의약분업 전,후 약품비 변동추세와 구조변화 분석

신종각 ( Chong Gak Shin ),이의경 ( Eui Kyung Lee ) 한국보건경제정책학회(구 한국보건경제학회) 2006 보건경제와 정책연구 Vol.12 No.1

국립대학교병원의 효율성 및 생산성변화 분석

신종각 ( Chong Gak Shin ) 한국사회보장학회 2006 社會 保障 硏究 Vol.22 No.4

생명보험회사의 설립형태 및 규모별 생산성 변화추이 분석

신종각 ( Chong Gak Shin ) 보험연구원 2006 보험금융연구 Vol.17 No.1

이 논문은 1991년 이후 최근까지 우리나라 생명보험회사의 설립형태 및 규모별 효율성을 측정하고 연도별 생산성의 변화를 측정하였다. 효율성과 생산성을 측정하는 방법으로 자료포락기법(DEA)과 Malmquist 생산성지수를 사용하였으며, 생산성 측정 변수로는 투입물 변수로서‘보험영업비용’과‘투자영업비용’을 채택하였고 산출물 변수로서 ‘수입보험료‘와 ’투자 영업수익‘을 채택하였다. 국내 생명보험산업의 최근 현황은 전반적으로 산업 성장성의 정체, 상위3개사 중심의 시장집중도 완화, 외국인 소유사의 시장점유율의 확대 추세, 중소형 생명보험사의 시장점유율 확대, 외국계 생명보험사와 국내생명보험사의 효율성 및 생산성 격차 심화(생산성의 경우 중소규모의 국내기업과 외국계 간의 차이), 방카슈랑스의 시행 및 확대 등으로 요약되며 전반적으로 시장경쟁이 심화되는 등 시장환경의 변화에 직면하고 있는 것으로 분석된다. 효율성과 생산성 분석 결과, 1990년대 중반 이후 우리나라 생명보험산업의 효율성은 크게 하락하였으며 그 결과 2차례의 생명보험사 구조조정을 초래한 주요 원인이 되었으나 최근 2년간(2003년, 2004년)에는 산업전체의 효율성이 상승(0.630, 0.742)한 것으로 분석되었다. 1993년도에서 2004년 기간 동안 생명보험사의 총생산성은 5.6% 하락한 것으로 분석되었는데 이중 효율성은 1.3% 증가한 반면 프런티어 변화는 4.8% 하락한 것으로 분석되었다. 외국계의 시장점유율 확대는 기술효율성이 국내사보다 뛰어나기 때문이며 특히 국내사에 비하여 규모의 경제를 유지하기 때문에 발생하는 현상으로 분석되었다. 중소생명보험사와 대형생명보험사와의 시장점유율격차 축소는 외국계를 중심으로 한 중소생명보험사의 순수기술효율성과 규모효율성 모두의 향상에 기인하나 규모효율성의 효과가 보다 큰 것으로 분석되었다. 국내 생명보험사가 적절한 경쟁력을 유지하려면 과잉생산규모(생산요소 포함)를 정리하는 등 적정생산규모의 유지가 필요한 상태이다. This article measures productivity growth and efficiency change in Korean life insurance industry since the 1991 financial year. DEA and Malmquist productivity index were used to measure efficiency and productivity. To measure productivity and efficiency, both operation income from insurance operations and investment income from investment activities were chosen as output variables, while both operation expense from insurance operations and operation expense from investment activities were chosen as input variables. According to analyses on efficiency and productivity, efficiencies in the Korean life insurance industry has dropped a lot before the financial crisis in 1997, and these low efficiencies has resulted in two times restructuring of the life insurance industry led by the government after the financial crisis. However, overall efficiencies of the industry has risen during recent two years, for the year 2003 the efficiency was 0.630 and for the year 2004 the efficiency was 0.742, respectively. For the period from 1993 to 2004 productivity growth had dropped 5.6%, of which efficiency change had risen 1.3% but frontier change has dropped 4.8%. Foreign owned insurance companies expanded their market shares due to superior technical efficiency, especially in scale efficiency, compared to domestic insurance companies. The difference in market shares between large companies and small and mid-sized companies which consist of both domestic and foreign companies has narrowed recently due to progress in both pure-technical and scale efficiencies led by foreign companies. Of the two effects, scale efficiency was dominant. In conclusion, the Korean life insurance industry needs optimal economies scale by curtailing overcapacity to maintain competitiveness in its already opened domestic market.

DEA에 의한 병원 효율성 평가에서 질적 측면 통합 모형에 관한 연구 -국립대학교병원에 대한 분석을 중심으로-

신동욱 ( Dong Wook Shin ),신종각 ( Chong Gak Shin ),정기택 ( Kee Taig Jung ) 한국병원경영학회 2008 병원경영학회지 Vol.13 No.3

Rising healthcare cost is a global phenomenon that justifies governments` introduction of `incentive regulation` plan for the improvement of hospital efficiency. A number of previous studies tried to evaluate the efficiency of healthcare organization by using Data Envelopment Analysis(DEA), a common efficiency benchmarking method. However, there is a concern that this kind of efficiency evaluation could induce “quantity-quality trade-off”. Moreover, as quality aspect is especially important in terms of `effectiveness` of health care, it should be considered in efficiency evaluation of healthcare organization. A number of different models were tried so far to incorporate quality aspect into DEA, however, none is universally recognized as a standard. Thus, in this study, previous quality-incorporating DEA models were categorized into 6 types according to the way of incorporating quality aspect, and strengths and limitations of each type were reviewed with a set of artificial data as an example. Based on this review, a new quality- incorporating efficiency evaluation model, named Quality-adjusted output DEA(QAO- DEA), was suggested. As an exploratory empirical analysis, technical efficiency of human resource were measured with different quality-incorporating DEA models, using 2004 data from National University Hospitals. In conclusion, Quality-adjusted output DEA(QAO-DEA) model seems to be one of the most desirable alternatives to incorporate quality aspect in efficiency evaluation of hospital, and deserves the consideration as a policy tool to induce simultaneous improvement of both efficiency and quality.

우리 나라 의료보험 급여비 증가요인 분석

신종각 세명대학교 2000 世明論叢 Vol.8 No.-

This article analysed causes of health care cost increases under NHI system in Korea from 1990 to 1998. During these periods the annual rate of increase in health care costs under NHI system is 16.2% on average. In 1990 the percentage rate of health care costs under NHI to GDP was 1.65 percents, which is about 2 trillion 942 billion wons, in 1998 that rate was 2.22 percents, which is about 9 trillion 965 billion wons. Major determinants of increases in health care costs under NHI are increases in per capita health care costs, the number of insurance claims, and frequency of utilization. Medical care consumers' utilization behavior also contributed to increases in health care costs increases under NHI. During those years between 1990 to 1998 the average per capita health care cost is quadrupled in General Hospitals, doubled in Hospitals, and increased two-thirds in Physician Offices. The above phenomena show that medical consumers preferences were concentrated in General Hospitals year by year. This article recommends that there should be some mechanism and procedures to control illegal health care benefits claims by both medical care providers and consumers.

노년층의 의료수요에 관한 경제학적 분석 : 미국의 외래의료기관 방문빈도의 결정요인 Physician Visits in the U . S .

신종각 한국사회보장학회 1999 社會 保障 硏究 Vol.15 No.1

본 논문의 주요 목적은 미국의 노년층(65세 이상)이 외래의료기관(병원 외래 및 의원급 의료기관)을 이용하여 의사의 진찰을 받은 연간회수(1987년)의 결정요인을 분석, 이해하여 노인의료수요의 예측과 의료보장제도의 개선방향에 관한 정책개발에 있다. 분석을 위한 경제학적 모형은 Grossman 박사의 의료수요에 관한 인적자본모형(Human Capital Model)에 기초하고 있다. 65세 이상 노인의 의료이용 정도를 분석하기 위한 두가지 지표(방문확률, 방분빈도)를 측정하기 위하여 다변수 분석이 실시되었다. 본 연구의 주요 연구결과는 다음과 같다. 첫째, 가구당 소득수준은 노인들의 외래의료기관 방문확률에 통계적으로 유의한 영향을 미쳤으나 방문회수에는 통계적으로 유의한 결정요소가 되지 못하였다. 이러한 결과는 노인의료보험제도(Medicare)와 저소득층 의료보험제도(Medicaid)를 포함하는 의료보장제도가 의료의 접근성 제고 목적에 부분적으로나 성공적 역할을 수행하고 있다고 평가된다. 둘째, 의료사보험(Medigap)의 유무는 외래의료기관 방문빈도에 통계적으로 유의한 영향을 미친 것으로 나타났다. 셋째, 노년층의 의료수요에 대한 가격탄력성은 청 ·장년층을 대상으로 한 다른 연구결과와 비교하여 비교적 높게 나타났다. 65세 이상 노인들은 의료이용(방문빈도)에 있어서 가격의 변화에 민감하게 반응한다고 볼 수 있다. 또한 미국의 의료보장제도에만 의존(Medicare와 Medicaid에만 의존)하는 노인들은 외래의료기관의 이용률이 매우 낮은 것으로 나타나. 이들이 의료보장제도의 남용으로 인한 의료비 상승의 원인으로 비난될 수 없음을 알게 되었다. 넷째, 노인들의 건강상태를 나타내는 지표들은 의료기관 이용빈도에 큰 영향을 미친 것으로 나타났다 다섯째, 여성이 남성보다 의료서비스 이용을 더 많이 한다는 가정은 노년층의 경우에는 외래의료기관 방문 확률에만 확인되었고, 방문 회수에서는 통계적으로 유의한 남녀간의 차이를 발견할 수 없었다. 이상의 연구결과에 기초하여, 특히 저소득층 노인들의 낮은 소득수준과 높은 가격탄력성에 근거하여, 본 연구는 노인의료보험 (Medicare)과 저소득층의료보험 (Medicaid) 제도를 개혁하려는 미국 의회의 논의는 새로운 비용 절감적 공공보건제도의 설계 뿐 아니라 이러한 새로운 제도의 저소득층 노인들에 대한 영향도 깊이 고려되어야 할 것으로 제안한다.

우리 나라 영유아 예방접종사업의 비용 추정 및 사업확대의 소요예산 추정

신종각 한국사회보장학회 2000 社會 保障 硏究 Vol.16 No.2

This article estimates the number and costs of immunization for infants and children in the Republic of Korea for years 1997, 1998, and 1999. Infants and children in Korea are vaccinated in BCG, TOPV, Hepatitis-B, MMR, and DtaP as a basic immunization program without charge in Public Health Centers or with charge in private physician offices or hospitals. About 97% of infants and children are estimated to be vaccinated. While 060% of them are vaccinated in physician offices of hospitals, the rest are vaccinated in Public Health Centers. In 1999 direct costs of immunization for infants and children are estimated 90 billion wons (about 85 million dollars). In PHCs about 23 billion wons were expended while in physician offices and hospitals about 67 billion wons were expended. This article assesses necessary budgetary money to transfer infants and children vaccinations in private health care center to PHCs. Necessary budget is estimated 102 billion wons if the government pay the expense as in private physician offices per vaccination and estimated 107 billion wons if the government pays the expense as in National Health Insurance fee schedule per vaccination in the year 2000. This article insists that current national immunization system for infants and children be maintained and the government expansion policy be not supported on the following ground. First, too much budget is required for the government to expand the immunization policy for infants and children compared to current system. Second, the excess engagement by the government will restrict seriously consumer's choice. Government should help needy infants and children not every children and their parents who can sufficiently pay for their vaccinations.

한국의 외환위기: 발생원인과 교훈

신종각 世明大學校 1998 世明論叢 Vol.7 No.-

This article investigates the development and causes of recent currency crisis in the Republic of Korea and examines closely lessons from the crisis. The development of currency crisis in Korea started when the economy began to slow down in 1996. A number of large companies collapsed due to high financial costa and low profitability in 1997. The Asian currency crisis which wtarted with the floatation of the Thain baht i early July 1997 spread to Korea in November 1997. The cause of the crisis can be summed up as follows. Market cofidence was eroded by a lack fo transparency in the Korean ecomnomy. The failure to observe market principles among economic entities led to the overall inefficiency of the economy. Fillally, inappropriate policy responses to the evolving problems also contributed to the worsening of situation.

우리나라 의료기관별 의료비 추계와 분석

신종각 한국사회보장학회 1998 社會 保障 硏究 Vol.14 No.2

This article presents data on health care spending for the Republic of Korea, covering expenditures for types of medical care providers and their sources of funding in 1995 (for hospitals from 1992 to 1995). In 1995 the Nation's medical care consumers spent 13.39 trillion won for medical care to medical care providers including hospitals, drug stores, dental services, and physician offices which is 78.9 percent of the Total National Health Expenditures. Expenditures for inpatient services were 4.58 trillion won and expenditures for outpatient were 7.51 trillion won. Medical care expenditures in General Hospitals amounted to 5.1 trillion won in 1995, accounting for 38.6 percent of the total. Expenditures in Hospital accounted to 1.4 trillion won. Expenditures in Physician Offices reached 3.2 trillion won, accounting for 24.5 percent. Expenditures for dental services were 1.3 trillion won (9.9 percent of the total), for drug stores were 0.9 trillion won (7 percent of the total), for traditional oriental herb and medical services were 1.4 trillion won (9.1 percent to the total), and for Health Centers and Maternity Centers were 61.5 billion won (0.5 percent of the total) . Third-party sources of funds, the amounts expended by national health insurance scheme, Medicaid, and private health insurance, accounted for 44 percent of all national health expenditures expended in health care providers. Out-of-pocket purchases accounted for 56 percent of the expenditures. This article shows that medical care consumers were under the burdensome out-of-pocket payments problem even though Korea has implemented the national health insurance program. This article recommends that Korean Government recognize the importance of estimating the National Health Expenditures correctly and implement policy measures to improve the data quality on National Health Expenditures.