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임진화,김성경,이은미,배신영,박재현,최귀선,함명일,박은철,Lim, Jin-Hwa,Kim, Sung-Gyeong,Lee, Eun-Mi,Bae, Sin-Young,Park, Jae-Hyun,Choi, Kui-Son,Hahm, Myung-Il,Park, Eun-Cheol 대한예방의학회 2007 예방의학회지 Vol.40 No.2
Objectives : The aim of this study is to identify factors determining the purchase of private health insurance under the mandatory National Health Insurance(NHI) system in Korea. Methods : The data were collected by the National Cancer Center in Korea. It includes cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer. Data were gathered from the hospital Order Communication System (OCS), medical records, and face-to-face interviews, using a structured questionnaire. Clinical, socio-demographic and private health insurance related factors were also gathered. Results : Overall, 43.9% of patients had purchased one or more private health insurance schemes related to cancer, with an average monthly premium of \65,311 and an average benefit amount of \19million. Females, younger aged, high income earners, national health insurers and metropolitan citizens were more likely to purchase private health insurance than their counterparts. Conclusions : About half of Korean people have supple-mentary private health insurance and their benefits are sufficient to cover the out-of-pocket fees required for cancer treatment, but inequality remains in the purchase of private health insurance. Further studies are needed to investigate the impacts of private health insurance on NHI, and the relationship between cancer patients' burden and benefits.
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민간의료보험이 암 환자의 의료이용과 의료비에 미치는 영향: 일개 암전문의료기관의 우리나라 주요 암종을 중심으로
임진화,최귀선,김성경,박은철,박재현,Lim, Jin-Hwa,Choi, Kui-Son,Kim, Sung-Gyeong,Park, Eun-Cheol,Park, Jae-Hyun 대한예방의학회 2007 예방의학회지 Vol.40 No.4
Objectives : To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. Methods : The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. Results : Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. Conclusions : We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.
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대장암 환자가 부담하는 직접비용: 2년간의 추적조사를 통해
최귀선,박은철,임민경,임진화,김성경,박재현,정승용,박지원,임석병,최효성,정경해,김대용,박재갑 대한대장항문학회 2008 Annals of Coloproctolgy Vol.24 No.5
Received February 1, 2008, Accepted September 11, 2008 Correspondence to: Jae-Gahb Park, Cancer Research Institute and Cancer Research Center, Seoul National University, 28, Yeongeon- dong, Jongo-gu, Seoul 110-744, KoreaTel: +82-2-8072-3380, Fax: +82-2-742-4727E-mail: jgpark@plaza.snu.ac.krCost of Colorectal Cancer Care in Korea: A Prospective Group Study with a 2-year Follow-up National Cancer Control Research Institute, 1Research Institute and Hospital, National Cancer Center, Goyang, Korea Kui Son Choi, Eun-Cheol Park, Min-Kyung Lim, Jin-Hwa Lim, Sung-Gyeong Kim, Jae Hyun Park, Seung-Yong Jeong1, Ji Won Park1, Seok-Byung Lim1, Hyo Seong Choi1, Kyung Hae Jung1, Dae Yong Kim1, Jae-Gahb Park1Purpose: The incidence of cancer incidence and the rate of mortality are increasing in Korea. Specifically, colorectal cancer in men is one of the most sharply increasing malignancies. The objective of this study was to assess the direct costs for colorectal cancer patients and to identify the factors that influence cancer costs. Methods: The direct costs of colorectal cancer were examined with a prospective group study at a hospital. The direct costs were assessed every 3 months over a 24-month period through patient interviews, medical records, and claims data. We identified the major factors associated with the cost of colorectal cancer by using a general linear model for the log-transformed data. Results: The group was comprised of 100 patients with colon cancer and 120 patients with rectal cancer. The average costs per patient during the first and the second years after diagnosis were ￦16,280,000 and ￦5,786,000, respectively. Medical costs accounted for about 68% (￦11,090,000) of the first year’s total cost and about 62% (￦3,602,000) of the second year’s total cost. National Health Insurance (NHI) paid approximately 50% of the total medical cost. The total cost of colorectal cancer was clearly associated with the stage of the disease at first diagnosis, the cancer site, therapeutic modalities, and recurrence. Conclusions: These results indicate that colorectal cancer has a heavy financial impact on cancer patients. The total cost of colorectal cancer is clearly associated with the stage of the disease at first diagnosis. Increased efforts in terms of prevention and early detection may assist in reducing the costs. 목적: 암 발생과 사망이 증가하고 있으며, 특히 남성에서 대장암 발생이 급격하게 증가하고 있다. 본 연구는 대장암 환자가 부담하는 직접비용을 추정하고, 이에 영향을 미치는 요인을 분석하였다. 방법: 일개 병원 대장암센터에 내원하여 대장암으로 치료받은 220명을 2년간 추적조사 하였다. 직접비용은 3개월마다 환자와의 인터뷰, 의료비 청구자료, 의무기록조사로 추계하였다. 로그치환된 선형회귀분석으로 직접비용에 영향을 미치는 요인을 파악하였다. 결과: 220명의 대장암 환자 중 100명은 결장암, 120명은 직장암이었다. 대장암 환자의 진단후 1년간 지출한 직접비용은 16,280,000원이었으며, 2년째 비용은 5,786,000원이었다. 이중 의료비가 62∼68%를 차지하였으며, 의료비 중 보험자 부담금은 50%였다. 환자의 진단 당시 병기, 위치, 치료유형, 재발 여부가 직접비용에 통계적으로 유의하게 영향을 미쳤다. 결론: 대장암 환자의 진단 후 1년간 직접비용은 16,280,000원으로 환자의 경제적 부담이 큰 것으로 조사되었다. 그러나 조기 대장암은 진행암에 비해 2배 이상 직접비용이 감소하였다.
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