건강보험 보장성 확대가 의료이용 및 건강수준에 미치는 영향
Impacts of Health Insurance Coverage Expansion on Health Care Utilization and Health Status
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초록
본 연구는 최근에 이루어진‘건강보험 보장성 확대’정책의 효과를 개인의 의료이용 및 건강수준을 중심으로 평가하였다. 2005년부터 시행된 건강보험 보장성 확대 정책은 암 등 의 중증질환자에 대한 본인부담 경감, 입원환자 식대의 급여전환, 비급여항목의 급여전환, 본인부담상한제 시행 등을 주요 내용으로 한다. 이러한 정책 변화에 대해 만성질환을 보유하고 있어 의료욕구가 일반적으로 높은 제도의 주요 수혜집단에 비해 급성질환 등으로 의료서비스를 이용한 집단의 입원이용이 상대적으로 증가한 것과 제도의 직접적인 수혜집단인 중증질환자 집단의 입원이용이 상당 정도 증가한 것을 확인하였다. 또한 이러한 건강보험제도의 변화가 입원이용에서 혜택을 누린 중증질환자의 단기간의 건강평가지표인 2주간이환경험 면에서 긍정적인 개선을 이끌어내고 있음을 확인하였다. 본 연구는 건강보험제도가 의료이용 및 건강수준에 인과적인 효과를 나타내고 있음을 확인하였고, 이후 건강보험보장성 확대의 정책설계에 대한 정책적 함의를 제공한다.
Abstract
The purpose of this study is to identify the relationship between health insurance and health by evaluating the impacts of health insurance coverage expansion on health care utilization and health status. To analyze the causal relationship between health insurance and health, this study employed a “difference-in-difference method” that could compare changes in health care utilization and health status across groups in health insurance coverage expansion in 2005. The researcher predicted that the expansion of health insurance coverage would be an exogenous source of variation in the prices of health service use. First, the difference-in-differences estimator between ‘illness group’ and ‘non-illness group’ revealed that the increase in coverage of inpatient care services would result from the increases in the stay of length of ‘non-illness group’ rather than that of ‘illness group’. However, the difference-in-differences estimator between ‘serious illness group’ and ‘chronic illness group’ identified that the policy change that focuses on expansion of the coverage for ‘serious illness’ effects on the increases in health care utilization and promotion of health status. In summary, the changes of health insurance coverage focusing on serious illness and inpatient care have positive effects on health care utilization and health status of serious illness group. But, ‘non-illness groups’ with acute illness receive more benefits from the policy change than ‘illness group’ with chronic illness.
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