의료기관 종별 소득계층간 의료이용 불평등
Income-related inequality in medical care utilization by provider types
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참고문헌
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초록
이 연구는 소득 계층별 의료이용 불평등 양상을 알아보았다. 소득 계층별 의료이용 불평등은 집중지수를 이용하여 측정하였으며, 외래와 입원, 의료기관 종별로 구분하여 측정하였다. 또한 소득계층간 의료필요에 의한 의료이용을 보정한 의료이용 불평등(CHI)을 측정하였으며, 의료필요는 성, 연령, 주관적 건강, 활동제한 유무로 보정하였다. 의료필요를 보정하지 않은 실제 외래 이용 집중지수(C)는 모든 의료기관에서 음수(-)로 나타나 저소득층의 외래 이용이 많은 불평등 양상을 나타냈다. 의료필요를 보정한 소득계층별 외래이용 불평등(CHI)은 저소득층의 이용이 많은 불평등은 거의 없어져, 소득계층 간에 동일 필요에 대한 동일한 의료이용 원칙이 지켜졌으나, 의료기관 종별로는 다른 양상을 나타냈다. 보건기관에서는 저소득층에 유리한 의료이용 불평등이 컸으나, 종합전문요양기관의 의료필요 보정 외래이용 집중지수(CHI)는 양수(+)로서 고소득층의 외래 이용이 많은 의료이용 불평등 양상을 보였다. 입원의 의료필요 보정 집중지수(CHI)는 음수(-)로서 저소득층의 이용이 많은 의료이용 불평등 양상을 나타냈다. 입원은 의료기관 종별에 관계없이 모든 의료기관에서 저소득층의 이용이 많은 입원이용 불평등 구조를 보였다. 앞으로 시계열 자료를 이용하여 의료제도나 건강보험의 정책변화가 소득계층별 의료이용 불평등에 어떤 영향을 미치는지에 관한 연구가 수행되어야 할 것이다.
Abstract
The purpose of this study is to examine the pattern of income-related inequality in medical care utilization of both outpatient and inpatient by provider types. We measured income-related inequality in medical care utilization by using concentration indices and also measured standardized income-related medical care utilization inequality(CHI) adjusted for medical needs. Age, gender, self-assessed health and activity limits variables are used in order to adjust medical needs among income groups. All unstandardized concentration indices(C) in outpatient visits by provider types have negative values which refer to inequality favoring the poor. After standardizing for need differences in physician visits, pro-poor inequality nearly disappears, which indicates equal treatment for equal need. But inequality in outpatient utilization varied by provider types. Strong pro-poor inequality tendency is seen in health centers, while the positive values for CHI in tertiary medical institutions and general hospitals present inequality favoring the better-off. Standardized concentration indices for inpatient admissions are negative, which shows inequality favoring the poor, in all medical institutions irrespective of provider types. In the future, by using longitudinal data, research on how various policy interventions of health insurance affect income-related healthcare utilization inequality should be carried out.
참고문헌 (20)
- 권순만, "보건의료이용의 형평성", 보건경제연구, 9(2), pp.13~24 (2003), 보건경제․정책학회
- 보건복지부, "2003․2004년 국민의료비 추계 및 국민보건계정 구축", ~ (2006)
- 보건복지부, "국민건강영양조사 제3기(2005)", ~ (2006)
- 이준협, "EQ‐5D로 측정된 소득 계층별 건강집중지수의 분해", 보건과 사회과학, (26), pp.67~87 (2009), 한국보건사회학회
- Aronson, J.R, "Redistributive Effect and Unequal Income Tax Treatment", The Economic Journal, 104(March), pp.262~270 (1994)
- Braveman P., "Social inequalities in health within countries: not only an issue for affluent nations", Social Science & Medicine, 54, pp.1621~1635 (2002)
- Clarke P. M, "A note on the decomposition of the health concentration index", Health Economics, 12, pp.511~516 (2003)
- Clarke P. M, "On the measurement of relative and absolute income‐related health inequality", Social Science & Medicine, 55, pp.1923~1928 (2002)
- Kakwani N, "Socioeconomic inequalities in health: measurement, computation, and statistical inference", Journal of Econometrics, 77, pp.87~103 (1997)
- Koolman X, "On the interpretation of a concentration index of inequality", Health Economics, 13, pp.649~656 (2004)
- Lu J.R, "Horizaontal equity in health care utilization evidence from three high- income Asian economies", Social Science & Medicine, 64, pp.199~212 (2007)
- Mackenbach J.P, "Measuring the magnitude of socio‐economic inequalities in health: an overview of available measures illustrated with two examples from Europe", Social Science & Medicine, 44(6), pp.757~771 (1997)
- Newhouse J.P, "Free for all? Lessons from the RAND Health Insurance Experiment" (1993), Harvard University Press
- van Doorslaer E, "income‐related inequalities in health: some international comparisons", Journal of Health Economics, 16, pp.93~112 (1997)
- van Doorslaer, E, "Equity in the delivery of health care in Europe and the US", Journal of Health Economics, 19, pp.553~583 (2000)
- van Doorslaer E, "inequalities in self‐reported health : varidation of a new approach to measurement", Journal of Health Economics, 22, pp.61~87 (2003)
- van Doorslaer E, "Explaining the differences in income‐related health inequalities across European countries", Health Economics, 13, pp.609~628 (2004)
- Wagstaff A, "On the measurement of inequalities in health", Social Science & Medicine, 31(5), pp.545~557 (1991)
- Wagstaff A, "What difference does the choice of SES make in health inequality measurement?", Health Economics, 12, pp.885~890 (2003)
- Wagstaff A, "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam", Journal of Econometrics, 112, pp.207~223 (2003)