퇴원 의지가 요양병원의 성공적 퇴원에 미치는 영향에 대한 다수준 분석

강하렴,이연주 한국보건행정학회 2022 보건행정학회지 Vol.32 No.4

Background: Since November 2019, long-term care hospitals have been able to provide patients with discharging programs tosupport the elderly in the community. This study aimed to identify both patient- and hospital-level factors that affect successfulcommunity discharge from long-term care hospitals. Methods: A multilevel logistic regression model was performed using hospitals as a clustering unit. The dependent variable waswhether a patient stayed in the community for at least 30 days after discharge from a long-term care hospital. As for the patient-levelindependent variables, an agreement between a patient and the family about discharge, length of hospital stay, patient category, andresidence at discharge were included. The number of beds and the ratio of long-stay patients were selected for the hospital-levelfactors. The sample size was 1,428 patients enrolled in the discharging program from November 2019 to December 2020. Results: The number of patients who were discharged to the community and stayed at least for 30 days was 532 (37.3%). Theintraclass correlation coefficient was 22.9%, indicating that hospital-level factors had a significant impact on successful communitydischarge. The odds ratio (OR) of successful community discharge increased by 1.842 times when the patients and their familiesagreed on discharge. The ORs also increased by 3.020 or 2.681 times, respectively when the patients planned to discharge to theirown house or their child’s house compared to those who didn’t have a plan for residence at discharge. The ORs increased by 1.922or 2.250 times when the hospitals were owned by corporate or private property compared to publicly owned hospitals. The ORsdecreased by 0.602 or 0.520 times when the hospital was sized over 400 beds or located in small and medium-sized cities comparedto less than 200 bedded hospitals or located in metropolitan cities. Conclusion: The results of the study showed that the patients’ and their family’s willingness for discharge had a great impact onsuccessful community discharge and the hospital-level factors played a significant role in it. Therefore, it is important toacknowledge and support long-term care hospitals to involve active in the patient discharge planning process.

Multilevel Analysis of the Relationship Between Prescribing Institutions and Medication Adherence Among Patients With Hypertension and Diabetes in Korea

강하렴,Lee Juhyang 대한예방의학회 2023 예방의학회지 Vol.56 No.6

Objectives: This study investigated the relationship between prescribing institutions and medication adherence among patients newly diagnosed with hypertension and diabetes.Methods: This study investigated patients with new prescriptions for hypertension and diabetes in Korea in 2019 with using data collected from general health screenings. A multilevel logistic regression model was applied to explore the relationship between patients’ first prescribing institution and their medication adherence, defined as a medication possession ratio (MPR) over 80%.Results: The overall adherence rates were 53.7% and 56.0% among patients with hypertension and diabetes, respectively. The intraclass correlation coefficients were 13.2% for hypertension and 13.8% for diabetes (<i>p</i><0.001), implying that the first prescribing institution had a significant role in medication adherence. With clinics as the reference group, all other types of hospitals showed an odds ratio (OR) less than 1.00, with the lowest for tertiary hospitals (OR, 0.30 for hypertension; 0.45 for diabetes), and the next lowest in health screening specialized clinics (OR, 0.51 for hypertension; 0.46 for diabetes). Among individual-level variables, female sex, older age, higher insurance premium level, and residing in cities were positively associated with adherence in both the hypertension and diabetes samples.Conclusions: This study showed that the prescribing institution had a significant relationship with medication adherence. When the first prescribing institution was a clinic, newly diagnosed patients were more likely to adhere to their medication. These results highlight the important role played by primary care institutions in managing mild chronic diseases.

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.

요양기관 종별 외래본인부담 차등정책의 효과분석

변진옥(Ji Nok Byeon),강하렴(Har Yeom Ghang),이현복(Hyun Boc Lee) 한국사회정책학회 2014 한국사회정책 Vol.21 No.2

본 연구는 2009년 7월과 2011년 10월 각각 시행된 외래 본인부담의 종별 차등제가 각 종별로 외래환자의 의료서비스 이용에 미친 효과를 살펴보는 데 목적이 있다. 이를 위해 2008년 1월 1일부터 2012년 12월 31일까지 5년 동안(2013. 5. 심사차수까지) 만 18세 이상(연말기준) 환자의 종별 건강보험 외래진료자료를 이용하여 단절적 시계열 분석 및 구간회귀분석을 진행하였다. 연구결과 2009년 상급종합병원 외래진료비 본인부담 인상정책 시행직후는 정책효과가 유의하지 않았으나, 시간이 흐르면서 상급종합병원의 외래 실수진자수와 총진료비에 부(-)의 효과를, 의원급 경증외래 실수진자수 및 총진료비에 정(+)의 효과를 나타내었다. 한편 2011년 상급 및 종합병원 외래 약제비 본인부담 차등화 정책의 시행직후 상급 및 종합병원에서 52개 경증질환 실수진자 변화에 부 (-)의 영향을 미쳤다. 그러나 이 정책이 병원 및 의원급 외래 실수진자수의 변화에 미친 효과는 유의미하지 않았다. 시간이 흐르면서 모든 종별에서 경증질환 외래 수진자수 및 총진료비에 부 (-)의 효과가 나타났다. 결론적으로 외래서비스에 대한 본인부담 차등제는 상급종합병원 및 종합병원의 외래수진자수 및 총진료비 감소에 영향을 미쳤다. 그러나 병원급 및 의원급의 외래 이용으로의 일관되고 명확한 이동을 보여준다고 보기는 어려워 본인부담률이라는 수요측면의 가격정책이 의료기관 종별 기능 재정립에 미치는 효과에는 한계가 있음을 확인하였다. This study addressed two differential cost-sharing polices in July 2009 and October 2011 to check whether outpatients were affected by the policies in using health care services and to draw out implications for establishing more efficient medical care delivery system by easing the tendency towards big hospitals. In 2009, the co-payment rate for outpatients at tertiary care hospital was increased. In 2011, the co-payment rate for pharmaceutical services were increased when people get drug prescriptions at general hospital and tertiary care hospital for treating 52 specific diseases. The study result showed that ‘time-after 2009 policy’, ‘the implementation of 2011 policy’, and ‘time-after 2011 policy’ factors had impacts on reducing the number of outpatients and the amount of outpatients` medical expenses in tertiary care hospital. However, these policies were not appeared to be effective in increasing the numbers of outpatients and the amount of medical expanses in clinics and hospitals. Based on this study, it`s not clear that decreased utilization of tertiary care hospital and general hospital through co-payment polices has been converted to demand for the small hospitals and clinics. These results imply that price policy such as dif-ferential cost-sharing intended to alter behaviors of demand side of health care service has limited effect on functionalizing the level of medical institutions. Important implications for Korea from the study are two-folds. First, what we need may not be the government`s leading role in increasing part-time work opportunities for most women, but rather, common efforts by workers and employers together with the entire society in deciding the future direction of the society model we want to pursue in the long run. Moreover, what types of roles women will be expected to play in the future Korean society must also be decided upon. Therefore, not only labour policies, but also women, family, and welfare policies should be considered all together in harmony.