예방과 일반 의료서비스 이용간의 관계
Prevention and Medical Care Use
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우리나라 건강보험의 재정안정화 방안으로 예방과 예방적 의료서비스의 이용증대가 강조되고 있다. 본 연구는 예방의 현황과 수요를 분석하고 예방과 일반 의료서비스의 이용간의 관계를 분석한다. 예방의 현황과 그 변화를 통계청 『사회조사』를 이용하여 살펴본 결과 1999년 이후 음주하는 사람들의 비율은 증가하였지만, 흡연하는 사람들의 비율은 감소하였다. 규칙적으로 운동하는 사람들의 비율도 증가하였으며 정기건강검진을 받는 사람들의 비율도 2003년 이후 크게 증가하였다. 또한 개인의 예방과 예방적 의료서비스의 수요를 『국민건강영양조사』를 통하여 살펴본 결과, 나이가 들수록 통계적으로 유의하게 건강검진, 암검진, 예방접종을 많이 받으며, 남성 고령층은 흡연을 줄이고 여성 고령층은 음주를 줄이는 경향을 보였다. 민간의료보험은 여성의 경우 사전적 도덕적 해이로 인해 예방을 낮추기 보다는 건강검진과 암검진 등의 예방적 의료서비스를 증진시키는 결과를 보였다. 한편, 개인의 예방과 예방적 의료서비스의 수요는 연령, 학력, 소득, 보험, 경제활동상태 등 뿐만 아니라 ‘건강에 대한 선호’ 혹은 ‘질병에 걸렸을 경우 의료비 지출에 따른 재정위험을 회피하려는 선호’ 등의 공통요인(common factor)에 의해서도 영향을 받는데 이는 서로 다른 예방과 예방적 의료서비스 이용간의 상관관계를 통해 확인할 수 있었다. 또한, 예방과 예방적 의료서비스 이용간의 상관관계 행렬을 통계적 기법인 요인분석(factor analysis)을 통하여 공통요인을 추정하고 추정된 공통요인이 외래서비스의 이용과 약국 이용을 통계적으로 유의하게 높이나 입원 서비스의 이용에는 통계적으로 유의한 영향이 없음을 발견하였다.
Abstract
Presently, there is a growing emphasis on prevention and preventive medical care as a financial stability measure for National Health Insurance. This paper studies the status of Korean prevention and preventive medical care, and estimates the determinants of them. Moreover, it examines the relationship between prevention and other medical care use. The results show that the proportion of alcohol drinkers has risen since 1999 while that of smokers has fallen. Simultaneously, the proportion of regular exercisers has risen and that of the people who undergo regular health check-up has significantly risen since 2003. In addition, the analysis on the demand for prevention and preventive medical care shows that as people grow older, they increasingly tend to undergo health check-up, cancer screening, and vaccinations. Also, the more they age, the less men smoke and women drink. It turns out also that the private medical insurance contributes to more use of preventive medical care for women, such as health check-up and cancer screening. In the meantime, people with less education and income undergo less health check-up and cancer screening This paper also estimates a common factor through factor analysis using correlation matrix between prevention and preventive medical care, and then examines the impact of the estimated common factor on the use of curative medical services. The results show that the common factor increases the use of outpatient service and pharmacy, but has no statistically significant effect on the use of inpatient service. Therefore, it is not desirable to blindly emphasize the use of prevention and preventive medical care to reduce medical expense. Only after measuring the cost and benefit of each prevention and preventive medical care service, the ones with more cost effectiveness should be introduced with priority.
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