비급여를 포함한 상병‧수술별 환자부담 진료비 추정 연구 : 경피적 대동맥판 삽입술(TAVI) 사례

김하윤,박보람,장종원 한국보건경제정책학회 2023 보건경제와 정책연구 Vol.29 No.4

It is very difficult to predict in advance the costs that patients pay for receiving medical services. The absence of useful information for patients, such as medical costs and safety, is causing various problems from a policy and economic perspective. Accordingly, in order for patients to use reasonable medical services at an appropriate cost, it is important to calculate and provide the total medical costs incurred per disease or surgery using comprehensive information that can be provided. Therefore, through the case of Transcatheter Aortic Valve Implantation(TAVI), which is burdensome for patients with severe aortic valve stenosis, the total medical costs and composition status including non-benefits medical costs were analyzed. First, the criteria and grounds for selecting disease and surgery to be analyzed were reviewed, and episode of care were defined. Second, the average medical costs including insurer's contributions, co-payments, non-benefits, and the composition of medical treatment items were analyzed. In addition, a comparison was presented between the total medical costs considering age group and comorbidities and the similar surgeries. This study used actual medical data to define episode of care and estimate total medical costs, to provide basic data for the composition of total medical costs, including non-benefits medical costs. In the future, there is a need for additional analysis to establish sufficient basis for the definition of episode of care and data sources, and to expand the target.

호스피스 케어를 위해 입원한 말기 암 환자의 사망직전 의료비용 실태 조사

유상연,이혜리,이용제,안미홍,염창환,Yoo, Sang-Yeon,Lee, Hye-Ree,Lee, Yong-Je,Ahn, Mi-Hong,Yeom, Chang-Hwan 한국호스피스완화의료학회 2002 한국호스피스.완화의료학회지 Vol.5 No.2

배경 : 세계적으로 암의 발생률과 사망률은 증가하는 추세로, 그로 인한 의료비 상승의 문제로 국가 정책의 필요성이 대두되고 있다. 이에 저자 등은 호스피스 케어를 위해 입원한 말기 암 환자들의 의료비용 실태를 조사하고 이와 관련된 요인도 함께 살펴보아 불필요한 의료비용 부분의 효과적 감소에 도움이 되고자 하였다. 방법 : 2000년 7월 1일부터 2002년 6월 30일 사이에 경기도 고양시에 소재한 모 병원 가정의학과에 말기 암으로 입원하여 사망한 환자 259명을 대상으로 인구통계학적 자료 암의 기왕력, 임상소견, 의료비용을 조사하였다. 의료비용은 환자의 사망직전 입원 당시의 원무과 계산서를 근거로 세부 항목을 조사하였다. 인구통계학적 특성, 암의 기왕력, 임상 소견과 평균 의료비용과의 상관관계를 ANOVA로 조사하였다. 결과 : 말기 암 환자 259명중 남자가 135명(52.1%), 여자가 124명(47.9%)이었으며, 암의 종류는 위암이(58명, 22.4%) 제일 많았다. 입원 당시의 임상소견은 식욕부진이 227명(87.6%), 통증이 199명(76.8%), 오심 구토가 152명(58.7%) 순으로 높게 나타났다. 총 의료비용은 740,628,045원이었으며 환자 1인당 평균 의료비용은 $285,968{\pm}3,070,272$원이었다. 총 의료비용 중에서 주사료가 237,038,259원(32.0%)로 가장 많았고 병실료가 206,416,669원(27.9%), 검사료(임상병리 검사료와 진단 방사선료)가 103,417,747원(14.0%) 순이었다. 평균 의료비용은 주사료, 치료방사선료, 병실료 순으로 높았다. 인구통계학적 특성, 암의 기왕력, 임상소견의 항목 중 통증만 유일하게 평균 의료비용과 상관관계가 있었다(P<0.05). 결론 : 호스피스 케어를 받는 말기 암 입원 환자들에서 불필요한 마약성 진통제 등 주사 투여를 가능하면 줄이고 가정 내 호스피스를 활성화하고 과도한 검사를 줄임으로써 보다 더 효과적인 비용 절감을 도모할 수 있을 것으로 보인다. Purpose : Death due to cancer has been continuously increasing, therefore cancer is the first in the cause of death now. A national policy for the elevation of medical costs in cancer patients is necessary, therefore, we searched for the medical costs and its related factors in terminal cancer patients for the effective reduction of the medical costs. Methods : We reviewed the medical records of 259 hospitalized terminal cancer patients who had died during the period of July 1, 2000 to June 30, 2002. History of cancer included type of cancer, type of past treatment, existence of metastasis. Clinical manifestation was examined and medical costs on last admission was categorized based on the account of charges of the department of patient affair on the last hospitalization. For analysis of factors related with medical costs, ANOVA was used. Results : Of the 259 patients, the number of male was 135 cases (52.1%), and the female, 124 cases (47.9%). The most frequent type of cancer was stomach (21.9%) cancer. Of the clinical manifestation, anorexia (87.6%) was the most frequent manifestation. Total medical costs was 740,628,045won, the mean costs was $285,968{\pm}3,070,272won$. The frequent category of medical costs was injection (32.0%), medical accommodation (27.9%), examination (14.0%), in order. The only factor related with mean medical costs was pain (P<0.05). Conclusion : If unnecessary injection of opioid analgesics is reduced, hospice care at home is activated and excessive examination is reduced In terminal cancer inpatients, it will be possible to reduce the medical costs in terminal cancer patients more effectively.

신체적 기능상태에 따른 장애인의 비급여 의료비용 및 추가비용 : 의료보호 장애인을 대상으로 in Medical Aid beneficiaries

이효영,김귀현 대한보건협회 2003 대한보건연구 Vol.29 No.1

This study is to measure the impact of disability on medical cost and additional cost not in Medical Aid allowance. It has three specific aims. The first aim is to identify how much extra expenditure needs in the disable using medical care. The second aim is to examine the relationship between the cost of disability and physical functioning levels of the disabled. The third aim is to examine the difference of medical cost and additional cost by disability level and type. Participants were the 864 subjects who were beneficiaries of National Mdcal aid and lived in 10 areas of Korea. A questionnaire was distributed during August to September 2001 through public offices. Social workers in public office helped this survey and it was conducted to visit the disabled families. Physical function of the disabled was examined by ADL, IADL. Medical cost and additional cost in medical care were examined by one month. The focus of this study is in relationship between physical functioning levels and medical cost and additional cost as a result of disability in medical care. Medical cost and extra expenditure per capita by one month did not increased with poorer physical function. But the cost were different from each physical functioning level, disability level and type. The Reevaluation of Medical Aid allowance range and supports for the disabled person will be enlarged to lessen economic burden of the disabled. Besides the disabled need more medical care and a huge amount of medical resources than non-disabled person. Cost-effective intervention programs for disability prevention urgently need to reduce medical care and its additional cost.

이차자료원을 활용한 의원 의료서비스 수입 및 비용 산출

김선제 ( Sun Jea Kim ),임민경 ( Min Kyoung Lim ) 한국병원경영학회 2021 병원경영학회지 Vol.26 No.1

Purpose: The purpose of this study is to estimate incomes and costs of the medical clinics by using secondary data. Methodology: The medical incomes and costs were estimated from 405 clinics operated by sole practitioner providing out-patient services among all clinics subject to the Medical Cost Survey on National Health Insurance Patients in 2017, excluding dental clinics and oriental medical clinics. The incomes and costs of the medical clinics were reflected with incomes and costs of health insurance benefits and were calculated by types of medical services (i.e., basic care, surgery, general treatment, functional test, specimen test and imaging test). The costs were classified as follows: labor costs, equipment costs, material costs and overhead costs. Secondary data was used to estimate the incomes and costs of the medical clinics. For allocation bases for costs for each type of the medical service, the ratio of revenue from health insurance benefits by types of medical services was applied. However, labor costs were calculated with the activity ratio by types of medical services and occupations, using clinical expert panel data. Finding: The percentage of health insurance income for all medical income was 73.1%. The health insurance cost per clinic was 401,864 thousand won. Labor cost accounted for the largest portion of the health insurance income was 191,229 thousand won (47.6%), followed by management cost was 170,018 thousand won (42.3%), materials cost was 35,434 thousand won (8.8%), and equipment costs was 5,183 thousand won (1.3%). Practical Implications: This study suggests a method of estimating incomes and costs of medical clinic services by using secondary data. It could efficiently provide incomes and costs to assess an appropriate level of the health insurance fee to the clinics.

Predictive costs in medical care for Koreans with metabolic syndrome from 2009 to 2013 based on the National Health Insurance claims dataset

( Jeong Seon Yoo ),( Eun Yeong Choe ),( Yoo Mee Kim ),( Se Hwa Kim ),( Young Jun Won ) 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.4

Background/Aims: Although metabolic syndrome has been associated with increasing medical costs worldwide, there have been no studies using a nationwide and longitudinal South Korean dataset. We investigated trends in subsidized medical costs among Korean adults with metabolic syndrome. Methods: This study was based on the National Sample Cohort database of South Korea. We used data of national health checkups in 2009 as well as data of subsidized prescription drugs and the Korean Classification of Disease diagnosis codes from claims in 2007 to 2008 to identify underlying diseases. We calculated the direct medical costs, which were subsidized by the Korean National Health Insurance, among 204,768 individuals older than 20 years from 2009 to 2013. Results: The proportion of subjects with metabolic syndrome was 27.2%. Direct medical costs for 5 years differed by a magnitude of 2.16 between subjects with and without metabolic syndrome. The costs increased by approximately 41.8% in the metabolic syndrome group in 5 years. Direct medical costs increased with every additional risk factor, even if a subject had less than three risk factors of metabolic syndrome. Metabolic syndrome per se and all of its components, except low serum high-density lipoprotein cholesterol level, resulted in a significant increase in medical costs. Conclusions: The medical costs of subjects with metabolic syndrome were higher than that of those without metabolic syndrome and it increased with the number of risk factors. Further research using cumulative data of more than 10 years, including unsubsidized and indirect costs, is needed in the future.

의료수가정책이 병원 수익성에 미치는 영향에 대한 사례연구

김세중,박진모 한국경영컨설팅학회 2016 경영컨설팅연구 Vol.16 No.3

우리나라의 의료산업은 전 국민 건강보험가입에 기반을 둔 보장성 위주의 정책을 통해 발전해왔으며, 의료수가는 행위별 수가제에 기반하고 있다. 우리나라의 의료체계가 다른 나라의 벤치마크 대상이 될 정도로 좋은 성과를 보이고 있지만 다른 한편에서는 보장성 위주의 저수가 정책에 따른 의료기관의 수익성 악화로 인해 의료기관간의 출혈경쟁, 과다진료 등의 문제점들도 나타나고 있는 것이 현실이다. 본 연구는 의료기관들의 실제 의료손익 분석을 통해 현재 의료수가정책의 실효성을 살펴보고 성공적 의료정책을 위한 필요사항들에 대한 제언을 마련하고자 하였다. 500병상 이상 규모의 병원 중 활동기준원가계산 방식으로 손익을 산출하는 24개 병원을 대상으로 분석한 결과 의료행위별 원가보존율과 진료과목별 손익 차이가 존재함을 확인하였다. 특히 외과계열의 진료과목은 68.1%가 적자로 운영되고, 일부 진료과목은 24개 병원 모두에서 적자로 운영되는 경우도 존재하였다. 현재 의료행위의 가격결정이 발생원가에 기반을 두지 않은 상태에서 결정됨에 따라 발생하는 결과라 할 수 있다. 이로 인해 진료과별 의료인력 수급 불균형이나 비급여 과잉진료 등의 문제가 심화될 수 있기 때문에 향후 의료수가 책정시 의료기관에서 산출된 실제 발생원가를 활용하고 원가보존율 차이에 따른 보상수준의 불균형을 보완하고 개선하기 위한 정책 마련 노력이 필요한 시점이다. Korean medical industry has been developed to the guaranteed policy on the basis of the national medical care insurance. Medical charge has selected to the compensation system on the number of order-for-service and has maintained the policy of low medical cost, so, the medical industry has been conducted to the type of public character. However, the main provision of medical service is absolutely accounted for private medical sector than national medical providers. The medical behavior of the excessive treatment or cutthroat competition between medical providers in relation to the guaranteed policy of low medical cost has brought a high demand on the cost recovery rate of medical practice and a change of medical policy. This study is focused to suggest needs for policy effectiveness and successful medical service by investigating three great influential cases on current medical cost policy and considering actual profit & loss for medical centers (more than 500beds in 24 large hospitals with Activity-based costing system). The cost recovery rate on the national insurance coverage of 2012 was 84%. The cost recovery rate of medical examination activity is more than 100%, and the cost recovery rate for medical treatment, hospitalization, operation, and so on is less than 100% because price determination of current medical practice is not based on the cost. The differences of the cost recovery rate for service has made the difference of profit & loss in each medical departments. Especially, the department of surgery is operating at a deficit of 68.1%, and some departments have 100% of deficit operation even from all of 24hospitals. These results will lead to demand and supply imbalance on medical workforce and excessive treatment for non-coverage of national insurance. RThe imbalance of compensation level on the difference of these cost recovery rate will improve and complement by the policy utilized on calculated cost in medical centers. this study shows the reason why the cost in medical providers can not be utilized by medical policy, so I suggest the importance and the direction how to improve the medical expense policy on the basis of cost.

교육비 분석에 근거한 의과대학 및 의학전문대학원 적정 등록금 산출

김병주(Kim Byoungjoo) 한국교육재정경제학회 2008 敎育財政 經濟硏究 Vol.17 No.1

  이 논문은 의과대학 교육비 분석의 사례를 제공하고, 이를 토대로 의과대학 및 의학전문대학원의 적정 등록금을 산출하는 데 목적이 있다.<BR>  연구목적을 달성하기 위하여 7개 의과대학의 실제 교육비를 분석하였다. 교육비 조사는 2007년 3월 1일부터 2007년 10월 31일에 걸쳐 이루어졌다.<BR>  교육비 분석결과를 토대로 의과대학 및 의학전문대학원의 적정 등록금 수준을 추정한 결과, 의과대학 및 의학전문대학의 적정 등록금 수준은 2006년 기준 각 대학의 실제 등록금을 약간 넘어서는 것으로 추정되었다. 교육비 분석결과 교육비 환원율은 모두 100%를 훨씬 초과하였다. 향후 각 대학들이 의과대학 및 의학전문대학원의 적정 등록금 수준을 추정하는데 있어서 수요탄력성 및 수익률, 사회적 기여도, 다른 재원의 활용가능성 등을 고려하여 이러한 교육비 분석결과를 활용할 수 있을 것이다.   The Purpose of this study is to develop a model to determine tuition level of medical school based on educational cost analysis, which has been noted as one of the most important issues recently.<BR>  Theoretical review of educational cost and tuition revealed that tuition needs to be based on educational cost analysis. According to the above purpose and theoretical review, the objectives of the study were established as follows:<BR>  1) To analyze the educational cost of medical school.<BR>  2) To produce reasonable tuition level of medical school based on educational cost analysis.<BR>  In order to accomplish the objectives of this study, following methodologies were adopted.<BR>  1) Review of the related literatures, statistical data, and previous studies concerning tuition and educational cost analysis.<BR>  2) Interview with officials and specialists in universities and medical schools tuition matter.<BR>  3) Survey about educational cost of medical schools. Seven medical schools were selected for the survey: two national and five private.<BR>  In order to produce reasonable tuition level of medical school, educational cost analysis was conducted. Cost analysis was undertaken by analyzing personnel expenses, administration and operating cost, expenditures for student activities, capital outlay, research expenses, depreciation cost, and other expenditures based on annual financial reports and survey of seven medical schools. Especially, the analysis was focused on the personnel expenses, which include not only teaching staffs but also a part of hospital staffs. The capital outlay includes the purchase of durable assets such as buildings or equipments which are expected to yield benefits over long period. However, the capital outlay was changed greatly from year to year. So the capital outlay could be displaced with depreciation cost.<BR>  The tuition levels based on educational cost analysis suggested in this study were slightly higher than real tuition levels in individual medical schools. Judging from the restitution rate of educational cost, the tuition levels suggested in this study were ten million won at undergraduate medical college and twenty million won at graduate medical school.<BR>  Based on the analysis and discussion, the conclusion and further suggestion of this study are as follows:<BR>  First, ultimately, tuition levels should be determined and estimated based on educational cost analysis.<BR>  Second, to improve the conditions of college education, the financial requirement should be met appropriately. Thus, tuition levels should be determined according to the quality of educational program offered by each medical school.<BR>  Third, the succeeding study on the expected rate of return to medical school education, the contribution of medical school to society, the demand elasticity of medical school, and relation between tuition and the number of enrollments should be conducted.

의료관련 산업의 마케팅 비용이 경제적 부가가치에 미치는 영향

김문태,이광석 한국회계정보학회 2013 재무와회계정보저널 Vol.13 No.3

This study examines the effect of marketing costs on the firm value in the medical firms. The research seeks to determine 1)whether there is a positive association between advertisement costs(AD) and economic value added (EVA), 2)whether there is a negative association between entertainment costs(ENT) and EVA after controlling variables such as firm performance, firm size, debt ratios, Research and Developments costs and Welfare costs. The test sample consists of 660 firms that were listed in the Korea Exchange between the years 2004-2011. The results of the study suggest that there is a positively significant relationship between EVA and AD;however, there is a negatively significant relationship between EVA and ENT. This implies that market reaction is a complete contrast to advertisement activities and Entertainment costs for the medical firms. 본 연구는 의료관련 산업의 마케팅 비용이 기업가치에 미치는 영향을 분석하는데 초점을 두었다. 마케팅 비용은 광고선전비와 접대비로 측정하였으며, 기업가치는 경제적 부가가치(EVA)로 측정하였다. 2004년부터 2011년까지의 총표본 660개를 연구대상으로 검증하였다. 분석결과는 다음과 같다. 첫째, 상관분석에서 광고선전비와 접대비는 경제적 부가가치와 각각 매우 유의한 양(+), 음(-)의 상관관계를 보여 대조되었다. 둘째, 평균차이분석에서 경제적 부가가치가 높은 집단의 광고선전비 비중은 낮은 집단보다 1% 유의수준에서 더 높은 결과로 나타났다. 반면, 경제적 부가가치가 높은 집단에서 접대비의 비중은 낮은 집단에 비하여 1% 유의수준에서 더 낮게 나타났다. 셋째, 통제변수를 포함한 선형회귀분석에서 광고선전비는 경제적 부가가치에 유의한 양(+)의 설명관계를 보였으나, 접대비는 유의한 음(-)의 설명관계를 보였다. 본 연구는 의료관련 기업들이 지출하는 광고선전비와 접대비에 대한 이해관계자의 관심을 인지하고, 이들 마케팅 비용이 미래의 실직적인 기업가치에 미치는 상대적인 영향을 분석한 결과를 제시하는데 의의가 있다. 본 연구는 의료관련 산업의 광고선전 효과를 확인하였으며, 접대관행에 대한 이해관계자의 올바른 판단을 유도하고, 당국에는 보다 철저한 감독을 수행할 수 있는 근거를 제시하는데 공헌한다고 본다. 그러나 본 연구는 경제적 부가가치의 다양한 개념과 측정 방법을 적용하기보다는 투하자산 수익률에 근거한 결과만을 제시하는 한계점이 있다.

Telecar 시스템의 경제성 평가에 관한 연구

이은표,이경희 한국보건정보교육학회 1999 보건정보교육학회지 Vol.1 No.1

AbstactThis study is aimed to provide the sources of rational decision making for installing(introducing) Telecar system through the cost effectiveness analysis which the direct effect of introducing Telecar system was analyzed by conversed currency value and the indirect effect was analysed by economics each effect point between users and non users this system.This study was analyzed by conversed up to data value of reduce effect on labor cost which is the direct effect of investment and maintenance cost accomplish by introducing Telecar system and the indirect effect was by comparison analysis of the better quality of medical service effects of which the details are the promptness of chart control, error rate and the extent of communication with the treating medical care, and also by comparing the number of persons in charge of chart control, departing rate, and the extent of satisfaction.According to the result of this study, the not effect of direct effect for the direct cost within limitation period was about 351 million Won and the cost rate for direct effect showed 0.65%But in the aspect of direct effect, there was no economical merit, nevertheless the indirect effect which was not measured by cost showed that the rapidity of the users of this system was 8.3min/6.7min faster in admission/outpatient, and the error case rate 0.63%/0.28% reduced in admission/outpatient. On the contrary, it showed lower extent of communication with medical care team in the user of this system according to the result of the survey using point extent.The users showed 0.1 person decrease in average numbers of employees per average lOOtimes of chart control. And the average satisfaction rate was higher than non-user group even though there was no meaningful difference in the satisfaction rate for the employee in charge of chart control in the user group.The rate of changing occupation of the user group was 4.9% higher than non-user group. Regarding the improvement of efficiency in the chart control part the user group task the recruitment the best way, and the other group took change of the chart control instrument.Although we can see the lack of the total analysis of the cost effectiveness according to use of data Telecar in this study, it could be a help in a development of the work in the medical record room by the cost-effectiveness analysis of the instrument and equipment widely used medical record room. This study is aimed to provide the sources of rational decision making for installing(introducing) Telecar system through the cost effectiveness analysis which the direct effect of introducing Telecar system was analyzed by conversed currency value and the indirect effect was analysed by economics each effect point between users and non users this system. This study was analyzed by conversed up to data value of reduce effect on labor cost which is the direct effect of investment and maintenance cost accomplish by introducing Telecar system and the indirect effect was by comparison analysis of the better quality of medical service effects of which the details are the promptness of chart control, error rate and the extent of communication with the treating medical care, and also by comparing the number of persons in charge of chart control, departing rate, and the extent of satisfaction. According to the result of this study, the not effect of direct effect for the direct cost within limitation period was about 351 million Won and the cost rate for direct effect showed 0.65% But in the aspect of direct effect, there was no economical merit, nevertheless the indirect effect which was not measured by cost showed that the rapidity of the users of this system was 8.3min/6.7min faster in admission/outpatient, and the error case rate 0.63%/0.28% reduced in admission/outpatient. On the contrary, it showed lower extent of communication with medical care team in the user of this system according to the result of the survey using point extent. The users showed 0.1 person decrease in average numbers of employees per average 1001imes of chart control. And the average satisfaction rate was higher than non-user group even though there was no meaningful difference in the satisfaction rate for the employee in charge of chart control in the user group. The rate of changing occupation of the user group was 4.9% higher than non-user group. Regarding the improvement of efficiency in the chart control part the user group task the recruitment the best way, and the other group took change of the chart control instrument. Although we can see the lack of the total analysis of the cost effectiveness according to use of data Telecar in this study, it could be a help in a development of the work in the medical record room by the cost-effectiveness analysis of the instrument and equipment widely used medical record room.

地域醫療保險資料를 利用한 醫療利用 分析

吳炳根 서울大學校保健大學院 1991 國民保健硏究所硏究論叢 Vol.1 No.1

So for with Mokpo city and Boeun county which were demonstrative areas of regional medical insurance and through the utilized data of Okchon county which was performed with the national converage of regional medical insurance, the analysis between variables was conducted. Independent variables; demographic characteristics of the insured people Dependent variables; reality of medical utility and medical cost. The results of analysis are as follows: 1. The utility rate by medical institute was significant between city(Mokpo) and county(Boeun and Okchon). In case of Mokpo city, the rate which clinic level or more were occupied was more than 99%, but medical utility of health facilities was only 0.1%, while in case of county area, the utility rate of clinic or more were as follows: Boeun county: about 38%, Okchon county: about 61% Utility rates of health facilities were as folows: Boeun county : 23%, Okchon county: 38% As above, the difference of utility rate by medical institute among city and county areas were correlated with the present distribution of medical institute of the corresponding area. 2. When the increasing factor of medical cost was shown as contribution rate, the increase of medical prices by increase was occupied by more weight than the increase of medical prices. 3. In the comparison of treatment rate by age group, the one of 0-4 age group was the highest among all age groups. 4. In the monthly numbers of out-patient utility by region, Okchon county was, the highest(3.77 times per 100 persons). It is because the coverage of medical insurance was performed most recently and the approach of medical utility became more easily. 5. In comparison of treatment days or medical care cost by treatment type, medical facilities, visiting days per case of clinical level was 2.3 days, which was the highest among all medical facilities. When medical care cost per case of clinic was regarded as 1, general hospital was 1.8, hospital was 1.4 and its cost of health facilities was only 0.3. On the other hand, in case of inpatients, hospitalization days per case of hospital level or more was 7-8 days, clinic was 5.6 days and health facilities were 1.4 days. As shown above, the bigger the scale of medical institute was the more the hospitalization days per case or the hospital fee per age were. 6. In comparison of treatment days per case or medical cost per case by age group, age groups which have the most treatment days or the most medical cost per case was almost included in 20-64 age group. In Korea, so far, the weight of medical cost of senile population above 65 years old is not so serious.