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이태진,정채림 대한예방의학회 2017 Journal of Preventive Medicine and Public Health Vol.50 No.6
Objectives: To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a “copayment ceiling,” which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients’ income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups. Methods: This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics. Results: The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients. Conclusions: The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.
서울시 가구의 과부담의료비 지출 발생 및 반복적 발생의 영향요인
정채림,이태진 한국보건행정학회 2012 보건행정학회지 Vol.22 No.2
The public health insurance system in Korea is characterized as relatively high out-of-pocket payments, which are the principal source of catastrophic health expenditure (CHE). The objectives of this study are to estimate the incidence of household CHE and to clarify the characteristics that affect the occurrence and recurrence of household CHE using the Seoul Welfare Panel Survey database for 2008 and 2010. Thresholds to estimate CHE were 10% and 20% of the total house income (T/X), and 25% and 40% of the income excluding food share (T/Y). Determinants of the occurrence and recurrence of CHE at the threshold of T/X=10% were analysed using multiple logistic regression models. Out of the 3,665 households that responded in 2008 survey, households with CHE were 12.07% (T/X≥10%), 5.34% (T/X≥20%), 6.84% (T/Y≥25%), and 4.44% (T/Y≥40%). Risk factors associated with household CHE included living with a spouse, non-Medicaid beneficiary, householder unemployment, low household income, the number of the disabled, poor subjective health, and the number of chronic diseases. A total of 41.78% of households with CHE in 2008 repeatedly experienced CHE in 2010. Risk factors of CHE recurrence included decreased household income and an increase in chronic diseases over the two time periods, the number of members with disability or chronic diseases, and the presence of cancer patients in 2008. Households with lower socioeconomic and health status had a higher financial burden on health care than do their counterpart households. There is a need to enhance society-wide financial protection in health spending among vulnerable citizens in Seoul, particularly, households with low income, disabled members or cancer patients.
정혜령,김대원,정승문,안지용,차봉기,김형준,도재혁,김재규,장세경,박실무,이태진 대한소화기내시경학회 2004 Clinical Endoscopy Vol.28 No.2
Neuroendocrine carcinomas of the colon and rectum are rare and have been known as either carcinoid tumors or undifferentiated cancers in the past. This type of tumor frequently occurred at cecum and is known for its aggressiveness and poor prognosis, differing from adenocarcinoma of colon. There has been no literature which describes endoscopic findings of colonic neuroendocrine carcinoma. Therefore, we report a case of neuroendocrine carcinoma of cecum in 36-year-old man with endoscopic findings. After right hemicolectomy followed by adjuvant chemotherapy, we have followed up the patient for 6 months without the evidence of recurrence. 대장의 신경내분비암종은 과거에 소세포암 혹은 미분화암으로 불렸고, 비교적 드문 질환이다. 대장의 신경내분비암종의 내시경적 소견은 정확하게 보고된 바가 없고, 임상적으로 산발성 대장암과는 달리 우측 결장과 맹장에서 호발하며, 대부분 나쁜 예후를 보인다. 본 증례는 36세 남자가 우하복부 통증을 주소로 내원하여 맹장의 신경내분비암종으로 진단하에 우측 결장반제거술을 시행 후 보강화학요법으로 치료 중인 예로 수술 후 6개월째 재발의 증거 없이 경과 관찰 중이다. 이에 저자 등은 맹장의 신경내분비암종 1예를 경험하였기에 문헌 고찰과 함께 보고한다.