Earticle

본 연구에서는 지난 10년간 우리나라 각 지역별 기후변화 인자(온도, 습도, 강수량)와 미세먼지의 농도를 관찰하고 기후변화 관련 질병의 보 건경영적 손실가치를 분석하였다. 즉, 각 지역별 기후변화 인자 및 미세먼지의 발생 농도와 기후변화 원인 질병(호흡기 질환, 만성폐쇄성 질환, 간질성 폐질환 등)의 환자 수, 의료비 등을 추적하였으며, 기후변화 인자와 환자 수 및 의료비의 인과관계를 계량적 기법으로 추정하였다. 분석 결과, 첫째로 기후요소가 호흡기 질환 환자 수에 미치는 영향에 대한 분석은 고정효과모형의 추정결과를 기반으로 하는 경우 전국의 평균기온이 상승할수록 기후변화 관련 질환 환자 수도 증가하는 경향이 있다. 또한 일교차가 클수록, 미세먼지와 초미세먼지 농도가 상승할수 록 관련 질환 환자 수가 증가한다. 두 번째로 패널 VAR 모형의 충격반응 함수를 이용하여 추정한 결과 평균 기온 1도 상승에 따라 1년간 환자 수가 1.71%, 의료비용은 1.365% 증가한다. 이 결과 2018년 1년간 의료비용(85,187억원)에 적용하는 경우 의료비용 증가폭은 최대 1,163억원에 달한다.

This study observed climate change factors (temperature, humidity, precipitation) and fine dust concentrations in each region of Korea over the past 10 years, and analyzed the healthmanagement loss value of climate change diseases. As a result of the analysis, first, the analysis of the effect of climate factors on the number of respiratory disease patients tends to increase the number of patients with climate change diseases as the average temperature increases, based on the estimation results of the fixed-effect model. Second, as a result of estimation using the impulse-response function of the panel VAR model, the number of patients increases by 1.71% and medical expenses by 1.365% per year as the average temperature rises by 1 ℃. As a result, when applied to medical expenses (85,187 billion Kwon) for one year in 2018, the increase inmedical damage cost reaches amaximumof 116.3 billion Kwon. This study introduced a new technique to analyze the causal relationship between climate change factors and the loss costs of climate change disease.

본 연구에서는 우리나라 각 지역별 미세먼지의 농도를 관찰하고 미세먼지로 인한 질병의 사회경제적 손실가치와 국민경제적 파급효과 그리고 국민 의료비지출을 분석하였다. 즉, 각 지역별 미세먼지의 발생 농도와 미세먼지 원인 질병(호흡기 질환, 만성폐쇄성 질환, 간질성 폐질환 등)의 환자 수, 의료비 등을 추적하였으며, 미세먼지 농도와 환자 수 및 의료비의 인과관계를 계량적 기법으로 추정하였다. 그리고 미세먼지 원인 질병의 치료를 위한 의료비의 증가는 직간접적으로 가계 소비지출을 감소시키고 이것이 국민경제 거시변수(생산, 부가가치, 고용)에 미치는 손실가치를 측정하였다. Panel VAR 모형을 이용한 미세먼지 농도와 환자 수 및 의료비의 관계를 추정한 결과, 미세먼지 농도가 월평균 1% 증가하면 환자 수는 연간 2백 6십여만 명 증가하고, 이에 따른 의료비는 연간 649억 원이 증가하는 것으로 추정되었다. 이러한 의료비 증가는 가계소비에서 의료비 외 부분의 지출을 감소시킨다고 볼 때 국민경제적으로 민간소비를 위축시키고 그 결과 미세먼지 농도 월평균 1%의 증가는 총생산(경상가격 기준, 2014년)을 0.0052% 감소(경상가격 기준 185,675백만 원)시키며, 이에 따라 부가가치는 0.005%(경상가격 기준 68,263백만 원), 고용은 0.0058%(취업자 인원 1,371명) 감소하는 것으로 추정되었다.

This study is to observe the concentration of particulate matter in each region of Korea, identify the occurrence of diseases caused by particulate matter, and to analyze the socioeconomic value of disease caused by particulate matter and its economic impact. We use the descriptive statistic approach to analyze the concentration of particulate matter in each region and the number of patients with micro dust-causing diseases. The causal relationship between dust concentration, number of patients, and medical costs is estimated by using econometric models such as Panel and Panel-VAR model. Finally, the value of loss on national economy due to increase of particulate matter concentration is measured by using the Input-Output analysis model. We found that if the concentration of particulate matter increases by 1% per year, the number of patients will increase by 2.6 million per year, and the medical expenses will increase by 64.9 billion won. In addition, 1% increase in particulate matter concentration will reduce 0.0052% (based on current price 185,675 million won) of total production (current price base, 2014), decrease 0.005% (current price 68,263 million won) of value added, and decrease 0.0058% (1,371 employed persons) of employment. It is necessary to recognize that the socioeconomic impact of particulate matter generation on the national economy is significant, and continuous research and development activities in the related fields such as medicine for prevention of fine dust are needed. It also emphasizes the need for international consultation efforts to solve the cross-border particulate matter problem, and the need for diverse policy support and social consensus for this.

본 연구는 2004년부터 실시해 온 노인일자리사업이 보충적 소득보장과 사회참여 이외에 노인의 신체적․정신적 건강 증진에 어떠한 영향을 미치는지 규명하여 노인의 건강을 중심으로 노인일자리사업의 효과성을 평가하고자 하였다. 연구대상은 만 60세 이상 노인 4,020명이며, 2008년도와 2009년도 한국복지패널 자료를 활용하였다. 분석방법으로는 정책 및 프로그램 효과성 평가에 적합한 Propensity Score Matching 방법을 사용하였다. 연구 결과, 노인일자리사업은 노인의 보건의료비 지출 감소에 유의미한 효과가 있는 것으로 나타났으며, 주관적 건강상태나 정신건강 측면에서 노인일자리참여 노인과 비참여노인간의 통계적으로 유의미한 차이가 발견되지 않았다. 본 연구결과를 기반으로 노인일자리사업의 효과성 증진을 위한 정책적 및 실천적 제언을 제시하였다.

This study aims to examine the effects of health promotion of the Elderly Employment Promotion Projects which has been executed since 2004. Data comes from the third and fourth wave of Korea Welfare Panel Survey(2008 and 2009) and the samples of this study are 4,020 elderly people aged over 60. To address the issue of selection bias, we employ propensity score matching analysis. We find that compared to the older who did not attend the Elderly Employment Promotion Projects, the older who did attend the Elderly Employment Promotion Projects are less likely to spend medical costs, but there are not significant differences on the self-reported health conditions and the depression between two groups. Based on these findings, the study has discussed some policy and practical implications to improve the effects of the Elderly Employment Promotion Projects.

Objectives: The purpose of this study is to analyze the relationship between the change gap in the perception of subjective hierarchy and medical expenditure and the factors influencing medical expenditure. Methods: An analysis based on the the data extracted from the Panel Study of Korea Health Panel for 2012–2013 (n=9,359) is conducted. Further in this study, data analysis included a chi-square test and logistic regression using SPSS version. 22.0 to analyze the factors influencing the turnover intention of industrial workers. Results: Model I showed decreases in medical expenditure by 1.247, 1.391, and 1.441 times in social classes one, two, and Model II showed an increase in medical expenditure by age, spouse, number of family members living together, insurance type, income class, economic activities, subjective health status, chronic illness and change on subjective recognition of social class. Conclusions: The study concludes that the state and community require psychological, social, and cultural support, in addition to individual efforts, to reduce medical expenditure.

본 연구는 고령자를 대상으로 민영의료보험 가입유형이 의료서비스 이용과 의료비지출에 미치는 영향을 살펴보 았다. 이를 위해 민영의료보험 가입여부, 정액형 보험 가입여부, 실손형 보험 가입여부에 따라 조사대상자를 구 분하고, 외래진료와 입원서비스 이용횟수, 그리고 보험금 수령 전후의 의료비지출에 어떠한 차이가 있는지를 비 교하여 고찰하였다. 한국의료패널 2016년도 자료를 이용하였으며, 65세 이상 고령자 4,051명을 대상으로 분석 을 실시하였다. 연구대상자의 일반적 특성은 민영의료보험 가입유형에 따라 상당한 차이를 보였는데, 전반적으로 비가입자에 비해 가입자가, 가입자 중에서는 정액형 보험 가입자에 비해 실손형 보험 가입자가 대체로 양호한 사 회경제적 지위에 있었다. 이 단계 모델 분석 결과, 정액형과 실손형 보험 가입은 외래진료 이용횟수에는 유의한 영향을 주지 않는 것으로 나타났다. 반면 입원서비스 이용횟수는 비가입자 대비 정액형 보험 가입자는 유의한 차 이가 없었으나, 실손형 보험 가입자는 연간 0.21회 이용횟수가 높아지는 것으로 분석되었다. 한편 보험금 수령을 고려하지 않은 의료비지출 총액은 민영의료보험 가입여부 및 가입유형에 의해 영향을 받지 않는 것으로 나타났 다. 그러나 보험금 수령액을 차감한 최종 본인부담금에 있어서는 비가입자 대비 정액형 보험 가입자는 유의한 차 이가 없었으나, 실손형 보험 가입자는 연간 약 63만원의 의료비경감 효과가 있는 것으로 나타났다. 이상의 결과 를 바탕으로 관련 정책 수립에 중요한 시사점을 제시하였다.

Although the interest of the elderly in private health insurance(PHI) is increasing, little attention has been paid to the relationship between having PHI and medical care use among the older population. Using the Korea Health Panel Survey(KHPS) in 2016, the current study investigated the effect of PHI on medical care use and out-of-pocket medical expenditure(OOP) by subscription type(i.e. fixed-benefit PHI and indemnity PHI) among the elderly(aged 65 and over). Considering the skewed distribution of medical data, two-part model was applied to identify the effect, controlling for demographic, socioeconomic, and health status. The results of this study showed that unlike having fixed-benefit PHI, having indemnity PHI was positively related to the number of admissions compared to having no PHI, However, the number of physician visits and the total OOP had no significant relationship with having any types of PHI. After considering the reimbursement from PHI, having indemnity was more effective to reduce the financial burden of OOP compared to having fixed-benefit PHI or no PHI. Based on the findings, implications for policymakers and scholars were discussed.

본 연구의 목적은 의료보장 유형에 따른 의료 접근성의 차이를 규명하는데 있다. 이를 위해 한국복지패널 자료를 이용하여 과부담 의료비 지출과 미충족 의료 경험의 현황 및 영향 요인을 분석하고, 그 결과에 기초하여 접근성 향상을 위한 정책적 함의를 제시하였다. 의료보장 유형을 건강보험 직장가입자와 지역가입자, 의료급여 1종 수급자와 2종 수급자로 구분하여 분석한 결과, 과부담 의료비 지출 가구의 비율은 역치 10%를 기준으로 할 때 각각 21.1%, 22.1%, 24.9%, 12.5%로 조사되었다. 과부담 의료비 지출 여부를 결정하는 요인에는 가구주의 성별과 건강상태, 노인 가구원 혹은 만성질환자 유무, 가구의 소득수준과 가구원수 등이 포함되며, 건강보험 직장가입자의 과부담 의료비 지출 가능성이 지역가입자에 비해 상대적으로 높고, 의료급여 수급자의 과부담 의료비 지출 가능성은 낮게 나타났다. 한편 전체 가구의 약 1.4%만이 미충족 의료 경험을 한 것으로 조사되었고, 그 경험에는 가구주의 교육수준과 건강상태, 가구의 소득수준, 노인 가구원 및 만성질환자 유무 등이 영향을 미치며, 건강보험 직장가입자와 의료급여 1종 수급자에 비해 높은 지역가입자의 미충족 의료 경험이 부각되고 있다. 이러한 결과에 비추어 볼 때, 건강보험 지역가입자에 대한 보험료 지원과 본인부담금 완화 등의 개선이 필요하며, 빈곤층과 차상위계층의 의료 접근성 향상을 위한 의료급여 본인부담금 수준의 조정 혹은 폐지가 요구된다.

The purpose of this study is to analyze the scale of occurrence and factors influencing the household Catastrophic Health Expenditure(CHE) and unmet needs based on the types of health care system, such as employee insured and self-employed insured in National Health Insurance(NHI), and Class 1 and 2 recipients in Medical Aid Program. For the empirical analysis, logistic regression analysis was employed using the data of 5th wave in Korea Welfare Panel(KOWEP). The occurrence of the CHE in the entire households appeared to be 21.1%, 22.1%, 24.9%, and 12.5% with the threshold at 10%, 20%, 30%, and 40%, respectively. The main factors that determined the CHE were the number of household members, the gender and health conditions of householder, the existence of either old aged or chronic disease patients, low-income households, and types of health care system, etc. It also showed that employee insured in NHI rated higher probability to have the CHE than those with self-employed insured or the recipients in Medical Aid Programs. Only about 1.4% of households experienced unmet health needs. The factors influencing those unmet needs were the educational level and health condition of households, the existence of either old aged or chronic disease patients, low income households, and types of health care system. It was also reveled that the probability of unmet needs for self-employed insurer was higher than that for employee insurer in NHI. These findings suggest that co-payment system in Medical Aid Program must be modified or eliminated in order to improve the equity of health accessibility among poor and near poor in Korea.

목적 : 본 연구에서는 빅데이터를 통해 정신과 질환을 가진 노인의 생활 습관 행태와 의료비 지출 크기간의 연관성을 분석하여 생활 습관의 긍정적 영향 및 중요성을 제시하고 이에 관련한 중재의 근거를제언하고자 하였다. 연구방법 : 건강보험공단에서 제공하는 노인 코호트 데이터베이스(Database; DB)의 2014, 2015년 자료를활용하여 이차데이터 분석을 시행하였다. 연구 목적에 따라 전체 변수 중 생활 습관 행태와 연간 의료비지출 크기를 추출하였다. 각각의 생활 습관 행태와 연간 의료비 지출 크기 사이의 연관성은 일반선형모형(Generalized linear model)을 사용하여 분석하였다. 결과 : 선정기준에 따라 추출된 총 32,853명의 데이터가 분석에 사용되었다. 12,617명(38.40%)의 남성과20,236명(61.60%)의 여성으로 구성되어 있었다. 생활 습관과 의료비의 연관성을 분석한 결과, 비흡연자의 경우 흡연자보다 의료비 지출이 유의하게 낮았으며(estimate = -218,255원, p = .037), 일주일 중30분 이상 걷는 일수가 증가할수록 의료비 지출이 유의하게 감소하였다(estimate = -58,843원, p < .0001). 반면, 일주일 중 술을 마시는 일수가 감소할수록 의료비 지출이 증가하는 양상이 나타나는결과가 도출되었다(estimate = 692,289원, p < .0001). 결론 : 본 연구는 정신과 질환을 가지고 있는 노인에게 있어 생활 습관의 행태에 따른 의료비의 변화를분석하였다. 흡연과 운동은 의료비 지출과 음의 연관성을 나타냈으며 걷기 운동을 많이 할수록, 흡연을하지 않을수록 의료비 지출이 감소함을 알 수 있었다. 이러한 결과는 정신과 질환을 가지고 있는 노인에게 있어 건강한 생활 습관의 중요성을 시사한다. 본 연구가 정신과 질환을 가진 노인의 신체적, 정신적건강 증진을 위한 생활 습관 관리 프로그램의 임상적 근거로써 활용될 수 있기를 기대한다.

Objective : This study aimed to analyze the association between lifestyle and medical expenses of older adults with mental illness using claims data. Methods : We conducted secondary data analysis using the older adult cohort database provided by the Korea National Health Insurance Service. The lifestyle and medical expense variables were extracted from the cohort database. We used a generalized linear model to examine the association between lifestyle and medical expenses. Results : In total, 32,853 records were extracted. The results showed that smokers had medical expenses (estimate = -218,255, p = .037). As the number of days of walking increased, medical expenses significantly decreased (estimate = -58,843, p < .0001). Furthermore, as the number of days of drinking decreased, medical expenses increased (estimate = 692,289, p < .0001). Conclusion : This study analyzed the estimates of medical expenses according to lifestyle among older adults with mental illness. Smoking and exercise were negatively associated with medical expenses. These results suggest the importance of a healthy lifestyle for older adults with mental illness. In addition, this study can be used as clinical evidence for lifestyle management programs to improve physical and mental health.

Objectives: This study analyzed regional differences in healthcare expenditures among elderly persons across four Korean regions and explored associated factors. Methods: Data from a 2022 national survey of Koreans aged ≥65 (N=402) were analyzed using ANOVA to compare spending across regions and logistic regression to identify factors associated with higher spending in each region. Results: Capital region's annual expenditure (3,302,600 KRW) was 1,492,800 KRW higher than that of Gyeongsang. Young-old people were concentrated in Capital region (51.0%), whereas old-old people were prevalent in Jeolla (68.9%) and Gyeongsang (62.7%). Significant regional differences existed in subjective health, economic status, and quality of life. Associated factors varied by region. Conclusions: Substantial regional disparities exist in elderly healthcare expenditure, necessitating differentiated region-specific policies.

본 연구는 직업분류에 따른 의료비 지출 영향요인을 분석하였다. 한국의료패널(Korea Health Panel)의 2012년도 데이터를 이용하여 만20세 이상의 성인을 대상으로 결측값을 제외한 총 4,538명을 최종 분석대상으로 하였다. 자료분석은 의료비 지출 영향요인을 분석하기 위하여 로지스틱 회귀분석을 하였다. 연구분석 결과 Model 1은 단순노무 종사자에 비해 농림어업 숙련 종사자, Model 2의 경우 직종의 경우 판매 종사자에 비해 단순노무 종사자에서 의료비 지출 증가에 영향을 주는 것으로 분석되었다. 성별은 남자에 비해 여자, 혼인은 무에 비해 유, 소득계층은 1분위에 비해 4분위, 5분위, 만성질환은 무에 비해 유에서 의료비 지출이 높은 것으로 분석되었다. 따라서, 건강검진 또는 예방활동 활성화를 위한 보건의료정책 및 보건학적 접근에 있어서 직종, 만성질환 등을 반영한 보다 체계화된 접근이 필요하다.

This study analyzed the size and influence factors of annual average health expenditure according to job type. Using data from the Korea Health Panel (2012), the final analysis was conducted on adults aged 20 years or older, excluding the missing data. Data analysis was done by logistic regression analysis to analyze the factors affecting medical expenditure. As a result of the study, Model 1 showed higher expenditure on medical expenses by skilled workers in agriculture and forestry fishery than those in simple labor. Model 2 was analyzed as having a positive effect on the increase of medical expenditure by the simple worker in the sales of the occupation, statistically significant by sex, marriage, income level and chronic disease. Therefore, it would be necessary to establish social security and health care & welfare policies, in order to grasp the disease with a high frequency rate according to occupation status and activate the physical examination and preventive actions.

The purpose of this study is to analyse the factors of "non-official medical expenses" in Kyeongju, which are defined as the monetary costs that are used to improve health or to heal disease, but are not captured by the official medical expense statistic. The non-official medical expense includes the monetary expenditure associated with the underground transactions of medical goods and services, as well as traditional treatment which is not yet scientifically proven effective, including "alternative medical treatment". The data used in this study was collected by the survey on 600 individuals in Kyeongju area. Logit analysis shows that the experience of having disease in the past and the age are the most influential factors that increase the probability of having the non-official medical expenses. there is a tendency that the older people becomes the more dependent they are on the non-official medical treatment. The result of regression analysis indicates that the experience of having been hospitalized, sex, and income are the significant factors that explain how much people would spend on the non-official medical treatment.

Older women who live alone are among society's most vulnerable people, since they experience increased risk of multiple chronic diseases and have limited financial protection. This can lead older women living alone to catastrophic health expenditure(CHE), which is defined as a healthcare expenditure that exceeds a certain portion of a household's ability to pay. Using the Korean Longitudinal Study of Ageing(KLoSA), this study investigated the incidence of CHE among older women living alone and identified the factors related to this incidence. Applying health expenditure thresholds of 10%, 20%, 30% and 40% of ability to pay, the proportions of those with CHE were 41.3%, 22.9%, 14.6%, and 9.4%, respectively. Logistic regression models were used to identify factors related to CHE incidence, which include demographics, income, the number of chronic diseases, perceived health status, and health insurance type. The results show that the health care safety net in South Korea is insufficient for older women living alone. The findings can guide policymakers in improving healthcare and welfare policies to protect people from catastrophic payments. Particularly, welfare policies should be established for poor non-recipients who are not included within the benefits scope of the National Basic Livelihood Security System due to the unrealistic criteria of income recognition and family support obligation.

본 연구는 정신보건법 시행에 따른 지역사회정신보건사업이 정신질환진료에 의한 의료비 지출을 감소시켰는지를 알아보는데 그 목적이 있다. 정신보건법은 그 제정이유에서 지역사회의 정신건강사업을 지원하는 등 지역 내의 정신질환자에 대하여 관리가 가능하도록 함을 밝히고 있으며, 지역사회에 기반한 재활을 촉진하기 위한 사회복귀시설 등의 시설, 장비 및 인력 기준 등에 관한 근거규정을 마련하고 있다. 즉 정신보건법은 지역사회정신보건사업을 촉진시킴으로써 정신질환자의 지역사회중심재활을 도모함으로써 정신질환자의 사회통합을 추구하고 정신질환 진료에 따르는 의료비용을 감소시키고자 하는 목적을 가지고 있는 것이다. 그 동안 국외에서는 단정적 지역사회 치료모델(ACT) 등의 지역사회정신보건사업이 병원 입원에 대한 대안으로 개발, 연구되어져 왔다. 이 사업의 실행 후 정신질환자들의 병원 재수용률이 낮아지고 사회재활능력이 상당히 높아진 것으로 나타났다(이윤로, 2002). 그러나 국내에서는 지역사회정신보건사업의 효과성에 대한 연구는 주로 개별 프로그램을 중심으로 이루어져 왔으며, 당해사업이 정신질환자의 삶의 질을 향상시켰는지 그리고 정신질환진료에 의한 의료비 지출을 감소시켰는지에 대한 연구는 미미하다. 하지만 자료의 부재로 인하여 정신질환자의 삶의 질 변화에 대한 고찰은 불가한 실정이다. 이에 본 연구에서는 정신보건법 실시 전후의 정신질환 의료비 지출 변화를 살펴보고자 한다. 그런데 정신질환으로 인한 의료비 지출의 증가 또는 감소에 영향을 주는 제도에는 정신보건법과 더불어 국민건강보험법과 의료급여법이 있으므로 이들 법의 주요 변화도 함께 고찰함으로써 분석의 기준으로 삼고자 한다. 본 연구의 결과는 정신질환으로 인한 의료비 지출의 증가 또는 감소 요인을 밝힘으로써 향후 지역사회정신보건사업의 방향을 설정하는데 도움을 줄 수 있을 것이다.

This study is to investigate whether community mental health project(CMHP) reduced medical expenses. The variation in the law of mental health, national health insurance and medicaid is reviewed, which is compared to the results in medical utility. As the variation in the law of national health insurance and medicaid influenced for a extraneous variable, It is difficult to be convinced that CMHP reduced medical expenses. However, since 1997, The utility per ambulatory diagnosis and treatment has reduced. Therefore I think the increase in mental health medical expenses is repressed by CMPH.

본 연구는 소득계층별 노인 가구와 비 노인 가구의 보건의료비 지출의 불평등과 그 특징을 확인함으로써 노인 가구 특성에 맞는 보건의료이용 불평등 해소정책을 제안하기 위해 수행되었다. 분석결과 노인 가구의 보건의료비 지출이 비 노인 가구에 비해 통계적으로 유의하게 많았다. 또한, 소득계층별 보건의료비 지출의 불평등을 확인하기 위해 집중지수를 산출한 결과 비 노인 가구, 노인 가구, 전체의 순으로 불평등이 컸다. 보건의료비 지출이 가구소득불평등에 미친 영향을 확인하기 위해 총 소득에서 보건의료비 지출액을 제외한 소득의 집중지수를 산출한 결과 노인 가구, 전체 가구, 비 노인 가구의 순으로 불평등이 컸다. 따라서 노인 가구와 비 노인 가구 각각의 보건의료비 지출의 불평등 차이가 크지 않았다. 또한, 노인 가구의 보건의료비 지출액이 비 노인 가구에 비해서 많고, 노인 가구의 소득계층별 보건의료비 지출의 불평등 정도가 심각한 것으 로 나타났다. 따라서 노인 가구에 대한 의료비 지원정책으로 필요한 의료서비스를 이용하지 못하는 사례가 없도록 함으로서 불평등을 해소하기 위해 노력하여야 한다.

This study aims to identify the inequalities and characteristics of health care expenditure of the elderly and non-elderly households by income level. As a result, health care expenditure of elderly households was statistically significantly higher than that of non-elderly households. As a result of calculating the concentration index of health care expenditure by income level, inequality was higher in order of non-elderly households, elderly households, and total households. In order to confirm the effect of health expenditure on household income inequality, we calculated the concentration index of income excluding total health care expenditure from total income. As a result, inequality was higher in order of elderly households, whole households, and non-elderly households. There was not much difference in inequality of health care expenditure among elderly households and non-elderly households. And, the health care expenditure of elderly households was much higher than that of non-elderly households. Also, inequality of health care expenditure by income group was serious. There should be no cases where the medical care support policy for elderly households can not use necessary medical services.

This study found a relationship between the characteristics of the elderly with disabilities and extra health care monthly costs caused by disability and suggests methods for effectively managing health care spending of the elderly with disabilities. This study used data from the 2011 Survey on the Disabled conducted by the Ministry of Health and Welfare and the Korea Institute for Health and Social Affairs. The results of the analysis indicate that the relations between the socio-demographic characteristics of the elderly with disabilities and extra health care monthly costs caused by disability of the elderly are influenced by factors such as gender, age, members of the household, average monthly income and type of health insurance. Elderly people with disabilities spend too much for their medical care. To solve this problem, the government needs to find a variety of policy approaches to improve administrative procedure, establish a medical delivery system and enhance health care services.

본 연구는 횡단면 자료의 개인지출의료비 예측에서 로그모형과 일반화선형모형의 예측성과를 비교할 것을 목적으로 한다. 한국의료패널 등의 서베이 자료를 사용하는 연구에서는 연속형 종속변수의 왜도를 교정하기 위해 변수를 로그변환을 한 후 선형회귀모형 등의 선형함수를 사용하는 경향이 있다. 이러한 배경 하에 본 연구는 개인지출의료비의 예측과 관련하여 선형함수에 기반을 둔 로그모형과 일반화선형모형의 사용에 초점을 두었다. 예측성과의 비교를 위해 로그모형의 등분산 변환과 이분산 변환 그리고 일반화선형모형의 포아송회귀모형과 감마회귀모형을 대상으로 교차검증을 실시하였다. 분석 결과, 로그모형의 등분산 변환에 의한 예측에서 편의가 존재하였고 나머지 모형의 예측성과는 통계적으로 유의한 차이가 없었다. 따라서 본 연구는 로그척도 오차항이 이분산적일 때 로그모형의 등분산 변환보다는 일반화선형모형이 더 나은 결과를 제공함을 보여준다.

The purpose of this study is to compare the predictive performance of the log model with that of the generalized linear models(GLM), when estimating the individual medical expenses in cross-sectional data. As a result of the analysis, the bias existed in the prediction by homoskedastic retransformation of log model and the prediction performance for the rest model was not statistically different from each other. When the log scale error term of log model is heteroskedastic, the homoskedastic retransformation of the log model can be biased. This study suggests using generalized linear models rather than the log model.

본 연구는 가구소득의 불평등에 민간보험수입과 의료비본인부담지출이 어떠한 영향을 미치는지를 확인하기 위하여 2015년 의료패널조사데이타에 대하여 소득계층별 집중지수와 집중곡선 분석을 실시하였다. 주요 분석결과는 다음과 같다. 첫째, 가구소득 집중지수가 0.3580으로 소득이 고소득층에 집중되어 있어서 불평등 정도가 상당히 큰 것으로 나타났다. 둘째, 민간보험수입이 고소득층에 집중하여 적지만 고소득층 가구의 소득집중현상을 강화시킨다. 셋째, 저소득층의 의료비 본인부담지출이 많은 것으로 나타났다. 끝으로 가구소득에서 전체 의료비본인부담지출을 제외한 소득에 대한 집중지수가 0.3676으로 나타나서 의료비본인부담지출 후에도 소득이 고소득층에 크게 집중되어 있었다. 따라서 민간보험수입과 의료 비본인부담지출은 모두 가구소득불평등을 심화시키는 요인으로 작용하고 있어서 융﹡복합적 연구 및 정책방안 마련을 통한 개선이 요구된다.

The purpose of this study is to investigate the effect of private insurance revenues and household spending on household income inequality. To this end, we conducted a concentration index and concentration curve analysis for the income level of medical panel survey data in 2015. The main results are as follows. First, the household income concentration ratio is 0.3580, which means that income is concentrated in the high income group, and the degree of inequality is considerably large. Second, although the portion of the private insurance benefits was small on the high-income household, it helped to strengthen the benefits concentration on this group. Third, the low income group has a large self-pay medical expense. Finally, the index of the income excluding the burden of the total medical expenses in the household income was 0.3676, so that even accounting for medical expenses, the income was concentrated in the high income class. Therefore, private insurance benefits and medical expenses were all contributing factors to the inequality of household income, and this study provides the essential materials for research and policy planning which could lead to the convergence of different fields.

본 연구는 2012년 한국의료패널자료의 보건의식행태에 응답한 만 18세 이상만으로 처리하였으며 전체 2,757명, 남자 2,614명(44.6%), 여자 143명(2.3%)으로 선정하였다. 흡연으로 의료이용 및 의료비지출 자료를 통하여 흡연자의 응급. 입원, 외래 의료이용횟수에 따른 의료비를 통하여 사회적 비용을 추계하였다. 사회적비용은 보건경제학자인 Rice(1968)의 의해 정립된 사회적관점을 채택하여 의료이용에 따른 의료비와, 보험자(공단)비용, 본인부담금, 비급여, 생산성 비용을 합산하여 사회적비용을 산출하였다. 흡연상태별 연간 응급의료이용률은 인구 백명당 흡연자 7.5%, 이 용횟수 9.8회 사회적비용은 809,003원으로 나타나고 있다. 흡연상태별 인구 백명당 연간 입원의료이용률은 인구 백명 당 흡연자 9.6%, 이용횟수 9회, 사회적비용은 706,870원으로 나타나고 있다. 흡연상태별 연간 외래이용률은 흡연 68.6%, 연간의료이용건수는 9건, 사회적비용은 706,870원으로 나타났다.

In this study, only 2,877 men, 2,614 men (44.6%), and 143 women (2.3%) were selected as the subjects who were over 18 years old in response to the health consciousness of the Korean medical panel data in 2012. Emergency of smokers through medical use and medical expenditure data by smoking. The social costs were estimated through medical expenses according to the number of hospitalization and outpatient medical use. The social cost was calculated by summing the social expenditure on health care costs, insurer (corporation) costs, copayment, non - salary, and productivity costs by adopting the social perspective established by the health economist Rice (1968). The rate of annual emergency medical use by smoking status is 7.5% for smokers per 100 people, 9.8 times for use, and 809,003 won for social expenses. The annual rate of hospitalization per 100,000 population by smoking status was 9.6% for smokers per 100 population, 9 times for use, The social cost is 706,870 won. Annual smoking rate by smoking status was 68.6% for smoking, 9 cases for annual medical use,

This paper analyzes the effects of population aging on the medical consumption expenditure based on auto-regressive distributed lag(ADL) model. By estimating medical consumption expenditure function, elasticities of age-specific income, price, and interest rate were derived and the impacts of population aging on medical consumption expenditure were investigated using quarterly data from 1990 to 2016. Essential estimation statistics of our model showed well as 0.85 ∼ 0.98 in  , no serial correlation, and satisfying 1% significance level in t-values. As main empirical results, first, Income elasticities were shown to be the biggest value 0.60 in the lower thirties and the smallest one of 0.29 in the upper sixties. These results means accelerating population aging will functions as a declining factor in medical industry. Second, price elasticities were found to be –1.04 in the household average and the most responsive value of -2.06 in the forties and the least responsive one of -0.52 in the upper sixties. As households older, their medical expenditure responded less to the relative price change of medical commodities which means these are near to necessities to them. If price of medical commodities will change in the declining direction, this will be a positive factor in growing of medical industry. Regardless of age groups, interest rate showed negative relation to the medical consumption expenditure. Interest rate elasticities were estimated to be –0.177 in the household average, the most responsive value –2.60 in the upper sixties, and the least responsive one –0.11 in the lower thirties. Due to recent Corona-19 disaster and low interest rat policy of U.S.A., on-going very low level of interest rate will contribute to growing demand in medical industry.

Purpose: This study examined the influencing factors for metabolic syndrome and the annual medical expenditures of metabolic syndrome among public officials. Methods: The National Health Insurance data in 2009 were collected for 364,932 public officials and the heath examination results and annual medical expenditures were analyzed using PASW 18.0 program. Results: The prevalence of metabolic syndrome is 17.6%, and it was higher in male officials than that of females in all age groups. In men, the influencing factors for metabolic syndrome were: age, family history of stroke, cardiovascular disease, hypertension, and diabetes mellitus, smoking, alcohol consumption, exercise, and obesity. However, in women, health-related behaviors such as smoking, alcohol consumption and exercise did not affect metabolic syndrome. People who had metabolic syndrome showed significantly higher medical expenditures than those without metabolic syndrome. The odds ratios of having the highest quartile in medical expenditures were 1.372 (95% CI 1.252~1.504, p<.001) in women with metabolic syndrome and 1.213 (95% CI: 1.184~1.243, p<.001) in men. Conclusion: The results implied that health-related behaviors were associated with metabolic syndrome, and resulted in higher medical expenditures. In order not only to decrease the risk of metabolic syndrome but also reduce medical expenditures, nurses should plan health promotion strategies to educate public officials about healthy life strategies.

Objectives: The purpose of this study was to investigate the inequality tendency of household medical expenditure distribution and associated factors with household catastrophic medical expenditure. Methods: The current study analyzed the raw data of the Korean Health Panel over the years 2009 to 2014. Results: The proportion of household medical expenditure to household income in 2014 was 16.9% in 1st income quartile, 9.7% in 2nd income quartile, 5.7% in 3rd income quartile, 4.1% in 4th income quartile, and 2.5% in 5th income quartile. The Gini coefficient for distribution of household medical expenditure was 0.548, 0.536, 0.533, 0.527, 0.523, 0.528 respectively between 2009 and 2014. The Gini coefficient for distribution of household medical expenditure according to income quartile was higher in lower income household than that of higher income household. The incidence rate of household catastrophic medical expenditure was higher when the total annual household income was lower, the age of the householder was older, the number of household members was smaller, the education level of the householder was lower, the healthcare coverage type was National Health Insurance, the householder had disability, and the prevalence rate of the chronic disease of the household was higher (p<0.05). Conclusions: In consideration of above findings, there was inequality of household medical expenditure distribution and the household medical expenditure was higher when the total household income was lower. Therefore, a policy for vulnerable households should be established.