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주요어 인력 고가의료장비 병상수 대학병원 상급종합병원 의료서비스학번
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구분정형외과이비인후과소화기내과소아청소년과 상수항 6.80(1.58)**** 5.50(2.34)** 6.03(3.06)* 2.04(3.75) 의사 1 인당초진환자수 -2.03(2.01) -5.29(2.40)** -3.94(8.38) -4.25(4.91) 병상수 9.28(2.50)**** 4.78(2.71)* 8.27(4.4)* 1.06(6.17)* 고가의료장비 -4.31(1.33)*** -6.57(1.49) -9.17(3.86)** -2.32(4.87) 인구밀도 -2.81(2.86) -4.84(3.00) -7.81(5.06) -1.51(1.69)* GRDP 1.02(5.99)* 2.50(6.53) -6.13(1.08) 1.60(1.44) 65 세이상노인비율 설립주체 ( 사립 :0, 공립 :1) -9.46(1.30) -1.44(1.57) 8.13(1.92) 8.99(3.19) -1.43(7.20)** -1.06(7.48) -5.16(1.27) -1.51(1.69) R square 0.544 0.378 0.260 0.386 F test (7,29) 4.93*** 2.52** 1.45 2.60** - 24 -
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구분정형외과이비인후과소화기내과소아청소년과 상수항 -1.73(2.15) 5.46(3.36) -2.97(6.83) 4.05(4.10) 의사 1 인당초진환자수 0.02(0.03) -9.92(3.96)** -4.29(1.87)** -1.58(5.37)*** 병상수 0.002(0.003) 4.04(4.37) 1.26(1.00) 5.27(6.74) 고가의료장비 0.007(0.029) -1.99(3.47) -3.98(7.93) 2.27(5.32) 인구밀도 -38.81(43.25) -4.13(4.86) -1.52(1.12) 1.24(7.37) GRDP 0.06(0.08) 1.48(1.04) 2.65(2.41) 2.25(1.57) 65 세이상노인비율 설립주체 ( 사립 :0, 공립 :1) 0.20(0.19) 1.15(2.40) 3.38(5.28) -2.20(3.49) 0.68(1.10) 4.57(1.22) 1.12(2.84) -1.08(1.85) R square 0.252 0.421 0.410 0.367 F test (7,29) 1.39 3.03** 2.87** 2.40** - 26 -
구분정형외과이비인후과소화기내과소아청소년과 상수항 6.97(11.78) 20.10(14.31) 9.36(1.51) 34.07(14.00)** 의사 1 인당초진환자수 -0.31(0.16)* -0.001(0.001) 3.70(4.15) 0.001(0.001) 병상수 -0.006(0.02) -0.01(0.02) 3.02(2.23) -0.01(0.02) 고가의료장비 0.23(0.15) 0.28(0.14)* -2.21(1.75) 0.10(0.19) 인구밀도 596.87(236.51)** 518.04(206.65)** -4.70(2.48)* 367.87(253.41) GRDP -0.27(0.48) -0.06(0.44) -7.60(5.34) -0.07(0.53) 65 세이상노인비율 설립주체 ( 사립 :0, 공립 :1) 0.54(1.04) -0.64(1.02) 4.70(1.16) -0.90(1.18) -12.85(6.02)* -13.89(5.21)** 1.27(6.28)** -2.00(6.32) R square 0.351 0.465 0.229 0.208 F test (7,29) 2.24** 3.59*** 1.23 1.09-27 -
구분정형외과이비인후과소화기내과소아청소년과 상수항 -0.07(12.00) 11.57(16.93) 3.18(1.40)** -10.97(13.29) 의사 1 인당초진환자수 0.03(0.15) 0.001(0.001) -3.91(3.85) 0.001(0.001) 병상수 -0.01(0.01) -0.02(0.02) -4.90(1.99) 0.01(0.02) 고가의료장비 2.33(1.01)** 0.26(0.17) 1.23(1.77) -0.01(0.17) 인구밀도 295.24(217.24) 556.58(244.59)** 1.50(2.32) 272.04(239.32) GRDP 0.03(0.45) -0.21(0.52) 6.21(4.96) -0.76(0.51) 65 세이상노인비율 설립주체 ( 사립 :0, 공립 :1) -0.69(0.98) 0.08(1.21) -1.75(1.08) 1.92(1.13) -12.13(5.45)** -8.90(6.17) -1.65(5.83)*** -4.21(6.01) R square 0.464 0.250 0.331 0.286 F test (7,29) 3.58*** 1.38 2.05* 1.66-28 -
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구분정형외과이비인후과소화기내과소아청소년과 상수항 8.12(2.87)*** 3.77(1.00)*** 3.03(1.73)* 3.55(1.36)** 의사 1 인당초진환자수 -0.001(0.04) -0.0005(0.0001) **** 2.56(4.75) -6.21(1.78) 병상수 -0.002(0.004) 0.001(0.001) 3.07(2.56) -1.61(2.24) 고가의료장비 -0.01(0.03) -0.015(0.01) 2.76(7.20) 2.83(1.76) 인구밀도 -72.03(57.66) 15.77(14.55) 4.65(2.84) -2.28(2.45) GRDP -0.05(0.11) -0.06(0.03)* -5.26(6.12) -4.74(5.24) 65 세이상노인비율 설립주체 ( 사립 :0, 공립 :1) 0.61(0.25)** 0.13(0.07)* 2.81(1.33)** 1.57(1.16) 2.85(1.46)** -0.37(0.36) 2.76(7.20)**** -1.57(6.16)** R square 0.544 0.378 0.260 0.386 F test (7,29) 2.91** 6.85*** 3.43*** 2.66** - 30 -
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A Study on the Effect of Resource Level in Extra-large Hospitals on Medical Service Delivery (Abstract) There is hard part that the general people can easily access the medical care because the medical knowledge is considerably specialized and segmented more than other fields. In other words, it appears the asymmetric information between the medical institutions as suppliers like providers and patients as consumers. As a result, there may be the factors in the medical institutions to change the behavior or amount of medical service delivery which offers to the patients according to the resource level which is inputted to the hospitals. In case of Korean health care system, especially, there is a higher probability in such behaviors by introduction of national health insurance system in unprecedentedly short period of time because there exist economic barriers in the medical service for the people and the payment system like fee-for-service is chosen without the limit of medical expenses. If the amount of medical service can be changed according to the resource level which inputs to medical institutions, not medical service delivery, based on the disease for the patients in the extra-large hospitals, it can have macroscopic effect on the expenditure size of medical expenses. However, a lot of difficulties exist in the information collection by medical institution in order to analyze the increase of expenditure size of medical expenses by the supplier side. In addition, there are difficulties in clearly classifying whether the change of medical service delivery level is affected by the resource level, or not. Eventually, related research analysis - 37 -
did not rise accordingly in Korea and it can have macroscopic effect on the expenditure size of medical expenses. Furthermore, most of research has been conducted by limiting its object as clinic class. However, since the Moon Jae-in government was recently inaugurated, the so-called "Moon Jae-in Care" remains to be a big issue of medical world based on down-regulating the annual upper limit on an individual's payment and paying the upper grade hospital room bills by making the non-payment item as paying like MRI and ultrasonic, etc. Such policy of expanding coverage can improve the accessibility of medical care and decrease the economic burden for the people, but in case of the mild disease for the patients due to the side effects, the "concentration of patients in university hospitals" in order to receive professional treatment in the university hospitals can be intensified. This study was to reflect on such situation positively and select the department of medicine which can have relatively various test and prescription, not large variation in severity, between the university hospital with the substantial expenditure of medical expenses and department of medicine in the upper-scale general hospitals as total four departments of medicine by surgical areas(orthopedics, otolaryngology) and medical areas(gastroenterology, pediatrics). In addition, this study was to do empirical analysis whether there are differences in the amount of medical service delivery according to the resource level of medical institutions as an object of such departments of medicine. For the behavior as medical service provided from the extra-large hospitals, this study was to calculate the admission rate, established patient rate, treatment cost per case and length of hospital stay. For the independent variables, this study was to include the three typical resources in the medical institutions like manpower, number of bed and ownership which displayed the characteristics of medical equipment and medical institutions, lastly population density to display the regional characteristics, GRDP per capita and rate of over 65-years old elderly. From the result of this research above, it may be summed up as follows. The more the number of bed in the whole department of medicine, the more the admission rate significantly increased. At three departments of medicine except the orthopedics is mainly hospitalization, the more the number of new patients per one doctor, the more the established patient rate to revisit the hospital by the patients was significantly increased. - 38 -
Besides, the effect of resource level on the medical service delivery differed from the characteristics by department of medicine. The more the expensive medical equipment, the more the otolaryngology increased in the outpatient treatment cost per case. In case of orthopedics, this study has shown the tendency that the hospital treatment cost per case has increased significantly. Additionally, from the change by ownership, this study has shown the tendency that the public hospitals had lower treatment cost per case than that of private hospitals. As such, it would mean a lot from the empirical analysis in this study that the differences in the volume of service could exist according to the input resources in the university hospitals and upper-scale general hospitals where to do high level of medical practice with the highest severity in the medical system in Korea. This study was to predict that the expenditure size of medical expenses increased by a substantial level due to the increase of patients with aging and chronic disease in Korea that was rapidly accelerating. The more difficult such situation, it needs to utilize the appropriate medical service for the patients who actually needed the medical service by putting the right man in the right place. For such prerequisites, it requires a move towards the construction of appropriate system in order to do physician practice, considering patients' health status only, based on the objective clinical data which has been accumulated for many years, not individual profit, when the supplier proceeded with the medical practice as medical care policy. Key words: manpower, expensive medical equipment, number of bed, university hospital, upper-scale general hospitals, medical service Student Number : 2015-24100 - 39 -