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예례미,최요한 건강보험심사평가원 심사평가정책연구소 2023 연구보고서 Vol.2023 No.0
The pediatric medical infrastructure in Korea has been weakened by a declining pediatric population, low scheduled fees compared to other department and the risk of litigation among other factors. Accordingly, there are concerns about the decline in accessibility to pediatric emergency medical care. but in has not been sufficiently investigated before. Therefore, this research explores the analysis of the utilization, resources and healthcare accessibility of pediatric emergency medical care and proposes improvement measures. We investigated utilization and resources about pediatric emergency medical based on health insurance claim data and medical institution status report data. Additionally we calculated the shortest distance from patient’s residence to the emergency service where the patient received care. The 2SFCA(Two-step floating catchment area) index was computed using data on pediatric population and the number of doctors working at emergency medical institutions. From 2017 to 2019 the number of children decreased but the number of claims increased for all age groups except for 0 years old. The number of pediatric emergency patients was highest for the age groups 2 years old, 1 year old and 3 years old in that order. After the age of 3, as the age increased both the number of claims and the number of patients decreased. The mild and noon-emergency(level 4-5) claims accounted for 53~65% in total pediatric emergency claims, level 3 claims accounted for 33~43%. During the analysis period, the number of pediatricians increased, while the number of medical residents decreased. The average distance in 2022 was 17.58km between patients and the hospital where emergency care was provided, which was longer than in 2017 and 2019. The distance was longer on weekdays compared to weekends. At a threshold distance of 30km, the average 2SFCA value for 249 regions in Korea in 2017 was 2.96, which increased to 3.85 in 2022. To enhance the efficiency of the emergency health care systenm it is essential to establish a delivery system that enables patients to access care baded on their degree od severity and acuity and to encourage appropriate healthcare utilization by patients.
강경림,예례미,이정은,권오탁 건강보험심사평가원 심사평가정책연구소 2022 연구보고서 Vol.2022 No.0
The purpose of this study was to review the necessity of introducing a systematic child health management system at the national level and to develop a pilot project operation model to operate as a health insurance system. The research method analyzed the medical use of pediatric and adolescent patients and the status of medical resources using medical expense claims data and medical institution reports, and reviewed the subjects and target institutions dedicated to participate in pilot projects. As a result of comprehensive consideration of expert opinions, it was suitable for children's ages and ages 0 to 2 who frequently visit pediatrics and adolescents to allow more children to participate in the project early in the project and to increase parental satisfaction. In addition, five criteria were selected as medical institutions that can participate in the pilot project in consideration of children's equity in participation in the project and regional deviation, and other pilot project service contents, service cycle, and cost were presented. Finally, the pilot project effectiveness evaluation index was set, and the index was set as input, activity, and calculation process.
한시적 비대면 진료(전화상담·처방) 시행에 따른 효과 평가 연구
조민호,예례미,황윤기,김명화,신재용,이혜진 건강보험심사평가원 심사평가정책연구소 2022 연구보고서 Vol.2022 No.0
Background: The government has temporarily allowed telephone consultations for the first time since February 2020 to prevent decreasing in medical use by health-vulnerable groups. As more than a year has passed since the policy was implemented, it is necessary to analyze the current status of telephone consultations and to analyze whether it has empirically been effective in terms of accessibility and medical continuity. Methods: This study analyzed health insurance claim data to examine status of health care providers and patients use for one year after telephone consultations allowed. Secondly, we analyzed policy effectiveness of telephone consultations with DID (Difference-in-Difference) and PSM (Propensity score matching) in order to see the difference between before and after the policy implementation. Results: The study found 966,918 patients used telephone consultation service and 63.5% of the total patients are older than 60 years of age for one year (2020.2.~2021.2.). In the hypertensive and diabetic patients group, DID results consider the effect of increasing on the medication possession ratio(MPR) was significant, and the effect of increasing on the continuous prescription group ratio was also significant. In the hypertensive group, DID results consider the effect of decreasing on hospitalizations ratio and emergency room visit ratio were significant. however, diabetic group was not shown any significant result in hospitalizations ratio and emergency room visit ratio. Conclusion: Based on the results, A number of relevant indicators have been shown to have appropriate effects on the main objectives of the policy in the COVID-19. However, beyond the result of the effectiveness of the policy, sustainable policy operation will be possible only when various concerns of the policy are addressed and operational guidelines that can increase the acceptability of patients and providers are applied.
의료보장형태와 수가체계에 따른 외래 정신질환 의료이용행태의 변화
김지우,예례미,김명화,이동윤 대한신경정신의학회 2022 신경정신의학 Vol.61 No.3
Objectives In Korea, health insurance payment systems are applied differently for mentally ill patients depending on the type of medical insurance. Moreover, medical use differs according to the type of medical insurance. In 2017, the payment system for outpatients with mental disorders under the medical aid program was changed to fee-for-service. This study examined the medical use of outpatients with mental disorders after the policy change. Methods This study used the data of claims from the Health Insurance Review and Assessment Service from 2015 to 2019. A controlled interrupted time series analysis of medical aid and health insurance patients was used as target and control groups. The dependent variables were the number of visits and prescription days for monthly outpatients, which can represent the medical use. Results 5020773 health insurance beneficiaries, and 433435 were medical beneficiaries. The Charlson Comorbidity Index was higher for medical aid patients than for health insurance patients. Before the policy, compared to health insurance patients, medical aid patients had a lower number of hospital visits and a higher number of days prescribed. After the policy, the number of hospital visits for medical aid patients increased (p<0.0001) compared to health insurance ones, and the trend increased (p=0.0070). The number of days prescribed decreased (p<0.0001) and the trend showed a decrease (p<0.0001). Conclusion After changes in the medical payment system, the differences in psychiatric outpatient treatment utilization decreased depending on the type of health insurance.