원저 : 암 사망자의 의료이용 변이

Abstract

This study focused on finding the variation of medical service utilization and medical payments of the patients died by three cancers, stomach, breast, and colon cancer. For this study, data of the one-year episodes of the health insurance subscribers died in 2004 were selected. The frequency of medical visits, the lengths of stays, the days of outpatient visits, the total period of medical services and the total medical payments were compared by the characteristics of the suppliers and utilizers. The data of the patients died by cerebrovascular diseases and cancer in 2004 were selected. To select the dead by cerebrovascular diseases and cancer in 2004, we matched the 2004 reimbursement data of all medical institutions to the data of funeral fee payment by the National Health Insurance Corporation from January 2004 to May 2005 for the death in 2004. The results of the analysis were as follows. The current study found that the variation of medical care utilization was influenced by the factors of suppliers, such as types and locations of medical institutions and the factors of users, such as sex and age. It was suspected that the reimbursement by fee-for-service contributed to the variation quite a lot, but we could not compare the variation between the different reimbursement systems in Korea. The results of the study suggested that the factors of suppliers and utilizers should be reviewed to reduce the under use and over use expressed by variations of medical service utilization. The processes of care, effective communication and management system should be investigated for the equity of medical service utilization. Additionally, prospective payment could be recommended to reduce the high variation of medical service use. To find the variation caused by under use and over use, further study need to control the severity of diseases, socio-economic status of the users and the system factors.