시각장애 발생 전후 의료 이용 및 비용 변화
Changes in Health Care Utilization and Medical Expenditures among the Visually Disabled
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목적: 시각장애 발생 전후 의료 이용 및 비용 변화와 시각장애 중증도에 따른 차이를 분석하고자 한다. 대상과 방법: 국민건강보험공단 청구자료와 장애인 등록자료를 이용하여 2005년부터 2013년까지 시각장애인으로 등록된 18세 이상의 환자들을 선정하였다. 관찰 기간은 시각장애 등록 전후 3년으로 정하였으며, 이를 6개월 단위로 구분하여 총 12개의 관심 시점에서 평균 의료 비용, 외래 이용 횟수, 및 입원 일수를 분석하였다. 대조군은 성별과 연령이 일치하도록 10배수 층화랜덤추출한 뒤, 보험료 분위와 거주지역에 대해 1:1 성향점수매칭을 통해 선정하였다. 결과: 총 131,434명의 시각장애인과 같은 수의 대조군과 비교하였다. 관찰 기간 동안 시각장애인에서 비장애인에 비해 평균 의료 비용이 1.9배 더 컸으며(p<0.001), 외래 이용 횟수와 입원 일수도 더 많았다(각각 1.4회, 3.5일, p<0.001). 또한 중증 시각장애인에서 경증보다 평균 의료 비용이 1.6배 더 컸으며(p<0.001), 외래 이용 횟수와 입원 일수도 더 많았다(각각 0.5회, 12일, p<0.001). 의료 비용과 입원 일수는 시각장애 등록 18개월 전부터 시각장애 여부와 중증도에 따라 격차가 벌어진 반면, 외래 이용 횟수는 장애 여부 및 중증도와 관련 없이 비교적 일정하게 증가하였다. 결론: 시각장애인에서 장애 정도가 중증일수록 비장애인에 비해 의료 이용과 의료비 지출이 큰 폭으로 증가하는 경향을 보였다. 시각장애인들이 경제적 부담을 덜고 적절한 치료와 꾸준한 건강 관리를 받을 수 있도록 의료비 지원을 확대하는 등의 정책적 개입을 고려해야할 것이다.
Abstract
Purpose: To identify changes in medical expenditures and health care utilization before and after visual impairment onset, then analyze differences according to visual impairment severity. Methods: Patients aged ≥ 18 years who were registered as visually disabled from 2005 to 2013 were selected using the database from the registry of the disabled and the National Health Insurance Service. The observation period of 3 years before and after the registration was divided into 6-month units (12 points of interest). At each point of interest, medical cost, number of outpatient visits, and length of hospital stay (LOS) were analyzed. The control group was obtained through 1:10 stratification randomization to match sex and age; individuals in the control group were then selected via 1:1 propensity score matching for the premium quantile and residential area. Results: In total, 131,434 patients with visual disability and the same number of non-visually impaired controls were included. Compared with non-disabled individuals, the mean medical cost and number of outpatient visits were higher for patients with visual disability (1.9- and 1.4-fold, respectively, p < 0.001); the LOS was also 3.5 days longer (p < 0.001). The mean medical cost and number of outpatient visits were greater in severely visually disabled patients than in mildly disabled patients (1.6- and 0.5-fold, respectively, p < 0.001); the LOS was also 12 days longer in severely disabled patients (p < 0.001). From 18 months before disability registration, medical costs and LOS increased according to the presence and severity of visual disability; the number of outpatient visits increased uniformly, regardless of disability and severity. Conclusions: More severe cases of visual impairment are associated with greater health care utilization and expenditures. Policy intervention is necessary to ensure that patients receive appropriate treatment and steady health care by reducing the burden of medical expenditures.
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