예방의료서비스의 건강보험 급여 우선순위 결정기준과 비만의 적용사례 연구

라규원,이선미 대한가정의학회 2023 Korean Journal of Family Practice Vol.13 No.2

Background: Under the increasing socioeconomic burden caused by rapid aging and chronic diseases, this study aimed to determine the priority criteria and evaluation indicators for preventive medical services focusing on obesity and propose a direction for benefits policies. Methods: A two-round Delphi survey was conducted to select the priority criteria for determining benefits and their evaluation index. The survey interviewed 21 experts with research experience in turning preventive medical services into health insurance benefits and expanding coverage. The first survey was conducted from July 28 to August 6, while the second was conducted from August 11 to August 20 by email every seven days. Results: When determining the benefit of preventive medical services as the priority criteria, experts listed the importance of treatment effectiveness, medical significance, and cost-effectiveness. The following people were prioritized as the beneficiaries of obesity preventive medical service: adults 18 years or older with a body mass index of 30 kg/m2 or more. The survey respondents tended to agree that education counseling on nutrition and physical activity combined with behavioral and pharmacological treatment should prioritize health insurance benefits of obesity preventive medical service. Conclusion: Focusing on the programs mentioned here, the intervention method of a multidisciplinary expert group centered on primary care, such as doctors, nurses, and nutritionists, should prioritize exercise prescriptions.

건강위험요인의 사회경제적 비용 및 정책우선순위 선정에 관한 연구

라규원,강하렴,엄태림,이선미 한국보건경제정책학회 2024 보건경제와 정책연구 Vol.30 No.1

현재 우리나라는 급속한 인구 고령화와 만성질환 증가에 따른 질병 부담에 대비하여 정부 및 지자체 단위에서 국민들의 건강행태를 개선시키기 위한 다양한 노력을 하고 있지만, 건강위험요인 관련 지표는 정체되어 있거나 악화되고 있는 실정이다. 이에 따라 이번 연구는 주요 건강위험요인으로 대표되는 흡연, 음주, 비만에 기인한 최근 5개 연도(2017~2021년)의 사회경제적 손실규모를 추정하고, 그중 폐해가 큰 인구집단 및 건강문제를 도출하여 향후 정책 우선순위 선정에 필요한 근거자료를 제시하고자 하였다. 이를 통해 산출된 비용 규모와 추이 변화는 국민들의 생활습관과 건강행태에 대한 최신 경향이 반영된 결과로 특히 2020년 코로나 이후 새롭게 변화된 양상을 확인하였다. 흡연 및 음주의 사회경제적 손실비용은 감소 및 정체 현상을 보인 반면, 비만의 손실비용은 2019년 대비 2020년에 큰 폭으로 증가하면서 건강위험요인으로 인한 지출 가운데 가장 큰 규모를 차지하였다. 특히 비만의 경우 다른 건강위험요인과 비교하여 사회경제적 비용의 증가 속도가 매우 빠르고 의료비의 비중이 높아 향후 비만으로 인한 건강보험 재정 부담이 점차 가중될 것으로 전망되는 바, 비만 예방 및 관리 정책이 적극 검토되고 시행되어야 할 것으로 보인다. As the burden of chronic disease is growing and the population is aging rapidly, there are various national and regional efforts to improve health behavior. However, the national indicators of health risk factors do not show improvements anymore and some are even worsening. Therefore, the objective of this study was to estimate the socioeconomic cost of health risk factors, such as smoking, alcohol drinking, and obesity over the past five years (2017-2021) and to identify most harmful factors and the population group in order to help policy makers set evidence based priority in health promoting policy. This study reflects the latest trend of the lifestyle and health behavior of the national population, and a new trend after the COVID-19 pandemic was able to be identified. The cost trend attributable to smoking and alcohol drinking was decreased or stalled, but the cost attributable to obesity increased substantially from 2019 to 2020, accounting for the largest part of the total burden. To make it worse, the increasing rate of cost attributable to obesity is higher than any other factors, and the medical expenditure comprises the most. Because of this trend the burden of health insurance expenditure attributable to obesity is expected to grow more in near future. Therefore, policies for obesity prevention and management are needed to be reviewed and implemented.

전기노인과 후기노인의 가계의료비에 영향을 미치는 요인비교 분석

라규원 ( Ra Gyu-won ),이해종 ( Lee Hae-jong ) 한국보건경제정책학회 2017 보건경제와 정책연구 Vol.23 No.2

이 연구는 한국복지패널 6차(2011년), 8차(2013년), 10차(2015년) 자료의 노인 가구주 가계를 전기노인(65~74세)과 후기노인(75세 이상)으로 구분하여 제 1 모형(횡단면 분석)에서 노인집단 간 가계의료비에 차이가 있는지 확인하고, 제 2 모형(패널 분석)에서 노인집단별 가계 보건의 료비 및 보건의료비 비중 변화의 영향 요인을 파악하였다. 패널 분석에서는 하우스만 테스트를 통해 패널 고정효과(fixed-effect) 모형 사용의 적정성을 검증하였다. 주요 연구 결과로 제 1 모형 분석에서 노인집단간 가계 보건의료비 및 보건의료비 비중에 유의한 차이가 있었고, 연령이 높아짐에 따라 정(+)의 영향을 나타내었다. 그리고 제 2 모형에서는 전기노인 가구주 가계에서 동일 가구 내 만성질환 및 장애여부와 같은 건강관련 요인이 발생하는 경우, 가계 보 건의료비 및 보건의료비 비중 변화에 정(+)의 영향을 끼쳤다. 반면, 후기노인 가구주 가계에서는 경상소득이 증가할수록 가계 보건의료비 비중 변화에 정(+)의 영향, 의료보장형태가 건강보험에서 의료급여로 변동되는 경우 보건의료비 및 보건의료비 비중 변화에 부(-)의 영향을 끼쳤다. 또한, 가구원 수가 늘어나는 경우 보건의료비 비중 변화에 부(-)의 영향을 미치는 것으로 나타나 후기노인에서는 가계 재정과 관련된 요소들이 가계의료비 지출 변화에 주된 영향을 미치는 것으로 나타났다. 이로써 노인을 단순히 65세 이상으로 구분하기보다는 연령대별 특성 차이를 고려한 보건의료 및 사회복지 정책이 강조되어야 할 것이다. The purpose of this study is to investigate the difference of the health care expenditure between the young-old and old-old age. The data is used by the Korean Welfare Panel(KWP) with the 6th(2011), 8th(2013), and 10th(2015). The research group is classified by young-old(65 to 74 years) and old-old(75 years or older) householder. Also this study use two analysis models. The first model is cross-sectional analysis of each year to investigated the healthcare expenditure difference between two groups. The second model is panel analysis for 3 years to investigate the affecting factors for the health care expenditure and the proportion of household health care expenditure by each old-age group. In the first model analysis results, there is a significant difference in the health care expenses between young-old and old-old age. Also it has a positive effect on the increase in age. In the second model, the factors affecting the young-old age household health care expenditure are the chronic diseases and the disability in household, which are influencing positive effect on the health care expenses. On the other hand, in the old-old age households, income is the positive effect factor and health insurance changes(from health insurance to medical benefits) is the negative effect factor on the health care expenses. Also, the increase in the number of household members has a negative effect on the proportion of household health care expenditure. The results give us a important political issues that the health medical and social welfare policy must be considered the characteristics by each old age group rather than simply dividing the elderly into over 65 years old.

Perceived Health Status and Health Promoting Behaviors among University Students

안요찬,박현숙,라규원 대한한의학회 2014 대한한의학회지 Vol.35 No.4

Objectives: This study aimed to investigate the relationship among perceived health status, dietary habit and health promoting behaviors of university students. Methods: The subjects were 464 university students. Data were collected by using self-reported questionnaires. The results were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient and multiple regression analysis with the PASW 18.0 program. Results: The mean score of perceived health status was 3.24, dietary habit was 2.85 and health promoting behaviors was 2.24. There were significant differences in perceived health status according to gender, BMI, exercise and stress. There were significant differences in dietary habit according to residence, monthly allowance, drinking alcohol, exercise, sleeping hours and stress. In addition there were significant differences in health promoting behaviors according to gender, residence, BMI, smoking and exercise. Also, perceived health status significantly positively correlated between dietary habit and health promoting behaviors. Conclusions: As the results of multiple regression analysis, the related factors of perceived health status of university students were exercise, stress and spiritual growth factor. Therefore, it is necessary to develop multiple health promoting programs considering characteristics of university students. And various strategies have been developed to increase the physical activity should be run.