지역별 의료비 및 의료이용 격차의 요인 분해

Abstract

Regional variation in healthcare expenditure is one of the key policy interests in pubilc health. There has been attempts in the literature to decompose the regional variation into demand-side factors, including differences in patient’s health and preferences, and supply-side factors such as regional infrastructure and the region’s physician practice styles. In particular, some recent studies have adopted a methodology introduced by Finkelstein, Gentzkow, and Williams (2016) which exploits patient migration. Assuming that a patient’s preference and health status do not change rapidly around the move, they decompose the sources of regional variation into patient-specific factors and place-specific factors. In extension to the literature this paper uses public insurance claims data and patient’s residential region records to decompose the regional variation in healthcare utilization into patient-specific factors and place-specific factors. We find that place-specific factors explain around 10 percent of the regional variation in inpatient expenditure. As for outpatient expenditure, place-specific factors explain around 7 percent of the variation in clinics but around 40~87 percent in hospitals. In general the supply share of the regional variation is smaller in Korea as compared to the results from other countries.