KCI등재
의료보험(醫療保險)이 의료이용양상(醫療利用樣相)과 의료균점(醫療均霑)에 준 효과분석(效果分析) = Effect of Health Insurance Programs on Utilization Patterns of and the Equality in Access to Medical Care in Rural Areas
저자
발행기관
학술지명
권호사항
발행연도
1988
작성언어
Korean
등재정보
KCI등재
자료형태
학술저널
수록면
73-102(30쪽)
제공처
Demand for health services increases as expanded coverage of health insurance programs, Accordingly, the equality in access to and fairness of medical care are the current major issues of health policy in Korea.
With this point of view, this paper seeks to provide the answers for the following key questions:
Question 1 : Could an innovative approach such as expanding the service points and ntroducing a financing mechanism similar to the community health insurance program tried in Ok-gu area significantly imporve utilization of medical care?
Question 2 : Did the community health insurance program have a substantial effect on the utilization patterns of medical care?
Question 3 : Did the community health insurance program contribute to the realization of equality in access to medical care for the residents in the area of its implementation?
Question 4 : Is there any significant difference in the utilization of medical care among the be-neficiaries of different insurance program between for the employed and by the community health insurance program in rural area?
This study focuses on the above questions and uses the empirical data from household interview surveys.
1. Results
(1) The effect of an innovative approach on medical care utilization.
a. Compared with control areas, input of additional medical resources such as community health practitioners and other, professionals contributed to an increases of 108.5 % in the total number of OPD visits to physician or CHP per capita in the Ok-gu de-monstration area during the period 1976 to 1979.
b. In 1987, residents in Ok-gu area who were covered by community health insurance program visited physician more frequently (50.1%) than those who were not covered by such a kind of insurance program.
c. Introduction of additional service points or community health insurance programs in the defined rural areas effected a substantial increase in the utilization of medical care during the period 1976 to 1987.
(2) Effect of community health insurance program on changes in utilization patterns of medical care.
a. Introduction of health insurance programs of financing mechanism has a significant effect on change in utilization patterns of medical care, replacing self-cure at home by medical care service provided at clinic or hospital.
b. Depolyment of community health practitioners and public health physicians also sig-nificantly contributed to replacing self-cure at home by visits to health center or sub-center or CHP`s services in rural areas.
(3) Contribution of community health insurance programs 10 realize the equality in access to medical care.
a. It is the results from multivariate regression analysis through using Andersen model and the household interview survey data in 1987 that rural community health insurance program significantly contributed to realizing the equality in access to medical care in Ok-gu area, where the mechanism was adopted in 1981.
b. The most Significant variable affecting the number of physician visits in past 15 daysis need factor considered to be immutable by health policy.
c. However, above and beyond this factor, enabling and predisposing factors significantly affect the number of physician visits in control areas where the mechanism is not introduced. As a result, it means that the equality in access to medical care is not achieved there.
(4) Effect on utilization of physician`s care by the type of health insurance programs.
a. Significant difference in percent of seeing or not a physician in specific time period of 15 days was shown in beneficiaries of each health insurance program for the empolyed and for the rural community residents.
But both of insurance types did not have significantly discriminant function about experience of seeing a physician.
Therefore it has come out through the analysis(X<sup>2</sup>-test and discriminant analysis) that seeing or not a physician is significantly affected by predisposing and need factors.
b. There is a singificant difference in number of physician visits per capita for 15 days between beneficiaries of health insurance programs for the employed and those of it for the community residents.
2. Conclusions
(1) This empirical study shows that major health policy including expansion of service points such as the deployment of CHPs or public health doctors and the adoption of health insurance programs significantly contributes to great increase in the utilization of physician`s care and subsequently to the equality in access to medical care in rural areas.
(2) It is proved that some limitation of choice of primary care facility does not significantly affect the utilization of outpatient care.
(3) Major innovative alternatives affect changes in the utilization patterns of medical care. So the change contributes to prevent from misuse or abuse of drugs, whereas it can be a factor raising unit cost per medical service.
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