입원진료비 상승요인 분석

한혜경 ( Hye-kyung Han ),이필도 ( Pil-do Lee ),노인철 ( In-chul Noh ) 한국보건사회연구원 1990 保健社會硏究 Vol.10 No.2

입원진료비의 상승은 높은 약제비 비중, 병원의 높은 수술률, 종합병원 이상의 검사비 등의 영향을 받는 것으로 나타났으며, 횡단면 다중회귀분석에 의한 입원진료비 결정요인은 입원일수, 전문의수, 의료장비수, 연령, 수술여부 등인 것으로 나타났다. 앞으로 45세이상 연령층의 만성질환으로 인한 입원진료비가 더욱 증가할 것이라는 전망에 따라 약제비 및 검사비에 대한 대책, 의료자원의 효율적인 사용을 위한 병원기능의 전문화 등 입원진료비의 경제성을 도모하기 위한 다양한 대책이 요구된다. The rapid increase in medical care costs have become a growing problems since health insurance was introduced. In particular, medical care costs for in-patients have tended to rise at a faster pace than those for out-patients. For example, while the out-patient costs in 1989 increased 3.32 times over those in 1983, the hospital care costs increased 3.75 times during the same period. Furthermore, the scale of hospital care costs continued to rise from about 33 percent in 1983 to 36 percent of the total expenditure in 1989. The principal cause of these increase was related to a considerable rise in medical care costs for out-patients less than 14 years old. Recently, however, the ratio of in-patient costs has risen markedly due to a sharp increase in the costs related to cancer and to chronic diseases of the circulatory system for those over 45. Since this age group continues to increase, it is expected that this pattern will continue as a leading factor in the increase in medical care costs. The concern over rising costs and a search for ways to control these costs are now stimulating interest in the development of public policies. The purpose of this study is, therefore, to examine factors giving rise to the cost escalation of hospital medical care and also to provide insight into the policy implications for containment of these costs. The data used here was obtained from a survey of the monthly insurance bills (13,532 cases) presented to the National Federation of Medical Insurance in February 1990. This group represented the employees and dependents of private companies as well as self-employed people. The main results and their implications are as follows : 1. The important factors which have influenced the increase in the medical care costs for in-patients was revealed as a high medication ratio, more examinations, a longer stay, and a high frequency of surgical procedures in the hospitals. 2. The portion of medication and injection costs was found to be extremely high. Medications constituted 37 % of total hospital care costs in excess of 500,000 Won per case. These extraordinarily high expenditures are due to excessive consumption and high prices. One alternative to limit expenditures on drugs is to establish a list of essential drugs as chosen for cost-effectiveness (low price with equal efficacy). Thus drugs not on this list would not be cove-red by insurance. Also important is the control of pharmacists` mark-ups, drug prices, and advertising expenditures by pharmaceutical firms for sales promotion. 3. The ratio of examination costs was about 30% of the total medical care costs per in-patient case, which was observed to be correlated mainly with the length of stay and the number of examinations, and the quantity of medical equipment in hospitals, so that in recent years the problem of excessive examinations has emerged particularly in both tertiary and general hospitals. The tertiary hospitals are prohibited from offering out-patient care. A committal order written by a physician in a clinic is required for a patient to receive hospital medical care. Both because of the poor flow of information between primary physicians and hospital physicians, and because outside physicians do not have access to superior hospital equipment, hospitals repeat many diagnostic examinations already performed by physicians prior to hospitalization. In fact, such duplication adds to the length of stay and ultimately to medical care costs. In addition, excess investments in such high- tech equipment as CT Scanner, MRI, and heart transplant equipment tend to result in new cost increases, so specialized central examination facilities with high-tech equipment should be established at the district level, both to share inforamtion and their use and to avoid duplication or excessive use of medical procedures and diagnostic tests. 4. The portion of medical procedure and operation costs in hospitals was relatively higher than those in both general hospitals and tertiary hospitals, which appeared to be associated with the high frequency of surgical produres in hospitals. The costs of medications and examinations were, however, shown to be highest in general and tertiary hospitals. One interesting result indicates that there is a negative correlation between surgical procedure costs and examination costs, suggesting that more examinations might reduce the frequency of surgery. 5. To cope with the soaring medical care costs, less expensive service facilities as are used in the developed countries ought to be developed or introduced into the health care sector. For example, there are day care centers, geriatric day hospitals, hospice systems, ambulatory surgical centers, nursing home care and home health care, which can be substituted for expensive hospital services. In addition, surgery and hospital admission and discharge can be managed in a rational manner to curb long-term hospital stays. For example, admission and discharge adjudication committees, composed of doctors including physicians in charge, and nurses and other medical care personnel should be set up in each hospital to check the condition of in-patients periodically to decide on whether they can be discharged.

비선형 화폐수요함수의 동태적 안정성

노인철 ( In Chul Noh ) 연세대학교 경제연구소 2008 延世經濟硏究 Vol.15 No.2

명목수요정책(名目需要政策)과 실질국민생산(實質國民生産) : 실증적(實證的) 분석(分析)

노인철 ( In Chul Noh ) 한국보건사회연구원 1987 保健社會硏究 Vol.7 No.1

장래에 대한 豫想 또는 豫測이 經濟行爲의 意思決定에 있어서 미치는 영향은 크다 할 것이다. 合理的 期待假說은 情報(inforamation)와 合理的 豫想의 개념을 도입하여 케 인즈이후 巨視經濟學에 微視的 基礎를 제공하였으며 巨視分析에 크나 큰 공헌을 하였다. 經濟主體들이 豫想을 形成할 때 주어진 모든 情報를 共有하고 效率的으로 이용하며, 每期마다 市場이 均衡되도록 價格이나 資金의 完全伸縮性을 인정하고,口民生産이 루카스(Lucas) 供給函數形態를 취한다는 것을 전제로한 合理的 期待模型에 따르면 總需要를 관리하는 政府의 經濟安定化政策이 長期에서 뿐만 아니라 短期에 있어서도 失業率이나 實質 GNP와 같은 實質變數에 아무런 영향을 주지 못한다는, 이른바 政策無力性命題를 定立하였다. 바꾸어 말하면,貨幣供給量이 변화하는 需要政策이 經濟主體들에 의해 合理的으로 期待될 때 豫想된 部分은 實質國民生産 (또는 潛在國民生産 - 實際國民生産) 에 영향을 전혀 미치지 않는 반면,豫想되지 못한 部分만이 일시적 實質效果 (random effect) 를 갖는다고 한다. 여기서 다루고자 하는 주제는 體係的인 名目需要政策의 豫想되지 않는 部分만이 實質GNP에 영향을 미치고 이미 豫測된 部分은 實質效果가 없는 가를 우리나라의 資料(1961: I -1984: Ⅳ)로 檢證하는 것이다. 名目所得增加率을 需要管理政策變數로 代用하여 分析한 결과 豫想된 部分과 豫測되지 못한 部分 모두가 實質國民生産에 영향을 미치는 것으로 나타났다.

지역의료보험의 국고지원방식에 관한 재검토

노인철 한국사회보장학회 1991 社會 保障 硏究 Vol.7 No.1

의료보험의 위험분산

노인철 한국사회보장학회 1988 社會 保障 硏究 Vol.4 No.1

입원진료비 상승요인 분석

한혜경,이필도,노인철 한국인구보건연구원 1990 保健社會論集 Vol.10 No.2

공무원연금이 가입자의 퇴직결정에 미치는 요인분석

지은정,김동배,노인철,이익섭 한국사회보장학회 2003 사회보장연구 Vol.19 No.2

사회보장제도 가운데 연금제도가 가입자의 퇴직행태에 미치는 연구는 OECD 국가중심으로 활발히 전해되고 있으나, 우리나라는 퇴직결정요인 특히, 연금이 미치는 영향에 대한 연구의 거의 전문한 상황이다. 이런 관점에서 이 논문은 2001년 퇴직공무원 21,509명 가운데 17년 이상 근속 후 퇴직급여를 수급한 14,201명의 공무원연금관리공단의 자료를 통해 퇴직행태 및 퇴직결정 요인을 분석한다. 먼저, 연금의 제도적 규정에 따른 퇴직행태는 생명표 분석(life-table method)을 통해 살펴보고, 일반직 각 재직기간별 중위소득자를 대상으로 측정한 재정적 퇴직유인이 실제 가입자의 퇴직발생확률에 미친 영향은 Time-dependent Cox regression으로 분석한다. 분석모델 A의 독립변수는 증액분(accrual)을, 분석모델 B는 최고가치(peak value)로 삼으로 성별, 직종, 직급, 최종보수, 급여종류, 퇴직사유, 재취업여부는 통제변수로 투입한다. 이런 분석을 통해서 얻어낸 결과는 첫째, 연금의 제도적 수급요건인 재직기간이 가입자의 퇴직결정에 유의한 영향을 미치는 것으로 나타난다. 둘째, 연금의 재정적 유인은 수급 요건 이후 기여금 납입과 수급기간의 단축에 따른 상실분을 보상하지 못하고 퇴직유인을 제공한 것으로 분석된다. 그러나 조기연금 수급권에 따른 퇴직발생확률의 급증은 수리적 차원의 고려보다 제도적 규정이 주는 심리적 요인이 더 크게 작용한 것으로 보여지며, 급여 증액률이 0이 되는 33년 이후는 모든 퇴직유인가치에서 근로유인을 저해하는 것으로 나타난다. 셋째, 회귀분석 결과 우리나라도 역시 강제적 퇴직사유와 더불어 재정적 유인이 주요 퇴직결정요인으로 분석된다. This, study has been done with the subject of 14,201 public officials who got pension benefit after having served over 17 years among the total 21,509 retired in 2001. This research used Government Employment Pension Corporation data and analysed the effects of the institutional rules focusing on entitlement condition through life-table method. It also measured the retirement incentives, pension wealth, accrual, peak value on the subject of median workers by its service period. Lastly, it analyzed how these financial incentives influence on actual retirement behavior through time-dependent Cox regression which dependent variables is retirement probability. Independent variable of Model A is accrual, Model B is peak value, and sex, occupation classification, class, final salary, kinds of benefit(pension or lump-sum), reason of retirement(voluntary or not) and re-employment as a control variable. The result of this research can be summarized as the followings. First, This shows that the institutional rule influence on the retirement probability. Probability of retirement jumps at the pensionable service period(the 20th and 33rd year). Secondly, financial incentives discourages to continue working beyond the pensionable tenure. Pension wealth is increasing up to the 33rd service period but the increasing rate is not that significant and is steadies or decreases after 33. Accrual is not shown linearly but increase retirement incentives by sharp decrease on the 33rd year. Peak value is falling by tenure, specially, retirement incentives is strengthened after 33 which has minus value. Therefore, adjustment to benefit is not large enough for civil servants to be offset the fewer years of benefit receipt and continuous contribution through additional years of work. Thirdly, as in the Model A, regression result is that accrual is affective on retirement probability but it is not so meaningful if considered the relative risk. In Model B, peak value and mandatory retirement are only statistically significant and the most crucial influence on retirement behavior as expected.