도시가계의 소득계층별 과부담의료비 실태 = Catastrophic Health Expenditures among Income Groups in Urban Households

다국어 초록 (Multilingual Abstract)

This study defined `Catastrophic Health Expenditure (CHE)` as spending more than some pre-specified percent (10?30%) of an urbanite`s household income on health care. Their total expenditure and the monthly mean expenditure outlay per household among income groups were analyzed together with their incidence during the period between 1998 and 2002. Additionally, we have identified influencing factors on their frequency of healthcare requirements by using the generalized estimating equations (GEEs) to account for the correlation between observations in generalized linear models. The data that we are using were taken from the 1998 -- 2002 Urban Household Expenditure Surveys. The results of this study show that the ratio (10.9?39.2%) of health care costs of the households with catastrophic health care expenditures to the total households` healthcare expenditures were higher than the proportions (2.0--11.8%) of total households They were the same cases, however the monthly mean health expenditure per household was significantly less in the poor(p<0.05). The incidence rates in the lowest income group were increased 1.5?1.9 times between 1998 and 2002. But, on the other hand, the other groups did not increase to that extent. Odds ratios of its incidence rate were significantly higher in only the lowest income group compared to the highest income group in both before (1.39?2.02, p<0.05 ) and just after that (1.13?1.84, p<0.05). The less family members there were with more of them being elderly, the higher the odds ratios of their incidence rates. Incidences of catastrophic health care expenditure may be potential things that contribute to the deficit of the national budget for health security. Additionally it is a financial burden that causes the poor to live in impoverishment. Consequently incidences of catastrophic health care expenditures need to be thoroughly investigated and more closely managed. As a priority, health security policies need to be developed that guarantee health coverage for the lowest income groups that have more elderly family members.

참고문헌 (Reference)

1 문성현, "한국의 보건의료의 부담과 수혜의 공평성" 20 (20): 68-72, 2004

2 김상욱, "직무만족와 이직의사의 행태학적 요인에 관한 연구 전국 패널자료를 사용한 GLM 및 GEE 추정" 2001

3 김재용, "주요질병의 사회경제적 격차 분석" 한국보건사회연구원 2003

4 정경희, "전국노인생활실태 및 복지욕구조사" 한국보건사회연구원 1998

5 "의료보험 환자가 병원진료시 부담하는 본인부담의 크기" 9 (9): 6-9, 1999

6 윤태호, "우리나라의 사회계층간 건강행태의 차이" 2000

7 김진욱, "소득계층의 실태와 특성에 관한 연구 재정연구" 3 (3): 1-4, 2003

8 유원섭, "빈곤층 의료보장 현황과 과제" 인도주의실천의사협의회 2004

9 권순만, "보건의료이용의 형평성" 9 (9): 13-24, 2003

10 이태진, "보건의료비용 지출의 형평성" 9 (9): 25-34, 2003

11 이수연, "도시근로자 소득수준간 의료서비스 이용 및 치료비 부담률의 형평성" 1997

12 박종연, "노인요양보험의 도입 및 조기정착을 위한 건강보험공단의 역할" 3 (3): 35-45, 2004

13 김창엽, "국민건강보험의 과제: 보장성 강화" (8월호) : 1-7, 2000

14 조홍준, "공교 의료보험 피보험자의 사회계층별 사망률 차이에 관한 연구" 1997

15 구미경, "고액진료비 환자 특성 및 재정환경분석" 국민건강보험공단 2001

16 이진경, "건강보험 본인부담 실태와 추이 분석" 1 (1): 51-72, 2001

17 조경애, "가난한 이들의 건강과 의료이용 현황" 건강연대 2000

18 양세정, "가구원수와 가계소비지출규모" 9 : 330-331, 1996

19 Wyszewinaski L,, "and their implication for policy formulation" distinctions 21 : 617- 634, 1986

20 Fabricant S. J, "Why the poor pay more: household curative expenditures in rural Sierra Leone" 14 (14): 179-199, 1999

21 Ruso G, "The determinants of household health care expenditures in the Philippins" East-West Center 1993

22 Cutler D. M, "The anatomy of health insurance National Bureau of Economic Working Paper" 1999

23 World Health Organization, "The World Health Report 2000, Health System: Improving Performance" World Health Organization 2000

24 Rice T, "The Medicare Catastrophic Coverage Act: A post- moterm" 9 (9): 76-87, 1990

25 Kawabata K, "Preventing impoverishment through protection against catastrophic health expenditure" 80 (80): 612-, 2002

26 "Nonmonetary Factors in the Demand for Medical Services Journal of Political Economy 83" 1975

27 Zeger S. L, "Models for longitudinal Data" 1049-44 1060, 1988

28 Burtless G, "Medical spending, health insurance, and measurement of American Poverty" Brookings Insitution 2001

29 Waters H. R, "Measuring financial protection in health in the United States" 69 (69): 339-349, 2004

30 Parker S. W, "Household income and health care expenditures in Mexico" 40 (40): 245-248, 1997

31 Xu K, "Household catastrophic health expenditure: a multi-country analysis" 362 (362): 111-117, 2003

32 OECD, "Health Data 2004(CD Rom)" 2004

33 "Families with catastrophic health care expenditures" 21 (21): 617-623, 1986

34 Wagstaff A, "Equity in the finance of health care: some further international comparisons" 18 : 263-290,

35 Stiglitz J, "Economics of the Public Sector" Norton & Company; New York 1988

36 Dicker M, "Determinants of financiallly burden-some family health expenses" 19881980

37 Congressional Budget Office, "Catastrophic health insurance" CBO 1997

38 Wagstaff A, "Catastrophe and impoverishment in paying for health care with applications to Vietnam 1993-1998" 12 (12): 921-934, 2003

39 Feldstein M, "A new approach to national health insurance" 1971

40 "A look at catastrophic medical expenses and the poor" 139-145, 1986

41 김창보, "2001년 건강보험 암환자 진료실태" 국민건강보험공단 2002