전국 건강보험가입자의 소득계층별 산과 의료서비스 이용 실적 비교분석
A comparative study on the obstetric services utilization by income classes among the National Health Insurance Beneficiaries
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참고문헌
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초록
목적본 연구는 소득계층별 산과 진료실적 추이, 주요 다빈도 질환 및 의료기관 이용양상을 비교분석하기 위해 시도하였다. 연구방법2004-2008년 지난 5년간 건강보험청구자료 중 산과코드(O00-O99) 전체를 발췌하여 분석하였다. 대상자의 건강보험 자격자료를 이용해 대상자의 일반적 특성을 구분하였고, 건강보험료 부과수준에 따라 소득분위를 5분위로 구분하여 분석하였다. 통계분석은 SAS 프로그램을 이용하였다. 결과소득 1분위 집단은 입원진료실적은 가장 낮은 비율을 차지하는 반면, 외래진료 실적은 최근 2년간 증가추세를 보이는 가운데 가장 높은비율을 차지하는 것으로 나타났다. 소득1분위는 유산, 전자간증, 자간증의 진료 비율이 높고, 분만은 적은 비율을 차지하였으며, 소득5분위는 고령임부, 다태임신 비율이 높은 것으로 나타났다. 또한 소득수준이 높아질수록 대형병원의 입원 및 외래 이용률이 높은 것으로 나타났다. 결론본 연구결과 소득계층별로 다빈도 산과질환 및 의료기관 이용이 차이를 보이는 것으로 확인되었다. 향후 대상자의 소득수준별 특성에 맞는 산전관리프로그램이 필요하며, 특히 저소득층 임신부를 위한 제도적 지원 강화 방안 모색이 필요하다.
Abstract
Objective This study was conducted to compare the trend of obstetrical care service and its performance, different kinds of common obstetrical disease, and different pattern of health care utilization by the classifi cation of income among the National Health Insurance Benefi ciaries. Methods This study was investigated on the base of data which were drawn from the “nationwide claim database of Korean National Health Insurance Corporation”. Data were composed of the total cases related to pregnancy, childbirth, and the puerperium from 2004 to 2008. Subjects were divided into fi ve income classes by the amount of medical insurance premium. Statistical analysis was performed using SAS program. Results In terms of the lowest income class, there was the lowest rate of admission but the highest rate of outpatient visits, which were remarkably increased during the last 2 years. The lowest income group showed higher rate of abortion (O00−O08), ectopic pregnancy and preeclampsia (O10−O16) but there was small number of delivery (O80−O84). The highest income group showed higher rate of multifetal gestation and elderly gravida. As they have higher income, they showed tendency to visit general hospital for admission care or outpatient care. Conclusion There were signifi cant differences in obstetric services utilization and prevalence of common obstetrical disease according to income class. New strategy of public medical insurance is needed to support different disease category according to the socioeconomic status. Especially, institutional support should be considered for lower income women who are exposed to higher pregnancy complications.
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