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신의철,Shin, Euichul 한국의료질향상학회 2006 한국의료질향상학회지 Vol.12 No.2
Background : Utilization review has been adopted as a vehicle for cost and utilization control of health care services. Its role was further stressed and expanded through the establishment of Health Insurance Review Agency in 2001. This article is to introduce concept, activities, and effect of utilization review based on the experiences of U.S. and to suggest important characteristics for ideal utilization review activities at the national level in Korea. Method : Twenty-five articles related with utilization review were reviewed after being selected through web site search through Med Line and Richis. Result : Utilization review was introduced mainly for health care expenditure control either by insurer, provider or the third parties under the pressure of increasing health care cost. It's activities can be categorized to prospective, concurrent and retrospective review according to the time of service provision. Based on most of studies, utilization review has been effective in controling rising health care cost and utilization. However it's effectiveness assumes a reimbursement structure of managed care like capitation payment. More worse, it is still unknown it's effectiveness on quality of care. Conclusion : Utilization review should be employed to increase the cost effectiveness of medical care by optimizing quality and patient's outcomes while also attempting to reduce the use of resources. So, it should consider outcomes before expenditures, check for both under and over-use, and construct an structure in which consumption is reduced equitably. Aggressive adoption of utilization review in Korean health care setting with fee-for-service reimbursement structure might not be a cost-effective approach before adoption of prospective payment system such as D.R.G. and capitation.
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박신후 ( Shin Hoo Park ),김호종 ( Ho Jong Kim ),정재연 ( Jae Yeon Jeong ),홍민정 ( Minjung Hong ),김나영 ( Nayoung Kim ),박종연 ( Chong Yon Park ),신의철 ( Euichul Shin ) 대한보건협회 2021 대한보건연구 Vol.47 No.1
연구목적 : 본 연구는 장애인과 비장애인의 치과의료 이용 현황을 파악 및 비교분석하고, 치과의료 이용과 관련된 특성을 보정 후 장애가 치과의료 이용 접근성에 미치는 영향을 파악하고자 하였다. 연구방법 : 2016년도 국민건강보험공단의 건강정보자료를 이용해서 장애인 251,497명, 비장애인 4,888,249명을 선별하고, 장애가 치과의료 이용 접근성에 미치는 영향을 분석하기 위해 통제변수인 성별, 연령, 의료보장유형, 소득수준, 지역, 흡연, 고위험 음주, 만성질환 여부를 통제한 상태에서 다중 로지스틱 회귀분석(multiple logistic regression)을 실시하였다. 연구결과 : 치과의료 이용률은 장애인 42.0%, 비장애인 43.2%로 장애인이 비장애인 보다 0.97배 낮게 나타났다. 그리고 통제변수를 통제한 상태에서 로지스틱 회귀분석 결과, 치과의료 이용 접근성과 관련된 특성을 통제하였을 때 장애인이 비장애인보다 치과의료 이용을 경험할 확률이 0.97배 낮은 것으로 나타났다. 결론 : 이상의 결과를 종합하여 살펴보면, 장애인은 보정 후에도 비장애인보다 치과의료 이용을 경험할 확률이 낮아 장애인의 치과의료 접근성이 낮은 것을 확인 할 수 있었다. 따라서 장애인의 치과의료 이용에 대한 접근성을 높이기 위한 정책적 방안이 필요하다. Background : The purpose of this study was to compare the current status of dental service utilization between People with Disabilities and People without Disabilities, and to investigate the effects of disability on access to dental service after adjusting the characteristics related to dental service utilization. Methods : Data used in this study from National Health Insurance Service 2016 health information data. Sample size were 251,497 People with Disabilities and 4,888,249 People without Disabilities. Analysis method in this study was multiple logistic regression analysis in which control variables were gender, age, health insurance type, income level, region, smoking, high-risk drinking and chronic disease. Results : Dental service utilization rate was 42.0% for the People with Disabilities and 43.2% for the People without Disabilities, which was 0.97 times lower than for the People without Disabilities. The result of logistic regression analysis with controlled variables indicated that the People with Disabilities was 0.97 times less likely to experience dental care than the People without Disabilities when the characteristics related to access to dental service utilization were controlled. Conclusion : In summary, People with Disabilities are less likely to experience dental service utilization than People without Disabilities, even after adjusting. Therefore, policy measures are needed to increase access to dental service utilization for the People with Disabilities.
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이소담,신의철,임재영,이상규,김지만,Lee, So Dam,Shin, Euichul,Lim, Jae-Young,Lee, Sang Gyu,Kim, Ji Man Korea Society of Hospital Management 2017 병원경영학회지 Vol.22 No.3
목적: 상용치료원(usual source of care)은 아프거나 건강문제에 대한 조언이 필요할 때 주로 방문하는 특정 개인의원, 보건소, 혹은 기타 장소로, 상용치료원 보유는 예방서비스를 제공을 더 받게 되며, 보건의료에 대한 전반적인 만족도가 높고, 입원율을 감소시키며 의료급여자의 의료비를 감소시킬 수 있다. 이 연구에서는 당뇨병을 보유하고 있는 20세 이상을 대상으로 상용치료원 보유 여부에 따른 대상자의 현황을 파악하고, 의료이용 횟수 및 의료비의 차이와 이에 영향을 미치는 특성을 분석하였다. 방법: 이 연구는 제7차 한국의료패널 자료를 이용하였다. 상용치료원 보유여부에 따른 의료이용 횟수와 의료비를 비교하기 위해 분산분석을 실시하였으며, 상용치료원 유형에 따른 의료이용 횟수와 의료비용에 영향을 미치는 요인을 파악하기 위해 Tobit 분석을 수행하였다. 결과: Tobit 분석결과, 상용치료원을 보유한 경우 보유하지 않은 경우보다 외래의료비는 증가했으나 입원의료비는 감소하였다. 상용치료원을 보유한 경우 보유하지 않은 경우보다 외래이용횟수와 입원횟수가 증가했으나 통계적으로 유의하지 않았다. 함의: 지속적이고 포괄적인 의료서비스가 제공되는 상용치료원을 당뇨병 환자들이 보유하게 되면, 외래 예방서비스의 이용을 통해 장기적으로 입원의료비의 감소를 기대할 수 있을 것이다. Purposes: Diabetes is a metabolic disorder that requires continuous care in order to prevent complications, as it can impose a critical burden on families and society due to various complications, including terminal renal failure, non-traumatic lower extremity amputation, and adult blindness. The usual sources of care are "specified private clinics, public health centers, or other facilities to visit when ill or when health-related advice is needed". These usual sources of care offer preventative services, have a high overall satisfaction rate in terms of public health care, and decrease the inpatient rates and medical costs of medical aid recipients. This study analyzed the current status of diabetic patients over 20 years of age based on their possession of a usual source of care, and the effects of this possession on the frequency of their medical service usage and its costs. Methodology: Based on data from the 7th Korea Health Panel, a Tobit analysis was used to analyze the different factors that can affect the frequency of medical service usage and its costs for diabetic patients with and without a usual source of care. Findings: The medical costs of diabetic patients with a usual source of care decreased in terms of inpatient, and the outpatient visits and inpatient costs of the group with a usual source of care in the form of a mainly-visiting doctor decreased more than those of the group with a mainly-visiting medical institution only. Practical Implications: Having a usual source of care can increase the treatment continuity, leading to reduced inpatient, and having a mainly-visiting doctor as the usual source of care further increases the treatment continuity. Based on these results, a new policy is needed to increase and strengthen diabetic patients? possession of a usual source of care.
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강희정 ( Hee Jeong Kang ),김지만 ( Ji Man Kim ),임재영 ( Jae Young Lim ),이상규 ( Sang Gyu Lee ),신의철 ( Euichul Shin ) 한국병원경영학회 2018 병원경영학회지 Vol.23 No.2
Purposes: This study aims to investigate the policy effect of mandatory application of DRG for 7 disease groups in general and tertiary hospitals. Methodology: As DRG was fully implemented in July 2013, this study compares two periods before and after the change(from July 2012 to June 2013, and from July 2013 to June 2014). The benefit claim data of the National Health Insurance Service was used for the comparison. Target patients were those who visited general or tertiary hospitals between July 2012 to June 2014. For pharmaceutical consumption, Interrupted Time Series (ITS) analysis was used to see the effect of DRG mandatory application. Findings: The number of drugs prescribed per patient and pharmaceutical expenditure both showed significant reduction compared to before the DRG implementation. Practical Implications: This study used 2 sets of 1 year period data from before and after the full implementation of DRG to analyze pharmaceutical consumption. When the comparison data accumulates further, it would be possible to conduct more diverse analysis to assess policy effect and to provide way forward for the future.
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김예순(Ye-soon Kim),박기호(Kee-ho Park),유효순(Hyo-soon Yoo),권준욱(Jun-wook Kwon),신의철(Euichul Shin) 한국역학회 2007 Epidemiology and Health Vol.29 No.2
communicable diseases. The purposes of the study is to estimate reporting proportion of National Notifiable Infectious Diseases(NNIDs) and investigate characteristics related to reporting using KAP(knowledge, attitude, practice) model. Method: We surveyed randomly selected 2,185 physicians (speciality: internal medicine, family medicine, pediatrics, dermatology, general physicians) of their knowledge, attitude, and practice of NNIDs reporting through self-administered mail questionnaires. Of them, 231 physicians responded (response proportion: 10.6%). Result: The reporting proportion was estimated to 27.0%. Recognition level (knowledge) of NNIDs was relatively high with proportion of 69.40/0, and attitude (public health importance) of reporting was 65.8%. Multiple logistic regression analysis showed that knowledge, attitude significantly affected physicians" reporting in a positive direction (O.R. 6.2, 6.2 respectively). Whereas, senior age group, specialty (family medicine, pediatrics, dermatology) showed significantly lower reporting. General (tertiary care) hospital level of care showed significantly higher reporting practice (α=0.05). Conclusion: The NNIDs reporting proportion, 27.0% is similar with those studied recently. Continuous efforts to increase the performance level of communicable diseases surveillance system. Of those, restructuring surveillance systems considering characteristics of notifiable diseases classes must be stressed. Educational approach of physicians needs to be tailored specially to newly-designated diseases such as Group Ⅱ, Designated Group NNIDs.
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