재난적 의료비 발생의 관련 요인 분석: 가구 내 노인 여부를 중심으로

구준혁 ( Jun Hyuk Koo ),정재연 ( Jae Yeon Jeong ),이우리 ( Woo-ri Lee ),유기봉 ( Ki-bong Yoo ) 한국보건행정학회 2020 보건행정학회지 Vol.30 No.4

Background: The purpose of this study is to explain the factors influencing the incurrence of catastrophic health expenditure of national health insurance households using panel data observed over a long period. Methods: The study targeted 3,652 households who had no censoring during the 11-year survey period (2007-2017) and householders whose insurance type was consistently maintained as national health insurance. Generalized estimating equations were adopted to identify factors affecting the occurrence of catastrophic health expenditure at 20%, 30%, and 40% threshold levels. A subgroup analysis was conducted by categorizing groups depending on the existence of the elderly in the household. Results: For the last 11 years, the incidence of catastrophic health expenditure in the households without the elderly decreased slightly at all threshold levels, but the households with the elderly seemed to be increased. At baseline, household type showed a statistically significant relationship with all other variables. The results of generalized estimating equations analyses show that household income was not significant at all threshold levels in the households without elderly. On the other hand, in the households with the elderly, the 2nd (odds ratio [OR], 1.33-2.05) and 3rd quintile groups (OR, 1.25-2.55) were more likely to have catastrophic health expenditure compared to the 1st quintile of household income group. Conclusion: As the amount of health expenditures relative to the ability to pay is increasing in households with the elderly, the application of an intervention followed by consistent monitoring is needed. This study found that there were differences in influencing factors according to the presence of the elderly in the households. In particular, in households with the elderly, interesting results have been drawn regarding the occurrence of catastrophic health expenditure in the near-poor, so additional research is required.

50~60대의 원격의료서비스 수용에 관한 연구

구준혁 ( Koo Jun Hyuk ),진기남 ( Jin Ki Nam ) 한국보건사회연구원 2021 保健社會硏究 Vol.41 No.1

코로나19로 인해 전 세계적으로 원격의료서비스에 대한 관심이 높아지고 있다. 이 연구는 선행연구 고찰을 통해 잠재적 서비스 이용자의 재가모니터링서비스와 ICT활용 방문간호서비스의 이용 의도에 영향을 미치는 요인을 설정하고, 통계분석을 통해 유의한 영향요인을 파악하여 이론 및 실증적으로 기여하고자 하였다. 온라인 설문조사를 통해 전국에서 모집한 원격의료서비스 경험이 없는 50∼60대 고령자 629명 중 성실하게 응답한 609명을 대상으로 분석을 진행하였다. 그 결과, 재가모니터링서비스에 직접적으로 영향을 미치는 요인은 노력 기대, 성과 기대, 사회적 영향, 개인정보 보호, 비용염려, 의료 접근성으로 나타났으며, 간접적으로 영향을 미치는 요인은 개인적 자기효능감과 환경적 자기효능감, 건강 염려였다. ICT활용 방문간호서비스에 직접적 영향을 미치는 요인은 사회적 영향, 의료 접근성으로 나타났다. 보다 정확한 결과를 도출해내기 위해 이후 연구에서는 개별 원격의료서비스에 대한 이용자의 인식을 고려하여 모델을 분리할 필요성이 있다. 추후 실제 서비스 시행 시, 이러한 서비스 별 차이를 고려한 접근과 더불어 세부집단을 구분한 분석이 이루어진다면 보다 효과적인 서비스 제공이 가능할 것이다. Due to Coronavirus Disease-19, interest in telehealth services is increasing worldwide. This study aimed to identify factors that affect the intention of potential users to use home monitoring services and visiting nursing services using ICT. Our analysis was conducted with 609 respondents in their 50's and 60's who have never experienced telehealth services recruited from across the country through an online survey. The results showed that factors that directly affected home monitoring services were effort expectancy, performance expectancy, social influence, privacy concern, cost concern, and health service accessibility. Personal self-efficacy, environmental self-efficacy, and health concern had an indirect effect on home monitoring services. Social influence and health service accessibility were found to have a direct effect on visiting nursing services using ICT. For more accurate results, additional studies should consider the users’ perception of individual telehealth services. In future service implementations, more effective service delivery can be achieved based on such a subgroup analysis and its findings of service-specific differences.

의료서비스경험조사로 분석한 외래서비스 만족의 결정요인

김희년(Heen-Yun Kim),구준혁(Jun-Hyuk Koo),최용석(Yong-Seok Choi),신정우(Jeong-Woo Shin) 한국보건복지학회 2021 보건과 복지 Vol.23 No.3

최근 보건의료 분야의 국제사회적 논의에 종종 등장하고 있는 ‘반응성(Responsiveness)’은 보건의료의 의료적 측면뿐 아니라 비의료적 측면에서의 제도 내지 서비스에 대한 기대가 제고되고 있음을 시사한다. 하지만, 지금까지의 의료의 질 연구는 주로 임상적인 면에 치중되어 있었다. 이에 본 연구는 현재 매년 수행되고 있는 의료서비스경험조사의 설문 문항 검증을 통해 우리나라 환자 중심 의료체계구상을 위한 기초자료의 타당성을 검토하고, 의료서비스 이용 경험과 만족의 관계를 확인하는 것을 목적으로 한다. 분석 자료는 보건복지부와 한국보건사회연구원이 시행하는 2019년 의료서비스경험 조사 원시자료이다. 분석 방법은 확인적 요인분석 및 위계적 회귀분석이며, 분석 도구는 SPSS AMOS 22.0과 SAS9.4 버전을 활용하였다. 분석 결과에 따르면, 의료서비스경험조사 문항의 신뢰도 및 타당도가 충분함을 확인하였다. 또한, 비임상적인 질(환자경험)이 환자의 의료서비스 만족을 결정하는 주요한 요인임을 확인하였다. 본 연구는 이와 같은 결과에 기초하여, 의료서비스를 제공함에 있어서 환자를 중심에 두는 사고(思考)의 확장을 강조한다. ‘Responsiveness’, which has often appeared in international discussions in the field of health care recently, suggests that expectations for institutions and services in the non-medical aspect as well as in the medical aspect of health care are being raised. However, most of researches on quality of medical care so far has mainly focused on clinical and empirical quality. Therefore, this study aims to verify the questionnaire items of the “Medical Service Experience Survey”, which is currently conducted every year, and identify the relationship between each medical service experience and satisfaction. And ultimately, this study pursues identifying factors that increase the value of outpatient services. As a result, it verifies that the reliability and validity of the “Medical Service Experience Survey” questionnaires are secured, and highlights the fact that non-clinical quality is also a major factor in determining patient satisfaction with medical services. Based on these results, this study emphasizes the expansion of people-centered thinking in providing medical services.

의료취약지 스마트의료에 대한 만족도와 요구도의 결정요인

진기남 ( Ki Nam Jin ),한지은 ( Ji Eun Han ),구준혁 ( Jun Hyuk Koo ) 한국병원경영학회 2021 병원경영학회지 Vol.26 No.3

There are few domestic studies on medical services in medically vulnerable areas where medical use is not met due to a lack of medical resources. The past studies on smart medicine targeting medically vulnerable areas grasp only the overall satisfaction level, or the sub-dimensions of satisfaction are not classified clearly. Also, it lacks consideration of the patient’s needs. This study aims to analyze the effect of users’ experience of the smart medicine pilot project conducted in medically vulnerable areas on satisfaction and demand. The user’s experience was measured by variables in the dimensions of structure, process, and outcome. Among the pilot project participants, 282 subjects responded to the 2019 survey. Using the hierarchical regression method, we tried to find out the determinants of satisfaction and service demands. Experience factors affecting satisfaction were found to be accessibility, certainty, effectiveness, and efficiency. In addition, it was found that the demand in their 60s was high and that accessibility, certainty, effectiveness, and efficiency had a statistically significant effect on the demand. It is expected that the smart medicine pilot project will be effectively operated by well utilizing the factors influencing satisfaction and demand revealed in this study.

외국인 건강보험가입자의 의료서비스 이용 현황 분석

박형아(Hyung Are Park),진기남(Ki Nam Jin),구준혁(Jun Hyuk Koo) 한국콘텐츠학회 2021 한국콘텐츠학회논문지 Vol.21 No.3

이 연구의 목적은 국내거주 건강보험 가입 외국인의 국적 및 자격유형별 의료이용현황을 분석하는 것이다. 2018년 건강보험 가입 외국인 중 보험료 결측인원을 제외한 1,058,886명을 분석대상으로 선정하였다. 분석결과, 의료를 한 번이라도 이용한 사람은 822,267명으로, 의료이용률은 약 78%임을 확인할 수 있었다. 이용 인원 수가 많은 국가는 중국, 베트남, 미국 순이었다. 1인당 총 진료비는 입원과 외래에 관계없이 미국이 가장 높았다. 자격유형별로는 지역가입자의 1인당 진료건수, 외래진료비, 입원진료비가 가장 높았으며, 1인당 입원일수는 직장피부양자가 가장 높았다. 마지막으로 중국인과 지역가입자는 다른 그룹에 비해 납부한 보험료 대비 많은 혜택을 누리고 있음을 확인할 수 있었다. 이 연구는 외국인 건강보험 당연적용제도 시행 이전 자료를 사용함으로 인해 현재 상황을 정확히 보여주고 있지 못하지만, 추후 변화에 대한 비교분석을 위한 기초자료를 만들었다는 점에 그 의의가 있다. The purpose of this study is to analyze the status of medical service use of foreigners living in Korea by their nationality and types of national health insurance. As of 2018, 1,058,886 people were extracted from the qualification DB, excluding people whose insurance premium is missing. The data analysis showed that nearly 78% of foreigners with national health insurance used medical services and the countries with the largest number of users were China, Vietnam, and the United States. The total cost of treatment per capita was highest in the United States regardless of hospitalization and outpatient. The number of medical treatments per person, and the medical expenses of outpatients & inpatients services were highest among the regionally-insured and the length of stay per person was highest among the workers’ dependents. Lastly, it was found that Chinese and regionally-insured received much more benefits than other groups compared to the premium they pay. After July 2019, foreign nationals residing in Korea for six months or longer are obligated to enroll in the national health insurance program. Since the latest data was in 2018, the result did not properly reflect the current situation, but it is meaningful that it made basic data for future comparative analysis.