장애인가구의 본인부담 보건의료비지출의 결정요인 및 소득탄력도 분석 = A study on the influencing factors and income elasticity about out-of-pocket expenditure in health care of the disabled household

다국어 초록 (Multilingual Abstract)

This study set out to analyze empirically the major characteristics of out-of-pocket expenditures in health care based on the desire and capacity to pay of disabled households under the goal of providing basic data for policies to guarantee their health right and increase equity for them. In this approach, the focus of analysis was on burden rather than benefit in the guarantee of health rights and on process rather than outcome to examine the sensitivity(elasticity) of income changes as capacity to pay as well as the determinants of health care expenditures. The raw data of Korean Health Panel(KHP) of 2015 was used in analysis, covering total 861 disabled households. The analysis results show that the absolute size and relative percentage of out-of-pocket expenditures in health care were relatively higher in disabled households than common households. The lower income class recorded relatively higher percentage of health care expenditures in total consumption and excessive burden of health care expenditures in income, thus suffering from aggravated economic burdens. The determinant analysis results reveal that important variables included the number of household members, age of the head of family and family members, type of disability of family members, and chronic diseases as desire characteristics in addition to capacity to pay as an income variable. The analysis results of income elasticity show that the entire disabled households recorded 0.4024 in income elasticity, which means that their income was not elastic. The non-elasticity index made a rather increase in the lower income class. Based on these findings, the study discussed a need to lower the burden of health care expenditures for disabled households in a rational manner and to consider additional policies for the lower income class as the relatively vulnerable class according to the analysis results, the households containing a member with an internal physical disability, the households containing an elderly member with a disability, and the households containing a member with a disability and chronic disease. It also discussed policy strategies to improve the out-of-pocket expenditure system in health insurance and expand and introduce the family doctor system through branch offices of community health centers.

국문 초록 (Abstract)

본 연구는 장애인가구의 건강권 보장과 형평성 제고를 위한 정책수립의 기초자료를 제공할 목적으로 장애인가구의 욕구 및 지불능력 특성에 기반 한 본인부담 보건의료비 지출의 주요 특성에 대해 실증분석을 하였다. 분석의 초점은 건강권 보장의 수혜가 아닌 부담에, 성과가 아닌 과정에 보다 초점을 맞춰 접근하였으며, 보건의료비의 결정요인과 지불능력으로서의 소득변화에 대한 민감성(탄력도)을 파악하고자 하였다. 분석자료는 2015년 한국의료패널 원자료를 활용하였고, 조사대상 장애인가구는 총 861가구이었다. 분석결과, 장애인가구의 본인부담 보건의료비의 절대적 규모와 상대적 비중은 모두 일반가구에 비해 상대적으로 높았으며, 특히 저소득계층으로 갈수록 총소비 대비 보건의료비 비중과 소득 대비 과부담 보건의료비 비중이 모두 상대적으로 높아져 경제적 부담이 가중될 수 있음을 확인하였다. 또한 결정요인분석에서는 지불능력으로서의 소득변수 외 욕구특성으로서 가구원 수, 가구주 및 장애가구원의 연령, 장애가구원의 장애유형, 만성질환 여부 등이 중요한 변수로 확인되었고, 소득탄력도분석에서는 전체가구 대상 소득탄력도가 0.4024로 비탄력적 특성을 나타냈으며, 이는 저소득계층으로 갈수록 비탄력성이 다소 증가하는 양상을 나타났다. 이러한 결과를 바탕으로 장애인가구의 보건의료비 부담을 합리적으로 낮추고, 특히 분석결과에서 나타난 상대적 취약계층으로서의 저소득계층, 내부 신체적 장애유형의 장애가구원이 있는 가구, 장애노인이 있는 가구, 만성질환의 장애가구원이 있는 가구 등에 대한 추가적 정책고려의 필요성과 건강보험 본인부담제 개선 및 보건지소를 통한 주치의제도 확대도입 등 정책적 전략들에 대해 논의하였다.

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