KCI등재
입원진료비 상승요인 분석 = An Analysis of Factors Influencing Hospital Care Costs
저자
한혜경 ( Hye-kyung Han ) ; 이필도 ( Pil-do Lee ) ; 노인철 ( In-chul Noh )
발행기관
학술지명
권호사항
발행연도
1990
작성언어
Korean
등재정보
KCI등재
자료형태
학술저널
수록면
99-118(20쪽)
제공처
입원진료비의 상승은 높은 약제비 비중, 병원의 높은 수술률, 종합병원 이상의 검사비 등의 영향을 받는 것으로 나타났으며, 횡단면 다중회귀분석에 의한 입원진료비 결정요인은 입원일수, 전문의수, 의료장비수, 연령, 수술여부 등인 것으로 나타났다. 앞으로 45세이상 연령층의 만성질환으로 인한 입원진료비가 더욱 증가할 것이라는 전망에 따라 약제비 및 검사비에 대한 대책, 의료자원의 효율적인 사용을 위한 병원기능의 전문화 등 입원진료비의 경제성을 도모하기 위한 다양한 대책이 요구된다.
더보기The rapid increase in medical care costs have become a growing problems since health insurance was introduced. In particular, medical care costs for in-patients have tended to rise at a faster pace than those for out-patients. For example, while the out-patient costs in 1989 increased 3.32 times over those in 1983, the hospital care costs increased 3.75 times during the same period. Furthermore, the scale of hospital care costs continued to rise from about 33 percent in 1983 to 36 percent of the total expenditure in 1989.
The principal cause of these increase was related to a considerable rise in medical care costs for out-patients less than 14 years old. Recently, however, the ratio of in-patient costs has risen markedly due to a sharp increase in the costs related to cancer and to chronic diseases of the circulatory system for those over 45. Since this age group continues to increase, it is expected that this pattern will continue as a leading factor in the increase in medical care costs.
The concern over rising costs and a search for ways to control these costs are now stimulating interest in the development of public policies. The purpose of this study is, therefore, to examine factors giving rise to the cost escalation of hospital medical care and also to provide insight into the policy implications for containment of these costs.
The data used here was obtained from a survey of the monthly insurance bills (13,532 cases) presented to the National Federation of Medical Insurance in February 1990. This group represented the employees and dependents of private companies as well as self-employed people.
The main results and their implications are as follows :
1. The important factors which have influenced the increase in the medical care costs for in-patients was revealed as a high medication ratio, more examinations, a longer stay, and a high frequency of surgical procedures in the hospitals.
2. The portion of medication and injection costs was found to be extremely high. Medications constituted 37 % of total hospital care costs in excess of 500,000 Won per case. These extraordinarily high expenditures are due to excessive consumption and high prices. One alternative to limit expenditures on drugs is to establish a list of essential drugs as chosen for cost-effectiveness (low price with equal efficacy). Thus drugs not on this list would not be cove-red by insurance. Also important is the control of pharmacists` mark-ups, drug prices, and advertising expenditures by pharmaceutical firms for sales promotion.
3. The ratio of examination costs was about 30% of the total medical care costs per in-patient case, which was observed to be correlated mainly with the length of stay and the number of examinations, and the quantity of medical equipment in hospitals, so that in recent years the problem of excessive examinations has emerged particularly in both tertiary and general hospitals.
The tertiary hospitals are prohibited from offering out-patient care. A committal order written by a physician in a clinic is required for a patient to receive hospital medical care. Both because of the poor flow of information between primary physicians and hospital physicians, and because outside physicians do not have access to superior hospital equipment, hospitals repeat many diagnostic examinations already performed by physicians prior to hospitalization. In fact, such duplication adds to the length of stay and ultimately to medical care costs.
In addition, excess investments in such high- tech equipment as CT Scanner, MRI, and heart transplant equipment tend to result in new cost increases, so specialized central examination facilities with high-tech equipment should be established at the district level, both to share inforamtion and their use and to avoid duplication or excessive use of medical procedures and diagnostic tests.
4. The portion of medical procedure and operation costs in hospitals was relatively higher than those in both general hospitals and tertiary hospitals, which appeared to be associated with the high frequency of surgical produres in hospitals. The costs of medications and examinations were, however, shown to be highest in general and tertiary hospitals. One interesting result indicates that there is a negative correlation between surgical procedure costs and examination costs, suggesting that more examinations might reduce the frequency of surgery.
5. To cope with the soaring medical care costs, less expensive service facilities as are used in the developed countries ought to be developed or introduced into the health care sector. For example, there are day care centers, geriatric day hospitals, hospice systems, ambulatory surgical centers, nursing home care and home health care, which can be substituted for expensive hospital services.
In addition, surgery and hospital admission and discharge can be managed in a rational manner to curb long-term hospital stays. For example, admission and discharge adjudication committees, composed of doctors including physicians in charge, and nurses and other medical care personnel should be set up in each hospital to check the condition of in-patients periodically to decide on whether they can be discharged.
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