사회경제적 형태에 따른 치매 유병률 변화: 건강보험, 의료급여 대상자를 중심으로

김상현,최윤정,김창수 건강보험심사평가원 2023 HIRA RESEARCH Vol.3 No.2

Background: Dementia is a critical health concern in Korea as the population ages and lives longer. Socioeconomic disadvantages have been identified as a risk factor for dementia. Our study aimed to estimate the prevalence of dementia by socioeconomic status in Korea by analyzing hospital utilization rates. Methods: We examined National Health Insurance claims data in the Health Insurance Review & Assessment Service (HIRA) from 2008 to 2016 and identified all dementia cases. We calculated crude age- and sex-standardized prevalence by socioeconomic status. Health insurance types (Medical Aid and National Health Insurance beneficiaries) were used as socioeconomic status indicators. Results: The age- and sex-standardized prevalence for dementia by health insurance type consistently increased, which was prominent among patients aged ≥85 years from 2008 to 2016. Rate ratio of age- and sex-standardized prevalence in Medical Aid beneficiaries (904.1–1,793.3 per 100,000 individuals, from 2008 to 2016) was approximately three times higher than that in National Health Insurance beneficiaries (311.0–622.6). Among patients aged <60 years, rate ratio difference of the age- and sex-standardized prevalence was estimated at 15.4 times in 2008 (15.2 in National Health Insurance and 233.6 in Medical Aid) and 26.5 times in 2016 (21.4 in National Health Insurance and 565.8 in Medical Aid). Conclusion: The rate ratio of age- and sex-standardized prevalence for dementia in Medical Aid beneficiaries was approximately three times higher than that in National Health Insurance beneficiaries from 2008 to 2016. Moreover, difference in prevalence of early onset dementia (<60 years of age) highly increased. Therefore, Korean healthcare policy must prioritize dementia prevention and treatment according to socioeconomic status (Medical Aid beneficiaries), specifically for early onset dementia.

USA Evidence on the Relation between Health Insurance, Outpatient Services and Inpatient Services for Children ACSC

김양균,성주호 한국보험학회 2004 保險學會誌 Vol.69 No.-

The purpose of the study is to identify influence of health insurance status on ambulatory care (outpatient) visits as primary care accessibility and on hospitalization as health outcome caused by lack of primary care accessibility, and to explore the factors affecting outpatient visits, hospitalization caused by lack of outpatient visits.One of indicators to identify the relationship between access to health care service caused by health insurance status and health service utilization is Ambulatory Care Sensitive Conditions (ACSC), which are conditions that when timely and effectively treated in the outpatient setting can help reduce the risk of hospitalizations by preventing onset of an illness. The study chooses ACSC to test the relationship the lack of primary care and hospitalization among diseases.We use the available recent health care survey data (i.e. 1996 Medical Expenditure Panel Survey; MEPS96). We find out the positive relationship between hospitalization and no health insurance, and the negative relationship between outpatient visit and no health insurance. This indicates that reducing accessibility for outpatient visit caused by no health insurance results in increasing hospitalization. Furthermore, this result strongly suggests that the uninsured children is actually not able to care in early disease stage so that they are likely to hospitalization when their disease was more sever and then they need long stay for cure. As a result, fortifying the accessibility to necessary health care in a way of sharing appropriately the role with private health insurance can lead to the efficiency of national health care delivery systems in view of total health care expenditure, in particular in a case of ACSC children. Additionally, this kind of health policy may be expected to reform gradually the population structure such as aging, aged and super-aged society. 본 연구는 미국 의료심사원에서 공표한 실제데이터(MEPS96)를 의료보험통계분석 소프트웨어인 SUDAAN에 적용하여 심각한 질병상태는 아니지만 통근치료가 필요한 질환상태 ACSC(Ambulatory Care Sensitive Conditions: 중이염, 세균감염, 피부염, 위장염 등)에 있는 18세 이하 어린이들의 외래통근치료 빈도, 입원 빈도 및 평균 입원 일수 등을 종속변수로, 이에 영향을 미치는 주요 경제적 요인(사보험가입 여부, 국영보험가입 여부, 가정의 여부, 주거지역 등), 인구통계적 요인(연령, 인종, 성별) 그리고 건강상태(건강체, 표준체, 미달체 등) 등을 독립변수로 두어, 다변량분석 및 다중회귀분석을 수행함으로써 이들간의 상호 인과 관련성을 검증하였다. 우리는 민영건강보험시장 및 국민건강보험의 발전 방향 수립에 참조가 될 수 있는 다음과 같은 주요 시사점들을 도출하였다: 첫째, 사보험가입상태, 국영보험가입상태 및 비보험상태 순으로 외래통근치료 빈도와 양의 상호관련성이 높았으며, 둘째 입원 빈도와 평균입원 일수 등은 모두 외래 통근 치료 빈도와 음의 상호관련성이 있으며, 셋째 유아기(0세-5세) 는 청소년기(6세-18세)에 비하여 공통적으로 통근치료 빈도, 입원 빈도 및 평균입원일수 모두 높음을 알 수 있다. 특히 유아기의 입원빈도 및 평균입원일수는 청소년기에 비해 약 3배 이상 높게 산출되고 있다. 이는 생명표상에 유아기 사망률이 높게 나타나고 있음과 깊은 상관관계가 있음을 시사한다. 따라서 국민건강보험 및 민영건강보험의 보험적용범위를 유아기 질병 조기진단 방향으로 확대 적용할 필요성이 있으며, 이는 궁극적으로 질병악화로 인한 고액 의료비 지출을 조기에 차단하는 재정안정화 효과와 더 나아가 인구구조의 고령화 속도를 지연하는 간접적 효과를 기대할 수 있을 것이다. 이에 대한 국내 실증적 분석은 향후 연구과제로 두고자 한다.

사회경제적 상태에 따른 건강정보이해능력 및 관련 요인

오윤진,박기현 대한가정의학회 2021 Korean Journal of Family Practice Vol.11 No.4

Background: In the past 50 years, Korea has achieved rapid economic development. Consequently, health and life expectancy have improved, butthere are differences in health status according to socioeconomic condition. Health literacy is a major determinant of health status. Accordingly, thisstudy sought to identify the factors related to the difference in health literacy between recipients of National Health Insurance and Medical careassistance. Methods: This study was conducted form May 21 to July 30, 2020 among patients who visited the outpatient Department of Family Medicine at ahospital located in Seoul. A total of 73 patients were enrolled: 42 middle-aged (40 years or older) patients with Health Insurance and 31 patientswith Medical Aid. The survey utilized the Korean Adult Health Literacy Scale. Results: The average age of Medical Aid patients was 70.00±13.57 years. Thirty-one (100%) of the Medical Aid patients had a period of education under12 years, and 30 (96.8%) had an average monthly income less than 990,000 won. The majority of Medical Aid patients obtained health-relatedinformation through TV/radio (71%). The average health literacy score of Medical Aid patients was 11.10±4.497, which was significantly lower thanthat of National Health Insurance patients (16.21±7.035, P<0.001)Conclusion: It was confirmed that Medical Aid patients had lower health literacy than National Health Insurance patients. In the future, research andpolicy development are needed to improve health literacy in recipients of Medical Care Assistance. 연구배경: 지난 50년 동안 우리나라는 국가주도의 경제발전을 통해빠른 속도로 경제발전을 이루었고, 국민들의 경제수준이 높아짐에따라 건강수준과 기대수명이 향상되었으나, 사회 경제적 지위에 따른 건강수준의 차이가 있었다. 건강정보이해능력은 건강수준을 결정하는 주요 요인으로, 본 연구에서는 의료급여환자와 건강보험환자를 대상으로 건강정보이해능력의 차이와 관련된 요인을 알기 위해 수행되었다. 방법: 2020년 5월 21일부터 2020년 7월 30일까지 서울 소재의 한 종합병원 가정의학과 외래를 방문한 환자 중 중장년층(40세 이상)의국민건강보험 환자 31명, 총 73명을 대상으로 하였고, 한국인의 건강정보이해능력 측정도구를 이용하여 설문하는 방식으로 진행되었다. 결과: 본 연구의 대상자 중 의료급여환자 31명의 평균나이는 70.00±13.57세였고, 성별은 의료급여환자의 경우 남자 16명(51.6%)으로 남성이 여성에 비해 높게 나타났다. 의료급여환자의 교육기간은 12년이하가 31명(100%)이었고, 월평균수입은 99만원 이하인 경우가 30명(96.8%)이었다. 의료급여 환자의 경우 건강정보 취득경로는 TV/radio 22명(71%)으로 주변인 5명(16.1%)보다 많았다. 의료급여환자의건강정보이해능력 총점수는 11.10±4.497점으로 건강보험환자가16.21±7.035인 것에 비해 유의하게 낮았다(P<0.001). 결론: 의료급여환자가 건강보험환자보다 건강정보이해능력이 낮음을 확인할 수 있었고, 앞으로 건강정보이해능력 향상과 영향을 미치는 요인에 대한 연구와 정책개발이 필요하다.

USA Evidence on the Relation between Health Insurance, Outpatient Services and Inpatient Services for Children ACSC

Kim, Yangkyun,Sung, Jooho 한국보험학회 2004 保險學會誌 Vol.69 No.-

본 연구는 미국 의료심사원에서 공표한 실제데이터(MEPS96)를 의료보험통계분석 소프트웨어인 SUDAAN에 적용하여 심각한 질병상태는 아니지만 통근치료가 필요한 질환상태 ACSC(Ambulatory Care Sensitive Conditions: 중이염, 세균감염, 피부염, 위장염 등)에 있는 18세 이하 어린이들의 외래통근치료 빈도, 입원 빈도 및 평균 입원일수 등을 종속변수로, 이에 영향을 미치는 주요 경제적 요인(사보험가입 여부, 국영보험가입 여부, 가정의 여부, 주거지역 등), 인구통계적 요인(연령, 인종, 성별) 그리고 건강상태(건강체, 표준체, 미달체 등) 등을 독립변수로 두어, 다변량분석 및 다중회귀분석을 수행함으로써 이들간의 상호 인과 관련성을 검증하였다. 우리는 민영건강보험시장 및 국민건강보험의 발전 방향 수립에 참조가 될 수 있는 다음과 같은 주요 시사점들을 도출하였다: 첫째, 사보험가입상태, 국영보험가입상태 및 비보험상태 순으로 외래통근치료 빈도와 양의 상호관련성이 높았으며, 둘째 입원 빈도와 평균입원 일수 등은 모두 외래 통근 치료 빈도와 음의 상호관련성이 있으며, 셋째 유아기(0세-5세)는 청소년기(6세-18세)에 비하여 공통적으로 통근치료 빈도, 입원 빈도 및 평균입된 일수 모두 높음을 알 수 있다. 특히 유아기의 입원빈도 및 평균입원일수는 청소년기에 비해 약 3배 이상 높게 산출되고 있다. 이는 생명표상에 유아기 사망률이 높게 나타나고 있음과 깊은 상관관계가 있음을 시사한다. 따라서 국민건강보험 및 민영건강보험의 보험적용범위를 유아기 질병 조기진단 방향으로 확대 적용할 필요성이 있으며, 이는 궁극적으로 질병악화로 인한 고액 의료비 지출을 조기에 차단하는 재정안정화 효과와 더 나아가 인구구조의 고령화 속도를 지연하는 간접적 효과를 기대할 수 있을 것이다. 이에 대한 국내 실증적 분석은 향후 연구과제로 두고자 한다. The purpose of the study is to identify influence of health insurance status on ambulatory care (outpatient) visits as primary care accessibility and on hospitalization as health outcome caused by lack of primary care accessibility, arid to explore the factors affecting outpatient visits, hospitalization caused by lack of outpatient visits. One of indicators to identify the relationship between access to health care service caused by health insurance status and health service utilization is Ambulatory Care Sensitive Conditions (ACSC), which are conditions that when timely and effectively treated in the outpatient setting can help reduce the risk of hospitalizations by preventing onset of an illness. The study chooses ACSC to test the relationship the lack of primary care and hospitalization among diseases. We use the available recent health care survey data (i.e. 1996 Medical Expenditure Panel Survey; MEPS96). We find out the positive relationship between hospitalization and no health insurance, and the negative relationship between outpatient visit and no health insurance. This indicates that reducing accessibility for outpatient visit caused by no health insurance results in increasing hospitalization. Furthermore, this result strongly suggests that the uninsured children is actually not able to care in early disease stage so that they are likely to hospitalization when their disease was more sever and then they need long stay for cure. As a result, fortifying the accessibility to necessary health care in a way of sharing appropriately the role with private health insurance can lead to the efficiency of national health care delivery systems in view of total health care expenditure, in particular in a case of ACSC children. Additionally, this kind of health policy may be expected to reform gradually the population structure such as aging, aged and super-aged society.

Trends in the Prevalence of Blindness and Correlation With Health Status in Korean Adults: A 10-Year Nationwide Population-Based Study

Na Kyeong Ik,Lee Won June,Kim Young Kook 대한의학회 2023 Journal of Korean medical science Vol.38 No.28

Background: Contemporary data on vision impairment form an important basis for public health policies. However, most data on the clinical epidemiology of blindness are limited by small sample sizes and focused not on systemic conditions but ophthalmic diseases only. In this study, we examined the ten-year trends of blindness prevalence and its correlation with systemic health status in Korean adults. Methods: This study investigated 10,000,000 participants randomly extracted from the entire Korean population (aged ≥ 20 years) who underwent a National Health Insurance Service health checkup between 2009 and 2018. Participants with blindness, defined as visual acuity in the better-seeing eye of ≤ 20/200, were identified. The prevalence of blindness was assessed, and the systemic health status was compared between participants with blindness and without blindness. Results: The mean prevalence of blindness was 0.473% (47,115 blindness cases) and tended to decrease over ten years (0.586% in 2009 and 0.348% in 2018; P < 0.001). The following factors were significantly associated with blindness: female sex, underweight (body mass index < 18.5), high serum creatinine (> 1.5 mg/dL), and bilateral hearing loss. In addition, except for those aged 30–39 and 40–49 years, high fasting glucose (≥ 126 mg/dL) and low hemoglobin (male: < 12 g/dL, female: < 10 g/dL) were significantly correlated with prevalent blindness. Conclusion: Our ten-year Korean nationwide population-based study suggested a gradual decrease in the prevalence of blindness and its association with specific systemic health status. These conditions might be the cause or consequence of blindness and can be used as a reference for the prevention and/or rehabilitation of blindness to establish public health policies.

한국 건강보험법 시행 30년의 역사와 과제

신언항 대한의료법학회 2007 의료법학 Vol.8 No.2

건강보험 재정 현황과 전망

주재홍,장성인,박은철 한국보건행정학회 2020 보건행정학회지 Vol.30 No.2

Background: Korea National Health Insurance Service (NHIS) is operated as a social insurance system in which people pay a portion of their monthly income as insurance premiums and receive benefits when they experience illness or injury. Since 2005, the national health insurance remained surplus accumulating cumulative reserves each year. However, as of 2018, NHIS revenue recorded 62.11 trillion won and spending of 62.29 trillion won. The deterioration of NHIS finances is expected to accelerate with the aging population, income growth, new medical technology development, and enhanced security policies. Methods: To examine the financial health and sustainability of NHIS, we estimated the future revenue and spending until 2030 using the data from Korea Health Insurance Review and Assessment Service statistical yearbook. 2004–2018 average percentage change in NHIS revenue and spending was calculated. We estimated the future NHIS financial status using two methods. In the first method, we calculated the revenue and spending of the future NHIS by applying the 2004–2018 average percentage change to the subsequent years consecutively. In the second method, we estimated the future NHIS financial status after adjusting for the predicted demographic changes such as the aging population and declining birth rate in South Korea. Results: The estimates from this study suggest that the NHIS’s cumulative reserves will run out by 2024. Conclusion: In terms of spending on current health insurance, there should be a search for ways of more efficient spending and funding options.

소득계층에 따른 건강수준 및 의료이용의 차이에 관한 연구

문옥륜,이선민 서울大學校 保健大學院 1996 國民保健硏究所硏究論叢 Vol.6 No.2

This study is based on the Social Statistical Survey data conducted by National Statistical Office in 1986 (35,433 cases), 1989 (62,429 cases), 1992 (24,432 cases) and 1995 (42,612 cases). This study looked into the differentials of prevalence rate, number of sickness days, number of days in bed confinement, self-perceived health status, rate of physician visits, and number of health care utilizations by income class. The above data were examined by χ^2- test and ANOVA test. Gini coefficient for each index was also used to see if level of health status and health care utilization of each income class showed same pattern or not. The major findings are as follows: 1. There were significant differences in the prevalence rate and number of sickness days by income class. Higher prevalence rate and more sickness days were observed in lower income class in four respective years, and they were higher in recent years. 2. Difference in number of days in bed confinement also existed by income class. There were more days in bed confinement in lower income class. 3. A significant difference in self-perceived health status was noted by income class. Lower income class tended to regard themselves as more unhealthy. 4. There was a significant difference in rate of physician visits by income class in 1986 and 1989 but not in 1992 and 1995. In 1992 and 1995, all the classes tended to visit physicians equally, regardless of their income differences. Since the economic barrier to entry is removed to some degree owing to the existence of the National Health Insurance, the differentials of health care utilization by income class has been greatly reduced.

체육계열 대졸자의 직장 건강보험 가입 일자리 취업에 따른 대학교육 만족과 부모의 사회경제적지위

박광호,조성원 한국사회체육학회 2022 한국사회체육학회지 Vol.- No.88

Purpose: The purpose of this study is to analyze whether there are differences in the satisfaction of university education support, major education satisfaction, participation in employment support programs, parental socioeconomic status according to employment for jobs providing the National health insurance program (NHIP) for graduates in sports studies and identify the influence relationship between variables. Method: 414 sports-related majors data from the Graduates Occupational Mobility Survey (GOMS) from 2017 to 2019 were used. Satisfaction of university education support, major education satisfaction, participation in employment support programs, and parental socioeconomic status were set as variables, To analyze the differences in variables, frequency analysis, factor analysis, reliability analysis, ANCOVA, independent sample T-test, and chi-square test were performed and to analyze the influence, logistic regression was also performed. Results: The results of this study are as follows. 1) There was no difference in satisfaction of university education support of graduates in sports studies according to employment for jobs providing NHIP. 2) There was no difference in the satisfaction of major education according to employment for jobs providing NHIP. However, among the sub-variables, the ability and enthusiasm of major professors were found to be higher in the employment group than in the unemployment group. The ability and enthusiasm of major professors were found to have a significant influence on employment for jobs providing NHIP. 3) There was no significant difference in participation in employment programs according to employment for jobs provided by NHIP. 4) There was a significant difference in the parental socioeconomic status according to employment for jobs providing NHIP. Among the sub-variables, differences were showed in the income and assets of the parents and assets were found to have an influence on employment for jobs providing NHIP. Conclusion: In summary, the factors that showed a difference in employment for jobs providing NHIP of those who graduated in sports studies were parental socioeconomic status (income, asset), and the ability and enthusiasm of professors teaching major subjects were found to be an important factor in the employment for jobs providing NHIP of graduates in sports studies. It is meaningful to use the index of employment for job providing NHIP as a variable, an indicator of the government’s employment rate management.

A일개 군지역 암등록자료의 국민건강보험 보장유무에 따른 암 생존율 차이

권순석 ( Sun Seog Kweon ),이영훈 ( Young Hoon Lee ),최진수 ( Jin Su Choi ),신민호 ( Min Ho Shin ),김혜연 ( Hye Yeon Kim ),최성우 ( Seong Woo Choi ) 한국보건행정학회 2009 보건행정학회지 Vol.19 No.2