지역노인의보건의료기관본인부담금이지역보건의료기관의이용및만성질환치료율,미충족의료수요에미치는영향 : Effects of Out-of-Pocket Payment Exemption in Local Public Health Center Among Korean Elderly

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dc.description학위논문 (석사) -- 서울대학교 대학원 : 보건대학원 보건학과(보건정책관리학전공), 2020. 8. 김창엽.-
dc.description.abstractThe 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.
dc.description.tableofcontents제1장 서론 1
제1절 연구의 배경 및 필요성 1
제2절 이론적 배경 3

제2장 문헌고찰 5
제1절 지방자치단체 자치법규 정책결정요인 5
제2절 보건기관 이용의 영향요인 6
제3절 미충족의료수요의 영향요인 7
제4절 본인부담금이 의료이용 및 건강 결과에 끼치는 영향 8

제3장 연구설계 및 연구방법 10
제1절 연구질문 및 연구모형 10
제2절 자료원 11
제3절 변수의 정의 12
1) 종속변수 12
2) 독립변수 14
제4절 분석 방법 17

제4장 연구결과 21
제1절 지방자치단체 법령 현황 및 지역의 일반적 특성 21
제2절 대상 인구집단의 일반적 특성 28
제3절 독립변수 간의 상관성 32
제4절 본인부담금 감면 정책 유무에 따른 종속변수의 차이 34
제5절 회귀분석 36
1) 보건의료기관 이용 37
2) 미충족의료수요 39
3) 만성 질환 치료 (고혈압, 당뇨) 41

제5장 결론 및 논의 45
제1절 연구결과 고찰 45
1) 지역의 본인부담금 현황 및 지역의 특성 46
2) 대상 인구집단의 특성 51
3) 본인부담금이 보건의료기관 이용에 미치는 영향 52
4) 본인부담금이 미충족의료에 미치는 영향 54
5) 본인부담금이 만성질환 치료에 미치는 영향 56
제2절 연구의 한계 및 제언 61

참고문헌 65
Abstract 68
dc.publisher서울대학교 대학원-
dc.subjectOut-of-pocket payment-
dc.subjectmedical utilization-
dc.subjectunmet need-
dc.subjectlocal government law-
dc.subjectpublic health center-
dc.title.alternativeEffects of Out-of-Pocket Payment Exemption in Local Public Health Center Among Korean Elderly-
dc.contributor.AlternativeAuthorKiryong Nam-
dc.contributor.department보건대학원 보건학과(보건정책관리학전공)-
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Graduate School of Public Health (보건대학원)Dept. of Public Health (보건학과)Theses (Master's Degree_보건학과)
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