미충족 의료의 동태적 변화추세와 관련 영향요인 = The longitudinal trend and association factors of unmet medical need

국문 초록 (Abstract)

목적 : 3개년(2005년∼2007년)의 한국복지패널자료에 대한 통계분석을 통해 ‘경제적 이유로 인한 미충족 의료’ 경험에 대한 단면적 현황 및 동태적 추세를 분석하고, 이에 영향을 미치는 관련요인을 밝히고자 한며, 미충족 의료를 감소시킬 수 있는 정책적 대안을 검토해 보고자 한다.

방법 : 19세이상 성인 11,907명에 대한 패널자료를 활용하여 미충족 의료의 영향요인간의 관계분석에는 로지스틱 회귀분석(logistic regression), 패널분석(panel analysis)을 사용하였으며, OR(대응위험도 : Odds Ratio)를 통해 비교분석하였다. 변수선택은 단계별 변수선택법(stepwise variable selection)을 사용하였으며, 분석에 사용한 통계 패키지는 SAS 9.1였다.

결과 : 연도별 미충족 의료는 1차 2005년은 7.00%, 2차 2006년은 3.69%, 3차 2007년의 경우에는 2.65%로 나타나서, 전반적으로 미충족 의료의 비율이 감소하고 있었다.
중등학교 졸업 이하의 저학력 계층과 만성질환 집단, 배우자 없는 집단, 주관적 건강상태가 불건강한 응답자, 미취업자 및 빈곤계층이 더 미충족 의료를 경험하는 것으로 나타났으며, 기초보장 수급자 집단, 건강진단을 받지 않은 집단의 미충족 의료비율이 높았으며, 입원을 경험한 계층, 생활비가 적은 집단에서 미충족 의료를 경험하는 것으로 분석되었다.
또한, 미충족 의료에 영향을 미치는 요인으로는 혼인상태, 주관적 건강상태, 빈곤, 기초보장 수급여부, 건강검진 여부, 입원여부, 생활비, 주거지역 등이었다.
한편으로, 3개년간의 미충족 의료의 동태적인 변화추세는 충족지속형이 전체의 89.30%로 나타났고, 하강형이 1.80%, 상승형이 6.15%, 미충족지속형이 0.36%로 분석되었는데, 이 같은 변화추세는 2005년 93%였던 충족의료 비율과 7%였던 미충족 의료비율이 감소한 반면, 나머지 10% 내외의 응답자는 하강형, 상승형 및 혼재형으로 다양하게 변화했음을 알 수 있다.
아울러, 미충족 의료의 동태적 변화유형에 영향을 미치는 요인으로는 하강형으로의 변화에는 교육수준, 혼인상태, 주관적 건강상태, 빈곤여부, 건강검진여부, 생활비, 주거지역 등의 변수가 유의미한 영향을 미치는 것으로 분석되었다.

결론 : 미충족 의료의 단면결과를 선행연구 결과와 비교했을 때, 건강검진과 주거지역은 추가로 유의미한 관련성을, 연령과 교육은 유의미한 영향을 미치지 않는 것으로 분석되었으며, 새롭게 추가한 변수인 건강검진과 생활비, 주거지역은 통계적인 유의미한 결과를 나타냈다.
또한, 미충족 의료의 동태적 변화요인과 관련해서는 교육수준은 동태적 변화유형에만 영향을 미치는 것으로 나타났으며, 국내외 선행연구 결과와 비교할 때는 교육수준과 혼인상태, 빈곤 등의 경제적 상태는 유사하게 미충족 의료의 동태적 변화에 중요한 결정요인으로 밝혀진 반면에, 주관적 건강상태 및 건강검진, 생활비 및 주거지역 등 더 많은 요인들이 통계적으로 유의미하게 관련되어 있는 것으로 분석되었다.
미충족 의료의 현황 및 변화와 관련된 이 같은 결과는, 비록 이번 연구가 미충족 의료만의 설문자료가 아닌, 3개년의 복지패널자료만으로 동태적 패널분석을 수행한 것으로 그 결과를 일반화하기에는 여러 제한점이 있을 수 있다고 하더라도, 정책적 관점에서 단기적으로 미충족 의료를 감소시킬 수 있는 방안과 함께 장기적으로 미충족 의료가 더 악화되는 것을 예방하기 위한 다각적인 정책대안이 필요하다고 하겠다.

다국어 초록 (Multilingual Abstract)

Objectives : The purpose of this study is to analyze the cross-sectional prevalence and longitudinal trend of unmet medical need caused by financial reasons for 3 years (from 2005 to 2007) and to find the association factors in order to review the related policies.

Methods : Based on the Korea Welfare Panel Data, the logistic regression and panel analysis were used as analytical tools to find the association factors of unmet medical need and Odds Ratio was also used to compare the influence of the variables. Stepwise variable selection was applied for variable selection and statistical program was SAS 9.1.
Results : The unmet medical need showed a steady decrease from 7.00% in 2005 to 3.69% in 2006, and to 2.65% in 2007. In particular, unmet medical need was more found in those who received under secondary education, those with chronic diseases, those without spouses, self-reported unhealthier people, unemployed, poverty group, recipients of public assistance and those who did not undergo a medical exam. And association factors of unmet medical need included marital status, self-reported health, poverty, public assistance, medical exam, inpatient, cost of living and residential district.
Longitudinal trend of unmet medical need was analysed 89.30% of met-maintaining type, 1.80% of declining type, 6.15% of rising type, 0.36% of unmet-maintaining type. Factors affecting declining type were education level, marital status, self-reported health, poverty, medical exam, cost of living and residential district.

Conclusion : Compared with prior studies, this study's cross-sectional analysis results were similar in that marital status, self-reported health status, poverty affected the unmet medical need, but newly added variables such as medical exam, cost of living and residential district showed the statistical significance. In addition, in longitudinal trend analysis, education, marital status and poverty were similar variables as in the precedent studies as affecting the unmet medical need declining, but more variating and additional factors including self-reported health, medical exam, cost of living and residential district were analyzed to be statistically significant.
In conclusion, even though this study has limits in generalizing its results as the analysis was conducted based solely on three-year panel data, it is suggested that short-term measures be required to reduce unmet medical need as well as a range of long-term policy approaches to prevent further deterioration of unmet medical need.

목차 (Table of Contents)

• 목 차
• Abstract ·············································· ⅰ
• Ⅰ. 서론 ··················································· 1
• 1. 연구배경 및 필요성 ··············································· 1
• 2. 연구목적 ····························································· 4
• Ⅱ. 이론적 배경 ·········································· 5
• 1. 미충족 의료의 개념 ··············································· 5
• 2. 미충족 의료의 평가방법 ·········································· 9
• 3. 미충족 의료 관련 선행연구 고찰 ······························· 10
• 4. 미충족 의료 분석의 정책적 의미 ······························· 17
• Ⅲ. 연구방법 ·············································· 21
• 1. 자료수집 및 분석 ················································· 22
• 2. 변수선정 및 정의 ················································· 23
• 3. 분석방법 ··························································· 32
• Ⅳ. 연구결과 ············································· 35
• 1. 연구대상의 일반적 특징 ········································· 35
• 2. 미충족 의료의 단면적 분석 및 영향요인 결과 ··············· 38
• 3. 미충족 의료의 동태적 변화 추세 및 영향요인 결과 ········ 57
• Ⅴ. 고찰 ·················································· 76
• 1. 연구방법에 대한 고찰 ············································ 76
• 2. 연구결과에 대한 고찰 ············································ 79
• 3. 연구의 한계 및 향후 연구방향 ··································· 89
• Ⅵ. 요약 및 결론 ······································· 92
• 참고문헌 ······························································ 95
• 부 록 ································································ 100
• 국문요약
• 감사의 글