우울증 여부에 따른 외래의료이용 비교 : 고혈압과 당뇨병 환자를 중심으로

서은원,최소영,이광수 사단법인 대한보건협회 2017 대한보건연구 Vol.43 No.4

Objective : This study purposed to analyze the differences of outpatient service uses for hypertension and/or diabetes patients by depression. Methods : Korea Health Panel Survey 2012 provided by the Korea Institute for Health and Social Affairs and National Health Insurance Service was used for the analysis. The number of outpatient days and total expenditure were used as dependent variables. Depression was used as independent variable and socio- demographic factors (gender, age, education level and presence of a spouse), economic factors (insurance types, presence of an economic activity and income level), health behavior (smoke and obesity)and chronic diseases types (hypertension and diabetes, hypertension only, diabetes only)were used as covariates. Chronic diseases types were defined by ICD-10 code given outpatients as their primary- and/or secondary- diagnosis. Results : There were differences in the number of outpatient days and total expenditure between patients with and those without depression. Patients with depression showed higher number of outpatient days and total expenditure. Regression analysis provided that depression had significant influence on the number of outpatient days and total expenditure. Conclusions : This study found that depression increased the number of outpatient days and total expenditure in hypertension and diabetes patients. Thus, it will need to consider depression in developing health policies for patients with chronic diseases and to provide integrated healthcare and management for those patients. 연구목적 : 만성질환과 우울증은 전 세계적으로 질병부담이 높은 질환으로 우리나라에서도 만성질환자와 우울증환자 수는 증가하고 있으며, 최근에는 만성질환과 우울증을 동시에 보유한 환자의 수가 증가하고 있다. 하지만 만성질환과 우울증을 함께 다룬 국내 연구는 많지 않으며, 특히, 만성질환과 우울증을 동시에 보유한 환자들의 의료이용에 대한 분석은 개인 및 사회의 부담을 줄이기 위한 정책 수립 시 필요하다. 따라서 본 연구는 우울증 유무에 따른 만성질환자(고혈압, 당뇨)의 의료이용 차이 및 우울증이 의료이용에 미치는 영향을 분석하고자 한다. 연구방법 : 연구 자료는 한국보건사회연구원과 국민건강보험공단이 제공하는 한국의료패널 2012년 자료이며 연구 대상은 2012년 1년 동안 요양기관을 외래로 방문한 30세 이상의 고혈압, 당뇨 환자였다. 분석에 사용된 종속변수는 의료이용을 나타내는 내원일수와 외래 총 진료비이며, 독립변수는 우울증 유무, 통제변수는 선행요인(성, 연령, 교육수준), 가능요인(배우자 유무, 의료보장 유형, 경제활동 유무, 소득수준), 욕구요인(흡연상태, 비만여부, 만성질환 유형)이다. 만성질환자는 ICD-10 코드로 주상병 혹은 부상병이 고혈압, 당뇨병으로 부여된 환자로 정의하였다. 연구결과 : 우울증 유무에 따라 연구 대상자의 일반적 특성 및 의료이용에서 차이가 있었다. 우울증을 보유하지 않은 환자보다 우울증을 보유한 환자의 내원일수가 더 길었고 외래 총 진료비도 높게 나타났다. 내원일수와 총 진료비를 종속변수로 하여 회귀분석을 실시한 결과, 우울증은 내원일수와 외래 총 진료비에 통계적으로 유의한 영향을 미쳤다. 즉, 우울증을 보유한 만성질환자일수록 내원일수가 길었고 총 진료비가 높았다. 결론 : 만성질환과 정신질환을 함께 가지고 있는 환자는 점점 많아지고 있고 이는 개인 및 사회에 다양한 문제를 야기할 수 있다. 따라서 만성질환과 정신질환을 각각 따로 관리하기 보다는 함께 관리하는 통합 치료 및 관리 프로그램이 필요하며, 본 연구는 그 정책을 수립할 때 기초자료로서 활용될 수 있을 것이다.

미국의 외상시스템 소개 및 시사점

서은원 건강보험심사평가원 2019 HIRA 정책동향 Vol.13 No.4

한국의 진료비 지불제도 현황과 혁신 과제

서은원,정설희 한국보건행정학회 2023 보건행정학회지 Vol.33 No.4

This study aims to propose the implementation of innovative payment models in Korea in order to promote the financial sustainability of the national health insurance system by reviewing the current status of the payment system in Korea and examining other countries’ experiences with various innovative payment models. Korea primarily uses a fee-for-service payment system and additionally uses various payment systems such as case payment, per diem, and pay-for-performance. However, each payment system has its limitations. Many OECD (Organization for Economic Cooperation and Development) countries have pointed out the limitations of existing payment systems and have been attempting various innovative payment models (e.g., add-on payment, bundled payment, and population-based payment). Therefore, it is essential for Korea to consider innovative payment models, such as a mixed payment model that takes into account the strengths and weaknesses of each payment system, and to design and pilot these models. This process requires stakeholders to work together to build a social consensus on the implementation of innovative payment systems and to refine legal and systematic aspects, develop an integrated health information system, and establish dedicated organizations and committees. These efforts towards innovative payment models will contribute to developing a sustainable health insurance system that ensures the public’s health and well-being in Korea.

미국과 캐나다의 아동 구강건강관리 제도

서은원 건강보험심사평가원 2020 HIRA 정책동향 Vol.14 No.3

정신질환 관련 의료자원 이용의 생산성 변화 분석

서은원 ( Eun Won Seo ),곽진미 ( Jin Mi Kwak ),진다빈 ( Da Bin Jin ),이광수(교신저자) ( Kwang Soo Lee ) 한국보건경제정책학회(구 한국보건경제학회) 2016 보건경제와 정책연구 Vol.22 No.1

본 연구는 맘퀴스트 생산성 지수(Malmquist Productivity Index, MPI)를 이용하여 정신질환 관련 의료자원 이용의 7년 간 생산성 변화 추이를 지역별로 분석하였다. 분석 단위인 DMU(DecisionMaking Units)는 16개 광역시·도이며 중앙정신보건사업지원단에서 제공하는 7개년 자료(2007-2013년)를 이용하였다. 맘퀴스트 생산성 지수 분석에 사용된 투입변수는 정신 의료기관 수,정신 병상 수, 정신과 전문의 수이며 산출변수는 정신 의료기관에 입원 및 외래로 방문한 환자수이다. 분석 결과, 생산성은 전반적으로 평균 0.6% 증가하였고 이 생산성 증가에 주된 영향을 미치는 요인은 기술 변화로 나타났다. 또한 지역별로 생산성 변화에 큰 차이가 있었는데, 평균적으로 생산성 증가가 크게 나타난 지역은 강원, 서울이었던 반면 생산성 감소가 큰 지역은 인천,제주였다. 본 연구는 7년 간 우리나라 정신질환 관련 의료자원 이용의 생산성 추이를 지역별로 파악할 수 있었고, 앞으로의 정신질환 관련 의료자원 이용 계획 수립 시 기초자료로 활용될 수있을 것이다. This study purposed to analyze the productivity trend of healthcare resources utilization about mental health by region in Korea. Data were derived from the National Mental Health Commission and this study included 16 metropolitan cities for 7 years from 2007 to 2013. To analyze productivity change using Malmquist Productivity Index(MPI), number of mental hospitals, number of mental hospital beds and number of psychiatrists were used as input variables. Number of inpatients and outpatients were used as output variables. Overall, MPI was increased by 0.6% on average during the period from 2007 to 2013. Technical change had more influence on productivity advance than pure efficiency change and scale efficiency change. There were differences in MPI by regions. Gangwon showed the highest productivity increase, while Incheon showed the highest productivity decrease. Study results presented that productivity change of healthcare resources utilization about mental health was differed by regions and that technical changes were mainly due to productivity change. Thus, health policy makers will need to prepare interventions to use resources about mental health efficiently by regions.

의료보장유형에 따른 Percutaneous Transluminal Coronary Angioplasty 입원 환자의 의료이용 차이 분석: Propensity Score Matching을 이용하여

서은원 ( Eun Won Seo ),이광수 ( Kwang Soo Lee ) 한국보건행정학회 2015 보건행정학회지 Vol.25 No.1

Background: Previous studies showed differences in healthcare utilization among insurance types. This study aimed to analyze the difference in healthcare utilization for percutaneous transluminal coronary angioplasty inpatients by insurance types after controlling factors affecting healthcare utilization using propensity score matching (PSM). Methods: The 2011 national inpatient sample based on health insurance claims data was used for analysis. PSM was used to control factors influencing healthcare utilization except insurance types. Length of stay and total charges were used as healthcare utilization variables. Patients were divided into National Health Insurance (NHI) and Medical Aid (MA) patients. Factors representing inpatients (gender, age, admission sources, and Elixhauser comorbidity index) and hospitals (number of doctors, number of beds, and location of hospitals) were used as covariates in PSM. Results: Tertiary hospitals didn’t show significant difference in length of stay and total charges after PSM between two insurance types. However, MA patients showed significantly longer length of stay than that of NHI patients after PSM in general hospitals. Multivariate regression analysis provided that admission sources, Elixhauser comorbidity index, insurance types, number of doctors, and location of hospitals (province) had significant influences on the length of stay in general hospitals. Conclusion: Study results provided evidences that healthcare utilization was differed by insurance types in general hospitals. Health policy makers will need to prepare interventions to influence the healthcare utilization differences between insurance types.

외국의 묶음지불제도 도입 현황 및 한국에의 시사점 : 미국, 영국, 호주를 중심으로

서은원 ( Eun-won Seo ),위세아 ( Se-ah Wee ),신양준 ( Yang-jun Shin ),이근정 ( Keun-jung Lee ),이진용 ( Jin-yong Lee ) 한국보건경제정책학회(구 한국보건경제학회) 2021 보건경제와 정책연구 Vol.27 No.2

전 세계는 고령화와 만성질환 증가 등으로 의료비가 증가함에 따라 보건의료시스템의 지속 가능성 위기에 직면하였고 이에 대한 대안으로 지불제도 개혁을 추진하고 있다. 우리나라 또한 유사한 보건의료 환경에 대응하기 위하여 다양한 지불제도에 대한 모색이 필요한 시점이다. 이에 이 연구는 묶음지불제도를 도입한 OECD 국가 중 미국, 영국, 호주의 사례를 살펴봄으로써 한국의 묶음지불제도 도입에 대한 정책적인 시사점을 제시하고자 하였다. 미국과 영국, 호주는 기존 지불제도의 한계를 보완하면서 의료 질 향상, 비용 절감, 의료연계 강화 등의 목표를 달성하기 위해 묶음지불제도를 도입하였다. 미국과 영국은 특정 질환 또는 처치에, 호주는 만성질환 관리에 묶음지불제도를 적용하였고, 그 결과 의료 질 관리와 비용 절감에 긍정적인 효과가 있는 것으로 나타났다. 따라서 우리나라에서도 포괄적, 연속적인 서비스 제공의 필요성과 적용 대상이 명확한 특정 질환에 대해 시범적인 묶음지불제도 도입을 고려할 수 있으며, 추후 제도의 적용 가능성을 판단하고 세부사항을 내실화한다면 건강보험 제도의 재정적 지속가능성 제고를 위한 정책 수립의 근거를 마련하는데 도움이 될 것이다. This study aims to offer policy implications for introducing the bundled payment system in Korea by looking into other countries’ experience. Three countries, which include the United States, the United Kingdom, and Australia, were selected through the method of purposive sampling. These countries have adopted Bundled payment models with the aims of improving the quality of care, reducing cost, and enhancing care coordination, while addressing the limitations of existing payment systems. The U.S. and the U.K.’s application of bundled payment models focuses on certain conditions or treatments, and Australia’s targets chronic condition management. The introduction of the bundled payment system in these countries resulted in having a positive effect on managing the quality of care and reducing medical spending. Such results suggest that Korea may consider introducing pilot initiatives that implement bundled payment models for certain conditions, with clearly identifiable targets, which require comprehensive and continuous services. Pilot implementations of the system will provide an opportunity to examine applicability of the system and improve the details, which, in turn, will contribute to making policies for enhancing financial sustainability of Korea’s health insurance system.

권역외상센터의 질 관리와 수가 개선 현황

서은원 ( Eun-won Seo ),임지혜 ( Jeehye Im ) 한국보건행정학회 2021 보건행정학회지 Vol.31 No.4

The emergency medical service system in Korea was built upon the Emergency Medical Service Act, 1995 to respond adequately to be much in demand for emergency medical services. In addition, the government recognized the importance of the trauma care system and set out to plan for the designation and establishment of the regional trauma center by 2012. This study aimed to investigate features of quality management and trauma fee schedule on better understanding of trauma care system. First, quality management of the regional trauma center has been implemented by several quality programs involved in quality assessment, committee on trauma quality management, and mortality and morbidity conference. Second, the trauma fee schedule has reflected a specific quality of severe traumatic conditions and added the result to it, which are graded A, B, and C according to quality assessment. Although the government has contributed to instituting a trauma quality assessment program and trauma fee schedule for the regional trauma center, it could not lead to such a fixed standard for quality management of them. Therefore, it will promote discussion on the sustainability of the regional trauma center that requires reducing preventable trauma death rate and the way to apply comprehensive quality management.

성별에 따른 지역 간 자살률 차이 및 영향요인 분석

서은원 ( Eun Won Seo ),곽진미 ( Jin Mi Kwak ),김다양 ( Da Yang Kim ),이광수 ( Kwang Soo Lee ) 한국보건행정학회 2015 보건행정학회지 Vol.25 No.4

Background: Suicide is one of important health problems in Korea. Previous studies showed factors associated with suicide in individual levels. However, suicide was influenced by society that individuals belong to, so it was required to analyze suicide in local levels. The purpose of this study was to analyze the regional disparities of suicide mortality by gender and the association between local characteristics and suicide mortality. Methods: This study included 229 city·county·district administrative districts in Korea. Age- and sex-standardized suicide mortality and age-standardized suicide mortality (male/female) were used as dependent variables. City·county·district types, socio-demographics (number of divorces per 1,000 population, number of marriages per 1,000 population, and single households), financial variable (financial independence), welfare variable (welfare budget), and health behavior/status (perceived health status scores and EuroQol-5 dimension [EQ-5D]) were used to represent the local characteristics. We used hot-spot analysis to identify the spatial patterns of suicide mortality and negative binomial regression analysis to examine factors affecting suicide mortality. Results: There were differences in distribution of suicide mortality and hot-spot regions of suicide mortality by gender. Negative binomial regression analysis provided that city·county·district types (city), number of divorces per 1,000 population, financial independence, and EQ-5D had significant influences on the age- and sex-standardized suicide mortality per 100,000. Factor influencing suicide mortality was the number of divorces per 1,000 population in both male and female. Conclusion: Study results provided evidences that suicide mortality among regions was differed by gender. Health policy makers will need to consider gender and local characteristics when making policies for suicides.

중국과 일본 들깨 수집 자원의 생육 특성 및 페놀 성분 분석

성은수,서은원,정일민,김명조,김희영,유지혜,최재후,김남준,유창연 한국약용작물학회 2015 한국약용작물학회지 Vol.23 No.2

This study was conducted to find out the variation in agronomic trait and chemical composition in the collected Perilla frutescens from China and Japan. From the results of growth investigation, the maximum number if branches was 26.7ea in Japan 134 line, followed by 25 nodes number in China 119 line. Among the different lines investigated, maximum number of panicle number (108.8) were observed in China 114 line. 1000 seed weight was maximum (4.12 g) in China 118 line. Flowering time of different collected lines varied significantly with average value of 175.5 days and the average line required for maturation of seedlings was 205.1 days. Plant height was the highest (248.9 ㎝) in China 107 line. Highest number of total picking leaves was 965ea, and the average picked period was 54 days. The major phenol compounds contained in Perilla frutescens showed wide variation for Syringic acid, Benzoic acid, Naringin, o-Coumaric acid, Myricetin, Naringenin and Hesperetin. Japan 139 line showed the highest level of total phenol contents (8254.0 ㎍/g, dry weight).