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1 J Korean Med. 2015;36(3): pissn eissn Original Article 보건의료빅데이터를이용한얼굴마비환자의의료비용에관한연구 홍민정 1, 엄태웅 2, 김신아 2, 김남권 2 1 부산대학교한의학전문대학원, 2 부산대학교한방의료비교효과및경제성평가연구센터 Medical costs for patients with Facial paralysis : Based on Health Big Data Min-Jung Hong 1, Tae-Woong Umh 2, Sina Kim 2, Nam-Kwen Kim 2 1 Pusan National University, School of Korean Medicine 2 Center for Comparative Effectiveness Research and Economic Evaluation in Korean Medicine, Pusan National University. Objectives: The purpose of this study was to analyze the medical cost of facial paralysis in payer perspective and to estimate the practice pattern of patient using 2011 Health Insurance Review & Assessment Service-National Patients Sample(HIRA-NPS). Methods: Basic statistical system was used for descriptive analysis of NPS dataset. A table for general information (table20) was extracted by disease code, and social demographic characteristics, distribution of the use among inpatients and outpatients, utilization of each kind of medical care institutions, medical cost were analyzed. Subgroup analysis was conducted for assuming the practice pattern of korean medicine and western medicine. Results: A total of 8,219 people and 64,345 claims data were identified as having facial paralysis. Proportion of outpatient was 95.23%, inpatient 0.84% and patient using both services 3.93%. Mean patient charges was 44,229 won per outpatient, 178,886 won per inpatient and 523,542 won per patient using both services. Utilization of korean medical care institutions was 68.81%(claims), 40.46%(patients), utilization of western medical care institutions was 31.19%(claims), 59.54%(patients). The amount charged by korean medical care institutions was 52.61% and western medical care institutions was 47.39%. Cost per claim was higher than those of the korean treatment and cost per patient of western treatment was lower than those of the korean treatment. Conclusions: The research assessed the medical cost and practice pattern associated with facial paralysis. These findings could be used in health care policy and subsequent studies. Key Words : Facial paralysis, Burden of illness, Health big data, Medical cost, Health insurance 서론안면마비는 7번뇌신경인안면신경의손상으로인해발생하는질환으로미각이나타액분비의장애, 누액분비의장애, 청각과민이나통증등의증상을동반하는질환이다. 과로및스트레스가가장큰 발병유인으로꼽히고있으며 1) 매년인구 10만명당 20-30명이발생한다고보고되고있다 2). 일반적으로그치료율은높지만, 치료를받는다하더라도완전히회복되지않고근육운동이약화되거나연합운동 (synkinesis) 이발생하는경우가있어 3), 후유증이남았을때는물론그치료과정중에도안면마비는환 Received:21 August 2015 Revised:30 September 2015 Accepted:30 September 2015 Correspondence to: 김남권 (Nam-Kwen Kim) 경남양산시물금읍범어리부산대학교한의학전문대학원한방안이비인후피부과 Tel: , Fax: , drkim@pusan.ac.kr 98

2 홍민정외 3 명 : 보건의료빅데이터를이용한얼굴마비환자의의료비용에관한연구 (247) 자의삶의질을저하시키는원인이된다. 안면마비는통증등의물리적문제로인한스트레스뿐만아니라심리적, 정신적문제로인한스트레스도심각한질환으로안면부에나타나기때문에사회적관계에부정적인영향을미친다. 한의학의안면마비에해당하는구안와사환자를대상으로한삶의질에관한문등 4) 의연구에서는치료의경과에따라마비도가감소하고삶의질이향상되었음을보였으며후유증은삶의질과밀접한관련을보였다. 생명을위협하는중증질환은아니지만현대사회의과다한업무및스트레스로인해안면마비로치료받는환자는해마다증가하고있으며이에따른진료비부담도증가하고있는추세이다. 건강보험심사평가원의 2014년진료비통계지표에따르면질병소분류별다발생순위별한방요양급여실적입원과외래에서안면마비청구건수가각각 8,610건, 1,528,470건에달했는데이를통해안면마비가청구건수가높은상병이며사회경제적으로도영향을미치고있음을확인할수있다 5). 질병의사회경제적비용을측정하는연구가활발히이루어지고있지만안면마비질환의질병부담에관한연구는아직보고되고있지않은실정이다. 증가하고있는안면마비질환의의료비용에대한연구가필요하나, 현재국내의경우안면마비의비용에대해서뿐만아니라, 건강보험심사평가원의환자표본자료를이용하여진행된연구도없는상태이다. 이에본연구에서는건강보험심사평가원국가환자표본자료 (HIRA-NPS) 를이용하여안면마비환자에대한기저분석과함께보험자적관점등에서안면마비질환에대해분석하여다음과같은결론을얻었기에보고하고자한다. 를활용함으로써연구에들이는시간과비용등을단축시킬수있다. 건강보험심사평가원의환자표본자료란건강보험환자표본자료를기초로하여진료개시일기준 1년간진료받은환자를대상으로표본추출한연구목적의자료로서, 원시자료 (raw data) 에서개인및법인에대한정보를제거한후통계학적으로표본추출된 2차자료이다. 1년간의료서비스를이용한모든환자를대상으로진료내역과처방내역을포함하여성별, 연령구간 (5세단위 ) 에따른환자단위층화계통추출되었으며본연구에활용된환자표본자료인 2011년환자환자표본자료 (HIRA-NPS) 은전체환자추출비율 3%( 약 140만명 ) 로구축되었다 6). 환자표본자료는분산에따라입원 / 외래비율을고려하여자료의효율성을증대시켰으며, 환자의인구학적부분을고려하여다양한에피소드구축이가능하다는장점이있으나, 표본자료이므로추출빈도가적은회귀질환은설명력이감소하고 1년간의표본자료이므로유병기간이긴만성질환연구시에는제한점이존재한다. 7) 2. 안면마비표본환자의정의 WHO 홈페이지상 ICD-10에서 facial palsy AND facial paralysis 로상병코드를검색하였고, 그결과는다음과같다. 동일상병의경우보험청구시에보건의료인에따라다른상병기호가사용될가능성이있다. 따라서이러한이유로발생하는보험청구명세서상상병분류기호의변이를최소화할필요가있는데상병분류기호를재조정하여유사한상병군에대해서는동일한상병기호로재부여를한다. 연구대상및방법 1. 연구대상건강보험심사평가원환자표본자료는제한적실험환경이아닌실제보건의료환경을반영하는데이터로서, 비교적일반화가용이하며이미구축된자료 ICD-10 G51.0 G51.1 G51.2 G51.3 G51.4 G51.8 G51.9 => ICD-10 G51 99

3 (248) 3. 관점의구분및정의질병비용분석관점은사회적관점 (societal perspective), 보험자관점 (payer perspective), 환자관점 (patient perspective), 보건의료체계관점 (health care system perspective), 정부관점 (governmental perspective) 등이있는데어떤관점을취하느냐에따라비용에포함되는항목이달라진다. 8) 본연구는건강보험심사평가원환자표본자료에기초하여 2011 년시점에서안면마비로인해발생한비용의규모를보험자적관점에서파악하고자한다. 보험자관점은의료비용중보험자가지출하는비용만을포함하기도하나본연구는본인부담비용을포함한의료비용까지확대해보는관점에따라본인부담비용을포함한보험자적관점등에서분석을진행하였다. 이는본인부담비율감소및급여확대가계속진행되고있는점을염두에두고급여내본인부담비용을포함한의료비용을제시하는것이보장성강화에따라 보험자가부담할재정을추정한다는측면과정책적인활용면에서더욱의미가있기때문이다. 8) 4. 연구분석및방법연구에활용된환자환자표본자료은명세서일반 (table 20), 진료내역 (table 30), 수진자상병 (table 40), 원외처방전교부상세 (table 53) 로구성되어있으며명세서의일반내역테이블 (table 20) 은서식코드, 수진자연령, 성별구분코드, 연령군, 진료과목코드, 보험자코드, 주상병코드, 부상병코드, 요양일수, 심결보험자부담금, 심결요양급여비용총액, 심결본인부담금, 수진자고유번호, 요양기관고유번호, 명세서연결코드등으로구성되어있다. 본연구는명세서일반 (table 20) 만을이용하여분석을시행하였으며환자표본자료의 table 20의총명세서수는 24,379,430건이었다. 분석을위해주상병코드가 G51, G530, G532, G538, P113, Q870인 Table 1. ICD-10 for analysis ICD-10 G51 안면신경장애 (Facial nerve disorders) G51.0 벨마비 (Bell s palsy), 안면마비 (Facial palsy) G51.1 슬신경절염 (Geniculate ganglionitis) G51.2 멜커슨증후군 (Melkersson s syndrome) G51.3 간대성반쪽얼굴연축 (Clonic hemifacial spasm) G51.4 안면근육파동증 (Facial myokymia) G51.8 기타안면신경장애 (Other disorders of facial nerve) G51.9 상세불명의안면신경장애 (Disorder of facial nerve, unspecified) G53 달리분류된질환에서의뇌신경장애 (Cranial nerve disorders in diseases classified elsewhere) G53.0 대상포진후신경통 (B02.2+)(Postzoster neuralgia) 포진후삼차신경통 (Postherpetic trigeminal neuralgia) 포진후슬신경절염 (Postherpetic geniculate ganglionitis) G53.1 달리분류된감염성및기생충성질환에서의다발성뇌신경마비 (A00-B99+)(Multiple cranial nerve palsies in infectious and parasitic diseases classified elsewhere) G53.2 사르코이드증에서의다발성뇌신경마비 (D86.8+)(Multiple cranial nerve palsies in sarcoidosis) G53.3 신생물질환에서의다발성뇌신경마비 (C00-D48+)(Multiple cranial nerve palsies in neoplastic disease) G53.8 달리분류된기타질환에서의기타뇌신경장애 (Other cranial nerve disorders in other diseases classified elsewhere) P11.3 안면신경의출산손상 (Birth injury to facial nerve) Q87.0 주로얼굴형태에영향을주는선천기형증후군 (Congenital malformation syndromes predominantly affecting facial appearance) 설명 100

4 홍민정외 3 명 : 보건의료빅데이터를이용한얼굴마비환자의의료비용에관한연구 (249) 명세서일반테이블 (table 20) 을데이터마이닝을통해추출해내었으며그결과추출된명세서수는 64,345건이었고추출된환자수는 8,219명이었다. 각명세서의해당요양기관을종별로구분하기위해명세서일반테이블 (table 20) 로부터추출한안면마비환자의일반내역명세서와요양기관명세서 table을결합하여명세서수와환자단위등으로분석을수행하였다. 5. 변수의정의 1) 요양기관종별이용률요양기관종별코드 (y_jong) 는 01= 상급종합병원, 11= 종합병원, 21= 병원, 28= 요양병원, 29= 정신요양병원, 31= 의원, 41= 치과병원, 51= 치과의원, 61= 조산원, 71= 보건소, 72= 보건지소, 73= 보건진료소, 74= 모자보건센터, 75= 보건의료원, 81= 약국, 92= 한방병원, 93= 한의원 으로정의되어있다. 본연구에서는 92= 한방병원, 93= 한의원만을한방으로분류하였으며그외는모두양방으로분류하였다. 2) 입원과외래본연구는 FOM_CD( 서식코드 ) 를이용하여입원과외래를정의하였는데서식코드 01은요양급여비용심사청구서이며 02,03,04,05,06,07,08,09,10,11,12, 13,20 모두요양급여비용명세서이다. 02: 의과입원, 03: 의과외래, 04: 치과입원, 05: 치과외래, 06: 조산원입원, 07: 보건기관입원, 08: 보건기관외래, 09: 정신과낮병동, 10: 정신과입원, 11: 정신과외래, 12: 한방입원, 13: 한방외래, 20: 직접조제 로명세서단위로분석시서식코드에기재된대로입원과외래를구분하였으며환자단위로분석시에는외래환자, 입원환자, 외래와입원을모두이용한환자로나누어분석을진행하였다. 3) 요양기관종별에따른명세서발생요양기관종별코드 (y_jong) 와서식코드 (FOM_CD) 변수를이용하여요양기관종별에따른한방 양방명세서발생분석을시행하였다. 12: 한방입원 과 13: 한방외래 는한방명세서로구분하였으며그외의과입원, 외과외래, 치과입원, 치과외래등은양방명세서로구분하였다. 1. 성별및연령분포 결과 성별분석결과, 남자는 2,963명으로 36.29%, 여자는 5,201명으로 63.71% 를차지하였다. 연령분석결과, 8,219명의환자중에서 51세에서 55세까지의환자가 1064명, 13.03% 로가장많음을확인할수있었고, 50-60대에서가장높은비율을차지하였지만 40대부터는분포에큰차이가없었으며소아는물론다양한연령대에서발병함을확인할수있었다. (Table 2, Table 3) Table 2. The gender distribution of the sample patients gender number of sample patients percentage(%) male 2, female 5, Table 3. The age distribution of the sample patients age number of sample patients percentage(%) 0~5세 (1) 세 ~10세 (2) 세 ~15세 (3) 세 ~20세 (4) 세 ~25세 (5) 세 ~30세 (6) 세 ~35세 (7) 세 ~40세 (8) 세 ~45세 (9) 세 ~50세 (10) 세 ~55세 (11) 세 ~60세 (12) 세 ~65세 (13) 세 ~70세 (14) 세 ~75세 (15) 세 ~80세 (16)

5 (250) Table 4. Frequency analysis of ICD-10 ICD-10 number of claims data percentage(%) number of sample patient percentage(%) G51 50, , G530 13, , G G P Q 주상병코드빈도분석명세서수와환자단위로추출된환자표본자료의주상병코드를빈도분석한결과, G51의벨마비가가장높은비율로나타났다. 명세서수로분석한경우, 50,864건, 79.05% 의결과를보였고환자수로분석한경우에도 4,838명, 58.86% 로가장비율이높게나타났다. 상병코드는명세서수로분석한경우 G51, G530, Q870, G538, P113, G532의순으로높은빈도를보였다.(Table 4) 3. 진료과목별빈도분석진료과목별로빈도분석을한결과, 한방내과가 27,712건, 1,876명으로 43.07%, 22.83% 를차지하였으며신경과가 9,282건, 2,297명으로 14.43%, 27.95%, 침구과가 15,625건, 1,359명으로 24.28%, 16.53% 를차지하였다. 명세서수로는한방내과, 침구과, 신경과의순이었지만환자들이안면마비질환으로내원하는경우, 신경과, 한방내과, 침구과순으로방문수가많음을확인할수있었다.(Table 5-1, Table 5-2) 4. 진료비분석안면마비질환으로인해발생한요양급여비용총액은 1,891,540,000원, 보험자부담금은 1,356,517, 460원, 본인부담금은 527,625,770 원이었다. 환자기준진료비분석결과, 안면마비질환자의평균본인부담금은 64,196원이었으며평균요양급여비용총액은 230,142원이었다.(Table 6) Table 5-1. Clinic frequency analysis of claims data clinic number of percentage claims data (%) department of korean internal medicine 27, department of acupuncture & moxibustion 15, department of neurology 9, dermatology 2, neurosurgery 1, anesthesiology 1, department of internal medicine 1, rehabilitation medicine oriental neuropsychiatric family medicine general surgery otorhinolaryngology urology division of korean ophthalmology, otolaryngology and dermatology general orthopedics korean rehabilitation medicine emergency medicine ophthalmology obstetrics and gynecology plastic surgery pediatrics korean emergency medicine radiology division of sasang constitution thoracic and cardiovascular surgery neuropsychiatry korean oriental pediatrics oral medicine oriental obstetrics & gynecology conservative dentistry oral and maxillofacial surgery laboratory medicine industrial medicine

6 홍민정외 3 명 : 보건의료빅데이터를이용한얼굴마비환자의의료비용에관한연구 (251) Table 5-2. Clinic frequency analysis of sample patients clinic number of sample patients percentage (%) department of neurology 2, department of korean internal medicine 1, department of acupuncture & moxibustion 1, dermatology department of internal medicine neurosurgery anesthesiology family medicine urology otorhinolaryngology general surgery rehabilitation medicine division of korean ophthalmology, otolaryngology and dermatology orthopedics emergency medicine general oriental neuropsychiatric ophthalmology korean rehabilitation medicine pediatrics plastic surgery obstetrics and gynecology neuropsychiatry korean oriental pediatrics korean emergency medicine radiology oriental obstetrics & gynecology conservative dentistry division of sasang constitution thoracic and cardiovascular surgery oral and maxillofacial surgery oral medicine laboratory medicine 입원 외래별진료비분포 서식코드변수를이용하여입원과외래로나누어진료비에대한분석을진행하였다. 표본자료에서추출한 8,219명의환자중외래환자는 7,827명, 95.23%, 입원환자는 69명, 0.84%, 입원과외래를모두이용한환자는 323명으로 3.93% 였다. 명세서기준분석결과, 외래명세서로청구된요양급여비용총액은 1,383,454,350원이었으며입원명세서로청구된요양급여비용총액은 508,085,650원이었고외래명세서의평균요양급여비용총액은 21,688원, 입원명세서의평균요양급여비용총액은 912,183원으로나타났다. 환자단위로분석한결과, 외래환자의평균본인부담금은 44,229원이었으며, 평균요양급여비용총액은 153,819원이었다. 입원환자의평균본인부담금은 178,886원, 평균요양급여비용총액은 843,499원이었으며입원과외래를모두이용한환자의평균본인부담금은 523,542원이었고평균요양급여비용총액은 1,948,597원이었다.(Table 7, Table 8, Table 9) 6. 요양기관종별이용률표본자료에서추출한명세서기준, 요양기관종별이용률은한방이 44,277건, 68.81% 로가장높은비중을차지하였으며양방은 20,068건으로전체의 31.19% 를차지하였다. 환자수로분석한결과한방의비율이 40.46% 를나타내었는데이를통해양방에비해한방이명당명세서수가더많음을알수있었다. 한방요양기관을더욱세분화해서분석해보니한의원이 65.82%( 명세서수 ), 36.70%( 환자수 ) 의비중을차지하였고한방병원은 3.00%( 명세서수 ), 3.76%( 환자수 ), 양방은 31.19%( 명세서수 ), 59.54%( 환자수 ) 의비중을보였다. 명세서수로분석한경우에비해환자수로분석한경우양방의비중이 31.19% 에서 59.54% 로증가하는것으로보아양방의경우, 한방에비해실제이용하는환자수의비중이명세서의비중에비해큼을확인할수있었다. 명세서기준으로는한방이 68.81% 로양방에비해높은비중을, 환자수기준으로는양방이 59.54% 로한방에비해높은비중을보였다.(Table 10) 7. 요양기관종별에따른비용부담분석한방과양방으로구분지어요양기관종별에따른 103

7 (252) Table 6. Analysis of medical cost based on claims data and sample patients Analysis of medical cost based on claims data (unit: won) burden of payer 1,356,517,460 21,082 97,280 12,810 burden of patient 527,625,770 8,200 32,926 4,500 sum of medical care expenses 1,891,540,000 29, ,644 15,970 Analysis of medical cost based on sample patients (unit: won) burden of payer 1,356,517, , ,652 36,940 burden of patient 527,625,770 64, ,875 13,200 sum of medical care expenses 1,891,540, , ,781 51,710 Table 7. Practice pattern of sample patients practice pattern number of sample patient percentage(%) outpatient 7, inpatient inpatient outpatient sum of sample patients 8, Table 8. Analysis of medical cost based on the inpatient claims data and outpatient claims data medical cost of inpatient claims data (unit : won) burden of payer 390,106, , , ,970 burden of patient 116,856, , , ,850 sum of medical care expenses 508,085, , , ,240 medical cost of outpatient claims data (unit : won) burden of payer 966,411,050 15,150 19,813 12,770 burden of patient 410,768,950 6,440 16,848 4,500 sum of medical care expenses 1,383,454,350 21,688 35,115 15,970 비용부담을분석한결과, 한방은 995,143,690원, 52.61%, 양방은 896,396,310원으로 47.39% 의비중을차지하였다. 한방의경우, 치료를위해방문한환자수의비중에비해요양급여비용의비중이컸고양방은환자수의비중에비해요양급여비용의비중이작은결과를보였다.(Table 11) 8. 요양기관종별에따른명세서발생분석요양기관종별코드 (y_jong) 와서식코드 (FOM_CD) 변수를이용하여요양기관종별에따른한방 양방명세서발생을분석한결과, 명세서기준으로는한의원내한방명세서청구건수가 42,349건으로가장많았고양방병원내양방명세서가발생한경우가뒤를이었다. 한방병원내한방명세서가발생한경우, 한의원내한방명세서가발생한경우, 양방병원내양방명세서가발생한경우와다르게요양기관종별과명세서발생이일치하지않는경우가있었는데한방병원내양방명세서가발생한경우, 양방병원내 104

8 홍민정외 3 명 : 보건의료빅데이터를이용한얼굴마비환자의의료비용에관한연구 (253) Table 9. Analysis of medical cost based on the inpatient and outpatient medical cost of outpatient (N=7,827) burden of payer 852,220, , ,095 33,300 burden of patient 346,178,570 44,229 90,428 12,400 sum of medical care expenses 1,203,941, , ,766 46,410 medical cost of inpatient (N=69) burden of payer 45,630, , , ,540 burden of patient 12,343, , ,683 84,830 sum of medical care expenses 58,201, ,499 1,185, ,110 medical cost of inpatient outpatient (N=323) burden of payer 458,667,360 1,420,023 1,087,294 1,080,530 burden of patient 169,104, , , ,390 sum of medical care expenses 629,396,760 1,948,597 1,442,195 1,594,550 Table 10. Utilization of each kind of medical care institutions Utilization of medical care institutions (korean western medicine) number of claims data percentage(%) number of sample patient percentage(%) korean medicine 44, , western medicine 20, , Utilization of medical care institutions number of claims data percentage(%) number of sample patient percentage(%) korean medical hospital 1, korean medical clinic 42, , western medical institutions 20, , Table 11. Burden of cost based on medical care institutions (based on claims data) korean medical institution western medical institution sum (unit : won) burden of payer 743,191,430(54.79) 613,326,030(45.21) 1,356,517,460(100.00) burden of patient 251,861,510(47.73) 275,764,260(52.27) 527,625,770(100.00) sum of medical care expenses 995,143,690(52.61) 896,396,310(47.39) 1,891,540,000(100.00) 한방명세서가발생한경우가있었다. 한방병원내양방명세서가발생한경우가 38건, 4명이있었으며양방병원내한방명세서가발생한경우가 189건, 57 명으로양방병원내한방명세서가발생한경우가한방병원내양방명세서가발생한경우에비해많았다. 환자기준으로, 한방병원에서발생한양방명세서 의평균본인부담금은 72,900원, 한방명세서의평균본인부담금은 192,785원이었으며한의원에서발생한한방명세서의평균본인부담금은 61,687원이었다. 양방병원에서발생한양방명세서의평균본인부담금은 57,036원, 한방명세서의평균본인부담금은 115,835 원이었다.(Table 12) 105

9 (254) Table 12. Claims data based on medical care institutions based on claims data based on patient korean medical hospital korean medical clinic western medical institutions korean medical hospital korean medical clinic western medicine claims data korean medicine claims data N Mean S.D. Median N Mean S.D. Median burden of payer 38 40,308 49,501 30,215 1,890 90, ,661 23,320 burden of patient 38 18,747 17,986 12,950 1,890 41,007 63,511 13,450 burden of payer ,349 13,480 4,048 13,090 burden of patient ,349 4,100 2,224 4,700 burden of payer 19,879 30, ,283 9, , ,896 30,470 burden of patient 19,879 13,618 54,046 3, ,696 49,213 10,730 burden of payer 4 113,493 81, , , , ,490 burden of patient 4 72,900 55,501 73, , ,697 86,000 burden of payer , , ,538 61,410 burden of patient ,016 61, ,198 18,600 western medical burden of payer 4, , ,736 22, , , ,210 institutions burden of patient 4,837 57, ,192 9, , ,575 71,600 * 정규분포를하지않는자료이지만질병부담추정을위해 mean 과 median 을제시하였음 106

10 홍민정외 3 명 : 보건의료빅데이터를이용한얼굴마비환자의의료비용에관한연구 (255) Fig. 1. Average cost of the claims data based on medical care institutions 고찰건강보험심사평가원이발표한자료에따르면안면신경장애 (G51) 질환자가 2008년에서 2012년의 5 년사이약 5만 7천명에서약 7만명으로약 1만 4 천명가량증가하였다 (24.2%). 총진료비역시 2008년 156억에서 2012년 215억원으로 5년사이 59억원 (38.3%) 이증가하였으며, 진료인원의연평균증가율은 5.6%, 총진료비의연평균증가율은 8.4% 로 9) 질환자의증가에따른의료비부담이점점가중되고있는실정이다. 질병비용연구는특정질환에대한경제적부담을확인하며정책의우선순위결정과예방, 치료프로그램의정당성확인등에이용된다. 8) 이에본연구는국내의건강보험심사평가원청구자료를이용 하여안면마비환자의의료서비스이용특성을살펴보고보험자적관점에서안면마비의의료비용을산출하기위해진행되었다. 2011년건강보험심사평가원국가환자표본자료를자료원으로활용하였으며환자의연령, 성별과같은인구사회학적특성과의료비용, 요양기관종별이용률, 입원 외래별진료비분포등을분석하였다. 분석에포함된명세서는 64,345건, 환자는 8,219명이었으며외래환자는 7,827 명, 입원환자는 69명, 입원과외래를모두이용한환자는 323명으로각각의비율은 95.23%, 0.84%, 3.93% 였다. 명세서기준요양기관종별이용률을분석한결과한방이 68.81%, 양방이 31.19% 를차지하였고환자수로분석한결과한방이 40.46%, 양방이 59.54% 로나타났다. 요양급여비용총액으로분석해보니한 107

11 (256) 방의비율이 52.61% 로나타났는데, 이를통해한방의명세서당치료비용이양방에비해낮음을확인할수있었다. 한방은양방에비해비용이낮으면서치료기간에따라비용이지속적으로발생하지만양방의경우는초기에비용이많이투입될뿐만아니라고가의진단비용때문에한방에비해청구되는비용이크다. 양방이차지하는요양급여비용의비중에비해명세서수의비중이작음을통해한방에비해양방의요양급여비용이높음을확인할수있었다. 협진에대한만족도와치료율이높은안면마비질환의특성상, 요양기관종별에따른명세서발생분석도중요한의미를보였는데요양기관종별코드와서식코드의두개의변수를통해한방과양방관련여부를확인할수있었다. 이두변수를활용하여요양기관종별에따른명세서분석을시행하였고분석을통해한방병원내양방명세서가발생한경우, 양방병원내한방명세서가발생한경우가있음을확인하였다. 안면마비는협진에대한연구가활발한질환이다. 실제치료결과한방치료만을시행한군보다한 양방치료를병행한군에서치료1,2주후치료효과가높게나타나고통계적으로유의성있는차이를보인연구등 10) 에따르면협진에의한얼굴신경마비의치료는만족할만한회복을보인다. 또한협진은양방치료보다비용효과적으로 11), 안면마비한 양방협진센터에서부터통합진료시스템등현재다방면으로이루어지는협진진료및연구에더하여, 요양기관종별에따른명세서발생자료를활용해본다면안면마비협진관련연구를더욱진행해볼수있을것이다. 본연구는유병환자를기준으로질병비용을산출하였다. 분석시점인 2011년에안면마비질환을앓고있는환자들의비용을고려하였는데더욱정확한분석을위해서는신환자를정의하고이들환자들의비용을추적하여산출하는것이필요하다. 신환자정의를위해 3개월, 1년등의과거력제외기간등이요구되는데본연구의연구기간은 1년에한정되어있으므로 3개월의기간을제외한다면연구기간이짧아제한적인연구가될것이라생각되어 1년의분 석기간을그대로이용하였다. 또한외래환자와입원환자, 입원과외래를모두이용한환자로나누어진료비에대한분석을진행하였는데본연구는 1년분석기간동안의총의료이용에대한연구로진료에피소드에대한개념없이시행되었다. 질병의발생부터종료까지를하나의사건으로측정하는단위 인진료에피소드를구축하여분석을진행한다면질환의재발및진료기간, 치료기간에따른진료비등에관한정보까지포함하여더욱정확한분석이이루어질것으로사료된다. 건강보험심사평가원의환자표본자료는방대한원시데이터로부터대표성을확보할수있도록추출된자료이며모집단추정에효율적이지만이후에추가적으로안면마비질환을가진전체환자표본자료을이용한분석이이루어진다면보다더의미있는연구가이루어질것으로사료된다. 또한본연구는주상병코드를이용하여추출한명세서와환자를기준으로분석을진행하였으므로분석결과가실제안면마비발생보다과소추정되었을우려가있지만, 안면마비의의료비용및질병부담을산출하는데그의의가있으며, 직접비의료비용및간접비용등에대한추가적인연구와안면마비관련한질병부담연구에근거자료로제공될수있을것이며, 정책결정에도중요한근거자료로이용될수있을것이다. 결론건강보험심사평가원의 2011년환자표본자료 (HIRA-NPS) 을분석자료로, 1년간안면마비로청구된명세서와환자를데이터마이닝등을통해추출한후분석하여다음과같은결과를얻었다. 1. 성별및연령분석결과, 여자가 63.71%, 남자가 36.29% 를보였으며 50대발병인원이 2,012명으로가장많았다. 주상병코드빈도분석결과, G51 ( 안면신경장애 ) 이 58.86%( 환자수 ) 로가장높게나타났으며, G51, G530, G538, Q870의순으로 108

12 홍민정외 3 명 : 보건의료빅데이터를이용한얼굴마비환자의의료비용에관한연구 (257) 환자수가많았다. 진료과목별로는신경과, 한방내과, 침구과, 피부과, 내과, 신경외과순으로방문수가많았으며진료비분석결과, 안면마비질환자의의료이용평균본인부담금은 64,196원이었으며평균요양급여비용총액은 230,142원이었다. 2. 환자기준진료형태분석결과, 외래환자의비중은 95.23%, 입원환자의비중은 0.84% 이었으며입원과외래를모두이용한환자의비중은 3.93% 였다. 외래명세서의평균요양급여비용총액은 21,688원, 입원명세서의평균요양급여비용총액은 912,183원으로나타났다. 환자단위로분석한결과, 외래환자의평균본인부담금은 44,229원이었으며, 평균요양급여비용총액은 153,819원이었다. 입원환자의평균본인부담금은 178,886원, 평균요양급여비용총액은 843,499원이었고입원과외래를모두이용한환자의평균본인부담금은 523,542원, 평균요양급여비용총액은 1,948,597원이었다. 3. 명세서기준요양기관종별이용률은한방이 68.81%, 양방이 31.19% 를보였으며, 환자수로분석한결과, 40.46%, 59.54% 를보였다. 한방요양기관에서발생한요양급여비용총액의비중은 52.61% 이었으며, 양방요양기관에서발생한요양급여비용총액은 47.39% 를차지하였다. 한방치료에비해양방치료의명세서당청구비용이높았으며환자당청구비용은낮았다. 명세서기준으로는한의원내한방명세서가발생한경우가 42,349건으로가장많은비중을차지하였고환자기준으로는양방병원내양방명세서가발생한환자가 4,837 명으로가장많았다. 한방병원내양방명세서가발생한경우와양방병원내한방명세서가발생한경우도있었다. 명세서발생건수는한의원내한방명세서가발생한경우, 양방병원내양방명세서가발생한경우, 한방병원내한방명세서가발생한경우, 양방병원내한방명세서가발생한경우, 한방병원내양방명세서가발생한경우순이 었다. 감사의글이논문은 2015년도정부 ( 미래창조과학부 ) 의재원으로한국연구재단의지원을받아수행된기초연구사업임 (NRF-2014R1A1A ). 참고문헌 1. Choi SW, Yook TH, Song BY. A Clinical Study About Factors to Have an Influence on the Prognosis of Bell s Palsy. J Korean Acupuncture & Moxibustion Society. 2004; 21(3): Korean society of otorhinolaryngology-head and Neck Surgery. Otorhinolaryngology. Seoul: Ilchokak. 2005: Choi MG. A Case Report of Reconstruction of Facial Paralyzed patient. J Korean association of maxillogacial plastic and reconstructive surgeons. 2005;27(3): M H, Park MC, Hong SH, Youn IH, Lee DH, Lee CH, et al. A Rearch on Quality of Life of Facial Palsy Patients. J Korean Oriental Medical Ophthalmology&Otolaryngology&Dermatology. 2009;22(1): Health Insurance Review & Assessment Service. Korean medicine medical care performance ranking classified by frequency Health Insurance Review & Assessment Service. Information. Available at: URL: or.kr/dummy.do?pgmid=hiraa &cmsurl=/cms/open/02/01/02/index.html 7. Kim LK.. How to configure and use of Health Insurance Review & Assessment Service National Patients Sample. Health Insurance Review & Assessment Service. 109

13 (258) 8. Lee TJ, Kim YH, Shin SJ, Song HJ, Park JY, Jung YJ, et al. Costing method in Healthcare. National Evidence-based Healthcare Collaborating Agency. 2012: Health Insurance Review & Assessment Service. 2008~2014 Health Insurance and medical care review data. 10. Park IB, Kim SW, Lee CW, Kim HG, Heo SW, Youn HM. Comparative clinical Study between Oriental Medicine and Oriental -Western Medicine Treatment on Bell s Palsy. J Korean Acupuncture & Moxibustion Society. 2004;21(5): Lee DH. Economic evaluation of medical usual care and acupuncture for the treatment of Bell s Palsy. Gwanju: Wonkwang Univ.; An SA. Direct Medical Costs for Patients with Parkinson s Disease : Based of National Patients Sample for the National Health Insurance Claims Data. Seoul: Sungkyunkwan Univ.; Yu JR. Direct Medical Costs for Patients with Breast Cancer : Based on National Patients Sample for the National Health Insurance Claims Data. Seoul: Sungkyunkwan Univ.; Byford S. Torgerson DJ. Raftery J. Cost of illness studies. Bmj. 2000;320(7245): Tarricone R. Cost-of-illness analysis. What room in health economics? Health policy (Amsterdam, Netherlands). 2006;77(1):

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012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar