재난적 의료비 지출이 빈곤화 및 빈곤 지속에 미치는 영향: 복지패널 2007-2012년 자료 분석

송은철 ( Eun Cheol Song ),신영전 ( Young Jeon Shin ) 한국보건행정학회 2014 보건행정학회지 Vol.24 No.3

Background: The low benefit coverage rate of South Korea`s health security system causes catastrophic health expenditure. And catastrophic health expenditure can be the cause of the transition to and persistence of poverty. This study was conducted to ascertain the effect of catastrophic health expenditure on the transition to and persistence of poverty, using 6 years of the Korea Welfare Panel Study Data. Methods: This study was conducted among the 22,528 households that participated in the Korea Welfare Panel Study, 2007-2012. Catastrophic health expenditure was defined as equal to or exceeds thresholds (10%, 20%, 30%, and 40%) of household`s capacity to pay. The effect of catastrophic health expenditure on the transition to and persistence of poverty was ascertained via multivariate logistic regression. Results: Four-point-seven percent to 20.6% of the households are facing catastrophic health expenditure. Rates of the transition to (relative risk [RR], 18.6 to 30.2) and persistence of (RR, 74.8 to 76.0) poverty of households facing catastrophic health expenditure was higher than households not facing catastrophic health expenditure. Even after adjusting the characteristics of the household and the household head, catastrophic health expenditure was found to affect transition to (odds ratio [OR], 2.11 to 3.04) and persistence of (OR, 1.53 to 1.70) poverty. Conclusion: To prevent catastrophic health expenditure and transition to and persistence of poverty resulting from catastrophic health expenditure, the reinforcement of South Korea`s health security system including the benefit coverage enhancement is required.

재난적 의료비 예방을 위한 포괄적 의료비 상한제: 비용 추계를 통한 적용 가능성을 중심으로

송은철 ( Song Eun Cheol ),신영전 ( Shin Young Jeon ) 한국보건사회연구원 2015 保健社會硏究 Vol.35 No.2

한국 건강보장제도의 낮은 보장성은 재난적 의료비의 원인이 되며, 재난적 의료비는 빈곤화의 원인이 될 수 있다. 재난적 의료비와 이로 인한 빈곤화를 예방하기 위한 정책이 필요하며, 그 정책의 하나인 포괄적 의료비 상한제의 적용 가능성을 검토하기 위해 연구를 진행하였다. 한국의료패널 2011년 자료를 이용하였으며, 재난적 의료비는 지불 능력에서 의료비가 차지하는 비율이 10~40% 이상 일 때로 정의하였다. 포괄적 의료비 상한제의 적용 단위를 설정하고, 그 기준을 소득 10분위별로 추정하였으며, 투입되는 추가 비용을 산출하였다. 5.9~23.7%의 가구가 재난적 의료비를 지출하고 있는 것으로 나타났다. 개인 및 가구 단위로 적용하는 경우 상한제의 효과가 가장 컸으며, 추정된 분위별 상한액은 재난적 의료비 기준이 10%인 경우는 0.0~285.0만원, 20%인 경우는 0.0~607.6만원, 30%인 경우는 0.0~1,095.2만원, 40%인 경우는 0.0~1,701.4만원이었다. 재난적 의료비 기준이 10%인 경우 15.9~26.3조원, 20%인 경우 11.9~19.7조원, 30%인 경우 9.3~15.4조원, 40%인 경우 7.8~12.8조원의 추가 비용이 필요한 것으로 추계되었다. 포괄적 의료비 상한제적용 시 재난적 의료비 발생률은 0.1~0.2%로 감소하며, 추가로 소요되는 비용은 전 국민이 한해 동안 민간의료보험료로 지출한 43.4조원의 18.0~60.6%로 나타났다. 포괄적 의료비 상한제 적용으로 건강보장제도의 보장성 강화와 함께 재난적 의료비의 예방이 가능할 것이다. The low benefit coverage rate of South Korea`s health security system can cause catastrophic health expenditure, and catastrophic health expenditure can be the cause of impoverishment. This study was conducted to ascertain the applicability of the comprehensive health expenditure ceiling system to prevent catastrophic health expenditure and impoverishment using cost estimation. The applicability was ascertained by analysis on data from the Korea Health Panel, 2011. Catastrophic health expenditure was defined as equal to or exceeding the thresholds (10%, 20%, 30%, and 40%) of the household`s capacity to pay. Ceiling limits of health expenditures were estimated by income groups, and the additional costs were also estimated. 5.9 - 23.7% of the households are facing catastrophic health expenditure. The estimated ceiling limits of the comprehensive health expenditure ceiling system were 0.0-2.9 (T/y≥10%), 0.0-6.1 (T/y≥20%), 0.0-11.0 (T/y≥30%), and 0.0- 17.0 million won (T/y≥40%). The estimated additional costs were 15.9-26.3 (T/y ≥10%), 11.9-19.7 (T/y≥20%), 9.3-15.4 (T/y≥30%), and 7.8-12.8 trillion won (T/y≥40%). The additional costs were estimated to 18.0 - 60.6% of total private health insurance premiums. There is a need for application of the comprehensive health expenditure ceiling system to prevent catastrophic health expenditure and impoverishment.

의료비 지출이 소득불평등에 미치는 영향

송은철,김창엽,신영전 한국보건행정학회 2010 보건행정학회지 Vol.20 No.3

The degree of income inequality deepened by health care expenditure was useful in assessing the health security level. This exploratory study was conducted to provide a basic evidence to prove the necessity of reinforcement the benefit coverage of South Korea’s health security systems. Data from the Household Income and Expenditure Survey of Korea and Luxembourg Income Study were used. Income inequality indices before and after deduction of health care expenditure were computed, and the degree of the increase in the indices was compared among 13 countries. The degree of decrease against the effect of income inequality reduction policies by health care expenditure was determined. The relationships between the national characteristics and the increase in income inequality were examined. In South Korea, all income inequality indices increased after deducting health care expenditure, but the difference was not high compared to the mean of 13 countries. However, the degree of decrease against the effect of income inequality reduction policies by health care expenditure was high,compared to the mean of 13 countries. The proportion of public sector spending on health care proved to be statistically significant with the increase of income inequality indices (p<0.05). In the context of the continuous increase in health care expenditure, if benefit coverage of health security systems is not reinforced, income inequality will all the more increase due to health care expenditure. In the establishment of the policies for reinforcement of the benefit coverage,income inequality after deduction of health care expenditure should be continuously monitored.

Trends in Scale and Structure of Korea’s Health Expenditure over Last Three Decades (1980-2009): Financing, Functions and Providers

정형선,Jeong-Woo Shin 대한의학회 2012 Journal of Korean medical science Vol.27 No.-

This paper introduces statistics related to the size and composition of Korea’s total health expenditure. The figures produced were tailored to the OECD’s system of health accounts. Korea’s total health expenditure in 2009 was estimated at 73.7 trillion won (US$ 57.7billion). The annual per capita health expenditure was equivalent to US$ PPP 1,879. Korea’s total health expenditure as a share of gross domestic product was 6.9% in 2009,far below the OECD average of 9.5%. Korea’s public financing share of total health expenditure increased rapidly from less than 50% before 2000 to 58.2% in 2009. However,despite this growth, Korea’s share remained the fourth lowest among OECD countries that had an average public share of 71.5%. Inpatient, outpatient, and pharmaceutical care accounted for 32.1%, 33.0%, and 23.7% of current health expenditure in 2009,respectively. A total of 41.1% of current health expenditure went to hospitals, 28.1% to providers of ambulatory healthcare (15.9% on doctor’s clinics), and 17.9% to pharmacies. More investment in the translation of national health account data into policy-relevant information is suggested for future progress.

과부담 의료비 지출이 빈곤화 및 빈곤 지속에 미치는 영향

송은철,신영전,Song, Eun-Cheol,Shin, Young-Jeon 대한예방의학회 2010 예방의학회지 Vol.43 No.5

Objectives: The low benefit coverage rate of South Korea's health security system has been continually pointed out. A low benefit coverage rate inevitably causes catastrophic health expenditure, which can be the cause of the transition to poverty and the persistence of poverty. This study was conducted to ascertain the effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea. Methods: To determine the degree of social mobility, this study was conducted among the 6311 households that participated in the South Korea Welfare Panel Study in both 2006 and 2008. The effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea was assessed via multiple logistic regression analysis. Results: The poverty rate in South Korea was 21.6% in 2006 and 20.0% in 2008. 25.1 - 7.3% of the households are facing catastrophic health expenditure. Catastrophic health expenditure was found to affect the transition to poverty even after adjusting for the characteristics of the household and the head of the household, at the threshold of 28% or above. Conclusions: 25.1% of the households in this study were found to be currently facing catastrophic health expenditure, and it was determined that catastrophic health expenditure is a cause of transition to poverty. This result shows that South Korea's health security system is not an effective social safety net. As such, to prevent catastrophic health expenditure and transition to poverty, the benefit coverage of South Korea's health security system needs to the strengthened.

OECD의 개념에 따른 우리나라 약제비의 국제 비교

정형선 ( Hyoung Sun Jeong ) 한국보건행정학회 2003 보건행정학회지 Vol.13 No.4

Detailed analyses of total health expenditure and its sub-categories are essential for the evidence-based health policy(EBHP). These analyses, again, should be based on timely and reliable data that are comparable across countries. The System of Health Accounts (SHA), published by the OECD in 2000, provides an integrated system of comprehensive and internationally comparable accounts. The author has implemented the SHA manual into Korean situation, and examined overall expenditure estimate and its basic functional breakdown following the manual. This study explains how pharmaceutical expenditure is estimated. The results are, then, analyzed particularly from the international perspective. Both administrative data in Statistical Yearbooks (National Health Insurance, Medical Aid, Industrial Accident Compensation Insurance) and survey data on Health and Nutrition are used for the estimation. Per capita pharmaceutical expenditure in Korea (183 US$ PPPs) was far less than the OECD average (308 US$ PPPs) in 2001, but pharmaceutical expenditure share in total health expenditure (20.3%) was higher than the average (16.7%). This can be explained by the fact that there is a statistically significant correlation between pharmaceutical expenditure share and per capita GDP of each country. Korean people follow the tendency of relatively low-income countries to spend less than OECD average for health care, but follow again their tendency to spend more on drugs than on other health care services. In consideration of results and analysis as above, per capita pharmaceutical expenditure in Korea is expected to grow in the future, but the growth rate of the pharmaceutical expenditure is expected to be less than that of overall health expenditure.

OECD국가에서 총 의료비 및 정부지출 의료비와경제성장의 Granger Causality: 2000~2012

변진옥 ( Jin Ok Byeon ),이현복 ( Hyun Boc Lee ) 한국사회보장학회 2014 사회보장연구 Vol.30 No.1

본 연구의 목적은 국민의 건강에 정부재정을 투입하는 정당성으로서 논의되는 경제성장을 위한 투자론에 대한 실증이다. 이를 위해 2000년부터 2012년까지 OECD국가들의 총 의료비 및 정부지출 의료비 등과 GDP와의 관계를 Granger Causality분석과 벡터자기회귀분석(VAR)을 이용하여 실증하였다. Granger Causality 분석결과 GDP와 총 의료비, GDP대비 정부지출 의료비, 정부지출 의료비, 일인당 의료비, 일인당 정부지출 의료비는 서로 쌍방향의 양(+)의 영향을 주고 있는 것으로 나타났다. 또한 충격반응 결과 GDP가 총 의료비 및 정부지출 의료비에 주는 영향에 비해 총 의료비와 정부지출 의료비가 GDP에 주는 영향은 더 장기적이었다. 이러한 결과는 총 의료비 지출과 정부지출 의료비가 노동생산성과 교육을 통한 인적자본의 축적 등에 직간접 영향을 준다는 기존의 논의를 지지할 가능성을 보여준다. The purpose of this study is to identify whether and the extent to which total health expenditure and (or) government health expenditure has granger causality in OECD countries after economic crisis. This study analyze the data including GDP, total health expenditure, government health expenditure, health expenditure per capita, government health expenditure per capita from 2000 to 2012 of each OECD countries and investigates the Granger-causality relationship between GDP and the other variables. The results show the positive(+) bidirectional Granger-causality not only between GDP and total health expenditure but also GDP and the variables relating governmental health expenditure. A VAR test verifies that governmental health expenditure compared to the total health expenditure has been long-term impact on the GDP. Therefore total health spending as well as the share of government affects directly or indirectly to national economic growth with the possibility of both to enforce the labor productivity and to help accumulating human capital.

가구 과부담의료비 측정에 관한 연구 고찰 및 시사점

정영일 ( Young Il Jung ),이혜재 ( Hye Jae Lee ),이태진 ( Tae Jin Lee ),김홍수 ( Hong Soo Kim ) 한국보건경제정책학회(구 한국보건경제학회) 2013 보건경제와 정책연구 Vol.19 No.4

보건의료체계는 건강을 증진시키는 역할과 함께 의료이용으로 인한 개인의 재정 악화를 보호하는 역할을 해야 하며, 이러한 재정 보호 역할은 가구 과부담의료비 발생률로써 측정이 가능하다. 최근 국내에 많은 연구들이 다양한 자료원을 사용하여 과부담의료비 발생을 분석하고 있으나, 통일된 측정 기준이 없이 연구자나 자료에 따라 다른 방법을 사용하고 있기에, 본 연구에서는 체계적 문헌고찰을 통해 우리나라의 과부담의료비를 분석한 연구를 선정하여 이들에서 과부담의료비의 측정이 어떻게 이루어지고 있는지 살펴보고, 향후 연구에 대한 시사점을 제시하였다. 선정된 총 24편의 연구들에 대하여 사용한 자료원, 대상 인구집단, 과부담의료비 측정 기준과 이에 따른 발생률 및 관련 요인을 살펴보았다. 주로 사용한 자료원은 (도시)가계조사와 한국복지패널이었고, 가구의 지불능력은 연구에 따라 생활비를 제외한 가구총지출, 생활비를 제외하지 않은 가구총지출, 가구총수입 등으로 다양하게 정의하고 있었으며, 포함된 의료비의 범위도 차이가 있었다. 이중 일부 연구들은 과부담의료비라는 용어를 사용하지 않고 가구총소득 대비 의료비 지출을 ‘의료비 부담’으로 간주하였으며, 가구가 아닌 개인 수준에서 부담을 측정 하기도 하였다. 본 고찰의 결과는 향후 연구에서는 지불능력 및 의료비의 측정에서 보다 연구 간 비교 가능한 항목 선정과 역치 적용의 필요를 보여주며, 패널 조사 자료를 활용하여 동일 가구의 지속적인 관찰을 통한 의료비 부담의 동적변화와 의료이용으로 인해 재정 악화의 위험이 높은 인구집단에 대한 연구가 이루어져야 함을 시사한다. Besides improving health, health systems must work on protecting people from financial risks associated with medical spending. This can be measured by catastrophic health expenditure, which is defined as the case when medical spending exceeds a certain fraction of household income. Many studies have analyzed the incidence of catastrophic health expenditure in Korea, but no concerted measure has been applied to them. Given the lack of reviews on this issue, this study attempted a systematic literature review on various definitions of catastrophic health expenditure and the consequential results. Total 24 studies were included. Data sources, study populations, the measures of catastrophic health expenditure, and the consequential incidences and determinants were summarized. Frequently used data sources were the Urban Household Expenditure Survey and Korea Welfare Panel Study. A households` capacity to pay was defined as household income, consumption expenditure, or consumption expenditure less food spending. There also existed studies used the term of ‘burden of medical cost’ instead of catastrophic health expenditure. The levels of analysis are mostly household. The findings of this review suggest that the concerted definition of capacity of pay need to be developed and applied to future studies on catastrophic health expenditure. Upcoming secondary data sources will enable researchers to investigate the dynamics of burdens of health expenditure and the consequences to subgroups who are vulnerable to financial risks.

개인의 지출의료비의 결정 요인 분석

박현애,송건용 서울대학교 간호대학 간호과학 연구소 1994 간호학 논문집 Vol.8 No.1

In order to study factors affecting individual's health care expenditure, Andersen's model for health utilization was modified by adding the health behavior component and health care expenditure and examined with two different approaches. Two different approaches were the multiple regression model and LISREL model. For multiple regression, dependent variable was reported health care expenditure during past 15 days before the survey and independent variables were various variables measuring predisposing factor, enabling factor, need factor, health behavior and health utilization. For the LISREL, six endogenous variables of health utilization, predisposing factor, enabling factor, need factor, health behavior, and health care expenditure and 10 exogeneous variables which measure six endogenous variables were used. According to the multiple regression analysis, number of visits to physician during past 15 days of utilization factor; chronic illness, health status, and perceived health status of the need factor; residence and education of the predisposing factor; health insurance of enabling factor; sleeping and doing any kind of healthy behavior of the health behavior factor were the significant exploratory variables for the health care expenditure. From LISREL, utilization affects health care expenditure most following by need factor, predisposing factor, enabling factor and health behavior. For LISREL model, age, education, and residence for predisposing factor; health status, chronic illness, and perceived health status for need factor; medical insurance for enabling factor; doing any kind of healthy behavior for the health behavior; number of physician during past 15 days for the utilization factor; and health care expenditure during past 15 days for the expenditure were found as the significant observed variables for each theoretical variables.

미충족의료와 비급여진료비가 과부담의료비 발생에 미치는 영향

이혜재 ( Hye Jae Lee ),이태진 ( Tae Jin Lee ) 한국보건경제정책학회(구 한국보건경제학회) 2015 보건경제와 정책연구 Vol.21 No.3

과부담의료비는 가구의 지불능력의 일정 수준을 넘어서는 의료비 지출이 발생했는지를 나타내는 지표이다. 본 연구는 한국의료패널 자료를 사용하여 과부담의료비 발생의 결정요인으로 이제까지 고려되지 않았던 미충족의료와 비급여진료비가 나타내는 영향에 대해 탐색하였다. 분석은 크게 두 부분으로 이루어졌다. 첫 번째 분석에서는 최근 5년 동안의 과부담의료비 발생률을 추정하였고, 두 번째 분석에서는 미충족의료와 비급여진료비가 과부담의료비 발생에 미치는 영향을 로짓 모형을 통해 살펴보았다. 과부담의료비 정의를 가구 소득 중 의료비 지출이 10%가 넘는 경우로 내렸을 때, 우리나라 가구 중 과부담의료비를 지출한 가구의 비율은 2008년 16.24%에서 2012년 18.66%로 꾸준히 증가하고 있었다. 로짓 모형 분석 결과, 미충족의료는 과부담의료비 발생 확률을 높였으며 비급여진료비는 과부담의료비 발생 확률을 높였으나 그 효과가 의료급여 군에서 더 높았다. 본 연구는 그동안 쉽게 다루어지지 않았던 미충족의료와 비급여진료비 변수를 독립변수로 고려함으로써 의료비에 대한 보다 풍부한 정보를 반영하여 과부담의료비의 결정요인을 확인하였다는데 의미가 있다. Health expenditure is considered as catastrophic when a household incurs out-of-pocket health payment exceeding pre-defined thresholds of its capacity to pay. This study explored the determinants of catastrophic health expenditure using two undiscovered variables so far: unmet medical need and payment for uncovered services. Korea Health Panel was used to estimate the incidence and determinants of catastrophic health expenditure. The results showed that the incidence of catastrophic health expenditure has been increased during last five years. Contrary to hypothesis, unmet medical need was associated with increased probability of catastrophic health expenditure, and payment for uncovered services showed higher impact on catastrophic health expenditure in medical aid group than national health insurance group. Although many studies have explored catastrophic health expenditure, variables used in previous studies were limited. This study tried to investigate the impact of two new variables on catastrophic health expenditure. The results can guide future studies and regarding policies.