베이비붐세대가 65세 노인인구로 전환 시의 만성질환 환자 수와 진료비 예측

이선영 ( Sun Young Lee ),김영훈 ( Young Hoon Kim ),김한성 ( Han Sung Kim ) 한국보건행정학회 2013 보건행정학회지 Vol.23 No.4

Purpose: The purpose of study is to estimate the number of chronic disease patients and medical care expenditure at the time baby-boomers belong to 65 years old aging population, and compare with current 65 year-old aging population. Methods: Analysis method used an estimating formula devised by the researcher and estimated the number of chronic disease patients and medical care expenditure of each generation. Results: When comparing the estimated number of chronic diseases patients of each generation, 40.6% of the first generation, 76.4% of the second generation, 95.2% of third generation are expected to get chronic disease. When comparing each generation`s total medical care expenditure, based on the estimated number of chronic diseases patients of each generation, the second generation( 1,206,251,224 thousand won) showed higher than other generation. This study compared the number of chronic disease patients and medical care expenditure between the second generation of the elderly and current elder generation. As a result, the second generation patients was higher than the fourth generation in high blood pressure, diabetes, psychological and behavioral disorder, and neurological diseases whereas the fourth generation is only high the number of patients in heart disease. As for total medical care expenditure, the second generation paid more in high blood pressure, psychological and behavioral disorder while the fourth generation in neurological disease and heart disease. Conclusion: It is desired that considering the number of chronic disease patients and medical care expenditure of baby boomers accounting for 14.6% of total population, in-depth follow-up study is carried out that inquires into what are issues with a current chronic disease management project, what business is needed in order to manage these issues, and how to fund to cover increasing medical care expenditure.

Disease burden of prostate cancer from 2014 to 2019: estimation from the Global Burden of Disease Study 2019 and Medical Expenditure Panel Survey

Lin Shen,Lin Dong,Li Yiyuan,Zhong Lixian,Zhou Wei,Wu Yajing,Xie Chen,Luo Shaohong,Huang Xiaoting,Xu Xiongwei,Weng Xiuhua 한국역학회 2023 Epidemiology and Health Vol.45 No.-

OBJECTIVES The aim of this study was to evaluate the disease burden of prostate cancer (PC) and assess key influencing factors associated with the disease expenditures of PC in the United States. METHODS The total deaths, incidence, prevalence, and disability-adjusted life-years of PC were obtained from the Global Burden of Disease Study 2019. The Medical Expenditure Panel Survey was used to estimate healthcare expenditures and productivity loss and to investigate patterns of payment and use of healthcare resources in the United States. A multivariable logistic regression model was conducted to identify key factors influencing expenditures. RESULTS For patients aged 50 and older, the burden for all age groups showed a modest increase over the 6-year period. Annual medical expenditures were estimated to range from US$24.8 billion to US$39.2 billion from 2014 to 2019. The annual loss in productivity for patients was approximately US$1,200. The top 3 major components of medical costs were hospital inpatient stays, prescription medicines, and office-based visits. Medicare was the largest source of payments for survivors. In terms of drug consumption, genitourinary tract agents (57.0%) and antineoplastics (18.6%) were the main therapeutic drugs. High medical expenditures were positively associated with age (p=0.005), having private health insurance (p=0.016), more comorbidities, not currently smoking (p=0.001), and patient self-perception of fair/poor health status (p<0.001). CONCLUSIONS From 2014 to 2019, the national real-world data of PC revealed that the disease burden in the United States continued to increase, which was partly related to patient characteristics.

Disease burden of prostate cancer from 2014 to 2019 in the United States: estimation from the Global Burden of Disease Study 2019 and Medical Expenditure Panel Survey

Shen Lin,Dong Lin,Yiyuan Li,Lixian Zhong,Wei Zhou,Yajing Wu,Chen Xie,Shaohong Luo,Xiaoting Huang,Xiongwei Xu,Xiuhua Weng 한국역학회 2023 Epidemiology and Health Vol.45 No.-

OBJECTIVES: The aim of this study was to evaluate the disease burden of prostate cancer (PC) and assess key influencing factors associated with the disease expenditures of PC in the United States. METHODS: The total deaths, incidence, prevalence, and disability-adjusted life-years of PC were obtained from the Global Burden of Disease Study 2019. The Medical Expenditure Panel Survey was used to estimate healthcare expenditures and productivity loss and to investigate patterns of payment and use of healthcare resources in the United States. A multivariable logistic regression model was conducted to identify key factors influencing expenditures. RESULTS: For patients aged 50 and older, the burden for all age groups showed a modest increase over the 6-year period. Annual medical expenditures were estimated to range from US$24.8 billion to US$39.2 billion from 2014 to 2019. The annual loss in productivity for patients was approximately US$1,200. The top 3 major components of medical costs were hospital inpatient stays, prescription medicines, and office-based visits. Medicare was the largest source of payments for survivors. In terms of drug consumption, genitourinary tract agents (57.0%) and antineoplastics (18.6%) were the main therapeutic drugs. High medical expenditures were positively associated with age (p=0.005), having private health insurance (p=0.016), more comorbidities, not currently smoking (p=0.001), and patient self-perception of fair/poor health status (p<0.001). CONCLUSIONS: From 2014 to 2019, the national real-world data of PC revealed that the disease burden in the United States continued to increase, which was partly related to patient characteristics.

지역별 특성, 질병과 의료비에 관한 연구

김진익 ( Jin-ick Kim ) 한국노인의료복지학회 2016 노인의료복지연구 Vol.8 No.1

This study explores the causes of disease and death depending on the local natural environment and individual health care from a local perspective. The study compares and analyzes medical expenditure per capita based on findings. As a result of comparing and analyzing the above contents, there were differences by area and generation in relation to living environments, health care, the causes of disease and death and medical expenditures. Therefore, it is necessary to develop health promotion programs and individual healthcare programs to meet the local needs. If the political supports such as a point accumulation system or medical discounts are applied to people who practice health care, it is assumed that the importance of personal health care can be the basis of medical care expenditures savings as social spread.

2015년 한국의료패널 자료 기반 아동의 장애여부에 따른 사회인구학적 특성, 만성질환, 의료이용의 차이 분석

문종훈,원영식 한국지식정보기술학회 2021 한국지식정보기술학회 논문지 Vol.16 No.3

The purpose of this study was to compare the sociodemographic characteristics, chronic disease, and medical expenditures between children with and without disabilities. Data from 3,481 children aged < 20 years and no university students were extracted from the Korea health panel 2015 database. The socio-demographic characteristics included age, sex, education level, family income and presence of national basic livelihood act recipients. The variables used were chronic disease, medical use (emergency room use, hospitalization use, hospital outpatient use), and medical expenditure. Differences of variables according to presence or absence of disability were analyzed by independent t test, Mann-Whitney u test, chi-square test, and logistic regression analysis. In results, of the 3,481 children, 32 (0.9%) were children with disabilities. Rate of male, rate of low income, chronic disease and medical expenditure were significantly higher in the disability group than the non-diability group (p<.05). Factors affecting disability of children were sex, presence of national basic livelihood act recipients and chronic disease. In children with disabilities, high levels of medical expenditure were found in cases of brain injury. These findings imply that the accessibility of health care services for children with disabilities is very low. A reasonable social security system for children with disabilities should be established.

Increased 10-Year Prevalence of Huntington’s Disease in South Korea: An Analysis of Medical Expenditure Through the National Healthcare System

Chan Young Lee,Jun-soo Ro,Hyemin Jung,Manho Kim,Beomseok Jeon,Jee-Young Lee 대한신경과학회 2023 Journal of Clinical Neurology Vol.19 No.2

Background and Purpose This study aimed to determine the updated 10-year prevalence of Huntington’s disease (HD) in South Korea and the medical and economic burdens across the duration of the disease. Methods Data from the National Health Insurance database during 2010–2019 were analyzed. We identified HD cases using predefined criteria. Information on age at diagnosis, sex, and common nonneurological comorbidities were collected. We analyzed individual patterns of the use of medical services and yearly medical expenditure. Incidence rates, 10-year prevalence rates, and longitudinal medical expenditure changes were assessed. Results New patients with HD (average=152.10) were detected every year, with an annual incidence of 0.29 per 100,000. The estimated 10-year prevalence of HD was 2.2 per 100,000. The most common ages at the time of diagnosis were 50–59 years (23.3%). In 2019, 56.4% of patients with HD were followed-up at referral or general hospitals, and 32.2% were managed at longterm- care hospitals. The annual medical cost for an individual was KRW 6,569,341±895,097 (mean±SD) (mean≈USD 5,653). Medical expenditure was the highest in those aged 60–79 years, and lowest in those younger than 30 years. However, in all age groups, the annual medical expenditure was highest during the 9 years following a diagnosis. Conclusions This study found that the actual prevalence of HD in South Korea was higher than previously thought and that patients are in a situation with high medical expenditure that persists over time.

4대 중증질환 보장성 정책이 환자의 의료이용과 재난적 의료비에 미친 영향 - 성향점수매칭과 이중차이분석을 활용하여 -

이현옥 한국사회복지학회 2018 한국사회복지학 Vol.70 No.1

The purpose of this study is to analyze the causal effects of the four major severe diseases benefit expansion policy implemented in 2013 on the health care utilization and catastrophic health expenditure of treatment groups. As a result of the simple difference-in-difference model, the four major severe diseases benefit expansion policy was effective in reducing the out-of-pocket payments and Non-covered services expenditures of the treatment group. However, no statistical significance was found in the number of outpatient visits and inpatient and the incidence of catastrophic health expenditure of the four major severe diseases household. The implications of this study are as follows. First, the effect of the four severe disease benefit expansion policy was identified through the non-covered medical services, an area in which previous research was insufficient. Second, in the analysis process, it was confirmed that the control group, patients with chronic illness or the non-four severe diseases, were experiencing similar medical expenses and catastrophic health expenditure like a severe diseases. Therefore, it is necessary to extend the benefit expansion policy not only to the four severe diseases but also to other diseases. This suggests that “Moon Jae-in care”, which is currently being implemented by the government, should be implemented immediately for all patients beyond the four major severe diseases. 본 연구의 목적은 2013년 시행된 4대 중증질환 보장성 강화 정책이 수혜대상의 의료이용과 대상가구 의 재난적 의료비에 미친 인과적 효과를 분석하는 것이다.분석 자료는 한국의료패널 2012년과 2014년 자료를 활용하였고,전체 3400명의 개인과 1700 가구를 분석대상으로 하였다.이중차이분석 결과, 4대 중증질환 보장성 강화 정책은 수혜대상의 본인부담금과 비급여 진료비를 경감하는데 통계적으로 유의미한 효과가 나타난 반면,의료이용횟수와 중증질환 가구의 재난적 의료비의 발생여부에는 유의미한 효과가 나타나지 않았다.보장성 정책의 인과적 효과는 4대 중증질환 환자의 의료비는 다소 경감시켰으나 지불능력 대비 과다한 의료비 지출로 인한 가구의 재정적 어려움을 해소하기에는 부족하였다. 논문의 함의는 4대 중증질환 보장성 강화 정책의 효과를 비급여 진료비를 통해 파악하였다. 또한 건강보험에서 규제되지 않는 비급여 진료비에 대한 전면적 급여 확대의 필요성을 확인하였다. 분석과정에서 대조군인 만성질환 및 비4대 중증질환자 역시 과중한 의료비 부담과 높은 재난적 의료비 발생률을 경험하는 것을 확인하였다. 이는 4대 중증질환에 한정된 보장성 정책을 넘어 현재 정부에서 추진중인 문재인 케어가 조속히 시행되어야 함을 시사한다.

건강보험 보장성 강화 정책에 대한 진료비중심 대안의 비교 및 실증 연구

김정훈 ( Jung Hoon Kim ),정기택 ( Kee Taig Jung? ),신은규 ( Eun Kyu Shine ) 경희대학교 경영연구원 2010 의료경영학연구 Vol.4 No.1

The national health insurance act was initiated in 1977. This act has maintained the low burden & low benefit`` policy. Also, the low coverage rate did not seem to be solved due to the shortage of the finance. To fix the low coverage rate of the national health insurance, the government introduced a new plan in 2005. The plan was set a goal to increase the coverage rate as the average level developed countries had. The government suggested a benefit plan based on the expansion of the benefit for diseases. However, this plan was criticized by many because high risk patients could not have enough benefits when they had diseases the new list in the expansion of the benefit for diseases was not held. This study suggested the expansion of the benefit for medical expenditure as an alternative way in order to increase the coverage rate. This study compared the coverage rate of the patients with high cost when the same amount of money applied to two different benefit plans. The medical security for patients with high cost was good when the out-of-pocket payment of limit system, one way for the expansion of the benefit for medical expenditure, was expanded. The expansion of the out-of-pocket payment of limit system is a proper way for increasing the coverage rate of the national health insurance.

장애아동과 비장애아동의 의료이용 및 질병특성 비교

김유진(Eu-Gene Kim),김경미(Kyung-Mee Kim),유동철(Dong-Chul Yoo) 한국콘텐츠학회 2017 한국콘텐츠학회논문지 Vol.17 No.7

본 연구는 장애아동과 비장애아동의 의료이용 및 질병이환의 특성을 분석하여 건강격차를 비교하고자 시행하였다. 연구자료는 2010년도 국민건강보험공단의 표본코호트자료를 이용하여 0-19세 장애아동과 비장애아동을 대상으로 의료이용량과 진료비, 질병보유수, 다빈도질환과 아동장애와 관련질환의 환자비율 등을 비교하였다. 분석결과 장애아동은 비장애아동보다 의료이용빈도 및 입원율, 질병보유수가 많아 건강상태가 좋지 않고 진료비를 더 많이 지출하였다. 두 집단 간에 많이 겪는 다빈도질환도 차이가 나서 장애아동은 신경계통질환, 순환기계질환 및 정신행동장애의 순으로 많은 반면, 비장애아동은 호흡기계질환, 손상 및 중독질환, 감염성질환 순이였다. 장애아동은 신경계통의 선천기형질환이나 신체장애와 밀접한 건강관련질환의 의료이용이나 진료비지출이 많으나, 비장애아동은 감염성질환에서 높게 나타났다. 결론적으로 비장애아동보다 잦은 진료와 입원, 과다한 의료비 지출과 복합적으로 보유한 질환 등으로 특징지워지는 장애아동의 의료접근성을 향상시키는 다양한 보건의료정책이 필요하다. 그리고 손상으로 인한 장애가 추가적으로 발생하거나 심화되지 않도록 장애아동 및 비장애아동의 부모에게 예방교육이 필요하다. This study is to examine health care utilization and morbidity of disabled and non-disabled children in Korea to evaluate the health disparities. We used medical claim data of 2010 from the National Health Insurance Service-National Sample Cohort data. As a result of the analysis, the disabled children are not in good health condition because they have more frequency of medical service use, hospitalization rate, and more number of diseases and spent more on medical expenses than non–disabled children. Patterns of the most frequent disease differ from significantly between disable and non-disabled. Disabled children had a higher prevalence of selected birth defects and selected health conditions associated with physical disability and a lower prevalence of selected infection disease than children without disability. In conclusion, Health policy changes that would extend the access to health service for children with disabilities characterized by frequent medical care, hospitalization, excessive medical expenditure and complex diseases.

연령대별 복합요인과 신체활동량의 변화가 만성질환의 수준과 의료비에 미치는 영향

지창진(Chang-Jin Ji) 대한고령친화산업학회 2023 대한고령친화산업학회지 Vol.15 No.2

연구목적 본 연구에서 4년 동안 연령대별 신체활동량 변화에 따른 의료비용 개연성을 살펴보고 해당 연구결과를 토대로 만성질환 패턴을 분석하고자 한다. 특정 연령대의 질환 발생을 예방하기 위한 정책 수립과 함께 만성질환 개선 사례와 생활습관의 관련성을 고찰하여 의료 정책 개발에 적용될 수 있는 대안을 제시하고자 한다. 연구방법 한국의료 패널데이터 ver. 1.71 를 활용하여 각각의 연령대별로 만성질환 위험도 및 의료비지출을 확인하기 위해 4년동안 설문지에 참여한 인원(7,184명)을 데이터 추출 후 종단 연구 분석을 실시하였다. 연령대별 신체활동량과 좌업 시간의 개별요인에 대해 기술 통계를 t-test 와 one-way ANOVA를 실시하였으며, 만성질환별 위험도를 살펴보기 위해 복합 요인들은 1분위(“High PA, Low Sit”,기준변수)와 비교하여, 2분위(High PA, High Sit), 3분위(Low PA, Low Sit), 4분위(Low Sit, High PA)에 따른 로지스틱회귀분석을 실시하였다. 연구결과 첫째, 장년층과 노년층 신체활동량은 정상그룹에 비해 단순만성질환에서 복합만성질환으로 갈수록 감소하였으며, 노년층은 의료비지출 평균이상 그룹에서 신체활동량 감소가 나타났다. 둘째, 노년층 좌업 시간은 정상그룹에 비해 단순만성질환에서 복합만성질환으로 갈수록 증가하였다. 셋째, 복합요인(신체활동과 좌업 시간)에서 고혈압과 당뇨병 위험도는 저위험군(1분위)에 비해 고위험군(4분위)에서 상승하였으며, 뇌혈관 질환 위험도는 저위험군(1분위)에 비해 좌업 시간이 높은 그룹(2분위,4분위)에서 상승하는 것이 나타났다. 심장질환 위험도는 저위험군에 비해 모든 그룹(2분위,3분위,4분위)에서 위험도가 상승이 나타났다. 결론 데이터 기반한 치료의학과 함께 예방의학 차원의 접근(운동처방 및 관리를 위한 지역별 전문기관 선정을 통한 네트워크 신체활동 프로그램)이 필요하다. 장년층 세대부터는 의료비 감소를 위해 선제적 만성질환 추적 플랫폼 시스템 개발 및 구축을 고민해야 할 시점이라 생각된다. Objective : The purpose of this study was to confirm the relationship between the disease degree and the lifestyle in the cases. Methods : Using Korean Health Panel Survey Data ver. 1.71 to determine the risk of chronic disease by age group, the complex factors, longitudinal study analysis was conducted for the data was extracted from the participants who participated in the 4 years questionnaire(n=7,184). Results : First, Age(50-64) and Age(over 65) group PA decreased from simple chronic disease to complex chronic disease compared to the normal group. Age(over 65) showed PA decrease in the group above the average medical expenditure. Second, compared to the normal group, the Sit time of the elderly increased from simple chronic disease to complex chronic disease. Third, in complex factor the risk increased of Hypertension and Diabetes odds in the high-risk group compared to the low-risk group, and the risk of Cerebrovascular Disease odds in the high sit grop compared to the low-risk group. Cardiovascular risk increased in all groups compared to low-risk group. Conclusion : Along with data-based therapeutic medicine, a preventive medicine-level approach is needed.