대장암 환자의 사회경제적 지위와 의료비 지출이 생존율에 미치는 영향

강희연 서울대학교 보건대학원 2011 국내석사

재가 말기 암환자 임종간호의 비용-편익 분석 : 입원대안으로

황나미 서울대학교 대학원 2000 국내박사

다수준분석을 이용한 입원형 호스피스 진료비에 영향을 미치는 요인 연구

이수미 연세대학교 보건대학원 2018 국내석사

단절적 시계열 분석을 이용한 호스피스완화의료 수가 제도 시행에 따른 의료비 변화 분석 : 국민건강보험공단 청구자료를 이용하여

성수아 연세대학교 보건대학원 2021 국내석사

유방암 수술 환자에 대한 가정간호서비스의 경제성 평가

고정연 서울대학교 대학원 2020 국내박사

Breast cancer ranked 1st in incidence amongst cancer in Korean women in 2017 and is a disease with high social awareness on its diagnosis and treatment. Additionally, it is among the most frequent diseases for which health insurance claims are made for hospital-based home care services. Thus, it is necessary to examine the associative effects of hospital-based home care services for breast cancer patients. This study compared the economic feasibility of hospital-based home care services for patients who had undergone breast cancer surgery using cost-minimization analysis and societal perspectives. This study was a descriptive study intended to evaluate the economic feasibility of continuing care through hospital-based home care services for patients who had undergone breast cancer surgery. 12,483 patients over 18 years of age who had received breast cancer surgery in 26 Korean tertiary hospitals with established hospital-based home care agencies between January 1 and December 31, 2018 were analyzed. Medical billing statements from insured patients were used to determine subjects for the study and to analyze direct medical costs such as inpatient care costs and hospital-based home care costs. Uncovered services in direct medical costs were derived from survey data for medical costs for insured patients, caregiving costs in direct medical costs and transportation costs for family-caregiver in direct non-medical costs from data from the Korea Health Panel Study, and indirect non-medical costs such as lost productivity costs from Economically Active Population Survey and the Survey on Labor Conditions by Type of Employment. The results of this study are as follows. There were 156 patients who through a hospital-based home care service within 30 days of breast cancer surgery. The average duration of hospitalization was 5.7±3.8 days for the group receiving continuous hospital-based home care and 7.3±3.9 for the group not receiving continuous hospital-based home care, demonstrating a statistically significant difference(p<.001). Average total inpatient care costs were 4,063,491±1,407,569 KRW for the group receiving continuous hospital-based home care and 4,906,965±1,571,705 KRW for the group not receiving continuous hospital-based home care, demonstrating a statistically significant difference(p<.001). Average uncovered inpatient care costs were 373,841±129,496 KRW for the group receiving continuous hospital-based home care and 451,441±144,597 KRW for the group not receiving continuous hospital-based home care. Average caregiving costs were 164,522±111,279 KRW for the group receiving continuous hospital-based home care and 210,175±113,459 for the group not receiving continuous hospital-based home care. The average number of sessions of hospital-based home care service used by the group receiving continuous hospital-based home care were 2.2±1.2 sessions. The average cost of care for hospital-based home care 119,281±68,871 KRW, average uncovered hospital-based home care costs were 10,974±6,336 KRW, and average transportation expenses for hospital-based home care 17,349±9,287 KRW. The average transportation costs for family-caregiver were 142,941±96,682 KRW for the group receiving continuous hospital-based home care and 182,605±98,576 KRW for the group not receiving continuous hospital-based home care. Average lost productivity costs were 357,629±246,656 KRW for the group receiving continuous hospital-based home care and 362,216±244,910 KRW for the group not receiving not receiving continuous hospital-based home care. Average total cost was 5,250,028±1,905,428 KRW for the group receiving continuous hospital-based home care and 6,113,402±2,033,739 KRW for the group not receiving continuous hospital-based home care, demonstrating a statistically significant difference between the average total costs(p<.001). The results of evaluating economic feasibilities of continuous hospital-based home care services in patients who had undergone breast cancer surgery indicated a total benefit of 953,691,000 KRW, total cost of 819,004,000 KRW, and a benefit-cost ratio of 1.16 in 2018. The evaluations demonstrated economic feasibility, as the net profit was greater than 0 and the benefit-cost ratio was greater than 1. According to the results obtained in this study, continuous hospital-based home care was considered economically feasible as the total costs for the group receiving continuous hospital-based home care were lower than that of the group not receiving continuous hospital-based home care. In particular, the significantly shorter inpatient days demonstrated in the group receiving continuous hospital-based home care indicated a decrease in inpatient care costs. Hence, we recommend the adoption of hospital-based home care services for patients who had undergone breast cancer surgery. 유방암은 2017년 우리나라 여성암 발생 1위를 차지하였으며 진단 및 치료에 대한 사회적 관심도가 높은 질환이다. 또한 가정간호서비스에 대한 건강보험 청구건수 상위의 다빈도 청구 질환으로 파악되었다. 그러므로 유방암 환자에 대한 가정간호서비스의 연계 효과를 확인하는 것이 필요할 것이다. 이에 본 연구는 유방암 수술 환자에 대한 가정간호서비스의 경제성 평가를 비용최소화 분석과 사회적 관점을 적용하여 시행하였다. 본 연구는 유방암 수술 환자를 대상으로 가정간호서비스 연계에 대한 경제성 평가를 목적으로 한 서술적 조사연구이다. 2018년 1월 1일부터 12월 31일까지 전국 상급종합병원 중 가정간호사업소가 설치된 26개 의료기관에서 유방암 수술을 받은 만 18세 이상 여성 환자 12,483명 전체를 대상으로 분석하였다. 건강보험환자 진료비 청구 명세서를 이용하여 대상자 산출 및 직접 의료비용인 입원 요양급여비, 가정간호 요양급여비 자료를 분석하였다. 직접 의료비용 중 비급여비는 건강보험환자 진료비 실태조사 자료, 직접 의료비용 중 간병비와 직접 비의료비용인 보호자 교통비는 한국의료패널 자료, 간접 비의료비용인 생산성 손실 비용은 경제활동인구조사와 고용형태별 근로실태조사 자료로 추정하였다. 본 연구의 결과는 다음과 같다. 유방암 수술 후 퇴원 30일 이내 가정간호서비스가 연계된 환자는 156명으로 나타났다. 평균 재원일수는 가정간호 연계군 5.7±3.8일, 가정간호 비연계군 7.3±3.9일 이었으며 통계적으로 유의한 차이가 있었다(p<.001). 입원 요양급여비 총액은 가정간호 연계군 평균 4,063,491±1,407,569원, 가정간호 비연계군 평균 4,906,965±1,571,705원으로 통계적으로 유의한 차이가 있었다(p<.001). 입원 비급여비는 가정간호 연계군 평균 373,841±129,496원, 가정간호 비연계군 평균 451,441±144,597원으로 나타났다. 간병비는 가정간호 연계군 평균 164,522±111,279원, 가정간호 비연계군 평균 210,175±113,459원으로 나타났다. 가정간호 연계군의 평균 가정간호서비스 제공 횟수는 2.2±1.2회였으며, 가정간호 요양급여비는 평균 119,281±68,871원, 가정간호 비급여비는 평균 10,974±6,336원, 가정간호 교통비는 평균 17,349±9,287원으로 나타났다. 보호자 교통비는 가정간호 연계군 평균 142,941±96,682원, 가정간호 비연계군 평균 182,605±98,576원으로 나타났다. 생산성 손실 비용은 가정간호 연계군 평균 357,629±246,656원, 가정간호 비연계군 평균 362,216±244,910원으로 나타났다. 총비용은 가정간호 연계군 평균 5,250,028±1,905,428원, 가정간호 비연계군 평균 6,113,402±2,033,739원으로 나타났으며, 평균 총비용은 통계적으로 유의한 차이가 있었다(p<.001). 유방암 수술 환자에 대한 가정간호서비스의 경제성 평가 결과 2018년 기준 총편익은 953,691천원, 총비용은 819,004천원으로 나타났으며 순편익은 134,687천원, 편익비용비는 1.16으로 분석되었다. 순편익이 0보다 크고 편익비용비가 1보다 크게 나타나 경제적으로 타당한 것으로 평가되었다. 본 연구 결과, 가정간호 연계군은 가정간호 비연계군에 비하여 총비용이 적게 나타나 경제적인 것으로 분석되었다. 특히 가정간호 연계군에서 재원일수가 유의미하게 짧게 나타나면서 입원 요양급여비가 감소한 것을 알 수 있었다. 이를 토대로 유방암 수술 환자에 대한 가정간호서비스 연계 제도의 활성화가 이루어 질 것을 제안한다.

입원형 호스피스 완화의료 제도가 말기암 환자 의료서비스에 미치는 영향

김남령 연세대학교 대학원 2018 국내석사

This study was conducted to analyze the differences in the levels of medical care provided by patients with terminal cancer patients and to see if there are any problems with the hospice palliative care system. We used the claims data from the Health Insurance Review and Evaluation Center of terminal cancer patients who died at a tertiary hospital between January and December 2017. The t-test was used to analyze the differences in the number of days spent in the palliative ward group and the general ward group, the daily cost, the cost per admission, and the number of daily analgesic use, Age, type of insurance, type of cancer, and accompanying disease scores, and regression analysis were performed to examine the number of days of hospitalization, daily expenses, and daily use of analgesics. The number of hospital days was significantly longer in the palliative ward group than in the general ward group. The cost of hospitalization per day was significantly lower in the palliative ward group than in the general ward group, and the cost per hospitalization was lower in the palliative wards group but not significant. The number of daily analgesic use was significantly higher in patients with palliative wards than those in general wards. Regression analysis of age, sex, type of cancer, type of insurance, score of accompanying diseases, number of days of hospitalization, cost of medical treatment (daily fee, cost per case), number of daily analgesic use regression analysis showed that the number of hospital days and the daily use of analgesics were significantly increased, and the daily medical expenses decreased significantly.In case of medical expenses per case, the use of palliative wards was lower than that of general wards, but it was not significant. The use of palliative care not only improves the quality of life of patients with terminal cancer, but also reduces medical expenses. In order to facilitate the use of palliative care, it is necessary to change the perception of the medical staff and the public according to the education and publicity related to palliative care. In addition, institutional support is needed to actively encourage the use of palliative care and to link hospitalized, home-based, and advisory hospice services. Key words: terminal cancer patients, hospice, palliative care, days of hospitalization, cost per day, cost per incident, number of daily analgesic use 이번 연구는 말기암 환자의 완화의료 이용여부에 따른 의료서비스 제공 수준의 차이를 분석하고 호스피스․완화의료 제도로 인한 문제점이 있는지를 보기위한 것이다. 2017년 1월 ~ 12월 상급종합병원에서 사망한 말기암 환자의 건강보험심사평가원의 청구 자료를 이용하였다. 완화병동 이용군과 일반병동 이용군의 재원일수, 일당진료비, 입원건당진료비, 일당진통제사용횟수의 차이를 비교(t-test)분석하였다. 완화병동 이용여부에 따른 재원일수, 일당진료비, 일당진통제사용횟수을 보기 위해 성별, 연령, 보험종류, 암종류, 동반질환점수를 통제하고 회귀분석을 실시하였다. 완화병동 이용군이 일반병동 이용군 보다 재원일수가 유의하게 길었다. 입원 일당진료비는 완화병동 이용군이 일반병동 이용군 보다 유의하게 낮았으며, 입운건당 진료비는 완화병동 이용군이 낮았으나 유의하지는 않았다. 일당진통제사용횟수는 완화병동 이용군이 일반병동 이용군보다 유의하게 높았다. 연령, 성별, 암 종류, 보험종류, 동반질환점수를 통제하고 재원일수, 입원건당 진료비, 입원일당 진료비, 일당진통제사용횟수를 회귀분석한 결과 일반병동 이용군에 비해 완화병동 이용군의 재원일수와 일당진통제 사용횟수가 유의하게 증가하였으며 입원일당 진료비는 유의하게 감소하였다. 입원건당 진료비의 경우 일반병동 이용군에 비해 완화병동 이용군이 낮았으나 유의하지는 않았다. 완화의료 이용은 말기암환자의 삶의 질을 향상시킬 뿐만 아니라 의료비용도 감소시킨다. 이에 완화의료 이용을 활성화하기 위해서는 완화의료 관련 교육과 홍보에 따른 의료진과 국민의 인식변화가 필요하다. 또한 완화의료 이용을 적극적으로 권장하고 입원형, 가정형, 자문형 호스피스 서비스를 연계 할 수 있는 제도적 뒷받침이 필요하다. 핵심어 : 말기암, 호스피스, 완화의료, 재원일수, 일당진료비, 건당진료비, 일당진통제

A Multidisciplinary Approach to Managing Financial Toxicity in Oncology Patients

Muse, Katelin Walden University ProQuest Dissertations & Theses 2023 해외박사(DDOD)

Patients with a cancer diagnosis are counseled at length about the standard of care treatment options, which may include surgery, radiation, anticancer medications, and chemo/immunotherapy through an informed consent process. Unfortunately, the potential economic burden and the accompanying psychological burden is seldom discussed up front. There is a significant need for routine screening and a multidisciplinary approach to the prevention of financial toxicity for the oncology patient. The purpose of this doctoral project was to lead an interprofessional team in the development of a clinical practice guideline for routine financial screening using the Comprehensive Score for Financial Toxicity (COST) tool and a formal triage process for additional support from the organization’s financial counselor and social worker. Sources of evidence to support project initiatives are based on current, peer-reviewed, literature supporting best practices in improving financial toxicity for oncology patients. The clinical practice guideline development process uses RAND’s modified Delphi model and is based on the AGREE II criteria. The overall AGREE II summative evaluation based on guideline development scoring and recommendation for use in practice was reviewed by an interdisciplinary team in the academic cancer center and totaled 6.75. Development of the clinical practice guideline is based on the Walden University social change theory for strategies to improve human conditions. The project uses the person-centered care model, which emphasizes empowerment of patients through education and resource utilization and improves the ability to be an autonomous decision maker in individual health plans.