보건의료환경이 일차의료 질 향상에 미치는 영향: 2008-2017년 OECD 보건통계 자료를 활용한 패널분석
The Effect of Healthcare Environment on Quality Improvement in Primary Care: Panel Analysis Using 2008-2017 OECD Health Statistics Data
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Objectives: Korea is struggling to join in the global trend toward strengthening the role of primary care in the healthcare system. Based on healthcare data collected from Organization for Economic Co-operation and Development (OECD), a plan for quality improvement in primary care is proposed through an analysis of the relationship between the supply of and accessibility to health resources and its impact on primary care quality. Methods: Based on the OECD healthcare data (2008-2017), Two-factors Fixed Effect Panel analysis was performed. Save for countries having insufficient variables, 16 out of 37 OECD countries were subjected to the analysis. The resulting variables were asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes and hypertension hospital admission rates, and five models were set for each disease. Life expectancy and alcohol consumption were used as variables for correction, and the number of general practitioners, the publicly-owned hospital rates, the number of consultations, and the number of discharges were set as major variables to identify the effect on the healthcare system. Additionally, current health expenses were used as explanatory variables. Results: Statistical significance between the number of general practitioners, the number of consultations, and the number of discharges and hospital admission rates for chronic disease was found. One person/1,000 population increase in the number of general practitioners was associated with 24.96 cases/100,000 population decrease in the asthma hospital admission rates (p= 0.006). One visit/person increase in the number of consultations was associated with decrease in the hospital admission rates for asthma (3.75 cases/100,000 population, p= 0.003), diabetes (18.51 cases/100,000 population, p= 0.003) and hypertension (16.82 cases/100,000 population, p= 0.003). One case/1,000 population in the number of discharges was associated with increase in the hospital admission rates for asthma (0.41 cases/100,000 population, p< 0.001), diabetes (1.44 cases/100,000 population, p= 0.002), and hypertension (1.14 cases/100,000 population, p= 0.006). Conclusions: To improve primary care quality in Korea, it is necessary to secure sufficient medical specialists through the establishment of community-oriented health service system, weaken access to inpatient services, and integrate the fragmented system for outpatient care.
Abstract
Objectives: Korea is struggling to join in the global trend toward strengthening the role of primary care in the healthcare system. Based on healthcare data collected from Organization for Economic Co-operation and Development (OECD), a plan for quality improvement in primary care is proposed through an analysis of the relationship between the supply of and accessibility to health resources and its impact on primary care quality. Methods: Based on the OECD healthcare data (2008-2017), Two-factors Fixed Effect Panel analysis was performed. Save for countries having insufficient variables, 16 out of 37 OECD countries were subjected to the analysis. The resulting variables were asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes and hypertension hospital admission rates, and five models were set for each disease. Life expectancy and alcohol consumption were used as variables for correction, and the number of general practitioners, the publicly-owned hospital rates, the number of consultations, and the number of discharges were set as major variables to identify the effect on the healthcare system. Additionally, current health expenses were used as explanatory variables. Results: Statistical significance between the number of general practitioners, the number of consultations, and the number of discharges and hospital admission rates for chronic disease was found. One person/1,000 population increase in the number of general practitioners was associated with 24.96 cases/100,000 population decrease in the asthma hospital admission rates (p= 0.006). One visit/person increase in the number of consultations was associated with decrease in the hospital admission rates for asthma (3.75 cases/100,000 population, p= 0.003), diabetes (18.51 cases/100,000 population, p= 0.003) and hypertension (16.82 cases/100,000 population, p= 0.003). One case/1,000 population in the number of discharges was associated with increase in the hospital admission rates for asthma (0.41 cases/100,000 population, p< 0.001), diabetes (1.44 cases/100,000 population, p= 0.002), and hypertension (1.14 cases/100,000 population, p= 0.006). Conclusions: To improve primary care quality in Korea, it is necessary to secure sufficient medical specialists through the establishment of community-oriented health service system, weaken access to inpatient services, and integrate the fragmented system for outpatient care.
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