醫療傳達體系 및 醫療保險 導入이 農村 醫療利用樣相에 미치는 影響 = Changes in Health Care Utilization Patterns in a Rural Area by the Introduction of Health Care Delivery System and Health Insurance

다국어 초록 (Multilingual Abstract)

To measure the changes in health care utilization patterns by the introduction of health care delivery system and health insurance, a field experimental study model was designed. Four myuns in Kang Wha gun were chosen for the experiment. Health care delivery system only·was introduced to one myun and health insurance program as well as health care delivery system was introduced to another myun. Two myuns out of 4 myuns were selected as control. In order to compare the utilization patterns and rates before and after the experiment, two health interview surveys in two year interval were conducted: one in November 1975 from 3, 037 persons and another one in November 1977 from 3, 733 persons.
The following results were obtained.
1. The incidence rates of self-reported acute diseases for the past 2 weeks were 13. 4% before the program(1975) and 12.2% after the program(1977). The prevalence rates of self-reported chronic diseases were 24.4% in 1975 and 21.4% in 1977.
2. In the area the health care delivery system only was introduced, the physician visits per person per year increased from 0.6 in 1975 to 1.1 in 1977(after the program). In the control area also, physician visits per person per year increased from 0.5 in 1975 to 1.3 in 1977. The group health insurance was introduced showed the highest physician visits after the program(1.6 visits per person per year).
3. While the Medical care utilization rate of the lower-income family group was significantly lower than that of the higher-income family group in the control area, the rates in the areas where the health care delivery system and health insurance were introduced showed even between low and high income groups.
4. In the control area, physician visits of the groups with highly educated head of household were higher than that of groups with less educated head of household. The rates, however, were similar regardless of the educational levels of head of household in the experimental areas.
5. In the control area, the longer the distance from the resident village to the bus road, the lower the rates of physician visits. Eventhough those groups lived in an area inconvenient to transportration, the rates for physician visits increased in the experimental group.
6. The treatment rates by physician among diseased persons for the past 2 weeks after the experiment were two times higher than that before the experiment. The health insurance program group showed the highest rate, 12.2%.
7. Medical care utilization patterns of the experimetal area by sources of treatment among the treated patients were compared with that of control area. In the area the health care delivery system was introduced the physician utilization was increased, while patients treated at the drugstore remained at a nearly constant. In the group the health insurance and the health care delivery system were introduced, patients treated at a drugstore or by other sources were significantly decreased and the rate treated by physician was increased.
With the above results, the following conclsions were drawn:
The introduction of a health care delivery system only contributed equal distribution of medical rare among different socieconomic classes but affects only slightly to the rate for physician care and visits.
The introduction of a health care delivery system and an appropriate financing mechanism together improve both equal distribution and utilization of medical care.