저작자표시 - 비영리 - 변경금지 2.0 대한민국 이용자는아래의조건을따르는경우에한하여자유롭게 이저작물을복제, 배포, 전송, 전시, 공연및방송할수있습니다. 다음과같은조건을따라야합니다 : 저작자표시. 귀하는원저작자를표시하여야합니다. 비영리. 귀하는이저작물을영리목적으로이용할수없습니다. 변경금지. 귀하는이저작물을개작, 변형또는가공할수없습니다. 귀하는, 이저작물의재이용이나배포의경우, 이저작물에적용된이용허락조건을명확하게나타내어야합니다. 저작권자로부터별도의허가를받으면이러한조건들은적용되지않습니다. 저작권법에따른이용자의권리는위의내용에의하여영향을받지않습니다. 이것은이용허락규약 (Legal Code) 을이해하기쉽게요약한것입니다. Disclaimer
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.,,,,,,,,,. 40 1,,,,,,,,,,,,,.,.,,., Sweet home,,. 2017 6
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,,,. 18, GEE., 0.93 (95% CI 0.80-1.08).., GEE, 0.2,, 0.1,. 23,187 - vi -
,, 332,346, 274,508,., 5 4 140,744, 3 201,410, 2 313,498, 1 386,010,..,,.. :,,,,, GEE - vii -
1. 1990,,.,, (, 2001). 2017,.,,,. 2015 100 65, 49.7, 35 (, 2016).,.,, - 1 -
,. 2011 2013 3. 2. 18.,,.., ( ).,. - 2 -
Ⅱ. 1. (2016),, (, 2008;, 2009; Kim et al., 2012),, (Kim et al., 2013), (, 2007).,. (2010) (RII; relative index of inequality) (CI; concentration index), 17%~30%.. (2011) 2009 4 3 Le Grand,.. Kim (2012) - 3 -
,. < 1>. 1. () 1 2 3 4 5 (2007) (GEE) (2008) (2011) (2005),,,, - 4 -
2.. Andersen.., (, 2009).,.,,,.,,,,,,...,. Andersen. (, 2000).,. - 5 -
.., (,, 2013)., (permanently sick), (RCGP et al., 1995).,.., (Monteiro, 1973). (,, 2006). (, 2009). (2010),,,. (2008),.. (2010),, - 6 -
, 10 10. 10.,., (Hafner-Eaton, 1993;,, 1994;, 2009;, 2000;, 2012;,, 2007). (2011), 3. (2009). (2013) 2009.,,,,,. (2012).,., - 7 -
,...,,,. (,, 2006;, 2007)..,,.,,..,. (,, 2012).,,,. (, 1994;, - 8 -
2007)., (2007), (2003).. (,, 1994;, 2007) (,, 2006;, 2007). (, 2003). (-),, (,, 2006;, 2007).,. (2009) 3,237 3.4% 110, 1,158 20% 228. 2.8, 2.1 6., 121(53.1%) 107 (46.9%), 110. (2010), - 9 -
(+).,. (2009),. (2007) 2005, 2 1,. (2014),,,.,,,,,.. - 10 -
3. (2011).,.,,,,.,,.,.,,.. (2004), (2008),. 1. - 11 -
,.. (2009) two-part.,,. (2010) () Le Grand.,.,,,,,, (Benach et al., 2004; Virtanen et al., 2005).,.,,, - 12 -
(, 2013;, 2011). (, ). (, 2008;,, 2010). (, 2003;,, 2006), (, 2009).. ( 1, 1).,. - 13 -
Ⅲ. 1. 2008 2013 (Korea Health Panel). 2008 ~2013 111,869 ( : 54,474 / : 57,395 ) 2008~2009, 2010, 2011 ~2013, 3 51,181. 2011 ~2013 60,688 ( : 22,795 / : 23,772 ),, 44,678, 18 18, 15,992 ( : 9,263 / : 6.785 ). < 1>. - 14 -
, 1. - 15 -
2...,, (, 2001;, 2007).,,,.,,,,... Two-Part Model. 1) - 16 -
,.,.,. 1,,. 2),..,,,.,, (log).. (2011, 2012, 2013 ), (, ), (20, 30, 40, 50, 60 ), (, //, ), (,,, ), (,, /), (1(20%) ~ 5 (20%)), ( 1, 4, 4 ), - 17 -
(, ), (,, ), (, ), (,, ). < 2>. - 18 -
2. 1. ( ) 2. 1. 2. 1. ( ) 2. 3. (,, ) 1. 2011 2. 2012 3. 2013 1. 2. 1. 20 2. 30 3. 40 4. 50 5. 60 1. 2. // 3. 1. 2. 3. 4. 1. 2. 3., 1. 1(20%) 2. 2 3. 3 4. 4 5. 5( 20%) 1. 1 2. 4 3. 4 1. 2. 1. 2. 3. 1. 2. 1. 2. 3. - 19 -
2. 3 (2011, 2012, 2013 ). ( /),,,., p-value, p-value<0.05., 2., (, ) ( ) T (ANOVA)., (/ ),,,,. (Generalized Estimating Equations) (,,,, ).. 0.05. SAS 9.4 SPSS ver. 24. SAS, SPSS. - 20 -
( 15,992 ) 1,, 1 ( / ) / ( ) / / ( + + ) GEE / 2. - 21 -
Ⅳ. 1. < 3>. 15,992 2011 2013 18 8,429 (52.7%), 7,563 (47.3%). 2011 2013 2011 4,980, 2012 4,745, 2013 6,267,. 9,207 (57.6%) 6,785 (42.4%), 62.6%, 60.7%,. 40 4,758 (29.8%), 40 63.1%, 60 70.5%., 11,328, 70.8%,,, 601 (3.8%), 553 (3.5%)., 7,568 (47.3%), 5,652 (35.3%).,, - 22 -
,., 13.163 (82.3%) 2,561 (16.0%), Q5 4,462 (27.9%) 5. 4 6,248 (39.1%), 12,873 (80.5%) 3,119 (19.5%). 7,221 (45.2%), 7,826 (48.9%), 8,166 (51.1%). 12,408 (77.6%).,. - 23 -
3. N N % N 2011 4,980 2,670 53.6% 2,310 46.4% 2012 4,745 2,474 52.1% 2,271 47.9% 2013 6,267 3,285 52.4% 2,982 47.6% 9,207 5,762 62.6% 3,445 37.4% 6,785 2,667 39.3% 4,118 60.7% 20 652 240 36.8% 412 63.2% 30 3,164 2,074 65.5% 1,090 34.5% 40 4,758 3,004 63.1% 1,754 36.9% 50 3,964 2,091 52.7% 1,873 47.3% 60 3,454 1,020 29.5% 2,434 70.5% 11,328 6,174 54.5% 5,154 45.5% 601 182 30.3% 419 69.7% 553 96 17.4% 457 82.6% 1,371 214 15.6% 1,157 84.4% 1,401 334 23.8% 1,067 76.2% 5,652 2,600 46.0% 3,052 54.0% 7,568 5,281 69.8% 2,287 30.2% 13,163 8,075 61.3% 5,088 38.7% 2,561 323 12.6% 2,238 87.4% 1 831 86 10.3% 745 89.7% 2 2,603 782 30.0% 1,821 70.0% 3 3,849 1,747 45.4% 2,102 54.6% 4 4,237 2,518 59.4% 1,719 40.6% 5 4,462 3,288 73.7% 1,174 26.3% 1 5,020 2,134 42.5% 2,886 57.5% 4 4,373 2,420 55.3% 1,953 44.7% 4 6,248 3,671 58.8% 2,577 41.2% 12,873 7,216 56.1% 5,657 43.9% 3,119 1,213 38.9% 1,906 61.1% 7,221 4,077 56.5% 3,144 43.5% 6,141 3,063 49.9% 3,078 50.1% 1,082 395 36.5% 687 63.5% 7,826 3,648 46.6% 4,178 53.4% 8,166 4,781 58.5% 3,385 41.5% 2,364 1,119 47.3% 1,245 52.7% 12,408 6,547 52.8% 5,861 47.2% 868 558 64.3% 310 35.7% 15,992 8,429 52.7% 7,563 47.3% p value 0.291-24 -
2. < 4>. 15,992 12,595 (78.8%), 3,397 (21.2%). 6,476 51.4%, 6,119 (48.6%), 1,953 (57.5%), 1,444 (42.5%)., 94.9%, 73.3%. 93.2%, 64.9%. 81.3%, 2,130 68.3%., 73.3%, 86.1%, 60 92.5%, 20 61.0%. 77.2%, 83.8%, 92.4%. - 25 -
4. p N N N value 2011 4,980 3,870 77.7% 1,110 22.3% 2012 4,745 3,752 79.1% 993 20.9% 0.183 2013 6,267 4,973 79.4% 1,294 20.6% 9,207 6,750 73.3% 2,457 26.7% 6,785 5,845 86.1% 940 13.9% 20 652 398 61.0% 254 39.0% 30 3,164 2,039 64.4% 1,125 35.6% 40 4,758 3,654 76.8% 1,104 23.2% 50 3,964 3,310 83.5% 654 16.5% 60 3,454 3,194 92.5% 260 7.5% 11,328 9,655 85.2% 1,673 14.8% 601 470 78.2% 131 21.8% 553 521 94.2% 32 5.8% 1,371 1,301 94.9% 70 5.1% 1,401 1,264 90.2% 137 9.8% 5,652 4,486 79.4% 1,166 20.6% 7,568 5,544 73.3% 2,024 26.7% 13,163 10,447 79.4% 2,716 20.6% 2,561 1,908 74.5% 653 25.5%, 268 240 89.6% 28 10.4% 1 831 682 82.1% 149 17.9% 2 2,603 2,091 80.3% 512 19.7% 3 3,849 2,923 75.9% 926 24.1% 4 4,237 3,296 77.8% 941 22.2% 5 4,462 3,595 80.6% 867 19.4% 1 5,020 4,271 85.1% 749 14.9% 4 4,373 3,396 77.7% 977 22.3% 4 6,248 4,741 75.9% 1,507 24.1% 12,873 10,465 81.3% 2,408 18.7% 3,119 2,130 68.3% 989 31.7% 7,221 5,578 77.2% 1,643 22.8% 6,141 5,146 83.8% 995 16.2% 1,082 1,000 92.4% 82 7.6% 7,826 7,295 93.2% 531 6.8% 8,166 5,300 64.9% 2,866 35.1% 2,364 1,983 83.9% 381 16.1% 12,408 9,994 80.5% 2,414 19.5% 868 430 49.5% 438 50.5% 8,249 6476 76.8% 1953 23.2% 7,563 6119 80.9% 1444 19.1% 15,992 12,595 78.8% 3,397 21.2% - 26 -
3.. 1) Two-part. < 5>. 10.8, 16.8,. 2011 12.6, 2012 14.0, 2013 14.4, 11.8, 16.0,. 60 23.4,.. 60 23.4,,.. 27.0,. 27.3,,. 1 (23.1 ) - 27 -
,. 1 17.4, 17.7,. 26.8, 18.4.. 15.2,.,, 10.2 14.5, 12.0 18.4.. - 28 -
5. N p value p value p value 2011 3,848 12.6 15.6 229 10.1 10.6 15.5 19.4 2012 3,739 14.0 18.6 282 11.1 13.1 17.0 22.5 0.004 2013 4,957 14.4 17.9 297 11.2 12.4 17.7 21.8 6,708 11.8 15.7 297 10.2 12.2 14.5 20.0 0.042 5,836 16.0 19.1 266 12.0 11.8 18.4 22.1 20 397 7.5 9.3 114 7.4 6.3 7.5 10.8 30 2,026 7.8 8.7 122 7.9 8.6 7.7 8.8 40 3,632 9.6 11.3 158 8.9 10.5 10.8 12.5 50 3,298 13.2 14.7 174 11.8 12.8 14.8 16.5 60 3,191 23.4 25.1 297 18.4 15.5 25.5 27.8 9,623 13.9 16.9 297 11.3 12.2 16.8 20.6 470 20.2 24.5 199 15.2 14.3 22.5 27.6 521 27.0 28.0 195 17.7 18.0 28.9 29.2 1,299 27.3 29.2 297 20.0 15.5 28.6 30.9 1,261 20.6 21.9 190 18.6 16.7 21.2 23.3 4,465 13.0 15.4 252 11.5 12.5 14.3 17.4 5,519 9.5 10.9 165 9.4 10.7 9.9 11.3 10,402 13.2 16.6 297 10.7 11.7 16.9 21.5 1,903 14.9 18.9 195 12.7 16.6 15.1 19.2, 239 29.1 28.9 196 28.9 27.2 29.1 29.2 1 680 23.1 28.1 266 12.6 11.5 24.4 29.2 2 2,083 16.3 21.5 297 11.4 13.1 18.4 23.9 3 2,904 13.7 17.0 199 10.7 12.3 0.014 15.9 19.5 4 3,282 12.1 14.5 190 10.9 12.5 13.9 16.7 5 3,587 11.9 14.0 252 10.6 11.4 15.6 18.8 1 4,261 17.4 21.5 297 12.7 13.3 20.7 25.3 4 3,384 12.5 15.9 282 10.3 11.7 15.2 19.4 4 4,716 11.5 13.7 221 10.1 11.5 13.4 16.1 10,420 12.9 15.5 252 10.7 12.0 15.6 18.6 0.013 2,124 17.7 24.6 297 11.2 13.0 21.1 28.3 5,550 10.9 13.5 282 9.3 10.3 12.8 16.4 5,136 14.9 17.6 297 12.2 13.0 17.4 20.7 999 26.8 29.2 266 17.6 18.2 31.7 32.7 7,279 18.4 20.5 297 14.5 14.0 21.7 24.1 5,265 7.2 8.6 130 6.8 7.8 7.8 9.5 1,978 15.2 18.3 191 11.6 12.8 18.3 21.4 9,956 13.9 17.6 297 11.0 12.2 17.0 21.6 426 5.4 5.9 47 5.7 6.4 4.9 4.9 12,544 13.7 16.6 - - 10.8 12.1-16.8 21.3-29 -
2) < 6>. 1., 12.5 (8.9 ). 11.6, 9.8,. 60 12.2,.. 16.3,. 13.2, 14.5, 1 13.0,. 13.8, 23.1. 15.9, 11.8..,, 12.1 22.2, - 30 -
8.5, 8.8, 8.5, 12.6, 12.8, 17.1. - 31 -
6. N p value p value p value 2011 391 11.7 14.9 111 9.7 12.3 13.4 16.8 2012 427 11.5 17.7 195 0.038 8.9 10.0 0.541 13.8 22.0 2013 522 9.5 12.3 115 8.4 10.7 10.5 13.6 0.008 721 11.6 17.5 195 9.9 12.1 13.7 22.2 0.029 619 9.8 11.3 76 7.3 8.5 11.4 12.5 0.002 20 21 9.3 10.2 34 10.1 11.1 8.9 10.1 30 233 6.9 5.9 40 6.9 6.3 6.7 5.1 40 324 11.0 16.8 195 10.0 11.9 0.068 12.5 22.3 0.038 50 334 11.6 15.5 108 8.8 11.6 14.3 17.9 60 428 12.2 16.4 164 10.2 13.1 12.9 17.3 1,089 10.2 14.0 195 8.7 11.2 11.6 16.1 72 16.3 23.3 164 8.8 6.6 0.532 19.2 26.6 45 15.6 18.6 100 12.7 14.7 16.4 19.7 0.004 184 13.2 15.2 115 14.7 11.9 13.0 15.6 156 14.5 18.2 111 14.3 20.6 14.5 17.1 493 11.5 16.7 195 9.5 11.0 13.1 20.0 0.069 507 8.0 11.0 164 7.5 8.3 9.3 15.4 1,076 9.8 11.5 111 8.7 10.6 11.1 12.5 230 13.8 23.6 195 12.9 16.3 0.029 13.9 24.5, 34 23.1 26.2 100 21.5 10.6 23.2 26.9 1 83 13.0 17.2 115 12.0 11.8 13.1 18.1 2 244 12.8 15.6 111 12.3 15.8 13.0 15.6 3 311 12.3 18.4 164 0.001 9.7 13.0 0.047 14.0 21.2 0.124 4 308 9.6 14.6 195 8.8 10.1 10.7 19.0 5 393 8.8 10.3 78 7.8 8.9 10.9 12.5 1 522 11.0 13.9 111 8.8 12.3 12.4 14.7 4 338 10.1 12.5 115 0.687 9.1 10.5 0.985 11.2 14.2 4 457 10.8 17.3 195 9.1 10.3 12.9 22.8 0.189 1,118 10.6 14.8 195 8.5 10.1 12.8 18.3 0.323 0.004 222 11.7 15.6 111 13.2 16.7 11.2 15.3 0.288 495 8.6 9.9 89 8.5 10.1 8.8 9.6 557 10.7 15.2 195 8.5 10.0 0.002 12.6 18.5 198 15.9 21.8 164 12.8 17.6 17.1 23.2 888 11.8 16.5 195 9.4 11.3 13.5 19.3 0.001 0.228 452 8.8 11.0 89 8.3 10.4 9.6 11.8 0.010 219 10.9 12.7 76 7.4 7.9 13.6 15.0 1,072 10.8 15.4 195 0.398 9.4 11.6 0.045 12.1 18.1 26 6.8 6.0 22 6.0 5.8 8.1 6.2 0.506 1,340 10.8 14.5 - - 8.9 11.0-12.5 17.7 - - 32 -
. 1) < 7~8>., 313,140 427,008. 324,223, 419,419, 60 579,121. 588,683, 634,775,, 393,310, 1 493,274.. 1 467,740,, 414,096. 741,258. 481,322 (212,551 ),., 388,484,., 2011 2013-33 -
, 289,035, 383,832, 358,817, 456,788 10. 308,950, 433,829, 420,882 389,761. 297,906, 475,451, 597,544, 819,103. - 34 -
7. () N p value 2011 3,848 326,520 582,458 12,047,530 2012 3,739 403,480 775,530 13,898,713 2013 4,957 405,786 842,241 20,106,927 6,708 324,223 766,777 20,106,927 5,836 419,419 732,950 10,922,280 20 397 244,103 542,054 5,410,030 30 2,026 237,232 569,826 12,047,530 40 3,632 262,938 575,291 13,898,713 50 3,298 376,627 746,362 10,910,610 60 3,191 579,121 981,137 20,106,927 9,623 378,365 758,981 20,106,927 470 480,041 929,852 9,774,613 521 588,683 868,182 8,467,640 1,299 634,775 1,091,391 20,106,927 1,261 504,345 767,979 9,774,613 4,465 356,965 715,496 8,830,080 5,519 284,149 656,272 13,898,713 10,402 359,408 739,570 20,106,927 1,903 393,310 789,380 12,047,530 1 680 493,274 903,699 10,910,610 2 2,083 381,800 714,899 9,774,613 3 2,904 368,854 797,628 20,106,927 4 3,282 336,341 750,354 13,898,713 5 3,587 366,724 704,232 8,610,362 1 4,261 467,740 888,410 13,898,713 4 3,384 342,627 618,456 8,830,080 4 4,716 301,440 699,098 20,106,927 10,420 359,221 720,028 13,898,713 2,124 414,096 894,680 20,106,927 0.002 5,550 287,362 590,493 8,243,925 5,136 394,088 761,069 12,047,530 999 741,258 1,257,657 20,106,927 5,265 212,551 555,149 12,047,530 7,279 481,322 850,398 20,106,927 1,978 388,484 662,972 6,633,109 9,956 374,856 772,208 20,106,927 426 172,755 691,582 12,047,530 125,444 368,513 747,412 - - - 35 -
8. ( ) p value p value 2011 246,704 551,123 330,472 612,349 2012 354,066 754,717 453,828 793,219 2013 335,562 711,032 479,464 955,454 289,035 690,211 383,832 878,370 358,817 659,292 456,788 772,610 0.001 20 283,148 699,349 219,620 413,919 30 237,088 507,571 237,523 678,999 40 253,258 612,713 279,436 504,953 50 352,027 760,813 403,408 729,603 60 505,091 840,012 609,432 1,032,016 324,428 687,292 439,310 828,451 390,097 942,764 0.024 520,571 922,573 528,773 849,614 600,859 872,369 571,793 821,482 646,304 1,133,794 480,089 852,826 511,818 740,200 333,011 725,149 377,117 706,794 276,758 626,563 302,048 723,070 308,950 677,641 433,829 816,856 0.045 420,882 757,534 389,761 793,533 0.020 1 344,888 553,239 511,120 935,795 2 297,964 697,395 416,118 719,360 3 287,842 623,058 0.374 429,650 902,246 0.007 4 308,029 710,969 374,879 799,508 5 331,754 683,854 461,877 749,054 1 381,059 833,387 528,739 920,453 4 317,037 619,400 372,978 616,159 4 267,959 599,880 347,543 814,131 315,098 673,295 412,711 769,591 0.519 297,906 734,033 475,451 963,433 0.012 257,228 549,504 325,213 636,357 344,378 689,338 440,722 820,090 597,544 1,175,688 819,103 1,294,130 205,896 547,787 222,223 565,668 413,740 771,411 538,153 907,748 334,626 644,218 435,223 675,656 319,039 697,382 434,188 840,527 146,097 371,804 222,829 1,057,564 0.008 313,140 680,448 427,008 818,151-36 -
2) < 9~10>. 1,909,143 2,349,677. 2,384,668, 1,866,153, 60 2,806,040,,. 2,266,552, 2,812,026. 1 2,223,145,. 2,569,136,. 4,290,537, 2,478,910 (1,530,012 ),. 2,478,910, 90,., 2,478,739 2,580,929, 1,754,668 2,356,901,. 60, - 37 -
, 20, 40, 60, 30, 50. - 38 -
9. () N p value 2011 391 2,435,502 6,304,229 97,468,041 2012 427 2,598,141 4,604,681 49,969,477 0.00 2013 522 2,209,907 3,232,595 22,012,080 721 2,384,668 5,444,427 97,468,041 619 1,866,153 2,873,439 32,518,664 0.01 20 21 855,296 870,131 2,600,996 30 233 1,316,340 1,704,687 15,000,000 40 324 1,986,621 5,535,575 97,468,041 0.00 50 334 2,039,656 4,227,083 49,969,477 60 428 2,806,040 4,654,787 42,327,530 1,089 2,266,552 4,774,607 97,468,041 72 1,958,106 2,821,998 19,013,830 0.02 45 1,328,449 2,171,592 15,313,150 184 2,812,026 4,887,363 40,199,932 156 2,647,952 4,590,127 30,308,475 493 1,998,170 3,878,051 49,969,477 0.01 507 1,843,894 4,669,832 97,468,041 1,076 2,052,367 4,355,909 97,468,041 230 2,569,136 4,765,815 49,969,477 0.79 1 83 2,352,008 4,452,101 36,181,141 2 244 2,329,161 4,246,158 30,308,475 3 311 2,162,314 4,344,076 42,327,530 0.80 4 308 2,144,515 5,547,905 97,468,041 5 393 1,964,732 3,530,876 49,969,477 1 522 2,223,145 4,093,788 49,969,477 4 338 2,145,675 5,138,883 97,468,041 0.71 4 457 2,005,716 3,881,508 40,199,932 1,118 2,052,367 4,355,909 97,468,041 222 2,569,136 4,765,815 49,969,477 0.06 557 1,958,741 3,266,927 36,181,141 198 4,290,371 5,916,176 20,964,301 495 1,900,803 5,144,095 97,468,041 0.00 888 2,478,910 5,081,223 97,468,041 452 1,530,012 2,814,297 30,118,200 0.00 219 2,197,487 1,844,071 15,099,700 1,072 2,161,063 1,682,729 15,000,000 0.40 26 2,103,357 818,958 3,297,320 1,340 2,140,916 4,386,002 - - - 39 -
10. ( ) p value p value 2011 2,513,569 8,516,698 2,189,526 3,324,946 2012 2,097,127 4,256,795 0.673 2,820,978 4,425,539 0.177 2013 2,072,946 3,153,641 2,355,894 3,352,415 2,478,739 6,578,215 2,580,929 4,259,064 0.109 1,754,668 2,957,273 2,356,901 3,228,211 0.428 20 1,322,340 694,369 766,232 864,280 30 1,251,136 1,399,479 1,951,626 2,426,404 40 2,607,703 7,802,160 0.037 1,869,695 2,597,995 0.002 50 1,997,483 4,355,448 2,139,677 3,438,104 60 3,240,015 5,877,391 3,067,916 4,455,430 2,363,820 5,950,717 2,531,912 3,852,171 1,509,195 1,779,877 0.707 2,773,466 3,947,935 0.729 1,355,217 1,108,017 2,114,354 2,447,240 2,360,389 2,941,918 3,196,507 4,911,078 2,960,059 5,655,812 2,383,316 3,498,069 0.563 2,438,155 5,506,390 2,096,597 2,933,670 0.028 1,949,717 5,622,184 2,384,953 3,669,100 2,198,199 5,605,592 2,570,196 3,953,796 0.858 2,502,542 3,615,101 2,162,173 3,141,092 0.410 1 1,550,021 1,864,135 3,311,501 5,742,700 2 2,493,120 4,679,273 2,314,270 3,668,940 3 1,838,306 4,404,767 0.891 2,416,149 3,611,481 0.361 4 2,406,651 7,898,616 2,256,247 3,076,928 5 2,224,090 4,232,677 2,496,035 3,223,256 1 2,322,756 5,228,763 2,582,695 3,802,336 4 2,499,668 7,871,146 0.582 2,538,484 4,244,004 0.579 4 1,948,540 3,613,032 2,244,554 3,232,022 2,093,873 5,239,416 2,353,472 3,657,929 0.102 3,336,305 7,715,732 2,810,806 3,975,568 0.170 2,102,432 6,814,971 2,084,772 3,137,347 2,138,824 3,239,607 0.995 2,197,278 3,454,882 2,073,612 4,202,945 3,755,387 4,938,890 1,449,543 2,209,525 1,741,152 2,450,544 2,753,636 6,941,165 0.003 2,717,430 4,071,403 0.002 1,525,909 2,550,072 2,708,370 3,867,112 2,363,079 6,032,087 0.390 2,419,877 3,754,716 1,948,979 1,780,139 2,347,306 2,133,976 0.740 1,909,143 5,019,244 0.03 2,349,677 3,815,636 0.03-40 -
4) < 11, 12>. 1,,. 782,364, 883,053. 880,827 788,437,. 60 1,178,060,. 1,021,259,., 1,164,967,,. 5 922,534,, 1 948,156, 881,945,., 1,505,135,, 1,018,512,.., 711,117, 836,098, 828,176, 889,918-41 -
. 60, 40., 1,155,416 1,142,342,. - 42 -
11 () N p value 2011 4,979 757,980 1,519,500 31,979,958 2012 4,746 860,637 1,709,756 21,455,579 0.001 2013 6,267 867,310 1,657,347 23,927,086 9,205 788,437 1,636,082 23,927,086 6,784 880,827 1,628,653 31,979,958 20 652 730,010 1,698,941 22,052,000 30 3,164 708,434 1,534,467 23,927,086 40 4,756 616,026 1,332,409 31,979,958 50 3,964 817,244 1,559,993 20,337,165 60 3,453 1,178,060 1,973,400 21,455,579 11,325 849,539 1,607,530 21,455,579 601 1,021,259 1,758,268 12,202,704 0.004 553 914,865 1,392,594 11,911,395 1,371 1,164,967 1,961,532 18,797,150 1,404 978,815 1,608,824 15,043,149 5,649 810,663 1,653,418 31,979,958 7,568 734,710 1,519,239 23,927,086 13,162 829,562 1,596,390 31,979,958 2,560 853,832 1,794,592 23,927,086, 267 751,974 1,836,001 15,590,912 0.966 1 830 855,603 1,871,591 20,041,953 2 2,602 750,316 1,455,557 22,052,000 3 3,848 797,861 1,588,568 21,455,579 4 4,237 811,088 1,625,229 23,927,086 5 4,462 922,534 1,722,297 31,979,958 1 5,019 948,156 1,702,693 21,301,078 4 4,373 830,457 1,669,696 31,979,958 4 6,246 729,268 1,542,575 23,927,086 12,870 821,687 1,616,637 31,979,958 3,119 881,945 1,711,863 22,052,000 0.026 6,140 862,004 1,613,211 21,455,579 1,081 1,505,135 2,421,031 31,979,958 7,220 681,457 1,409,708 23,927,086 7,827 1,018,512 1,762,009 31,979,958 8,165 563,551 1,384,539 23,927,086 2,362 848,056 1,678,389 31,979,958 12,407 843,855 1,636,684 23,927,086 868 492,749 1,388,962 17,219,800 15,992 829,988 1,622,948 - - - 43 -
12. ( ) p value p value 2011 694,077 1,363,147 777,181 1,639,100 2012 778,618 1,572,661 0.108 894,193 1,802,381 0.026 2013 777,020 1,502,183 916,401 1,773,907 711,117 1,503,958 836,098 1,775,241 0.003 828,176 1,435,746 889,918 1,722,291 0.235 20 652,670 1,245,556 745,539 1,902,567 30 692,865 1,326,291 652,905 1,823,738 40 575,862 1,152,881 626,218 1,550,731 50 820,632 1,655,482 767,119 1,413,370 60 1,160,614 1,956,828 1,159,722 1,966,725 776,996 1,526,598 883,272 1,660,938 906,287 1,449,743 0.438 1,057,309 1,872,539 0.188 910,333 1,364,417 894,657 1,390,511 1,155,416 1,803,581 1,142,342 1,976,684 1,005,942 1,789,125 960,314 1,544,337 783,518 1,574,078 797,240 1,690,386 694,469 1,379,134 732,793 1,745,917 740,309 1,447,574 896,126 1,748,076 0.003 1,090,086 2,260,700 813,898 1,715,792, 601,634 1,078,053 736,299 1,879,908 0.140 1 652,335 977,193 863,471 1,937,933 2 620,473 1,381,907 779,286 1,465,451 3 665,573 1,369,230 867,181 1,709,799 0.011 4 742,054 1,421,847 847,827 1,828,127 5 831,856 1,602,002 1,036,571 1,928,296 1 859,026 1,615,775 982,288 1,742,519 4 767,307 1,448,710 847,166 1,859,049 4 676,504 1,417,763 741,261 1,652,963 747,190 1,454,817 860,865 1,757,398 0.520 784,461 1,677,477 891,737 1,699,119 0.562 624,384 1,278,840 697,274 1,517,040 832,125 1,568,558 854,665 1,630,839 1,239,868 1,795,936 1,623,864 2,681,237 955,044 1,629,120 1,051,478 1,854,580 534,774 1,271,766 532,063 1,463,688 796,458 1,531,003 863,286 1,776,158 765,795 1,501,793 878,717 1,734,950 391,122 874,081 562,046 1,923,702 0.093 782,364 1,503,923 883,053 1,755,568-44 -
4. 1) < 13~14>. < 13>, 0.93 (95% CI 0.80-1.08).. (p>.05) 13. ( ) OR 95% CI 0.93 0.80-1.08 0.32 < 14>,, 0.4 (95% CI 0.36-0.48),, 1.5 (95% CI 1.16-2.00) (p<.05), 1.4 (95% CI 0.89-2.06),. 1.5 (95% CI 1.04-2.28), 1.9 (95% CI 1.31-2.71), 1.9 (95% CI 1.34-2.70), (p<.05).,, - 45 -
1.5 (95% CI 1.24-1.76), 0.7 (95% CI 0.35-1.39),. 4 4 1.3 (95% CI 1.14-1.55), 2.0 (95% CI 1.71-2.37),., 0.8 (95% CI 0.74-0.95), 0.6 (95% CI 0.42-0.79). 5.1 (95% CI 4.42-5.87). 2.5 (95% CI 1.92-3.18) (p<.05)., 0.45 (95% CI 0.36-0.56), 0.38 (95% CI 0.31-0.47) (p<.001). 2.2 (95% CI 1.77-2.83), 1.9 (95% CI 1.48-2.35), (p<.001). 4.2 (95% CI 3.53-5.05), 6.9 (95% CI 5.45-8.65), (p<.001). - 46 -
14. ( ) OR 95% CI OR 95% CI OR 95% CI 2011 2012 0.95 0.82-1.10 0.50 0.92 0.76-1.11 0.37 1.01 0.80-1.29 0.92 2013 0.88 0.07 0.82 0.69-0.98 0.03 0.97 0.77-1.21 0.76 0.42 0.36-0.48 0.00 0.45 0.36-0.56 0.00 0.38 0.31-0.47 0.00 60 50 0.43 0.09-2.14 0.30 0.31 0.04-2.62 0.28 1.51 0.12-19.15 0.75 40 0.65 0.13-3.24 0.60 0.33 0.04-2.76 0.31 2.18 0.17-27.31 0.55 30 0.71 0.14-3.51 0.68 0.31 0.04-2.58 0.28 1.97 0.16-24.66 0.60 20 0.60 0.12-3.01 0.54 0.19 0.02-1.60 0.13 1.43 0.11-18.03 0.78 1.52 1.16-2.00 0.00 1.16 0.70-1.91 0.56 1.71 1.22-2.39 0.00 / 1.35 0.89-2.06 0.16 1.32 0.60-2.93 0.49 1.38 0.83-2.28 0.21 1.88 1.31-2.71 0.00 1.34 0.59-3.04 0.49 1.58 1.00-2.48 0.05 1.90 1.34-2.70 0.00 1.41 0.68-2.93 0.35 2.10 1.39-3.16 0.00 1.54 1.04-2.28 0.03 1.57 0.76-3.28 0.23 1.70 1.09-2.65 0.02, 1.47 1.24-1.76 0.00 1.27 0.86-1.88 0.24 1.53 1.25-1.88 0.00 0.69 0.35-1.39 0.30 1.61 0.34-7.67 0.55 0.64 0.29-1.42 0.27 5 4 0.77 0.56-1.06 0.11 1.41 0.62-3.20 0.42 0.81 0.57-1.15 0.25 3 0.82 0.60-1.12 0.21 1.77 0.79-3.96 0.16 0.86 0.60-1.22 0.39 2 1.04 0.76-1.40 0.82 1.29 0.58-2.87 0.54 0.73 0.50-1.07 0.11 1 0.90 0.66-1.23 0.52 1.11 0.50-2.48 0.79 0.91 0.60-1.38 0.67 4 4 1.33 1.14-1.55 0.00 1.19 0.94-1.50 0.14 1.09 0.85-1.42 0.49 1 1.13 0.96-1.34 0.15 1.44 1.16-1.77 0.00 1.19 0.95-1.50 0.14 2.02 1.71-2.37 0.00 2.24 1.77-2.83 0.00 1.87 1.48-2.35 0.00 0.57 0.42-0.79 0.00 0.89 0.76-1.04 0.15 0.77 0.63-0.94 0.01 0.84 0.74-0.95 0.01 0.57 0.36-0.89 0.01 0.59 0.37-0.94 0.03 5.10 4.42-5.87 0.00 4.23 3.53-5.05 0.00 6.86 5.45-8.65 0.00 0.96 0.81-1.13 0.62 1.08 0.86-1.35 0.53 0.85 0.66-1.09 0.19 2.47 1.92-3.18 0.00 2.58 1.86-3.57 0.00 2.52 1.65-3.83 0.00-47 -
2) (GEE) ) GEE,. < 15>, 0.2,,, 0.1,. 15. ( ) 0.23 0.54-0.10 0.56 < 16>, 2013 2012 0.7, 2011 2.4,., 3.1,, 60 50 6.5, 40 8.5, 30 8.0,. - 48 -
0.3,, 2.6, 6.1., 9.8, 9.5.. 4 1 1.7,. 4.4, 5.7. 5.6., 2.5, 4.1., 16.4, 7.2, 13.8, 7.1.. < 17>, 2013 2012 0.4, 0.4, - 49 -
1.3. 0.4, 0.7. 2.1. 2.0, 2.3. 0.3,, 0.5, 0.7. 2.3, 0.5.,,. 2.0, 2.9,. - 50 -
16. () 2013 2012-0.74 0.014-0.11 0.762-1.73 0.001 2011-2.43-1.21-3.72-3.14-2.50-4.06 60 50-6.54-4.50-7.45 40-8.48-6.64-9.04 30-7.98-5.76-8.44 20 6.35 0.626-9.28 28.30 0.322-1.70 0.280 1.73 0.363-1.68 0.361 // 0.03 0.986 2.39 0.287 0.67 0.781 0.26 0.492 0.42 0.301 0.66 0.281 2.57 0.004 3.46 0.011 2.53 0.019 6.09 3.15 0.029 6.32, -9.77-16.39 0.003-7.20 0.001-9.52-13.75 0.016-7.12 0.001 5 4-0.51 0.248 0.21 0.599-0.03 0.972 3-0.12 0.799-0.33 0.482 0.50 0.593 2 0.59 0.296-0.59 0.336 1.39 0.159 1 1.79 0.100-0.69 0.574 2.66 0.072 4 4 0.61 0.093 0.38 0.321 0.50 0.453 1 1.65 1.29 0.006 1.81 0.025-0.66 0.329 0.41 0.528-1.16 0.209-4.41-3.00 0.001-4.66-5.73-4.30-6.40 5.56 5.25 6.23 3.08 2.37 4.57 2.94 2.25 4.04-51 -
17. () 2013 2012 0.37 0.019 0.35 0.736 4.51 0.013 2011 0.17 0.235 1.71 0.155 1.68 0.297 0.42 0.011 2.28 0.082 0.51 0.772 60 50-0.35 0.089 0.77 0.600 0.77 0.740 40-0.26 0.276 3.01 0.051-0.09 0.979 30 0.20 0.401 0.44 0.772-4.18 0.107 20 5.86 0.124 8.98 0.230 0.30 0.432-1.55 0.748-2.96 0.463 // 1.29 0.048-2.19 0.659 8.46 0.107 0.35 0.034 2.18 0.045 2.88 0.238 0.73 0.024 6.36 0.048 3.32 0.240 0.53 0.093 9.25 0.002-0.32 0.924, -2.11 0.050-7.26 0.379-4.51 0.421-1.85 0.093-3.06 0.731-1.75 0.753 5 4-0.18 0.221 0.26 0.804-0.97 0.655 3 0.06 0.745 0.92 0.476-4.64 0.044 2-0.23 0.321 2.07 0.383-4.25 0.047 1-0.22 0.658 6.05 0.062 9.61 0.007 4 4 0.07 0.656 0.30 0.807 0.50 0.792 1 0.30 0.073 1.02 0.471 5.07 0.003 0.36 0.092-2.03 0.397 2.93 0.163-1.96-3.02 0.170-7.19-2.29-2.50 0.255-9.14 0.29 0.016-0.37 0.736 2.15 0.184 0.45 0.012 3.52 0.023-0.44 0.898 0.68 5.18-0.43 0.896-52 -
) GEE < 18~20>.. < 18> 23,187,. 18. ( ) () OR OR 0.09 0.024 23,187.23 0.564 < 19~20>,, 332,346, 274,508,., 5 4 140,744, 3 201,410, 2 313,498, 1 386,010,., 4 4 92,164, 1 159,866, - 53 -
. 280,283. 545,641, 683,813. 2013 2011 155,092, 39,781,, 370,644, 201,466. 60 50 312,156, 40 458,550, 30 216,289,... - 54 -
19. () () 2013 2012-0.05 0.122-0.07 0.177-0.02 0.601 2011-0.19-0.20-0.16-0.27-0.36-0.18 0.001 60 50-0.43-0.40-0.45 40-0.71-0.68-0.71 30-0.38-0.37-0.40 0.001 20-0.21 0.749-0.68 0.086 0.16 0.860 0.19 0.020 0.22 0.224 0.15 0.094 // 0.40 0.30 0.163 0.40 0.001-0.02 0.625-0.02 0.782-0.02 0.765 0.05 0.432 0.06 0.602 0.05 0.564 0.06 0.379 0.07 0.563 0.05 0.547, 0.85 1.01 0.011 0.89 0.78 1.09 0.009 0.78 5 4-0.16-0.11 0.059-0.26 3-0.26-0.25-0.31 2-0.34-0.40-0.38 1-0.48-0.24 0.221-0.55 4 4 0.08 0.042 0.08 0.137 0.08 0.181 1 0.15 0.14 0.019 0.15 0.007 0.09 0.075 0.07 0.415 0.11 0.071-0.46-0.37-0.53-0.65-0.59-0.70 0.73 0.72 0.75 0.53 0.40 0.001 0.77 0.58 0.43 0.83-55 -
20. () 2013 2012-29,335 0.431-35,133 0.474-19,313 0.723 2011-155,092-130,503 0.004-170,867 0.001-39,782 0.316-69,144 0.171-26,124 0.650 60 50-312,156-241,636 0.032-356,351 40-458,550-410,354-467,513 30-216,289 0.003-160,900 0.189-254,707 0.020 20-407,659 0.101-117,191 0.679 201,466 0.017 164,290 0.308 200,806 0.035 // 370,644 0.001 244,407 0.210 418,077 0.002-5,491 0.895 39,397 0.423-80,645 0.243-16,957 0.810 34,284 0.794-81,508 0.375 61,311 0.463 83,632 0.583-17,616 0.869, 274,508 0.055 538,671 0.004 290,512 0.059 332,346 0.022 877,936 312,511 0.043 5 4-140,743 0.003-110,680 0.037-180,224 0.032 3-201,410-189,669 0.002-215,355 0.007 2-313,498-288,105-332,101 1-386,010-391,183 0.002-399,725 4 4 92,164 0.020 118,095 0.020 65,220 0.275 1 159,866 155,731 0.007 148,054 0.012 53,365 0.307 9,770 0.904 85,786 0.177-545,641-330,025 0.001-672,081-683,813-469,549-817,817 280,283 298,863 302,750 208,583 0.005 274,895 0.002 161,872 0.215 265,308 257,288 285,189 0.023-56 -
Ⅴ. 1., (causal) (static), (dynamic)., (unobserved heterogeneity) (model mis-specification). (multi-collinearity) (, 2014).,.,,. GEE,. - 57 -
,.,,.,,. 2011 2012 2.20%, 2013 2.36%. 2011 2012 2.8% 5.80% (), 170.0 (), 2013 1.6% 5.89% (), 172.7 (). 0 0,. - 58 -
2. 52.7% 47.3%, 78.8% 21.2% 78.8%.,.,, 60.,,.,... 30,. - 59 -
,,. 60. 3..,,,,,,,,.,,.,, (, 2012)..,.. - 60 -
.,.,,..,,,. - 61 -
Ⅵ. 2011 2013 3.,,,,,,,,.,.,,,..,. (32%~40%) (85%~99%) 1/3 (, 2016), - 62 -
(, 2016)..,,, ( / ),..,.,,. - 63 -
. : Andersen. [ ] ; 2009... [ ] ; 2014.,,,,... 2003; 9(2):13-23.. [ ] ; 2015.. : Le Grand., 2011;27(3):91-12,,.,, 2008;24(3):53-75.,.. 2008;18(4):23-48.. :,, 2010; 49-62,,,,.,, 2016;119-157.,. (GEE),, 2008;16:77-103.,.., 2012, 107-125..,, 2011;15-23.., [ ] ; 2010. - 64 -
, : (2008-2010) Two-Stage,, 2014;2:101-113.., [ ] ; 2016.,.,, 2009;2(4):119-156.., [ ] ; 2016.. :,, 2001;7(2):67-96.,.,. 2006, 24:173-199., [ ] ; 2016..,, 2011; 64-81... 2003;9(1):71-105..,, 2004;56(3):5-35.,.,. 2016.., [ ] ; 2012.., [ ] ; 2014.., ; 2015. - 65 -
,., (Work History) (Life-Course). 2003;23(S):33-53. Crystal,S., Johnson, R. W., Harman, J., Sambamoorthi, U., Kumar, R.. Out-of-pocket health carecostsamong older Americans. Journal of Gemntology SOCIAL SCIENCES 2000; 55(1):S5I-S62. Holmlund, B., & D. Storrie. 2002. Temporary work in turbulent times: The Swedish experience. Econ J. 112(480): 245-269. Kalleberg A.L., Nonstandard Employment Relations: Part-Time, Temporary and Contract Work, Annual Review of Sociology, 2000;26:341-365. Kim, I. H., Muntaner, C., Khang, Y. H., Peak, D. M., & S. I. Cho. The relationship between nonstandard working and mental health in a representative sample of the South Korea population., 2006, Soc Sci Med. 63(3): 566-574. Virtanen P., Vahtera, J., Kivimaki, M., Liukkonen, V., Virtanen, M., & J. Ferrie. Labor market trajectories and health: a four-year follow-up study of initially fixed-term employees. Am J Epidemiol. 2005, 161(9): 840-846. - 66 -
ABSTRACT Medical Use and Medical Expenses by Work Status of Wage Earner This study addresses the main social issue including the work status of wage earner, the socio-economic condition of permanent employee and temporary employee, which is one of main causes of labor polarization, income inequality, working environment, etc. Considering these conditions, in the view of public health, this study seeks to speculate on the problems related to the health problems, such as medical use and medical expenses. The main purpose of this study is to understand the effect of the work status of wage earner on medical use according to the analysis on the difference of medical expenses and the frequency count of medical use depending on the work status of wage earner over 18. The main method of this study is a logistic regression analysis depending on the status of medical - 67 -
use of wage earner. In order to research the important variables that influence the frequency count of medical use of wage earner, this study analyzes the frequency count of medical use and the days of hospital treatment through GEE consequently. The result of this study is as follows. First, according to the result of the logistic regression analysis by the status of medical use of wage earner, in the case of permanent employee related to the work status, the odds ratio of medical use is 0.9 times lower than that of temporary employee. Statistically, however, it has no significant meaning though. Second, in order to research the variables that influence the frequency count of medical use of wage earner, this study used an estimation analysis, such as GEE related to the frequency count of medical use and the days of hospital treatment. In reference to the medical service use of hospital outpatient department, it is showed that the medical use of permanent employee is about 0.2 times more than that of temporary employee, but it has no significant meaning statistically. Third, as for the main causes of the days of hospital treatment on the basis of the work status, regarding permanent employee, it is showed that the days of hospital treatment is 0.1 times lower than that of temporary employee. This result, however, is not statistically significant. - 68 -
Fourth, with regard to the main causes of medical expenses related to the work status, referring the annual total medical expenses, it is showed that permanent employee spends KRW 23,187 more than that of temporary employee, hence it has a significant meaning statistically. Fifth, as for the medical service of social security service, which is expected to deeply related to the work status, it is showed that locally insured person spends KRW 332,346 more than that of medical insurance subscriber. In the case of person insured the employer-provided health insurance, they spends KRW 274,508 more than that of medical insurance subscriber. Consequently, all results are statistically significant. Lastly, for the result of research by income quintile, it is showed that the case of person in the second quintile of income spends KRW 140,744 less than that of person in the first quintile of income. Additionally, the case of person in the third quintile of income spends about KRW 201,410 less than that of person in the first quintile of income. In the case of person in the fourth quintile of income, it is KRW 313,498, and KRW 386,010 in the case of person in the fifth quintile of income is less than that of person in the first quintile of income respectively. All results are statistically significant accordingly. In general, the variables, which have an impact on total medical expenses, are mostly related to the health care field rather than the socio-economic field. Despite the result, it is show that the influence of the variables that - 69 -
connote socie-economic meaning including the work status on total medical expenses is still statistically significant. In particular, for the main causes of total medical expenses, this study confirms the various variables with socio-economic meaning, such as medical services of social security service, income, etc, according to the present work status. Thus, if it maintains a continuos flow of the classification of work status of wage earner or more in global labor market as well as our country, the efforts to improve the quality of life of temporary employee in medical use and medical expenses through the welfare policies would be necessary. Keywords: Wage Earner, Temporary Employee, Medical Use, Medical Expenses, Health Panel, GEE - 70 -