disabled with appropriate medical securities for each type of disabilities and effectively customized medical support according to individual needs. Methods: This study utilized data from the Disability Survey (2017) and the Community Health Survey (2017). Disabled people with types of frequent disabilities (physical, brain lesions, visual, hearing, and mental disorder) and non-disabled people were extracted through a 1:5 propensity score matching by full-fitting all the characteristics included in the analysis. The differences in the experience of unmet healthcare needs and the reason of occurrence were compared between 5,229 people with disabilities and 26,145 non-disabled people. Moreover, the differences in the experience of unmet healthcare needs and the reason of occurrence were compared between types of disabilities. Chi-square test and conditional logistic regression analysis with SAS ver. 9.4 program were used as analysis methods. Results: As a result of the study, experiences of unmet healthcare needs occurred in 17.7% of the disabled and 11.5% of the non-disabled. It was analyzed that the number of incidences of experiences of unmet healthcare needs in both the disabled and non-disabled groups was high in females, 80 years of age or older, residing in rural area, one-person households(living alone), living apart or divorced or decreased, high school diploma or lower, economically inactive, low household income, poor self-rated health status, having no health checkups and cancer screenings within the last 2 years, symptoms of depression, two or more chronic diseases, and a low quality of life index. Therefore, it was found that experiences of unmet healthcare needs are more likely to occur in the socially, economically, and medically vulnerable groups. In the difference of influencing factors of experience of unmet healthcare needs, the odds ratio of disabled people was 1.57 times (95% confidence interval : 1.43 to 1.73) higher than that of the non-disabled people. When the experience of unmet healthcare needs of the disabled to the non-disabled was compared and analyzed by influencing factors, the experience of unmet healthcare needs increased in the disabled groups of female, age of 50 years or older, one-person households (living alone), living apart or divorced or decreased, high school diploma or lower, economically inactive, low household income, poor self-rated health status, two or more chronic diseases, and quality of life index in the lower 25% range. The reasons for the experience of unmet healthcare needs in the disabled group were analyzed to be in the order of economic reasons > difficulties in mobility > other reasons > time availability reasons, and the reasons of non-disabled group were analyzed in the order of other reasons > time availability reasons > economic reasons > difficulties in mobility. Within the group of people with disabilities, the reason for occurrence of experience of unmet healthcare needs was high for economic reasons, but the reason for occurrence compared to the non-disabled person was different due to the high difficulty in mobility. In the type of frequent disabilities, brain lesion disorder had the highest rate of experience of unmet healthcare needs, Looking at the causes of disability types, there were many difficulties in mobility for brain lesion disorder and economic reasons for physical disabilities, visual impairment, hearing impairment, and mental disorder. The occurrences of experience of unmet healthcare needs by types of disabilities compared to those of the non-disabled people, the odds ratio of the hearing impaired person was the highest, 1.92 times (P<0.01) higher than that of the non-disabled person, and when analyzed for reasons of occurrences, in terms of economic reason, visual impairment was the highest, 5.06 times (P<0.01) higher than that of the non-disabled person. And in terms of difficulties in mobility, brain lesions were the highest, with 5.84 times (P<0.01) higher than that of the non-disabled people, and in terms of time availability reasons, mental disorder were 0.15 times (P<0.01) lower and brain lesions were 0.06 times (P<0.01) lower than non-disabled people. Conclusions: As shown in the above result, the difficulties in mobility that was highly analyzed as the occurrence reason of experience of unmet healthcare needs in brain lesion, and the economic reasons that were highly analyzed as the occurrence reason of experience of unmet healthcare needs in the disabled group differ depending on the types of disabilities, but they exist as barriers that hinder the accessibility of health care services for people with disabilities. The Ministry of Health and Welfare and related ministries have made great efforts to provide medical care and policy support for the disabled, but the role of the government is continuously growing crucial to improve the quality of life of the disabled with social support and consideration. People with disabilities who can adapt to and replace functions lost by various diseases and accidents and move on with their lives, and those with disabilities whose symptoms may worsen without continuous treatments and skill trainings, will have different medical approaches. Therefore, it is possible to improve the quality of life by improving the health level of people with disabilities if budgets and support can be used in a timely and appropriate manner to the disabled with customized medical service support for prevention and treatment that can be applied realistically by grasping the reasons why medical service are not satisfactory for each type of disabilities. It is expected to reduce the economic burden of medical assistance and reach the center of efficiency and equity scale.
우리사회는 인구의 고령화로 노인성 질환에 따른 장애발생이 증가하고 있으며 선천적 원인과 후천적 장애발생 요인인 각종 질환과 사고에 의한 장애 인구가 지속적으로 증가하고 있다. 장애인복지법에 따라 15가지 장애유형과 중증도가 분류되어 정책지원을 하고 있으나 장애인의 특성과 장애유형에 따른 여러 가지의 의료접근성 문제로 미충족 의료경험이 발생되어왔다. 이렇게 반복된 미충족 의료경험은 현재의 질병을 악화시키거나 이차적 의료문제를 야기하여 삶의 질을 떨어뜨리고 더 많은 의료지원과 의료비에 대한 부담이 증가되기 때문에 장애인에 대한 체계적인 의료관리의 관심이 필요하다. 최근 미충족 의료경험에 관한 연구가 증가하였으나 장애인과 비장애인의 비교연구 및 그 비교 대상수가 충분치 않았으며 장애유형별 비교연구 또한 드물었다. 따라서 우리사회의 취약계층인 장애인에게 발생되는 미충족 의료경험을 비장애인과 비교하여 차이를 살펴보고, 이를 통해 장애인 정책에 형평성을 강화하고 장애유형별 적절한 의료보장과 필요에 따른 효율적인 맞춤형 의료지원으로 장애인의 삶의 질을 개선할 수 있는 방향을 모색하고자 하였다. 이 연구는 장애인실태조사(2017)와 지역사회건강조사(2017) 자료를 활용하여 다빈도 장애유형(지체, 뇌병변, 시각, 청각, 정신적 장애)의 장애인과 비장애인에 대해 분석에 포함된 모든 특성을 맞춤 보정하여 1:5 성향점수매칭을 통해 대상자를 추출하였으며, 장애인 5,229명과 비장애인 26,145명에 대해 비장애인과의 비교를 중심으로 장애인의 미충족 의료경험과 발생이유 차이, 장애유형별 미충족 의료경험과 발생이유 차이를 카이제곱검정과 조건부 로지스틱 회귀분석을 통하여 비교 분석하였다. 연구결과 전체 대상자의 미충족 의료경험은 장애인 17.7%, 비장애인 11.5%에서 발생하였다. 또한 특성 중 여성, 80세 이상, 수도권과 광역시 이외지역, 1인 가구(독거), 배우자와 별거·이혼·사별, 고등학교 졸업이하, 비경제활동, 낮은 가구소득, 주관적 건강상태 나쁨, 최근 2년 이내에 건강검진과 암 검진을 받지 않은 집단, 우울증과 2개 이상의 만성질환 보유, 낮은 삶의 질 지수의 집단에서 미충족 의료경험의 발생이 높은 것으로 분석되었다. 따라서 미충족 의료경험은 사회적, 경제적, 의료적 취약계층에게서 더욱 차이가 발생된다는 것을 알 수 있었다. 미충족 의료경험의 영향요인별 차이에서는 장애여부에 대한 오즈비가 비장애인에 비해 장애인의 미충족 의료경험이 1.57배(95% 신뢰구간: 1.43-1.73) 높았으며, 비장애인 대비 장애인의 미충족 의료경험을 영향요인별로 비교 분석하였을 때 장애인의 특성 중 여성, 50세 이상 연령이 증가할수록, 1인 가구(독거), 별거·이혼·사별의 결혼상태, 고등학교 졸업이하의 교육수준, 비경제활동, 낮은 가구소득, 주관적 건강상태 나쁨, 2개 이상의 만성질환 보유, 삶의 질 지수가 하위 25%일 때 미충족 의료경험은 증가했다. 장애인 집단의 미충족 의료경험 발생이유는 경제적 이유 > 이동의 어려움 > 기타 이유 > 시간적 이유 순서였고, 비장애인 집단의 이유는 기타 이유 > 시간적 이유 > 경제적 이유 > 이동의 어려움 순서로 분석되었다. 또한 장애인 집단 내에서는 발생이유로 경제적 이유가 높았지만, 비장애인 대비 발생이유는 이동의 어려움이 높아 차이를 보였다. 다빈도 장애유형에서는 뇌병변장애가 미충족 의료경험 발생률이 가장 높았고, 장애유형별 발생이유를 살펴보면 뇌병변장애는 이동의 어려움이, 지체, 시각, 청각, 정신적 장애는 경제적 이유가 많았다. 비장애인 대비 장애유형별 미충족 의료경험 발생은 청각장애인의 오즈비가 비장애인에 비해 1.92배(P<0.01)로 가장 높았으며, 발생이유로 비교 분석하였을 때, 경제적 이유 측면에서는 시각장애인이 비장애인에 비해 5.06배(P<0.01)로 가장 높았고, 이동의 어려움 측면에서는 뇌병변장애인이 비장애인에 비해 5.84배(P<0.01)로 가장 높았으며, 시간적 이유 측면에서는 비장애인에 비해 정신적 장애인이 0.15배(P<0.01), 뇌병변장애인이 0.06배(P<0.01) 낮았다. 위의 결과와 같이 뇌병변장애에 높게 분석된 이동의 어려움 측면과 장애인 집단에서 미충족 의료경험의 많은 발생이유인 경제적 이유는 장애유형별 차이가 있으나 장애인의 보건의료서비스의 접근성을 저해시키는 다양한 장벽으로 존재한다. 보건복지부와 관계부처들은 장애인의 의료보장과 정책지원을 위해 많은 노력을 기울여 왔으나 앞으로도 사회적 지지와 배려 속에 장애인의 삶의 질을 향상시키기 위한 정부의 실효적인 역할은 더욱더 요구되어질 것이다. 다양한 질병과 사고에 의해 상실된 기능에 적응하고 대체하여 삶을 살아갈 수 있는 장애인과 지속적인 치료와 기능훈련을 받지 않으면 증상이 악화될 수 있는 장애인은 의료적 접근이 다를 것이다. 따라서 장애유형별로 의료가 충족되지 못하는 이유를 파악하여 현실적으로 적용될 수 있는 예방과 치료의 맞춤형 의료서비스 지원으로 장애인에게 예산과 지원이 적시적소에 사용될 수 있다면 장애인의 건강수준을 향상 시켜 삶의 질을 개선할 수 있으며 향후 의료 지원의 경제적 부담을 줄이고 효율성과 형평성 저울의 중심점에 다가갈 수 있을 것이라 기대해본다.
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4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 2. Thesis
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https://ir.ymlib.yonsei.ac.kr/handle/22282913/180920
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