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65세 이상 본인부담 상한 적용 노인의 의료서비스 이용 현황과 특성

Status and Characteristics of Applying a Copayment Ceiling for the Elderly

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Objectives: This study is the human factors and disease factors of the copayment system for the elderly (>65 years old) and to identify does the current status and characteristics of the applied elderly and conducted to provide basic data. Methods: Sample cohort data from the National Health Insurance Corporation database, from the years 2012-2015, were analyzed of 21,772 elderly people over the copayment ceiling. Results: The ratio of those who exceeded the copayment ceiling system rose sharply from progressive rates of 3.39% in 2012, 3.69% in 2013 and 5.03% in 2014, to rates of 37.13% from 2013. Factors identified that affect the instances of being over the copayment ceiling were: age, income group, region, severity, disability, sickness distribution, inpatient days, and outpatient days. Conclusions: The reorganization of the copayment ceiling system in 2014 favored low-income families of the elderly, but in 2015, the proportion of elderly was low (only 5.78%). The government's policies needs to change to allow for the amount of the deductible upper limit for low- and middle- income groups to be further subdivided in order for the elderly to receive more deductibles.

Abstract

Objectives: This study is the human factors and disease factors of the copayment system for the elderly (>65 years old) and to identify does the current status and characteristics of the applied elderly and conducted to provide basic data. Methods: Sample cohort data from the National Health Insurance Corporation database, from the years 2012-2015, were analyzed of 21,772 elderly people over the copayment ceiling. Results: The ratio of those who exceeded the copayment ceiling system rose sharply from progressive rates of 3.39% in 2012, 3.69% in 2013 and 5.03% in 2014, to rates of 37.13% from 2013. Factors identified that affect the instances of being over the copayment ceiling were: age, income group, region, severity, disability, sickness distribution, inpatient days, and outpatient days. Conclusions: The reorganization of the copayment ceiling system in 2014 favored low-income families of the elderly, but in 2015, the proportion of elderly was low (only 5.78%). The government's policies needs to change to allow for the amount of the deductible upper limit for low- and middle- income groups to be further subdivided in order for the elderly to receive more deductibles.

참고문헌 (15)

  1. 김경아, "건강보험 고액 본인부담 지출 환자의 특성에 관한 연구", 석사, 의료경영학, pp.2011
  2. Efficiency Plan of copayment system, National health insurance, "Y. S. Choe", Health Insurance Policy Researcher, 23~27 (2011)
  3. 박윤수, "노인의 건강상태와 신체활동에 관한 연구", 보건의료산업학회지, 13(3), pp.93~103 (2019), 보건의료산업학회[DOI]
  4. 정영호, "우리나라의 생애의료비 분포 추정", 보건사회연구, 31(1), pp.194~216 (2011), 한국보건사회연구원[DOI]
  5. H. R. Yoo, "A Study on the Effectiveness of Out-of-Poket Maximum on the Health Care Utilizations: Focused on the Insured of National Health Insurance System", pp.2016
  6. Y. S. Hwang, "A Study on the Change of Medical Use pattern before and after the Improvement of Copayment Ceiling system", pp.2018
  7. Analysis of the impact of the system for improving the out-of-pocket ceiling and a study of policy plans, National health insurance, "S. J. Im", Health Insurance Policy Researcher, 17~46 (2015)
  8. J. E. Ko, "Comparison of equity in healthcare utilization and expenditures among older people by region", pp.2019
  9. H. O. Lee, "Effect of four major severe diseases benefit expansion policy: Focused on health care utilization and catastrophic health expenditure", pp.2017
  10. A Study on Rationalization of Copayment Limitation by Reforming Health Insurance System and Expanding Coverage, National health insurance, "S. J. Im", Health Insurance Policy Researcher, 13~97 (2018)
  11. 유혜림, "건강보험 본인부담상한제의 효과성에 관한 연구", 사회보장연구, 32(2), pp.135~164 (2016), 한국사회보장학회

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