무엇이 과잉진료를 부추기는가?: 과잉진료의 원인 고찰과 대책
What Factors Promote Overtreatment in Korea?: Causative Considerations and Solutions to Overtreatment
1
조회
0
다운로드
12
인용
0
참고문헌
키워드
초록
과잉진료(불필요한 진료)는 의료서비스를 적정한 선 이상으로 제공하는 것을 말한다. 좋은 진료를 제 공하고 불필요한 해악을 피하는 것은 의료의 기본이다. 최근 이익이 적고 해악이 많은 진료를 지양하는 적정진료의 필요성이 강조되고 있다. 과잉진료는 제한된 자원의 낭비를 초래한다는 점에서 정의의 원 칙에 위배된다. 또한 환자에게 직접적인 손해를 끼치므로 해악금지의 원칙에 반한다. 의사들은 효율적 인 시스템이나 자신의 경제적 욕구가 아니라, 환자의 최선의 이익이라는 가치에 의해서 동기부여가 되 어야 한다. 하지만 현실적인 제약으로 인해 실제 진료와 이상적인 진료 사이의 간격은 점점 벌어지고 있 다. 본 논문에서는 과잉진료가 환자의 이익보다 자신의 경제적 이득을 추구하는 의사들의 문제라는 단 순한 도식만으로는 이해될 수 없다는 것을 밝히고, 과잉진료의 유형과 다양한 원인들을 고찰한 다음, 과 잉진료원인을 행위의 주체에 따라서 분류함으로써, 각 주체들이 문제의 해결을 위해 기여해야할 각각 의 몫들이 있음을 지적하고자 하였다. 그리고 이런 일이 가능하도록 주도적으로 작용해야 하는 것은 의 사, 의사단체라는 점을 강조하였다.
Abstract
Overtreatment (or unnecessary treatment) occurs when medical services are provided with a higher volume or cost than is appropriate. Of course, practicing good medicine and avoiding unnecessary harm have always been principles of medical practice. Currently there is a new emphasis on reducing practices that are likely to have limited benefit or that involve potential harm. Waste due to overtreatment has been described as a violation of the principle of justice on the assumption that every system has limited resources and any wasted resource necessarily means those resources will no longer be available for use by others in need. Overtreatment may also cause direct harm to patients, thus violating the principle of nonmaleficence. Physicians are rarely motivated by the desire to achieve system efficiency or to save money for its own sake. However, it is widely understood that physicians should be motivated by a desire to do the right thing in terms of promoting the patient’s best interest. And doing the right thing includes an ethical imperative to provide parsimonious care. Recognizing this fact helps to bridge the enormous quality chasm that still exists between the medical care that is currently provided and the medical care that should be provided. The purpose of this study is to identify and assess the factors that cause overtreatment (unnecessary treatment) in the Korean medical system and to suggest certain solutions to this problem.
참고문헌 (52)
- Walsh-Childers K, "Competing with the conventional wisdom: newspaper framing of medical overtreatment", Health Commun, 29(2), pp.157~172 (2014)
- Siwek J, "Getting medicine right: overcoming the problem of overscreening, overdiagnosis, and overtreatment", Am Fam Physician, 91(1), pp.18~20 (2015)
- 최윤주, "의사성과급제에 따른 의료공급자 유인수요에 관한 연구", 석사, 사회복지학과 사회정책전공, pp.2014
- Brody H, "From an ethics of rationing to an ethics of waste avoidance", N Engl J Med, 366(21), pp.1949~1951 (2012)
- Berwick DM, "Eliminating waste in US health care", JAMA, 307(14), pp.1513~1516 (2012)
- Ebell M, "Improving quality by doing less: overscreening", Am Fam Physician, 91(1), pp.22~24 (2015)
- Ebell M, "Improving quality by doing less: overdiagnosis", Am Fam Physician, 91(3), pp.162~163 (2015)
- Ebell M, "Improving quality by doing less: overtreatment", Am Fam Physician, 91(5), pp.289~291 (2015)
- Wiener RS, "When a test is too good", BMJ, 347, pp.f3368~ (2013)
- Donato AA, "Clinical outcomes in patients with isolated subsegmental pulmonary emboli diagnosed by multidetector CT pulmonary angiography", Thromb Res, 126(4), pp.e266~e270 (2010)
- "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JNC 7 complete report: the science behind the new guidelines"[URL]
- Cushman WC, "Effects of intensive blood-pressure control in type 2 diabetes mellitus", N Engl J Med, 362(17), pp.1575~1585 (2010)
- Ralston SL, "Doing more vs doing good; aligning our ethical principles from the personal to the societal", JAMA Pediatrics, 169(12), pp.1085~1086 (2015)
- Daniels N, "Access, cost, and financing: achieving an ethical health reform", Health Aff (Millwood), 28(5), pp.w909~w916 (2009)
- Welch HG, "Overdiagnosis in cancer", J Natl Cancer Inst, 102(9), pp.605~613 (2010)
- Munson R, "의료문제의 윤리적 성찰", pp.64~66 (2001), 단국대학교 출판부
- Snyder L, "American College of Physicians Ethics Manual: sixth edition", Ann Intern Med, 156(1 pt 2), pp.73~104 (2012)
- Kay M, "The unethical revenue targets that India’s corporate hospitals set their doctors", BMJ, 351, pp.h4312~ (2015)
- "환자부담없게...‘돈 되는’ 시술 않는 착한 치과"[URL]
- "‘충치 3개에 45만원?’ 해도 너무한 치과 과잉진료... 환자만 운다"[URL]
- "산모줄자... 산부인과, 과잉진료 논란"[URL]
- "어느 한의원의 달콤한 유혹"[URL]
- "과잉진료 막으니... 갑상선암 환자 3년새 반토막"[URL]
- "한국 갑상선암 여 90%, 남 70% “과잉진단된것”"[URL]
- McGregor MJ, "Testing 1, 2, 3: is overtesting undermining patient and system health?", Can Fam Physician, 58(11), pp.1191~1193 (2012)
- Teke A, "How to control physicians’ overutilization of resources to reduce the health services costs?", TAF Preventive Medicine Bulletin, 12(4), pp.465~470 (2013)
- Kazemian A, "How much dentists are ethically concerned about overtreatment; a bignette-based survey in Switzerland", BMC Med Ethics, 16, pp.43~ (2015)
- Brownlee S, "Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer" (2007), Bloomsbury USA
- Emarujel EJ, "The perfect storm of ovemtilization", J Am Med Assoc, 299, pp.2789~2791 (2008)
- Llewelyn H, "Evidenced based practice should reduce overdiagnosis and overtreatment", BMJ, 344, pp.e4296~ (2012)
- Katz MH, "Undertreatment improves, but overtreatment does not", Intern Med, 173(2), pp.93~ (2013)
- Torjuul K, "Action ethical dilemmas in surgery: an interview study of practicing surgeons", BMC Med Ethics, 6, pp.E7~ (2005)
- Jox RJ, "Limiting life-sustaining treatment in German intensive care: a multiprofessional survey", J Crit Care, 25(3), pp.413~419 (2010)
- 리인홀드 니버, "도덕적 인간과 비도덕적 사회" (2004), 문예출판사
- Ralston SL, "Doing more vs doing good; aligning our ethical principles from the personal to the societal", JAMA Pediatrics, 169(12), pp.1085~1086 (2015)
- Mooney G, "Agency in health care:getting beyond first principles", J Health Econ, 12, pp.125~135 (1993)
- 김창보, "우리나라 의원에서의 의사유인수요 가설 검증", 박사, 보건행정학, pp.2002
- 은상준, "의사성과급: 수익에서 의료의 질로", 복지동향, 169, pp.55~56 (2013)
- 정유석, "국내 의료계에서 시행 중인 금전적 인센티브 제도의 윤리적 쟁점들", 한국의료윤리학회지, 18(2), pp.190~199 (2015), 한국의료윤리학회
- 이용철, "국민건강영양조사 대상자들의 민간의료보험 가입 요인 및 가입여부에 따른 건강행태․의료이용 비교", 한국콘텐츠학회 논문지, 10(12), pp.190~204 (2010), 한국콘텐츠학회
- 이성원, "민간보험 도입 후 개원의사들이 느끼는 진료환경의 변화", 한국의료윤리학회지, 18(1), pp.70~79 (2015), 한국의료윤리학회
- Richardson PS, "Dental treatment needs of a cohort of Royal Air Force recmits over 5 years", Community Dent Health, 13(1), pp.11~16 (1996)
- 권순만, "의료산업과 가격규제: 효과와 개혁방안", 한국정책학회보, 8(2), pp.255~271 (1999)
- "Clean slate for doctors on medical negligence"[URL]
- Travasso C, "Indian cardiologists plan campaign to reduce unnecessary investigations", BMJ, 349, pp.g4740~ (2014)
- Eisenberg JM, "Physician utilization. The state of research about physician's practice patterns", Med Care, 23(5), pp.461~483 (1985)
- Heffner JE, "Altering physician behavior to improve clinical performance", Top Health Inform Manage, 22(2), pp.1~9 (2001)
- Hawley ST, "Social and clinical determinants of contralateral prophylactic mastectomy", JAMA Surg, 149(6), pp.582~589 (2014)
- Lostumbo L, "Prophylactic mastectomy for the prevention of breast cancer", Cochrane Database Syst Rev, (11), pp.CD002748~ (2010)
- "44% advised unnecessary surgery:2nd opinion-givers"[URL]
- Jones JW, "Discovering overtreatment: second-opinion dilemma", J Vasc Surg, 60(6), pp.1690~1692 (2014)
- Chassin M, "The urgent need to improve health care quality: Institute of Medicine National Roundtable on Quality", JAMA, 280(11), pp.1000~1005 (1998)