한국의 노인의료비 지출과 결정요인: 연구 현황과 과제
Population Aging and Health Care Expenditure in South Korea: A Critical Review
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본 연구는 국외 노인의료비 연구 동향을 참고하여 국내 노인의료비 연구 현황을 파악하고 향후 연구 과제를 도출하는 것을 목적으로 한다. 이를 위하여 현재까지 국내외에서 발표된 29편의 한국의 노인의료비 연구를 분석 대상으로 선정하였다. 선정된 연구는 외국의 연구 사례를 근거로 거시적 연구와 미시적 연구로 구분하였는데, 거시적 연구는 국가 수준에서 전체 노인 인구의 의료비 지출을 다룬 연구로, 미시적 연구는 노인 개인이나 노인 가구의 의료비 지출을 다룬 연구로 정의하였다. 또한 미시적 연구는 하위 의료비 현황, 의료비 결정요인, 의료비와 개입의 상관관계 분석 연구로 세분하였다. 분석 대상 선행 연구들을 의료비의 정의와 개념, 연구 가정과 방법, 연구 내용을 중심으로 고찰하였고, 이로부터 향후 연구 과제를 도출하였다. 의료비의 정의와 개념의 측면에서는 민간보험과 예방·공중보건서비스 비용에 대한 고려, 노인보건복지사업을 통한 개입이 의료비에 미치는 영향에 대한 연구가 필요하다. 연구 가정과 방법의 측면에서는 의료비와 그 결정요인에 대한 모형화 작업이 필요하고, 건강한 고령화와 의료비를 절감하기 위한 정책적 요인에 대한 고려가 시급하다. 마지막으로 연구 내용에서는 장기요양보험과 의료비, 사망시점과 사망의료비에 대한 연구가 확대되어야 할 것이다.
Abstract
The purpose of this study is to critically review studies on health care expenditure and its determinants among older people in South Korea. Based on a comprehensive search and quality evaluation of aging and health care expenditure studies targeting the Korean older population, we selected 29 empirical papers for review. Eight macro-level studies concentrated on national-level health care expenditure mainly using national health insurance data; other micro-level studies focused on individual- or household-level healthcare cost and utilization patterns using various panel or survey data. Only a few evaluation studies exist on the effects of certain interventions on the healthcare costs of older people. We critically examined and compared definitions, assumptions, research methods, and findings across studies, from which three major recommendations for future research are provided. First, better consideration of private insurance and prevention/health promotion services is necessary in future studies’ definition and scope. Second, further development of the modeling of healthcare expenditure is needed, taking into consideration to aging patterns and impacts of cost-containment policies. Third, more research is necessary in long-term care services and insurance, time to death and health care expenditure, and death-related costs in the Korean context.
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