ORIGINAL ARTICLE pissn , eissn J of Oriental Neuropsychiatry 2019;30(1): 한국치매환자의건강보험

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1 ORIGINAL ARTICLE pissn , eissn J of Oriental Neuropsychiatry 2019;30(1): 한국치매환자의건강보험의ㆍ한의진료비용에관한연구 이정배, 강형원 *, 김재욱, 김가혜, 김남권 부산대학교한의학전문대학원, 원광대학교산본병원한방신경정신과 & 인암뇌신경연구센터 *, 한국한의학연구원, 부산대학교한방의료비교효과및경제성평가연구센터 A Study on Medical Expenses of Modern and Korean Medicine for Dementia Patients Under National Health Care Jung Bae Lee, Hyung Won Kang*, Jaeuk Kim, Gahye Kim, Nam-Kwen Kim School of Korean Medicine, Pusan National University, *Department of Korean Neuropsychiatry Medicine & Inam Neuroscience Research Center, Wonkwang University Sanbon Hospital, Korea Institute of Oriental Medicine, Center for Comparative Effectiveness Research & Economic Evaluation in Korean Medicine, Pusan National University Received: February 12, 2019 Revised: March 22, 2019 Accepted: March 27, 2019 Correspondence to Nam-Kwen Kim Center for Comparative Effectiveness Research & Economic Evaluation in Korean Medicine, Pusan National University, Mulgeum-eup, Yangsan, Korea. Tel: Fax: drkim@pusan.ac.kr Acknowledgement This work supported by main business of Korean Oriental medicine research institute (Grant No. KSN ). Objectives: To identify the cost effectiveness of early dementia diagnosis using the 2014 Health Insurance Review & Assessment Service-National Patients Sample (HIRA-NPS). Methods: The medical costs of dementia between Western medical care and Korean medical care were compared through the reimbursement and non-reimbursement item code for dementia examination. In addition, the medical expenses of patients with dementia and mild cognitive impairment were compared and analyzed with respect to Western and Korean medical care. Results: There were 87,434 claims, of which 16,101 patients were diagnosed with dementia and 38,680,789,560 won was found to be the medical expenses. 12,881 patients (80.0%) with dementia, 3,144 patients (19.5%) with mild cognitive impairment, and 76 patients (0.5%) progressing from mild cognitive impairment to dementia. The proportion of medical expenses was 97.6% for dementia patients, 2.3% for mild cognitive impairment, and 1% for patients progressing from mild cognitive impairment to dementia. 86,070 claims (98.4%) were from Western medical care, with16,824 patients (98.2%), and the medical expenses was 38,546,895,400 won (99.7%). 1,361 claims (1.6%) were from Korean medical care, with 303 patients (1.8%), and the medical expenses was 133,894,160 won (0.3%). Conclusions: This study compared and analyzed the medical costs of dementia patients and the diagnosis of both Korean and Western medical care. The results of this study are expected to be used as basic research data for investigating cost effectiveness of developing early diagnosis of dementia. Key Words: Dementia, Mild cognitive impairment, Early Dementia Diagnosis Technology. Copyright 2019 by The Korean Society of Oriental Neuropsychiatry. All rights reserved. CC This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 32 A Study on Medical Expenses of Modern and Korean Medicine for Dementia Patients Under National Health Care I. 서론 치매는전세계의공공보건정책에서우선순위가높은질병으로 1), 노인인구에서발생빈도가높은신경계퇴행성질환이며 2), 유병률은 65세이상에서약 5 10%, 65세이후는연령이 5년씩증가할때마다 2배정도증가한다고보고되어있다 3). 우리나라는노인인구비율이증가하는상황에서 4), 65세이상노인의치매유병률이 2008 년에 8.4% 인 42만명, 2015 년에는 9.8% 인 64만 8,223 명으로추정하고있으며, 2050 년에는 65세이상노인인구의약 15% 가될것으로추정되고있다 5,6). 치매유병률이높아질수록의료비의증가를초래하게되며, 2016 년보건복지부보고서 6) 에의하면치매환자 1인당연간진료비는 2010년에 294만 9천원에서 2014년에 364 만 5천원으로증가하였고, 연간총치매진료비는 2010 년 7,854억원에서 2014년 16조 1,418억원으로증가하였다. 또한국가치매관리비용은 2015 년에 13조 2천억원에서 2050 년에는 106조 5천억원으로증가할것으로보고하고있다. 치매환자의부양비용은치매정도가심해질수록비용이증가하는것으로알려져있으며 7), 1인당의료비용발생또한중증치매환자가경도인지장애 (mild congnitive impairment, MCI) 환자보다 8배정도높다고보고하고있다 8). 경도인지장애는인지기능의저하가정상의범위를벗어나지만, 아직치매로진단할수있을정도로심하지않는상태를말하며, 시간이경과하면서치매로발전할가능성이높은것으로알려져있다 9). 이와관련하여최근경도인지장애에서치매로전이확률을추정할수있는국내코호트연구 10) 가보고되었으며, 경도인지장애환자및경증치매환자들에대한조기검사및관리가중증치매환자로의진행률을감소시켜총의료비의발생을절감한다는연구도보고된바있다 11). 이에저자는 2014년의건강보험심사평가원환자표본자료 (HIRA-NPS) 를대상으로하여, 치매조기진단기술개발의비용효과성등의규명을위한기초연구로서건강보험급여체계의의료시장현황을분석하여, 의과, 한의과의치매진단검사항목에따른이용과건강보험의료비용등을비교분석하여다음과같은지견을얻었기에보고하는바이다. II. 연구자료및분석방법 1. 연구자료건강보험심사평가원의환자표본자료는실제보건의료환경을반영하는데이터로서, 건강보험환자표본자료를기초로하여진료개시일기준 1년간진료받은환자를대상으로표본추출한연구목적의자료이며, 2010 년이후년단위의환자자료를제공하고있으며, 원시자료 (raw data) 에서개인및법인에대한정보를제거한후통계학적으로표본추출된 2차자료를제공하고있다 12). 본연구에활용된 2014 년국가환자표본자료 (HIRA- NPS) 는 2014 년 1월 1일부터 12월 31일까지국내건강보험대상진료를받은전체환자중추출비율 3% ( 약 140 만명 ) 로구축되었으며, 추출에대한가중치등은현재제공하고있지않으며, 환자상병과의료기관및진료과목등을포함하여건강보험급여항목의진료내역과처방내역에대한변수들로구성되어있다. 본연구는상기환자표본자료를활용하여, KCD 질병상병코드를근거로치매와경도인지장애환자를정의하였으며, 해당환자들의의료이용에대한데이터를대상으로치매관련검사빈도및의료비현황등을분석하였다. 2. 치매및경도인지장애표본환자대상선정환자대상선정방법은국가환자표본자료에서연구대상인치매및경도인지장애의정보를추출하기위해서 KCD-6 기준으로상병코드를사용하여환자표본을선정하였다. KCD-6 은제 6차한국표준질병사인분류체계 (Korean Standard Classification of Diseases) 로의무기록자료및사망원인통계조사등질병이환과사망자료를그성질의유사성에따라체계적으로분류한것이다. 본연구에서치매및경도인지장애환자표본을선정하기위한상병코드의결정은해당진료과목전문의등의자문을통하여시행하였으며, 치매와경도인지장애에관련된상병코드를 KCD-6 의질병분류목록에서소분류기준 47항목으로최종선정하였다 (Table 1). 3. 치매관련검사항목선정치매관련검사항목선정방법은건강보험요양급여비용에서, 의과의치매검사는선별검사인한국형간이정신상태

3 JB Lee, HW Kang, J Kim, G Kim, NK Kim 33 Table 1. KCD-6 Related to Mild Cognitive Impairment and Dementia KCD code Diagnosis KCD code Diagnosis F00 Dementia in Alzheimer s disease (G30.-+) F023 Dementia in Parkinson s disease (G20+) F000 Dementia in Alzheimer s disease with early onset (G30.0+) F023 Dementia in parkinsonism (G20+) F000 Alzheimer s disease, type 2 (G30.0+) F024 Dementia in human immunodeficiency virus [HIV] disease (B22.0+) F000 Dementia in Alzheimer s disease with early onset (G30.0+) F028 Dementia in other specified diseases classified elsewhere F000 Primary degenerative dementia of the Alzheimer s type, F028 Dementia with Lewy bodies (G31.82+) presenile onset (G30.0+) F001 Dementia in Alzheimer s disease with late onset (G30.1+) F028 Dementia in vitamin B 12 deficiency (E53.8+) F001 Alzheimer s disease, type 1 (G30.1+) F03 Unspecified dementia F001 Primary degenerative dementia of the Alzheimer s type, F03 Presenile dementia NOS senile onset (G30.1+) F001 Senile dementia, Alzheimer s type (G30.1+) F03 Presenile psychosis NOS F002 Dementia in Alzheimer s disease, atypical or mixed type F03 Primary degenerative dementia NOS (G30.8+) F002 Atypical dementia, Alzheimer s type (G30.9+) F03 Senile dementia NOS F009 Dementia in Alzheimer s disease, unspecified (G30.9+) F03 Senile dementia depressed or paranoid type F01 Vascular dementia F06.7 Mild cognitive disorder F01 Arteriosclerotic dementia G30 Alzheimer s disease F010 Vascular dementia of acute onset G30 Senile and presenile forms F011 Multi-infarct dementia G300 Alzheimer s disease with early onset F011 Predominantly cortical dementia G301 Alzheimer s disease with late onset F012 Subcortical vascular dementia G308 Other Alzheimer s disease F013 Mixed cortical and subcortical vascular dementia G309 Alzheimer s disease, unspecified F018 Other vascular dementia G31 Other degenerative diseases of nervous system NEC F019 Vascular dementia, unspecified G3100 Behavioral variants of frontotemporal dementia F02 Dementia in other diseases classified elsewhere G3100 Pick s disease F020 Dementia in Pick s disease (G31.00+) G3100 Frontotemporal dementia (FTD) F021 Dementia in Creutzfeldt-Jakob disease (A81.0+) 검사 (MMSE-K, Mini Mental State Examination-Korean) 와치매단계평가검사인전반적퇴화척도 (GDS, Global Deterioration Scale), 임상치매척도 (CDR, Clinical Dementia Rating), 일상생활을평가하는치매일상생활력척도 (ADL, The Activities of daily Living), 감별검사인 CT, MRI&A 영상검사등이사용되었다 (Table 2). 혈액검사는광범위해서제외하였다. 한의과에서는 GDS, CDR, K-DRS (Korean Dementia Rating Scale) 등의치매검사와기타건강보험요양급여및비급여항목들로등록된진단검사관련의료기술들이모두사용되었다 13) (Table 3). 4. 분석방법본자료데이터 (HIRA-NPS) 는명세서일반 (table 20), 진료내역 (table 30), 수진자상병 (table 40), 원외처방전교부상세 (table 53) 로구성되어있으며, 명세서의일반내역테이블은수진자고유번호, 요양기관고유번호, 서식구분코드, Table 2. Western Medical Care Dementia Examination of Reimbursement and Non-Reimbursement Item Code Reimbursement Non-Reimbursement Code Examination Code Examination F6216 Mini Mental State Examination-Korean F6221 Global Deterioration Scale F6222 Clinical Dementia Rating FY685 The Activities of daily Living SS021 CT SS011 MRI&A 진료과목코드, 수진자연령, 성별구분코드, 진료과목코드, 보험자코드, 주상병코드, 부상병코드, 요양일수, 심결보험자부담금, 심결요양급여비용총액, 심결본인부담금, 명세서연결코드등으로구성되어있다. 본연구의분석관점은보험자관점이며, 의료비용중보험자가지출하는비용만을포함하면서급여내본인부담비용을포함한의료비용까지를범위로확대하여분석하였다. 분석을위해명세서일반테이블 (table 20) 에서주상병코드

4 34 A Study on Medical Expenses of Modern and Korean Medicine for Dementia Patients Under National Health Care Table 3. Korean Medical Care Dementia Examination of Reimbursement and Non-Reimbursement Item Code Reimbursement Non-Reimbursement Code Examination Code Examination Yangdorak Finger photoplethysmogram Pulse Test Second derivative of photoplethysmogram waveform Electroacupuncture according to Dr. Voll (EAV) Posture & movement test Vertigo test Mental examination by QSCCII Personality test Mental examination & consultation by QSCCII Dementia Test (MMSE, GDS, CDR, K-DRS etc) physical type examination by Facial Scanning System physical type examination by Body measuring method Pulse wave velocity Moire topography Table 4. Data Outline for 2014 Patient Sample Data (NPS2014) Number of claims Patient Total medical expenses Average Maximum Standard deviation 27,784,176 1,447,441 1,413,908,900,000 50, ,872, (MSICK_CD) 중치매및경도인지장애질환별상병코드만분류하고, 요양기관고유번호 (YNO) 를이용하여한방병원 (92), 한의원 (93) 과서식코드 (FOM_CD) 에서한방입원 (12), 한방외래 (13) 를이용하여한의과진료로분류하였으며, 그외는의과로분류하였다. 심결본인부담금 (RVD_SLF_BRAMT) 과심결보험자부담금 (RVD_INSUP_BRAMT) 을합쳐서의료비를파악했으며, 명세서일반테이블 (table 20) 의주상병코드와진료내역 (table 30) 의항코드 (CLAUSE_CD) 와목코드 (ITEM_CD) 를이용하여치매진단검사의빈도를추정하였다. III. 결과 1. 질환별검사항목사용빈도분석결과 NPS2014데이터를대상으로 2014년 1월 1일부터 2014년 12월 31일까지의기간에건강보험대상인구중요양기관에서진료를받아청구건수가발생한환자들을모집단으로하여약 3% 의표본을추출한빅데이터로서, 1년단위약 만명의명세서자료로구성되어있으며청구건수, 수진자수및의료비등의데이터개요는다음과같다 (Table 4). 2. 치매및경도인지장애환자의료비분석건강보험요양급여총청구건수중치매및경도인지장애상병 ( 전체 ) 의청구건수는 87,434 건 (0.3%) 이며, 환자수 Table 5. Analysis of Medical Expenses for Patients with Dementia N % Number of claims 87, % Number of patients 16, % Total medical expenses 38,680,789, % Average medical expenses per claim 442,415 Average annual medical expenses per patient 2,402,384 는 16,101명 (1.1%), 의료비는 38,680,789,560원 (2.7%), 청구건당평균의료비는 442,415원, 환자당연평균의료비는 2,402,384원으로추정되었다 (Table 5). Table 6에서는확인된청구건수등을대상으로 2014 년에유병이확인된경도인지장애, 치매, 경도인지장애와치매동반상병코드를가진환자등을대상으로의료비분석을시행하였는데, 경도인지장애와치매동반상병코드를가진환자는경도인지장애에서치매로진행된환자로추정하여분석하였다. 분석결과, 경도인지장애환자는전체치매환자에서 3,144 명 (19.5%) 를차지하고있으며, 경도인지장애와치매로같이청구된경우 ( 진행된환자 ) 는 76명 (0.5%) 이며, 치매환자는 12,881명 (80.0%) 으로추정되었으며, 환자당연간의료비는경도인지장애환자가 288,388 원, 경도인지장애와치매를같이진단받은환자는 218,824 원, 치매환자는 2,931,253원으로추정되었다. 치매환자들의의과, 한의과의진료빈도를확인하여전체환자에서의비율을추정하였으며, 의과에서치매상병을

5 JB Lee, HW Kang, J Kim, G Kim, NK Kim 35 Table 6. Mild Cognitive Impairment, Dementia, Progression from Mild Cognitive Impairment to Dementia Medical Expenses Number of patients (Ratio of total dementia patients) Total medical expenses Ratio of medical expenses Average annual medical expenses per patient Mild cognitive impairment 3,144 (19.5%) 906,692, % 288,388 Dementia 12,881 (80.0%) 37,757,466, % 2,931,253 Mild cognitive impairment & Dementia 76 (0.5%) 16,630,600 1% 218,824 Table 7. Medical Expenses of Korean Medical Care Expenses & Western Medical Care in Patients with Dementia Western medical care Korean medical care N % N % Number of claims 86, % 1, % Number of patients 16, % % Total medical expenses 38,546,895, % 133,894, % Average medical expenses per claim 447,855 98,379 Average annual medical expenses per patient 2,291, ,895 Table 8. Frequency of Dementia Diagnosis in Western Medical Care Code Examination Frequency Percentage F6216 Mini Mental State 5, Examination-Korean (MMSE-K) F6221 Global Deterioration Scale (GDS) 3, F6222 Clinical Dementia Rating (CDR) 2, SS011 MRI 2, FY685 Dementia Activity of Daily living (ADL) 1, SS021 CT 1, *Frequency 3.34 = The total number of patients can be estimated. *Percentage of patients with total dementia. Table 9. Frequency of Dementia Diagnosis in Korean Medical Care Code Examination Frequency Percentage Pulse test 5 < Heart rate variability (HRV) 4 < Yangdorak 3 < Dementia Test 2 < Autonomic bioelectric 1 <0.01 response test (ABR) Infra-red Therapy (IR) 1 <0.01 *Frequency 3.34 = The total number of patients can be estimated. *Percentage of patients with total dementia. 등록한환자수는 16,824명 (98.2%), 한의과에서의환자수는 303명 (1.8%) 으로나타났으며, 의과의청구건수당평균의료비는 447,855 원, 한의과는 98,379 원이었고, 환자당연간평균의료비도의과의경우는 2,291,185원, 한의과의경우는 441,895원으로각각추정되었다 (Table 7). 3. 치매질환다빈도검사항목분석의과, 한의과에서시행하는치매환자의검사빈도 ( 표본데이터의빈도 ) 를분석하여전체치매환자에서의발생비율을추정하였다. 분석결과의과의경우, 간이정신상태검사 (MMSE-K, Mini Mental State Examination-Korean) 는전체치매및경도인지장애환자의 6.6% 에서사용된것으로나타났으며, 전반적퇴화검사 (GDS) 는 3.9% 치매척도검사 (CDR) 는 3.3%, 치매일상생활력검사는 1.1% 등으로나타났고, MRI 는 3.1%, CT는 1.1% 로각각확인되었다 (Table 8). 한의과의경우는검사빈도가매우낮았으며, 가장많이사용된검사는맥전도검사였으며, 경락기능검사, 양도락검사, 치매검사등의순으로확인되었다 (Table 9). IV. 고찰 치매와경도인지장애의용어는 DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) 에서 ICD-10 (the 10th revision of the International Statistical Classification of Diseases and Related Health Problems) 에있던인지장애를모두주요및경도신경인지장애 (major and mild neurocognitive disorder) 에포함시켰다. 즉, 과거의치매는주요신경인지장애에, 과거의경도인지장애 (mild cognitive impairment) 는경도신경인지장애에해당된다 14).

6 36 A Study on Medical Expenses of Modern and Korean Medicine for Dementia Patients Under National Health Care 2016 년보건복지부보고서 6) 에의하면치매유병률은 2015 년에는 9.8% 인 64만 8,223 명으로추정하고있으며, 17년마다두배씩증가하여 2024 년에 100만명 ( 유병률 10.3%), 2041년에 200만명 (12.3%) 을넘어설것으로추정하고있다. 총진료비역시치매환자 1인당연간진료비는 2010년에 294만 9천원에서 2014년에 364만 5천원으로증가하였고, 연간총치매진료비는 2010년 7,854억원에서 2014 년 16조 1,418 억원으로증가로유병률의증가에따른의료비부담이가중되고있는실정이다. 질병비용연구는특정질환이나건강행동에대한경제적부담을확인하며, 정책의우선순위를결정하거나예방또는치료프로그램의정당성을확인에활용된다 15). 본연구는환자표본자료 (NPS2014) 를이용하여치매조기진단기술개발의비용효과성등의규명을위한기초연구로서건강보험급여체계의의료시장현황을분석하여, 의과, 한의과의치매진단검사항목에따른이용과건강보험의료비용등을비교분석하였다. 건강보험요양급여의총청구건수중치매상병의청구건수는 87,434건 (0.3%), 환자수는 16,101명 (1.1%), 의료비비율은 38,680,789,560원 (2.7%) 이며, 청구건당평균의료비는 442,415원, 환자당연평균의료비는 2,402,384원으로추정되었다. 의과는청구건수는 98.4%, 환자수는 98.2%, 의료비는 99.7% 로한의과에비해높은비율을차지한다. 2014년통계청보고서 16) 로전체인구조사를보면, 65세이상의노인치매유병률은 2.1% ( 남성 1.6%, 여성 2.4%) 로나타났으며, 이환자들중치료를하는비율은 95.3% ( 남성 97.1%, 여성 94.4%) 로나타났다. 국가인구통계에따라총인구 50,763,158명 ( 남성 25,375,486명, 여성 25,388,672 명 ) 을유병률과치료율에대입하면유병률은 16,759,497 명 ( 남성 4,965,436 명, 여성 11,705,557 명 ) 이며, 치료율은 15, 971,801명 ( 남성 4,821,438명, 여성 11,050,046명 ) 을추정할수있다. 또한 2014년통계청보고서 17) 의건강보험질병소분류별상병급여현황에의하면, 치매연관질환의다빈도순위는알츠하이머병의치매 (F00) 가 177위, 상세불명의치매 (F03) 가 338위, 혈관성치매 (F01) 가 420위이며, 세질환에서발생하는의료비는 2014 년전체진료비 54조 (544, 271,565,867,000) 와급여진료비 40조 (407,920,841,521, 000) 원에서약 2.3% 를차지한다. 치매진단검사의빈도는간이정신상태검사 (MMSE), 전반 적퇴화척도 (GDS), 임상치매척도 (CDR), MRI, 치매일상생활력척도 (ADL) 등의순으로의과의진단검사빈도가한의과의치매검사보다높은빈도를보이며. 치매진료에대한의료시장은의과가한의과에비해월등히높은비율을차지하는것을확인하였다. 이는한의과의치매검사는한방신경정신과전문의로한정되어있고, 그것도의과처럼개별검사수가를책정한것이아닌, GDS, CDR, K-DRS 등치매선별, 임상단계평가로포괄적으로사용하게하고있다는점에서한의과임상현실을반영하지못한급여항목의불균형에서비롯된것으로사료된다. 본연구에서치매의정도에따른의료비현황을분석하였다. 먼저분석대상환자중경도인지장애는 19.5%, 치매가 80%, 경도인지장애에서치매로진행된환자수는 0.5% 로나타났다. 경도인지장애와치매동반상병코드를가진환자수가 76명 (0.5%) 이라는의미는 2014년한해단편적수치라할수있지만, 경도인지장애에서치매로진행된환자수및의료비를추정할수있을것으로사료된다. 하지만, 정상노인군의 1 2% 가매년치매로진행하고, 기억성경도인지장애의진단기준을사용할경우매년 10 15% 의경도인지장애환자가치매로진행된다는기존연구 9) 와는차이가많다고볼수있어, 보다엄격한경도인지장애코호트연구를통해치매진행과정을추산할필요가있을것으로사료된다. 환자당연평균지출의료비는경도인지장애가 288,388 원, 경도인지장애에서치매로진행이 218,824 원, 치매는 2,931,253원이었데, 이는중증치매환자의 1인당의료비용이경도인지장애환자보다 8배정도높다고하였고 8), 부양비용도최고도의치매노인이경도치매노인의부양비용에비해거의두배정도증가한다 7) 고한연구와유사하다. 따라서경도인지장애에서치매로진행되면의료비가급격히높아지며, 경도인지장애에서치매로진행되지않도록조기검사및관리가시행하면의료비를절감할수있다. 외국의치매관리현황을보면, 영국은치매에대한국가적으로높은우선순위이며, 모든노인에게보편적으로접근하여예방적서비스를제공하는전략으로 18), 치매에대한인식개선, 치매환자에대한지속적이고통합적인조기진단과치료및지원체계확립, 중앙정부와지자체그리고의료기관과의료인력의역할강화, 연구개발증진등모든분야에서치매관리에대한보다강화된정책을포괄하고있다 19). 미국의경우는치매의예방, 진단, 치료에대한연구의촉진

7 JB Lee, HW Kang, J Kim, G Kim, NK Kim 37 과환자에대한서비스전달의용이성등을입법정책의주요현안으로하고있다 20). 우리나라는최근의과에서는만 60세이상의치매환자의경우신경인지검사가건강보험에적용되었으며, 노인장기요양보험의과, 한의과 ( 한방신경정신과 ) 에서모두치매진단기본검사를통한치매등급평가를통한소견서발급을시행하고있으므로, 향후개발된치매조기진단기술이건강보험급여시장의성공적인진입을위해서는의과, 한의과에서동시에사용할수있도록하는것이바람직할것으로사료된다. 또한의과, 한의과두분야에서시행하는검사들에대한확진율 ( 민감도. 특이도 ) 을높임으로서, 조기진단, 예방및관리를통한국가의료비절감에기여할수있을것으로생각된다. 본연구는건강보험급여체계의의료시장현황을분석하여, 의과, 한의과의치매진단검사항목에따른이용과건강보험의료비용등을비교분석하였으며, 치매조기진단기술개발의비용효과성의규명을위한기초연구로중요한근거자료로이용될수있을것으로사료된다. V. 결론 본연구는치매조기진단기술개발의비용효과성에대하여 2014 년의건강보험심사평가원환자표본자료 (HIRA-NPS) 를대상으로하여, 건강보험급여체계의의료시장현황을분석하고의과, 한의과의치매진단검사항목에따른이용과건강보험의료비용등을비교분석하여다음과같은결론을얻었다. 1. 치매및경도인지장애질환별검사항목사용빈도분석결과, 청구건수는 27,784,176건, 수진자수는 1,447,441 명, 의료비는 1,413,908,900,000원으로조사되었다. 2. 총청구의건강보험요양급여중치매및경도인지장애상병 ( 전체 ) 의청구건수는 87,434 건 (0.3%), 환자수는 16,101명 (1.1%), 의료비는 38,680,789,560원 (2.7%), 청구건당평균의료비는 442,415원, 환자당연평균의료비는 2,402,384원으로추정되었다. 3. 경도인지장애환자는전체환자에서 3,144명 (19.5%), 경도인지장애와치매로같이청구된경우 ( 진행된환자 ) 는 76명 (0.5%), 치매환자는 12,881 명 (80.0%) 으로추정되었으며, 환자당연간의료비는경도인지장애환자가 288,388 원, 경 도인지장애와치매를같이진단받은환자는 218,824 원, 치매환자는 2,931,253 원으로추정되었다. 4. 의과에서치매및경도인지장애상병을등록한환자수는 16,824 명 (98.2%), 청구건수당평균의료비는 447,855 원, 환자당연간평균의료비는 2,291,185 원으로나타났으며, 한의과에서의환자수는 303 명 (1.8%), 청구건수당평균의료비는 98,379원, 환자당연간평균의료비는 441,895원으로각각추정되었다. 5. 의과의경우, 간이정신상태검사 (MMSE) 는전체치매및경도인지장애환자의 6.6%. 전반적퇴화척도 (GDS) 는 3.9% 치매척도검사 (CDR) 는 3.3%, 치매일상생활력척도검사 (ADL) 는 1.1% 등으로나타났고, MRI는 3.1%, CT는 1.1% 로각각확인되었다. 6. 한의과의경우는검사빈도가매우낮았으며, 가장많이사용된검사는맥전도검사였으며, 경락기능검사, 양도락검사, 치매검사 (MMSE, GDS, CDR, K-DRS 등 ) 등의순으로확인되었다. 7. 본연구는치매조기진단기술개발의비용효과성의규명을위한기초연구로주요한근거자료로이용될수있을것으로사료된다. 감사의글 본연구는한국한의학연구원주요사업중치매조기예측을위한미세생체신호기반한 양방융합기술개발과제 (Grant No. KSN ) 의지원을받아수행되었음. REFERENCES 1. Ko SK et al. The Social Burden and Care Management for People with Dementia. Korea institute for Health and Social Affairs Lautenschlager NT, Almeida OP. Physical activity and cognition in old age. Current Opinions in Psychiatry. 2006;19(2): Jorm AF. Is depression a risk factor for dementia or cognitive decline? A review. Gerontology. 2000;46: Statistics korea. Population Projections for Korea : Seoul National University Hospital. Nationwide study on the prevalence of dementia in Korean elders. Seoul: Ministry for Health, Welfare and Family Affairs; National Institute of Dementia, Korean Dementia Obser-

8 38 A Study on Medical Expenses of Modern and Korean Medicine for Dementia Patients Under National Health Care vatory Park CJ, Kang WM. Estimating the Economic Costs of Informal Caring for the Demented Elderly. Journal of the Korea Gerontological Society. 2002;22(3): Hong CM. A study on dementia and mild cognitive impairment. The Korea Contents Society. 2012;6: Korean Dementia Association. Dementia A Chlinical Approach. 2nd ed. Anyang:academya. 2011: Kim et al. Gender differences in risk factors for transition from mild cognitive impairment to Alzheimer s disease: A CREDOS study. Comprehensive Psychiatry. 2015;62: Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST. Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review). Neurology. 2001;56: Park HS, Uhm TW, Kim NK. A Study on the facial palsy patients use of Western-Korean collaborative treatment: Using Health Insurance Review & Assessment Service- National Patients Sample. Journal of the Korean Data & Information Science Society. 2017;28(1): Korean Medical Association. Health Care Medical Care Costs Min SK. Modern PSYCHIATRY. 6th ed. Seoul:Ilchokak. 2016: Kim Y, Shin S, Park J, Jung YJ, Kim J, Lee TJ, Bae EY, Song HJ. Costing methods in Healthcare. National Evidence-based healthcare Collaboration Agency Statistics korea. Prevalence and cure rate of doctors diagnosis of chronic diseases of elderly people over 65 years old, Statistics korea, The multi frequency private st class pay present condition by elderly disease sub-category over the age of Yoo CU, Lee HJ, Yang YA. Common Diseases in the Elderly -Data from Korea National Statistical Office-, Korean Aging Friendly Industry Association, 2013;10(1): Kim MK, Seo KH. A Comparative Study on the National Dementia Policy, Institute of Public Policy & Administration, 2017;31(1): Cho H, Ko Zk. Current State of Senile Dementia and Improvement of the Long Term Care Insurance for Elderly People. Korea Academy Industrial Cooperation Society. 2012;12:

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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