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복합만성질환자의 다빈도 만성질환조합 유형과 질병부담

Common combinations of chronic diseases in multimorbidity and their effect on healthcare cost in Korea

유원섭|김창훈|이미리내
한국보건경제정책학회 (The Korean Association of Health Economics and Policy)|2014.12|보건경제와 정책연구 (The Korean Journal of Health Economics and Policy)|제20권 제4호|pp. 81-102

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만성질환복합만성질환multimorbidity의료비healthcare costschronic conditions
주제분류사회과학일반

초록

복합만성질환은 흔하게 나타나는 건강문제이며, 의료이용과 비용을 향상시키고, 건강결과를 악화시키는 것으로 알려져 있으나, 본격적인 연구가 시행되지 않고 있다. 이 연구는 복합만성질환자의 다빈도 만성질환조합의 유병양상과 그 비용을 산출하고 복합만성질환에 대한 중재전략을 모색 시 질병부담 측면에서 우선순위가 높은 다빈도 질병조합군을 확인하고자 하였다. 2011년 한국의료패널 자료를 활용하여 시설에 거주하지 않는 20세 이상 성인을 대상으로 다빈도 질환조합을 확인하고 노인층과 청장년층으로 구분하여 1인당 평균의료비와 질병조합군별 총 의료비용을 추정하였다. 청장년층에서 유병율 기준으로 가장 빈도 높은 2개 질환조합과 3개 질환조합은 각각 고혈압-당뇨(3.6%)와 고혈압-관절염-골다공증(0.9%)이었고, 노인층에서는 고혈압-관절염(8.6%), 고혈압-고지혈증-관절염(3.1%)이었다. 복합만성질환 중 가장 많은 비용이 지출되는 질환조합은 청장층의 경우 천식-만성폐쇄성폐질환(2개 질환조합)과 고혈압-관절염-당뇨(3개 질환조합)이고, 노인층의 경우 고혈압-관절염(2개 질환조합), 고혈압-고지혈증-관절염(3개 질환조합)이었다. 이 연구를 통해 확인된 복합만성질환을 구성하는 주요 질환들과 다빈도 질환조합군들은 복합만성질환자들의 의료이용을 적정화하고, 건강결과를 향상시키며, 보건의료비용을 감소시키기 위한 전략과 중재를 모색할 때 우선순위 높은 표적집단으로 활용할 수 있을 것이다.

Abstract

Background: Multimorbidity is common health condition especially in the older population and associated with high levels of healthcare utilization and costs. But little is known about its frequent patterns and association with healthcare utilization or cost in Korea. The purpose of this paper is to investigate the prevalent combinations of common chronic conditions and their effect on healthcare cost and to find out target groups for an intervention to relieve disease burden. Methods: We analyzed the Korea Health Panel Data representing non-institutionalized Korean adult populations aged 20 and over with chronic conditions. Also we identified the most prevalent combinations of common chronic conditions and estimated their mean and total healthcare cost for the elderly and nonelderly patients. Results: The most common dyad and triad of chronic conditions for the nonelderly patients are hypertension-diabetes(3.6%), hypertension-arthritis-osteoporosis(0.9%) and for the elderly are hypertension-arthritis(8.6%), hypertension-hyperlipidemia-arthritis(3.1%). The most burdensome combinations for the nonelderly are asthma-COPD, hypertension-arthritis-diabetes and for the elderly are hypertension-arthritis, hypertension-hyperlipidemia-arthritis(dyad and triad, respectively)Conclusion: Our findings suggest that national strategy and intervention for chronic diseases should place the priority to the multimorbid population causing the highest medical cost.

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