지역 노인의 보건의료기관 본인부담금이 지역보건의료기관의 이용 및 만성질환 치료율, 미충족의료수요에 미치는 영향 : Effects of Out-of-Pocket Payment Exemption in Local Public Health Center Among Korean Elderly

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서울대학교 대학원
Out-of-pocket paymentco-paymentmedical utilizationunmet needelderlylocal government lawpublic health center
학위논문 (석사) -- 서울대학교 대학원 : 보건대학원 보건학과(보건정책관리학전공), 2020. 8. 김창엽.
The distribution of hospitals in Korea is unbalanced in terms of accessibility. The people of regions where there are not many hospitals have difficulty of access in medical utilization which result in high unmet medical need and low rate of treatment in chronic disease. This is apparent for the vulnerable population, such as the elderly. Public Health Centers of such areas play an important role in solving the medical resource distribution problem. Many local Public Health Centers are exempting out-of-pocket payments by Local Government Law to increase coverage for the vulnerable population. However, this varies through different administrative regions where many make the exemption for the elderly while others don't. This study aims to evaluate the effects of out-of-pocket payment exemption in local Public Health Centers among the elderly. The outcome variables are Public Health Center utilization, unmet medical need, and treatment rate of hypertension and diabetes mellitus.
The study uses the online data of the Korean National Law Information Center to gather data of the individual local governments' law of exemption of out-of-pocket payment among elderly. The individual-level outcome data and confounding factors data are gathered from the 2018 Community Health Survey data and the regional-level confounding factors data are gathered from the Korean Statistical Information Service and the data of Health Insurance Review and Assessment Service. Regions, where there are too many private hospitals, were excluded for the analysis and the population of those who do not take advantage of the Local Government Law were excluded.
The study analyzed 132 regions with 44,918 elderly people who lived in comparatively rural areas. Statistical analysis of risk difference and 2-level multiple logistic regression was carried out with 4 independent regional-level variables and 3 individual-level variables. The risk difference percentage between the out-of-pocket payment exemption compared to those without was 1.97% (95% CI 1.07, 2.88) in public health center utilization, -0.121% (95% CI -0.635, 0.393) in unmet medical need, 1.37% (95% CI 0.667, 2.08) in hypertension treatment rate, 2.19% (95% CI 0.635, 3.74) in diabetes treatment rate. The result of the logistic regression showed that the exemption of OOP showed effect on hypertension treatment with a fixed effect odds ratio of 1.246(95% CI 1.045, 1.484) whereas on other outcomes it didnt have any statistically significant effect.
The conclusion of this study showed though a relatively small amount of out-of-pocket payment can affect medical utilization in Korea, especially in hypertension treatment, whereas the unmet medical need is not affected. There is a need to expand the OOP exemption for better healthcare utilization in Korea as well as further studies are needed to evaluate the effect properly.
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Graduate School of Public Health (보건대학원)Dept. of Public Health (보건학과)Theses (Master's Degree_보건학과)
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