공간분석기법을 이용한 경쟁병원이 병원내원 환자 수에 미치는 영향 분석

다국어 초록 (Multilingual Abstract)

This study purposed to evaluate the influences of rival hospitals on the number of patients who visited the a study territory hospital. Spatial analysis technique was used to measure the impact of rival hospitals in study region.
Selected hospitals were all medical school affiliated hospitals which were located in Daejeon metropolitan city and Chungchungnamdo. Patient data was collected from the claims data of the study hospital, and the number of inpatient and outpatients who visited the study hospital between January and June in 2008 were calculated on the smallest administrative district, Eup, Myeon, and Dong, in study region. To control the differences of regional characteristics among Eup, Myeon, Dong, socio-economic variables (total population, number of people aged over 65, number of basic livelihood security recipients, distance from the study hospital to the centroid point of each Eup, Myeon, Dong, number of business, and number of employees) were included in analysis model. These variables were collected from the annual year book of city as well as county located in study region.
Cluster analysis classified the study region into three groups by using the difference of between th actual number of inpatient/outpatient and the predicted number of inpatient/outpatient in Eup, Myeon, and Dong. Most areas around the rivalry hospitals were categorized into same group. Multiple regression analysis indicated that areas around rivalry hospitals had statistically significantly negative relationship with the number of inpatients and outpatients who visited the study hospital. As the buffer size was increased from 5Km to 10Km, the standardized regression coefficients were decreased.
These study results confirmed that rivalry hospitals in region had negative impacts on the performance of hospitals. It suggests that hospitals will require not only to select their location to minimize the effects of rivalry hospitals, but also to establish their strategy to cope with the rivalry’s threats in their region.

목차 (Table of Contents)

• Abstract
• 1. 서론
• 2. 연구방법
• 3. 연구 결과
• 4. 토의
• 5. 결론
• 참고문헌

참고문헌 (Reference)

1 이광수, "한방병원의 입지특성과 내원환자 규모 간의 관계에 관한 연구" 한국보건행정학회 20 (20): 97-113, 2010

2 이건세, "지리적 접근성을 이용한 도시지역 보건지소의 입지선정" 29 (29): 216-218, 1996

3 최용환, "의료서비스 이용자의 선호행태에 관한 연구" 성균관대학교 대학원 2001

4 김춘배, "우리나라 의사의 지역적 분포에 관한 연구" 延世大學校 大學院 1996

5 조우현, "소규모 지역간 의료이용 차이에 관한 문헌고찰" 1 (1): 42-53, 1991

6 양봉민, "보건경제학" 나남 2007

7 송지준, "논문작성에 필요한 SPSS/AMOS 통계분석방법" 21세기사 2011

8 이광수, "공간분석에기초한 건강보험 병원서비스 이용권역 측정 모형 개발" 국민건강보험공단 2011

9 이광수, "공간분석모델링을 이용한 병원의 적지평가 모형 개발" 한국콘텐츠학회 9 (9): 258-267, 2009

10 Ginsburg, P. B., "Wide variation in hospital and physician payment rates evidence of provider market power" 1-11, 2010

11 Chassin, M. R., "Variations in the use of medical and surgical services by the Medicare population" 314 (314): 285-290, 1986

12 Lesser, C. S., "The end of an era：what became of the‘managed care revolution’ in 2001?" 38 (38): 337-355, 2001

13 Lindrooth, R. C., "The effect of urban hospital closure on markets" 22 (22): 691-712, 2003

14 Folland, S., "The economics of health and health care, 2nd Ed" Prentice Hall 1997

15 Anderson, T.F., "The challenges of medical practice variations" McGillan Press 1990

16 Darthmouth Medical School Center for the Evaluative Clinical Sciences, "The Dartmouth Atlas of the Health Care" Amer Hospital Pub 1996

17 Barney, J.B., "Strategic management and competitive advantage： concepts and cases" Pearson Education 2010

18 Luke, R. D., "Spatial competition and cooperation in local hospital markets" 48 (48): 207-237, 1992

19 Bombardier, C., "Socioeconomic factors affecting the utilization of surgical operations" 297 (297): 699-705, 1977

20 Wennberg, J.E., "Small area variations in health care delivery" 182 (182): 1102-1108, 1973

21 Carey, K., "Single specialty hospitals and service competition" 46 (46): 162-171, 2009

22 배화수, "SAS Enterprise Miner를이용한 데이터마이닝" 교우사 2004

23 Luke, R. D., "Local markets and systems：hospital consolidation in metropolitan areas" 30 (30): 555-575, 1995

24 Basu, J., "Impact of local resources on hospitalization patterns of Medicare beneficiaries and propensity to travel outside local markets" 26 (26): 20-29, 2010

25 Porter, M.E, "How competitive forces shape strategy" 57 : 137-156, 1979

26 Wilson, P., "Hospital use by the aging population" 18 (18): 332-344, 1981

27 Boscarino, J., "Hospital shopping and consumer choice" 2 (2): 25-34, 1982

28 Pham, H. H., "Health care market trends and the evolution of hospitalist use and roles" 20 (20): 101-107, 2005

29 Feldstein, P. J., "Health care economics, 3rd Ed" A Wiley Medical Publication 1988

30 Zwanziger, J., "Has competition lowered hospital prices?" 42 (42): 73-85, 2005

31 McLaughlin, C. G., "HMO growth and hospital expenses and use：a simultaneous-equation approach" 22 (22): 183-205, 1987

32 김선희, "GIS를 이용한 입원환자의 지리적 접근성 분석 : 경기도 소재 한 대학병원을 대상으로" 연세대학교 보건대학원 2006

33 Benjamin, A. E., "Determinants of state variations in home health utilization and expenditures under Medicare" 24 (24): 535-547, 1986

34 Anderson, J. G., "Demographic factors affecting health services utilization：a causal model" 11 (11): 104-120, 1973

35 Porter, M. E., "Competitive strategy：techniques for analyzing industries and competitors" The Free Press 1980

36 Wilson, P., "Community correlates of hospital use" 19 (19): 333-355, 1984

37 Mccue, M.J., "Assessing the performance of freestanding hospitals" 52 (52): 299-307, 2007

38 Mitropoulos, P., "A biojective model for the locational planning of hospitals and health centers" 9 (9): 171-179, 2006

39 대한병원협회, "2011 전국명원명부"