마산의료원 신축사업.hwp

2011 년도타당성재조사보고서 마산의료원신축사업 2011. 9. 공공투자관리센터 한국개발연구원

요약

제 I 장타당성재조사의개요 1. 사업추진배경과필요성 1972.,. SARS,, 2. 사업추진경위 ( ) 3 17 2008 ( ) 1) -

50 50 1 50%. 2007 4 08. 2008 10 2009 9 ( ++ 35). < 표 1> 사업진행현황 2007. 4. 08 2007. 12. 18 2008. 10. 16 2009. 9. 10 - + + 35 2010. 2. 5 ( ) 2010. 4. 30 2010. 9. 9 ( ) 2010. 9. 29 2010. 6. 15 () 2010. 11. 5, (707,, ) 2010. 12~2011. 7 KDI 3. 사업내용 : 3, 4 3-6 : 2008~2014 (7 ) : 28,449 (8,605 ) : 29,685

- 27,395, 2,290 - : 2 ~ 6 - : 300( 250, 50) [ 그림 1] 조감도 : 664.65 : (: ) : 50%, 50% 4. 총사업비변경내역 ( ) ) 35. - : 13,288 28,449 ( 15,161 ) - () 2008~2013 () 2008~2014

- : 450 664.65( 214.65) - : 205 300( 95) < 표 2> 총사업비비교표 (A) (B) (B-A) % <> 45,000 66,465 21,465 47.7 35,843 52,942 17,099 47.7 (205 300) (13,28828,449 ) 4,157 5,423 1,266 30.4 5,000 8,100 3,100 62.0 : ( -1011, 2010.12.03) 5. 타당성재조사의배경 450 664.65 ( 500 300 ). : 10 49 1 < > 49 ( ). 1.,, 2)

제 Ⅱ 장기초자료분석및조사의주요쟁점 1. 기초자료분석 3) 2. 공공의료기관및마산의료원현황 가. 공공의료기관현황 -,,,,,,. 2010 34 29, 5. 2010 5, 3, 2. 300 9, 1, 200~300 11, 2.

200 14, 2. < 표 3> 지방의료원현황 500 23 70 70 -, 500 19 48 48 -, 421 20 32 32-290 17 30 30 -, 125 11 18 11 7 x x 149 15 24 18 6 x 143 15 20 13 7, 151 13 18 11 7 x 252 17 23 16 7 100 15 19 12 7 x 250 13 24 16 8 111 14 18 11 7 143 13 19 12 7 x 190 14 16 7 9 x 125 12 14 7 7 x 424 22 34 29 5 238 15 19 12 7, 154 10 12 7 5 212 13 20 13 7 422 18 30 20 10 190 15 21 14 7 430 21 53 45 8, 350 18 32 25 7, 130 12 16 9 7 x 120 10 12 3 9 x x 180 9 13 6 7 x 261 14 18 12 6 200 18 22 13 9 x 165 17 21 13 8 105 11 18 9 9 x 231 15 21 15 6 240 15 23 16 7 x 297 7 11 2 9 x x 218 14 24 14 10 x : 1), 2), 3) *** ( ) :,, 2010.

< 표 4> 적십자병원현황 360 18 36 36 -, 153 12 15 15 - x 249 13 21 15 6 129 9 11 5 6 x 84 12 11 4 7 x x : 1), 2), :,, 2010. 나. 경상남도, 창원시의료기관현황. < 표 5> 경상남도내공공의료기관현황 231 15 21 15 6 240 15 23 16 7 x 129 9 11 5 6 x 84 12 11 4 7 x x 171 12 17 16 7 : 1), 2), :,, 2010. 2009 13.4 7.8.,

-.. - 2015 700. < 표 6> 통합창원시의료기관현황 (2009 년 ) 460 7,797 6 1,854 8 1,677 1 6 3 481 4,751 3 1,148 7 1,203 1 3 2 161 2,086 1 250 2 308 1 1 2 1,102 14,634 10 3,252 17 3,188 3 10 7 다. 마산의료원현황 1914 1983. 13,288.3, 11,408,,,,, 1972. 231, 6 5 70%. < 표 7> 마산의료원의병상현황 () (%) 3 1.3% 1 6 2.6% 2 12 5.2% 3 15 6.5% 4 16 6.9% 5 50 21.6% 6 108 46.8% 7 14 6.1% 7 3.0% 231 100%

- 14(,,,,,,,,,,,,, ) - 158 155 7 51 < 표 8> 마산의료원의인력현황 158 16 2 70 17 19 2 5 27 155 14 2 70 17 18 2 5 27 : 7, 51. - 2009 100 61,664, 29,338. 16.7%, 21.8%. - 2001 2010 80.3%,,. < 표 9> 마산의료원의연도별병상이용율 ( ) ( ) 2001 68.2% 57,471 157 15 2002 71.5% 60,282 165 17 2003 87.5% 73,741 202 18 2004 88.3% 74,637 204 16 2005 85.5% 72,115 198 17 2006 75.8% 63,952 175 15 2007 81.1% 68,402 187 15 2008 86.0% 72,725 199 15 2009 80.8% 68,156 187 14 2010 78.6% 66,245 181 14 80.3% 67,773 186 16 : ( )

. -,,, 10,198 (2010 ). -, U-Health care. 3. 타당성재조사의주요쟁점 -. -,, - 231 69 300.. -,.,. - 664.65.,.

- 300. - D. - ( ) - (, 1996~2008) - 2.. -,,.

제 Ⅲ 장사업계획의적절성검토 1. 사업의개요, 664.65 2015 2011 ~2014,. < 표 10> 사업주체제출총사업비 (: ) 24,265 1,669/ 40,498,000 5,420 1,028/ 5,572,000 46,070,000 6,685 1,028/ 6,872,000 52,942,000 5.15% 2,727,000 4.0% 2,118,000 57,787,000 ( + + ) 1.0% 578,000 58,365,000 250 50,000 60% 7,500,000 50 20,000 60% 600,000 8,100,000 66,465,000 300 < 11>. - 16,735, 24,265, 36,370.

< 표 11> 마산의료원신축부문별면적 (300 병상기준 ) ( ) ( ) -1 832-2 832-3 832-4 832 832 358 4,518 / 493 / 241 /// 263 / / 237 484 316 70 249 2,353 647 629 / 139 440 ( ) 550 329 2,734 150 380 197 167 515 250 / 1,369 82 3,110 810 200 320 40 360 1,730 (8 ) 2,290 2,290 16,735 ( 1.45 ) 7,530 24,265 80.9 5,420 29,685 99.0 6,685 36,370 121.2

-. -,,,,, 4),. 2. 시설규모의적정성검토. 28,449 82.65 (25 )~165.29 (50 ) 300 24,795 ~49,587. (G/N ) -. - 34 2000.

< 표 12> 병상당연면적기준유사사례 ( ) ( ) 2001 38,705.03 500 77.41 23.42 / 2002 22,351.90 427 52.35 2002 24,868.24 400 62.17 17.49 / 2002 10,488.38 105 99.89 2002 18,543.06 297 62.43 18.89 / 2007 28,244.00 400 70.61 21.36 / ( ) 68.16 20.37 / : (, 2006.11) -,,, 4. - 250. - 160, 90,. - 121.2, 250 68.16 20,448. < 표 13> 업계획및검토안의시설면적추정 205 300 300 13,288 28,449 28,449 29,685 36,370 20,448 (8,980 ) (11,021 ) (6,186 ) ( /) 144.8 121.2 68.16 (21.33 ) : 36,370 6,685.

3. 공공병원으로서의역할에대한적정성검토 가. 지역거점공공병원의개념과기능 10. (,,, ),. 2008... 나. 마산의료원의공공보건의료사업현황및계획,,. 2008. U-Health care 2010

< 표 14> 마산의료원의공공의료실적 (: ) 2008 2009 459 167 2,090 2,722-40 - 49 40 29-93 163 5,035 109 112 414 492 610 1,042 70 417 40-260 - 72-4,327 10,198 : 1), 2008, 2009. 2), 2009, 2010. < 표 15> 연도별법정전염병진료현황 (: ) 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 141 79 93 241 176 65 56 53 120 73 1,024 1,431 1,131 1,319 2,584 3,051 813 505 785 752 552 12,371 다. 지역거점공공병원으로서역할검토. - U-Health care,,

.. 제 Ⅳ 장비용추정 1. 비용추정의개요. < 표 16> 비용추정조사절차및방법, -. - 2009.

< 표 17> 본사업의현행및요구안검토 ( ) 40,000 58,365 5,000 8,100 45,000 66,465 205 300 ( 15 ) 13,288 28,449 29,685 36,370 ( 6,685 ) 2, 6 2, 6 2008 ~2011 2008 ~2014 2. 항목별비용추정 가. 공사비산정,,,, 5 < 표 18> 공공병원유사사례공사비단가산정 (: ) ( ) ( ) ( ) 16,608 1,842,256 2007 113.3% 2,087,276 1,897,524 14,051 1,865,794 2008 101.7% 1,897,512 1,725,011 92,884 1,825,767 2008 101.7% 1,856,805 1,688,005 26,487 2,083,883 2009 100.0% 2,083,883 1,894,439 24,689 1,793,511 2009 100.0% 1,793,511 1,630,465 () 1,944,000 1,767,000

-,. - 20,448, 176.7. - (300) 397.45. < 표 19> 건축공사비산정 ( ) ( ) ( ) (300) 20,448 1,767,000 36,131.6 39,744.8 나. 용지보상비산정 ( 5 ).,.,,. 69.26. 141.26.

< 표 20> 용지보상비산정 (: ) 5,882.2 403.8 6,286.0 6,286.0 8.2 / 329.4 337.5 337.5 () 7,200.0-54.7 54.7 247.8 247.8 14,126.0 6,926.0 - : 36, 22 - : 2, 5, 4 / ( ), ( ) 다. 시설부대경비산정 = + + -. - 2009. - 2009 20.83, 19.19, 0.91, 40.93.

< 표 21> 시설부대경비총합 (: ) (300) 2,082.6 1,918.5 91.4 4,092.5 라. 기타투자비산정 2007 ( ) - 2007, 300. < 표 22> 병상당의료장비비및비품비 (: ) (300) (2007 ) 51.2 (%) 107.6% () 55.1 16,530.0 2009 8,657.7( 37.5) :. :, 2007, 2008. 7,872.3 231 300-300 17.28 2010 10.74

- 2010 2009 6.35., 2009 < 표 23> 개원전운영비합계 (1) (300) 300 69 245,295 103,155 348,450 ( ),,. < 표 24> 이전비및철거비산정 (: ) () (2009 ) 2008 67,400 69,287,,,,, 89.26. < 표 25> 기타투자비산정 (:, ) (300) 7,872.3 5 635.4 5 245.3 (1) 103.2 348.5 69.3 8,925.5

3. 총사업비종합 2009, 596.89. < 표 26> 총사업비집계 (: ) (A) ( 09.12) (B) (B)-(A) A. 52,942.0 39,744.8-13,197.2 5,423.0 4,092.5-1,330.5 B. 2,727.0 2,082.6-644.4 2,118.0 1,918.5-199.5 578.0 91.4-486.6 C. - 6,926.0 6,926.0 8,167.4 8,925.5 758.1 8,100.0 7,872.3-227.7 D. - 635.4 635.4 348.5 348.5 67.4 69.3 1.9 E. 66,532.4 59,688.8-6,843.6 : 1). 2) 3) 66,465 66,532.4. 4. 경제성분석을위한비용산정,, 5 5-71.57, 5.78 77.34.,

37 46. - 2009 1 < 표 27> 장기요양병상인건비 1 () ( ) 40 1 1 188,502 188.5 6 37,868 227.2 6 1 2 29,599 59.2-2 43,590 87.2-1 37,516 37.5 12 599.6-2009 < 표 28> 장기요양병상관리운영비 () ( ) ( ) 231-4,142,962 17,935-83 46 17,935 825.0 D. D C. < 표 29> 단순구조개선보강공사비산출 (: ) 159.9 1,068.4 18.7% 29.9 199.8, 27.3% 43.7 291.7 ( ) 233.5 1,559.9 ( ) 212.3 1,418.1

제 Ⅴ 장수요추정 1. 병상수요추정의전제. -,,,,, - 80.8%, / 6.3% - / 76.1%, / 6.9%, 5.2% - 2006 55 ( ) (RI) -. < 표 30> 마산시에대한지역친화도 RI 66.1 41.8 26.5 17.7 15.4 10.2 6.1 3.5 409,776 68,926 30,965 62,085 508,984 58,554 109,578 491,899 : RI (2008). 2009. 3,.

2. 병상수요추정. - 2006 ~2009 0.58% 2007. 2007 2006 ~2009 2.21% 0.63%. -. -, 65 20%.. - 2018. 2044. (CI: Commitment Index) 지역소재의료기관을이용한 지역환자의의료이용량 지역소재의료기관을이용한총의료이용량 - 52.0%, 12.4%, 6.0%, 3.8%, 3.1%, 3.0%. - 58.8%, 10.3%, 8.4%, 6.0%. - 61.6%. (RI: Relevance Index) 지역소재의료기관을이용한 지역환자의의료이용량 지역거주환자의총의료이용량

- 66.1%, 9.9%, 8.6%, 4.3%. - 56.5%, 15.4%, 10.2%, 5.0%. - 38.0%. RI CI. / 76.1%, 83.3%. (RI) RI 6.9%. - 18.0%, 11.2%, 8.4%, 7.5%, 7.3%, 6.9%. -.. -,,,. -,,,,,, ( ). 169~229. - 1: 186 ( 185.775) 24%( 10 ), 45(186 24%), 141(186-45). 80.33%

, 19.67%, 169( 141*(1+0.1967)=168.73). - 2: ( 식 1) k, k.,, k. (1) 명 일 병상 ( 식 2) 일 (2) 병상 병상 ( 식 3) (3) = 174.58 + 54.83 = 229.41 77 83. - 1:,, RI 1,199( ) 0.069( RI)=83-2:. 34% 77. 3,930() 0.0575() 0.3 4() = 77 246 312.

제 Ⅵ 장편익산정 1. 편익의종류와추정방식. - ( ). - do-nothing. (public healthcare). 83, 37 46. - 46 100%, 45.6 368. 병상 일 약 명 일 10.34. 1 0.2248/ 45.6 (0.125 ) 368 = 10.34() - QALY(quality-adjusted life years) 5)

. - QALY 30.17%*17,132,215 +33.70%*39,322,000 +22.33%*16,034,720 +13.80%*3,462,910 =22,478,737.8 0.2248/ / - 45.6 ( 1.5, 0.125 ). - / 84.5%, / 4.3%. - / 84.5%, 67%, 2.4%. 60.02. 158 *6.7%*5.67 60.02-158 2006 2010. - 6.7% (2008). - 5.67 1 2009 6). ( ) 10.(55.5%, ) - (WHO) (2010), 2009

2,292. - Kang(2006) 7) (2006) 8) () 1 4.2, 18.3, 35.0. (drug susceptible TB patients) 2.4. 10.63. 12 *0.35+9 *0.1125+226 *0.024 10.63-2008 10 150.8 618. 4%, 24.7. - 24.7 10 247. 5% 12. - 235 4% 9, 226 (drug susceptible TB patients). - 12 35, 9 11.25, 2.4, 10.63. 0.62. - 2001 ~2008 12.1% WHO.

- (2009) 9) (contingent valuation method: CVM) () 168.5. () = *12** 60-60 0.37% 0.62.. -. -. -,. 2015 2044 30 81.61. < 표 31> 편익의종합 (: ) () 2015 10.34 60.02 11.25 81.61 2044 10.34 60.02 11.25 81.61

제 Ⅶ 장경제성분석 1. 경제성분석의전제 ( 5 ) 30. 2011 2014 2015 30-2011 2044, 2009. -. : 5.5% 2. 경제성분석결과 907.53, 798.08 B/C 1.14. < 표 32> 경제성분석결과 300 ( ) (:, %) B/C NPV IRR 798.08 907.53 1.14 109.45 7.12 B/C 1. 3.5%~7.5% B/C 1.34~0.97. -30%~+30% B/C 1.62~0.87.

-30%~+30% B/C 0.80~1.48. < 표 33> 비용및편익흐름 (: ) 2011 141.26 69.43 22.59 233.27 209.59 2012 69.43 3.65 73.08 62.24 2013 86.78 5.48 21.47 1.16 114.89 92.74 2014 121.50 5.48 3.49 0.63 50.10 4.62 185.81 142.17 2015 14.25 14.25 10.33 10.34 60.02 11.25 81.61 59.19 2016 14.25 14.25 9.79 10.34 60.02 11.25 81.61 56.10 2017 14.25 14.25 9.28 10.34 60.02 11.25 81.61 53.18 2018 14.25 14.25 8.80 10.34 60.02 11.25 81.61 50.40 2019 71.57 5.78 14.25 91.59 53.62 10.34 60.02 11.25 81.61 47.78 2020 14.25 14.25 7.91 10.34 60.02 11.25 81.61 45.29 2021 14.25 14.25 7.49 10.34 60.02 11.25 81.61 42.93 2022 14.25 14.25 7.10 10.34 60.02 11.25 81.61 40.69 2023 14.25 14.25 6.73 10.34 60.02 11.25 81.61 38.57 2024 71.57 5.78 14.25 91.59 41.03 10.34 60.02 11.25 81.61 36.56 2025 14.25 14.25 6.05 10.34 60.02 11.25 81.61 34.65 2026 14.25 14.25 5.73 10.34 60.02 11.25 81.61 32.84 2027 14.25 14.25 5.43 10.34 60.02 11.25 81.61 31.13 2028 14.25 14.25 5.15 10.34 60.02 11.25 81.61 29.51 2029 71.57 5.78 14.25 91.59 31.39 10.34 60.02 11.25 81.61 27.97 2030 14.25 14.25 4.63 10.34 60.02 11.25 81.61 26.51 2031 14.25 14.25 4.39 10.34 60.02 11.25 81.61 25.13 2032 14.25 14.25 4.16 10.34 60.02 11.25 81.61 23.82 2033 14.25 14.25 3.94 10.34 60.02 11.25 81.61 22.58 2034 71.57 5.78 14.25 91.59 24.02 10.34 60.02 11.25 81.61 21.40 2035 14.25 14.25 3.54 10.34 60.02 11.25 81.61 20.29 2036 14.25 14.25 3.36 10.34 60.02 11.25 81.61 19.23 2037 14.25 14.25 3.18 10.34 60.02 11.25 81.61 18.23 2038 14.25 14.25 3.02 10.34 60.02 11.25 81.61 17.28 2039 71.57 5.78 14.25 91.59 18.38 10.34 60.02 11.25 81.61 16.37 2040 14.25 14.25 2.71 10.34 60.02 11.25 81.61 15.52 2041 14.25 14.25 2.57 10.34 60.02 11.25 81.61 14.71 2042 14.25 14.25 2.43 10.34 60.02 11.25 81.61 13.94 2043 14.25 14.25 2.31 10.34 60.02 11.25 81.61 13.22 2044-138.24 71.57 5.78 14.25-46.64-7.63 10.34 60.02 11.25 81.61 12.53 3.02 347.14 37.21 3.49 0.63 500.96 40.43 427.38 1,360.37 798.08 310.2 1,800.6 337.5 2,448.3 907.53

3. 재무성분석및민자유치가능성검토 B/C 0.9. 2 BTO BTL. -. < 표 34> 마산의료원신축사업의 1 단계 Check List 평가결과 1 2 3 2? Yes Yes Yes Yes SOC,,??? (toll/user fee) Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No, No No No No? 1 Check List. BTO BTL. BTL, 1 BTL.

제 Ⅷ 장정책적분석 1. 지역균형발전 16 9, 168 50. - (43 ), (29 ), (43 ), (81 ), (65 ). - 21. < 표 35> 지역낙후도산정결과 0.498 46.803 33.203 10.943 23.435 0.882 0.104 3.013-0.157 9 7 2 10 6 12 10 12 11-0.324 40.390 38.500 4.723 23.497 1.659 0.151 5.906 0.331 50 65 46 43 81 43 29 21 40 < 표 36> 지역경제파급효과 () (%) () (%) ( ) (%) ( ) (%) 524.11 63.06 224.80 68.51 458.58 79.16 481.65 74.41 2,042.58 100.00 811.23 100.00 1,521.50 100.00 1,695.99 100.00

,. - 0.0277% 2008 0.1789%. < 표 37> 지역경제활성화효과 (: ) () 398.5 224.8 (GRDP, 2009 ) 811,657.1 0.0277% : 1) 2009. 2) AHP GRDP. 3) 2008 42 0.1789%. 2. 정책의일관성및추진의지 3 4, 17,. 2010 12. 3 (2008~2020) (2011. 3)..

300 100,.. -. -.. -.. 3. 사업추진상의위험요인 (2010~2014),. -, 4., 518.

- 2010 409 109 4 300. < 표 38> 2010 년도보건복지부소관분야별세출예산 10 (A) 11 (B) (:, %) (B-A) % 19,473,580 20,692,179 1,218,599 6.3 14,275,740 15,315,372 1,039,632 7.3 5,197,840 5,376,807 178,967 3.4-878,289 729,665-148,624-16.9-4,319,551 4,647,142 327,591 7.6 :, 2011, 2010. 12. < 표 39> 경상남도분야별예산현황 (:, %) 2011 2010 (%) 5,844,918 5,617,073 227,845 4.1 180,474 116,012 64,462 55.5 711,753 648,409 63,344 9.7 419,651 351,280 68,371 19.4 625,499 815,638-190,139-23.4 225,282 201,566 23,716 11.7 1,558,049 1,487,373 70,676 4.7 2,124,210 1,996,795 127,415 6.4,,,.,,.. -,.

제 Ⅸ 장종합결론및정책제언 1. AHP 종합평가 AHP 300 AHP. < 표 40> 마산의료원신축사업의조사결과요약 ( ),, 28,449 (8,621 ), 20,448 (6,186 ) 2011~2014 ( 4 ) 50%, 50%. - : 25,449 (8,621 ) - : 20,448 (6,186 ) : 300 2008~2014 () 596.89 B/C 1.14 NPV 109.45 IRR 7.12% : 50/168 ( ) : 9/16 () (%) 0.0277% AHP, 6 0.5,

0.564. < 표 41> AHP 평가결과 1 0.612 0.388 2 0.582 0.418 3 0.540 0.460 4 0.559 0.441 5 0.538 0.462 6 0.537 0.463 0.564 0.436 2. 종합결론. 3, 4 3-6 28,449, 36,370 2008~2014. - 49 1 1 : 205 300 : 450 664.65 2000 68.16 : 596.89(2009 )

- : 397.45 - : 69.26 - (,, ): 40.93 - (,,, ): 89.25 /,,,,,, 169~229, 77~83 246~312,, ( ) 2015 2044 30 81.61, B/C 1.14. - 2 BTO - 16 9, 168 50. - 0.0277% 2008 0.1789%. -,,,.

-,. -. -,,. -,. < 표 42> 타당성재조사결과비교 (: ) ( 09.12) 1) 3, 4 - : 13,288 - : 29,685 : 205 2, 6 - : 28,449 - : 36,370 4) : 300 2, 6 2008~2014 (7 ) - : 28,449 - : 20,488 : 300 2, 6 35,843 52,942 39,745 - - 6,926 35,843 52,942 46,671 2,727 2,083 2,118 1,919 578 91 4,157 5,423 4,093 5,000 8,167 8,925 45,000 66,532 5) 59,689 B/C - - 1.14 AHP - - 0.564 : 1). 2),. 3). 4) 36,370 6,685. 5) 664.65 665.32.

3. 정책제언,,.,,,. (2011. 3.),..