노인 치과 임플란트 본인부담 의료비 감면 정책에 따른 의료 이용의 변화 : 인구 집단에 따른 정책효과 및 정책예정 집단의 치료 지연 효과의 차이
Changes in Healthcare Utilization According to the Cost Sharing Reduction Policy on Elderly’s Dental Implants: Differences in Policy Effects and Treatment Delaying Effects by Population Groups
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초록
본 연구에서는 본인부담 의료비 감면에 따른 의료 접근성 향상의 정책효과와 함께, 정책 시행과 더불어 얻게 될 간접 소득에 대한 기대로 인해 일시적으로 치료를 미루는 치료 지연효과가 나타났는지를 노인 치과 임플란트 본인부담 경감정책을 통해 살펴보았다. 한국의료패널 자료(2012-2016)를 이용, 정책 집단인 실험군(71-74세)과 정책 적용을 받지 않은 대조군(61-64세)을 정의하고 이중차이(DID)를 이용한 분석결과, 본인부담 의료비 경감은 의료이용을 높인다는 일반적인 가설을 지지하였고, 정책효과 및 치료 지연효과는 인구 집단의 특성에 따라 그 크기와 유의성이 이질적임을 확인하였다. 진료시간에 대한 기회비용이 작을수록, 지불능력이 클수록, 정책 전후 본인부담 의료비의 변화가 클수록, 정보 접근성이 높은 집단일수록 정책효과가 컸으며, 치료 지연으로 인한 불편비용이 작을수록, 정보접근성이 높을수록 치료 지연효과가 크게 나타나, 본 연구에서 제시하였던 경제학적 가설에 부합함을 실증적으로 보였다. 이 결과는 일반적으로 임플란트 접근성이 높았다고 할 수 있는 집단에게서 정책효과가 크게 나타남을 일관되게 보여주어, 정책 목표가 무엇인지에 따라 세분화된 타겟 그룹 설정 및 본인부담 수준에 대한 고려가 필요함을 시사한다.
Abstract
In this study, I investigate the policy effect of improving healthcare accessibility due to the reduction in healthcare cost sharing on elderly’s dental implants, as well as the existence of treatment delaying effects prior to the policy, driven by expectations of indirect income to be obtained along the policy implementation. Using Korea Health Panel(KHP, 2012-2016) data, treatment group(71-74yrs., policy targeted group) and control group(61-64yrs., who were never in policy targeted ages) were defined. As a result using DID(difference in differences) analyses, the hypothesis that the reduction in healthcare cost sharing increases the healthcare usage was supported. The positive policy effects and treatment delaying effects were heterogeneous by the characteristics of the population groups, and it was empirically shown that these patterns were consistent with the economic hypotheses presented in this study. The results showed that the effect of elderly’s dental implant policy was greater in the groups with higher healthcare accessibility, suggesting that it is important to consider the policy targeted groups along with setting up the standards of subsidy, depending on the policy goals.
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