국내 백내장 수술 현황과 향후 전망: 국민건강 영양 조사자료
Current Status and Future Expectations of Cataract Surgery in Korea: KNHANES Ⅳ
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목적: 국내에서 시행되는 백내장 수술의 지역별, 환자별, 보험혜택 구분에 따른 사회 경제학적인 요인의 차이를 알아보고 현행 포괄수가제가 현 의료상황에 미치는 영향을 예측하고자 한다. 대상과 방법: 2008년부터 2012년까지 국민건강영양조사를 완료한 성인 28,980명을 대상으로 수술 비율, 지역, 나이, 소득, 보험여부등의 백내장 수술 관련 요인을 분석하였다. 결과: 2012년에 80대 전체인구 기준 47.5%가 백내장 수술을 받아, 많은 고령인구가 백내장 수술의 혜택을 받았다. 지역별로 40대이상 인구 추정대비 전남이 12.0%로 가장 높았고, 대전이 3.6%로 최하, 서울은 6.8%였다. 지역별 안과의사당 백내장 수술 환자수는전남이 40,115명으로 가장 많았으며, 서울이 1,094명으로 가장 낮았다. 나이와 지역차이를 보정한 관련인자분석에서는 소득과 교육수준 등 사회인구학적인 요인은 백내장 수술 여부와 관련이 없었으며, 반면 의료보호 1종과 2종에서 국민 건강보험 수혜자에 비해 대응비 1.6 (95% 신뢰구간 1.3-2.0)으로 더 많이 수술을 받았다. 결론: 백내장 수술률 및 안과의사당 수술 수는 지역 간 차이가 크며, 우리나라는 현재 사회인구학적 격차와 상관없이 저소득층을 포함하여 모든 국민이 백내장 수술의 혜택을 잘 받고 있다. 포괄수가제도입 후 수가변동은 지역 간 백내장 수술의 차이를 고려할 때 지역간 의료 불균형의 악화와 질적 하락을 고려하여 신중하게 결정되어야 하겠다.
Abstract
Purpose: To identify socio-demographic factors in cataract surgery in Korea and expect future effect of the bundle of service system. Methods: We analyzed the number of people undergoing cataract surgery and associated factors such as surgery ratio, region,age, income, and insurance status of 28,980 patients older than 40 years using data from the fifth Korea National Health andNutrition Examination Survey 2008-2012 (KNHANES). Results: Among total population in 2012, 47.5% of elderly aged 80 years and older have received cataract surgery. According toregion in patients older than 40, Jeollanam-do showed the highest proportion of patients undergoing cataract surgery, at 12%,Daejeon showed the lowest proportion of 3.6%, and Seoul showed 6.8%. Regional analysis was also performed by analyzing thenumber of cataract patients per ophthalmologist. Jeollanam-do showed the highest with 40,115 patients per ophthalmologist, andSeoul showed the least with 1,094 patients per ophthalmologist. The sociodemographic factors such as education or income, werenot associated with cataract surgery after adjusting for age and regional difference. On the other hand, subjects with medicaidwere associated with 1.6-fold (95% confidence interval, 1.3-2.0) higher rate of cataract surgery than subjects with national healthinsurance. Conclusions: Regional disparity was found in the cataract surgery rate and surgery rate per an ophthalmologists, whereas sociodemographicfactors were not significant in receiving benefits of cataract surgery. Before the amount of bundled payment is changing,down-leveling of quality of care and deepening of disparities among health care provider should be considered.
참고문헌 (18)
- World Health Organization, "ICD 10: International statistical classification Of diseases and related health problems", 429~458 (1992)
- Resnikoff S, "Global data on visual impairment in the year 2002", Bull World Health Organ, 82, pp.844~851 (2004)
- Thylefors B, "Global data on blindness", Bull World Health Organ, 73, pp.115~121 (1995)
- Rim TH, "Cataract subtype risk factors identified from the Korea National Health and Nutrition Examination survey .2008-2010", BMC Ophthalmol, 14, pp.4~ (2014)
- Lansingh VC, "Global cost-effectiveness of cataract surgery", Ophthalmology, 114, pp.1670~1678 (2007)
- Baltussen R, "Cost-effectiveness analysis of cataract surgery: a global and regional analysis", Bull World Health Organ, 82, pp.338~345 (2004)
- Finger RP, "The impact of successful cataract surgery on quality of life, household income and social status in South India", PLoS One, 7, pp.e44268~ (2012)
- Zhou JB, "A study on the awareness of cataract disease and treatment options in patients who need surgery in a rural area of Eastern China", Eur J Ophthalmol, 18, pp.544~550 (2008)
- Kovai V, "Reasons for refusing cataract surgery in illiterate individuals in a tribal area of Andhra Pradesh, India", Ophthalmic Epidemiol, 21, pp.144~152 (2014)
- 임형택, "한국인의 백내장에 대한 인지도 역학 조사: 제4기 국민건강영양조사자료", 대한안과학회지, 54(1), pp.72~77 (2013), 대한안과학회
- Mitchell P, "Prevalence of cataract in Australia: the Blue Mountains eye study", Ophthalmology, 104, pp.581~588 (1997)
- Kahn HA, "The Framingham Eye Study. II. Association of ophthalmic pathology with single variables previously measured in the Framingham Heart Study", Am J Epidemiol, 106, pp.33~41 (1977)
- Chung HW, "An epidemiological study for relationship between risk factors and types of cataract", J Korean Ophthalmol Soc, 36, pp.227~233 (1995)
- Williams A, "Longitudinal rates of cataract surgery", Arch Ophthalmol, 124, pp.1308~1314 (2006)
- Erie JC, "Incidence of cataract surgery from 1980 through 2004: 25-year population-based study", J Cataract Refract Surg, 33, pp.1273~1277 (2007)
- Gollogly HE, "Increasing incidence of cataract surgery: population-based study", J Cataract Refract Surg, 39, pp.1383~1389 (2013)
- Tyler Hyung Taek Rim, "Factors Associated with Diabetic Retinopathy and Nephropathy Screening in Korea: The Third and Fourth Korea National Health and Nutrition Examination Survey (KNHANES III and IV)", Journal of Korean Medical Science, 28(6), pp.814~820 (2013), 대한의학회
- A study on the current state and direction of bundled payment, "Park EC", Research institute for healthcare policy korean medical association institute, ~ (2014)