중증도 분류에 따른 진료비 차이: 간질환을 중심으로

신동교,이천균,이상규,강중구,선영규,박은철 한국보건행정학회 2013 보건행정학회지 Vol.23 No.1

Background: Diagnosis procedure combination (DPC) has recently been introduced in Korea as a demonstration project and it has aimed the improvement of accuracy in bundled payment instead of Diagnosis related group (DRG). The purpose of this study is to investigate that the model of end-stage liver disease (MELD) score as the severity classification of liver diseases is adequate for improving reimbursement of DPC. Methods: The subjects of this study were 329 patients of liver disease (Korean DRG ver. 3.2 H603) who had discharged from National Health Insurance Corporation Ilsan Hospital which is target hospital of DPC demonstration project, between January 1, 2007 and July 31, 2010. We tested the cost differences by severity classifications which were DRG severity classification and clinical severity classification-MELD score. We used a multiple regression model to find the impacts of severity on total medical cost controlling for demographic factor and characteristics of medical services. The within group homogeneity of cost were measured by calculating the coefficient of variation and extremal quotient. Results: This study investigates the relationship between medical costs and other variables especially severity classifications of liver disease. Length of stay has strong effect on medical costs and other characteristics of patients or episode also effect on medical costs. MELD score for severity classification explained the variation of costs more than DRG severity classification. Conclusion: The accuracy of DRG based payment might be improved by using various clinical data collected by clinical situations but it should have objectivity with considering availability. Adequate compensation for severity should be considered mainly in DRG based payment. Disease specific severity classification would be an alternative like MELD score for liver diseases.

식품 가격인상 정책의 비만중재 효과에 관한 연구의 고찰: 가당음료를 중심으로

김정주,신동교 대한비만학회 2014 The Korean journal of obesity Vol.23 No.4

배경: WHO가 비만을 세계적 전염병으로 명명한 이래 세계 각국에서 비만의 사회경제적 비용에 주목하면서 다양한 가격정책을 도입,시행하고 있다. 본 연구는 세계 주요국의 비만도 감소를 위한 가격정책 중 소아청소년기 비만의 주원인으로 주목받고 있는 가당음료에 대한 가격정책 사례를 분석하여 향후 우리나라에서의 효과적 비만중재방안을 제안하고자 하였다. 방법: 세계 주요국의 식품 가격정책 중 특히 탄산음료세 가격인상 도입 효과를 분석한 논문을 대상으로 비만 가격정책의 효과를 메타분석 기법 중 하나인 투표수 방법(vote-counting method)을 이용하여평가하였다. 결과: 슈가택스(sugar tax), 탄산음료세 및 패스트푸드(fast food) 가격인상 도입 효과를 분석한 논문 19개의 분석결과 세금 부과에 의한 비만중재 효과는 긍정적 효과를 보인 경우가 12건으로 가장 많았고, 효과가 중립적인 경우가 7건으로 나타났다. 그리고 부정적 효과가 있다는 결 론을 가진 논문은 없었다. 결론: 비만의 재정정책은 비만관리를 위한 의미 있는 중재방안이나식생활 및 식품가격에 대한 인식은 나라마다 달라 한국사회에 관련제도 도입은 장기적으로 신중한 접근이 필요하다. 한편 본 분석에 포함된 연구에서 사용된 지표가 각기 달라 명확한 근거를 제시하는 데에 한계가 있고 투표수 방법 검정의 한계로 정책효과의 긍정 및 부정등 방향성만 제시하였을 뿐 그 효과의 크기를 알 수 없어 향후 이에 대한 보다 폭넓은 연구가 필요할 것으로 판단된다.

COVID-19 발생 전·후의 응급의료이용 변화: 종합병원급 이상 의료기관을 중심으로

김정주,김상미,신동교 한국보건사회연구원 2022 保健社會硏究 Vol.42 No.3

This study examined to what extend the outbreak of Covid-19 influenced emergency medical service utilization. Changes in medical services utilization were analyzed using monthly data for the years 2018 to 2020 from the Health Insurance Review and Assessment Service. Percentage analysis was conducted on changes in medical use before and after COVID-19, and the difference in usage between perids 2018-2019 and 2019-2020 was analyzed by linear regression. Changes in the trend of emergency medical services used due to the COVID-19 outbreak were analyzed using local weighted regression method. In 2020, the utilization of emergency medical services at general hospitals or higher-tier medical institutions decreased by 22.8% compared to the average before the COVID-19 outbreak, and the number of patients decreased significantly during the first, second, and third waves of the COVID-19 pandemic. Specifically, medical use declined more significantly among patients with mild conditions than among those with severe conditions. Meanwhile, the mortality rate within 7 days of visiting the emergency room increased by 32.6% after COVID-19, indicating that a decrease in emergency medical use led to a decrease in the performance of emergency care. 이 연구에서는 COVID-19 발생 전․후의 응급의료이용을 비교함으로써, COVID-19가 응급의료이용에 미치는 영향을 파악하였다. 건강보험심사평가원의 2018년부터 2020년의 월별 응급의료이용 자료를 이용해 의료이용 변화를 분석하였다. 코로나 전․후의 의료이용 변화는 백분율 분석을 진행하였으며 선형회귀분석을 통해 2018~2019년과 2019~2020년의 의료이용 차이를 확인하였다. 이중차이 분석 및 국소회귀분석을 통해 COVID-19로 인한 의료이용 추세 변화를 확인하였다. 2020년 종합병원급 이상 의료기관의 응급의료 이용자 수는 COVID-19 발생 전 2년 평균 대비 -22.8% 감소했고, COVID-19 1, 2, 3차 유행시기에 이용자 감소폭이 컸다. 특히, 중증질환보다 경증질환에서 큰 폭의 감소가 있었다. 한편, 응급실 방문 후 7일 이내 사망률은 COVID-19 후 32.6% 증가해 응급의료이용량 감소가 응급의료 성과 감소로 이어졌음을 확인할 수 있었다.

신포괄수가 시범사업 모형 개선 이후의 지불정확도 변화

최정규,김선희,신동교,강중구,Choi, Jung-Kyu,Kim, Seon-Hee,Shin, Dong-Gyo,Kang, Jung-Gu 한국보건행정학회 2017 보건행정학회지 Vol.27 No.3

Background: Korea set up new diagnosis related group (DRG) as demonstration project in 2009. The new DRG was reformed in 2016. The main purpose of study is to identify the effect of reform on accuracy of payment. Methods: This study collected inpatient data from a hospital which contains medical information and cost from 2015 to 2016. The dependent variables were accuracy of total, bundled, unbundled payment, and payment for procedures. To analyze the effect of reform, this study conducted a multi-variate regression analysis adjusting for confounding variables. Results: The accuracy of payment increased after policy reform. The accuracy of total, bundled, unbundled payment, and payment for procedures significantly increased 3.90%, 2.92%, 9.03%, and 14.57% after policy reform, respectively. The accuracy of unbundled payment showed the largest increase among dependent variables. Conclusion: The results of study imply that policy reform enhanced the accuracy of payment. The government needs to monitor side effects such as increase of non-covered services. Also, leads to a considerable improvement in the value of cost unit accounting as a strategic play a role in development of DRG.

당뇨환자 등록 DB 구축 및 환자만족도 10% 향상 활동

송영득,김유미,남주영,박현주,최행정,신동교,윤미선,지수나,문여진,김경미 한국의료QA학회 2006 가을학술대회 Vol.2005 No.2

퇴원의무기록 주진단명 기록 및 코딩 적합도 20% 향상

이천균,이상훈,김용배,최영은,김유리아,최행정,류상희,신동교,정성원,송현정,조희원 한국의료QA학회 2007 가을학술대회 Vol.2007 No.3

활동기준원가를 이용한 충수절제술과 폐렴의경제적 재원일과 재원과 재원일 단축에 따른 기회이익

김상미 ( Sang Mi Kim ),이해종 ( Hae Jong Lee ),신동교 ( Dong Gyo Shin ) 한국보건행정학회 2013 보건행정학회지 Vol.23 No.2

Background:This study aimed to measure the opportunity income by identifying the economic length of stay (ELOS) which is the intersection point of daily revenue and cost on appendectomy and pneumonia cases. Methods: The research subjects were 460 patients of appendectomy and 606 patients of pneumonia, discharged from a general hospital between July 1, 2009 and June 30, 2010. ELOS calculated with both of total revenue on diagnosis-related group (DRG) and fee-for service (FFS). The cost is calculated by activity-based costing system of the hospital. Results: Average length of stay (ALaS) of appendectomy was 4.48 days and its average revenue per case were 1,710,215 (1,989,105) won by DRG (FFS). The variable cost was 491,262 won which was 28.7% (24.7%) of DRG (FFS) total revenue. And 97.2% of the total variable cost was incurred within 2 days from admission. The ELOS was 4 (5) days in DRG (FFS). Shortening three days (two days) would increase opportunity income 52.0% (82.2%) in DRG (FFS). ALaS of pneumonia case was 4.86 days and its average revenue per case were 489,448 (761,426) won by DRG (FFS). The variable cost was 27,230 won which was 5.6% (3.6%) ofDRG (FFS)total revenue. Thirty-eight point nine percent olthe daily variable cost was incurred in discharge date. The ELOS was 2 (4) days in DRS (FFS). Shortening three days (one day) would increase opportunity in­come 27.6% (37.2%) in DRG (FFS). Conciusion:The ELOS would be used by strategic index for achieving minimum profit and developing thewaysto get there. But we also should not pass overthat the opportunity income obtained by the reducing ALaS may cause some problem of quality.

인지기능 정보 연계를 통한 치매 환자 대상 노인장기요양급여 확대 정책 효과

손강주 ( Kang Ju Son ),이지은 ( Jee Eun Lee ),윤여주 ( Yeoju Yun ),신동교 ( Donggyo Shin ),이준홍 ( Jun Hong Lee ) 한국보건경제정책학회 2021 보건경제와 정책연구 Vol.27 No.4

우리나라는 경증 치매 환자도 장기요양등급을 부여하기 위해 2014년 7월 치매특별등급, 2018년 1월 인지지원등급을 신설하였다. 정책 확대에 따라 경증 치매 환자에서 등급인정률이 높아지는지 계량적으로 확인할 필요가 있다. 이를 위해 국민건강보험 일산병원 인지기능 검사 자료와 공단 청구 및 장기요양 자료를 연계하여 인지기능을 반영한 장기요양 등급인정 데이터를 구축하였다. 그 결과 시간이 흐름에 따라 치매 환자 등급인정률은 높아지는 추세였다. 인지기능 수준이 저하될수록 장기요양 인정점수는 높아지는 편이었지만, 정책 확대에 따른 인정점수는 변함이 없었다. 인지기능 수준과 등급인정 사이에 관련성은 찾기 어려웠다. 그렇지만 정책이 확대될수록 치매 환자에서 등급인정 가능성은 커졌다. 이는 우리나라가 경증 치매 환자 등급인정을 위해 장기요양인정점수 산정방식에 변화를 주기보다 치매 환자일 때 등급인정을 부여하는 정책 방향과 부합하는 결과임을 시사한다. 본 연구는 현재 장기요양 급여 확대 정책이 경증 치매 환자 장기요양 등급인정에 긍정적인 효과를 발휘하고 있음에 대한 근거로 활용 할 수 있다. Republic of Korea(ROK) has implemented dementia limited long-term care(LTC) rate that Rating-V at July 2014, Cognitive assistant Rating at January 2018. It needs to be Quantitatively confirmed that the approval rate of dementia to increase after policy extension. This study combined National Health Insurance Service Ilsan Hospital cognitive function test and National Health Insurance data and Long-term Care Insurance data. the approval rate of dementia has been increasing between 2011~2018. The approval points(AP) for LTC tended to increase as the cognitive function level deceases, but there was no significant change in the AP according to the policy expansion. although there was not quite the correlation between cognitive function level and LTC approval, it was confirmed that the possibility of LTC approval increased as the policy extended. ROK has directed LTC approval to mild dementia rather than changing the LTC AP calculation method. the result of above is consistent with the policy direction. This study can be used as evidence that the current LTC policy is a positive effect on LTC approval for mild dementia.

치매 환자의 장기 요양 이용 현황 분석 및 생애 의료비 측정

정석종(Seok Jong Chung),이지은(Jee Eun Lee),김동욱(Dong Wook Kim),윤소라(So Ra Yoon),신동교(Dong Gyo Shin),최문영(Moon Young Choi),이준홍(Jun Hong Lee) 대한임상노인의학회 2021 대한임상노인의학회지 Vol.22 No.1

Background: To investigate the current status of long-term care services for patients with dementia and lifetime medical costs for dementia in South Korea. Methods: This study utilized the National Health Insurance Service-National Health Information Database (NHIS-NHID) from January 2013 to December 2017. The prevalence and incidence of dementia was estimated by extracting people who were diagnosed and treated with dementia (age≥45 years) from the database. The use of long-term care services by the elderly with newly diagnosed dementia was also investigated. Additionally, the lifetime medical expenses for dementia were estimated using data on a single year’s medical costs, population data, and a life table from Statistics Korea. Results: The prevalence of dementia increased from 2015 to 2017, while the incidence of dementia gradually decreased. Among the patients with newly diagnosed dementia, approximately 30% used the long-term care services, while 4th graders accounted for the highest proportion every year. The older the individual and the lower their income quartile, the shorter the time they took to apply for long-term care services after diagnosis of dementia. The total medical expenses per capita increased steadily every year, and the lifetime medical expenses were higher for women than men. Half of the lifetime medical costs of dementia occurred after 67 years of age for men and 83 years for women. Conclusion: This study suggests that medical, social, and political measures are needed to effectively manage the long-term care of service recipients and prepare for rising medical costs for dementia.