ECHE 2012 참석및 Poster 발표 출장목적 : ECHE 2012 참석및 Poster 발표 출장자 : 도세록, 서성우 출장기간 : 2012년 7월 17일 ~ 7월 24일 방문기관 : 스위스쮜리히대학 주요활동 : ECHE 2012 중요 참가및 Poster 발표 Ⅰ. 출장목적 보건경제학 (Health Economics) 은보건의료활동에대한합리적인의사결정을위하여다양한실태파악과비용편익적인분석이활용됨 현재보건경제학에서사용하고있는최신방법론을파악하여본과제의연구를수행하는데적용함. 유럽보건통계학회 (ECHE) 는유럽국가중심으로운영되고있으나논의되는주제가우리가당면한공통관심사가논의되고있어연구활동에많은참고가될수있음 외국의활발한보건경제연구결과를참고하고우리의연구결과를알려서상호교류와연구의질향상을추구함 2012. 7. 31 한국보건사회연구원 Ⅱ. ECHE 2012의주요주제및진행 ECHE 2012 주요주제 ECHE(European Conference on Health Economics) 의주요주제및범위 - 건강보험의경제학 (Economics of health insurance) - 보건의료시장 (Markets for health care: competition vs regulation) - 예방과중독의경제학 (Economics of prevention and addiction) - 형평성과건강 (Equity and health), 제약경제학 (Pharmaceutical economics) - 보건경제학과방법론 (Health econometrics and methodological issues) - 보건의료- 공급자분석 (Analysis of health care providers) - 건강과보건의료평가 (Health and health care valuation) - 공공보건과보건의료공급 (Public health and health care provision) - 건강과경제발전 (Health and economic development) - 실증적보건경제 (Experimental health economics) ECHE 2012 진행방법및발표논문 - Conference 기간및장소 : 2012년 7월 18 21일스위스쮜리히대학 - 발표논문 : 총 132개 에서 513편논문발표와 86편의 Poster 게재 - 3-4개의단위논문을묶어서 (Organize) 하나의관련된주제명 ( Title) 을정하고관련연구의좌장 (Chair) 을선정하여 3-4개논문을차례로발표
- 발표논문은 2011년 11월 30일까지제출받았고발표논문 Abstract를 2012년 1 월 30일까지제출받음 Ⅲ. ECHE 2012 발표내용 : 주요관심분야중심 장기요양 (Long Term Care) - OECD 국가의연령구조와산업국가로진행되면서인구사회경제적으로장기요양의비용효과에대한정부개입필요성이대두되고장애인이증가하면서장기요양수요가많아짐. 전통적인의료방법으로문제해결을위한접근과함께경제성평가의필요성이증가함. 장기요양에대한경제성평가는특별한방법이필요한데방법론적개발보다는명확한의사결정에의한경제성추구가더욱필요함 - 프랑스의장기요양보험의역선택과수요를파악하기위하여시장의금융자료를활용하여장기요양보험계약확률을추정함. Logit모형과부트랩방법을활용하여장기요양보험계약확률을추정한결과연령, 소득, 재산에비선형적이었고보험시장에서역선택은나타나지않음 - 보편적건강보험추진등으로국민이장수하는국가가된일본은의료자원의분포와의료비가지역간많은차이를보임. 공급자유발의료수요억제방안으로정부는병원신설과병상수를줄이는정책과장기요양보험 ( 개호보험 ) 을도입하여병원입원수요를장기요양서비스로전환하도록추진함. 의료자원분포와의료비의지리적인변동에대한실증적인연구를위하여 47개도도부현건강관련자료와시계열의료비자료를활용하여입원, 외래, 치과진료의지역적변이와수렴 (Convergence) 을추정함. 1980년대노인당의료비변이가매우컸으나병상수를제한하면서차이가매우줄어드는현상을보이며 2000년대개호보험도그러한효과를줄것으로기대하고분석을통하여변이의정도와어느방향으로수렴하는지를발견함 - 노인에대한가정요양에대한대안으로시설요양의비용편익을분석함. 가정보호와너싱홈에있는노인에대한조사자료를기초로분석함. 가정과시설요양원의있는노인의신체적 정신적인장애에대해서설문문항이있는조사자료를근간으로분석하였고시설요양은가정보호보다비용이더욱많이드는것으로나타남. 1. Methodological Challenges and Issues in Economic Evaluations of Long Term Care Interventions: Helen Weatherly (University of York. Centre for Health Economics) 2. Adverse selection and demand for long term care insurance in France ; Manuel Plisson (Paris Dauphine University. LEDA-LEGOS) 3. Geographical Variation and Convergence of Medical Cost in Japan; Tomofumi Anegawa (Keio University. Graduate School of Business Administration) 4. Costs and benefits of residential care ; Lucy Kok - UvA. SEO Economic Research 환자의입원기간 (Length of Stay) 입원환자가병원에머무른기간즉입원일수는중요한보건의료지표임. 질환별, DRG 제도도입에따라노령연령층입원영향을줄수있음. 뇌졸중환자입원일수에 영향을주는요인분석, 노인환자의과도한병상점유, DRG제도시행에따른입원일수에미치는영향력등이연구됨 - 급성뇌졸중환자입원기간에영향을주는요인을국공립급성병원퇴원기록자료와가구조사자료를활용하여 GLS 모형으로분석한결과연령, 동반질환, 뇌졸중종류가환자의입원기간에영향을주는요인으로나타남 - 병상수감축은병원의변화를가져오는것으로병원병상수증가는그만큼사회적요양의축소를가져옴. 노령층환자의과도한병상점유는필요한환자의입원을막는요인이됨. 지역의보건제도의특성과입원기간, 과도한병상점유간관계를찾고자함. 환자의입원자료와각지자체의료자원자료간의병합자료를구축하여다차원분석을시도한결과병원특성과지방정부의특성이입원기간에영향을주고과도한병상점유에지방정부의역할이중요함 - DRG제도는입원기간을줄이지만치료의질을저하시키는우려가있는데 2002년스위스의 DRG 도입에따른입원일수와재입원관계를분석함. 스위스는입원기간이긴국가로 DRG 제도도입과관련하여입원일수와재입원이늘어날수있는부분은환자에의한변동으로의료기관특성에의한영향은나타나지않음. 통계적으로유의성이나타나지않음 - DRG 제도가동질적인질환에대한지불제도이지만같은 DRG 내에서평균재원일수의변동을환자와병원단위로각각분석한결과환자의임상적인요인, 응급요인, 질환과수술수에따라평균재원일수에차이가나타남 1. Acute stroke care analysis of factors influencing length of stay in acute hospitals; Samantha Smith (Economic & Social Research Institute. Health Research & Information Division) 2. Hospitals Bed Blocking by Elderly Patients: Do Social Care Resources Matter? ; Kamrul Islam (Uni Research. Uni Rokkan Centre) 3. Effects of DRGs on length of stay and readmissions in Swiss hospitals ; France Weaver (University of Geneva. Department of Economics) 4. Variation in Length of Stay within Diagnosis Related Groups in Ireland: A Multilevel Assessment of Patient- and Hospital-level Characteristics ; Jacqueline O'Reilly (Economic and Social Research Institute. Health Research and Information Division) EuroDRG - EuroDRG는유럽국가간의 DRG 비교를통하여투명하고, 효율적이며고품질이병원진료를목표로추진하는 Project임. 유럽의각국가들은동일한질환치료에의료비가다르고각국가는의료비상승을제어하고자하는국가정책과범유럽사회로발전하는데의료서비스는중요한문제가되어관련국가들이모여서 DRG 제도에대한논의를하고있음 - EuroDRG 참가국가는 12개국 ( 오스트리아, 영국, 에스토니아, 핀란드, 독일, 아일랜드, 네덜란드, 폴란드, 포르투갈, 스페인, 스웨덴 ) 이며이번 ECHE 2012에서는 7월18 과 20일에관련된논문발표가있었음. 7월 18일은 DRG 제도에서의환자의분류, 지불율, 그동안 EuroDRG Project의성과와의료의질평가관련발표가있었고 7월 18일은특별워크숍을개최하여 EuroDRG 전반에대한개요, 환자분류문제. 의료자
원활용과 DRG시스템의설명력, 2개수술 ( 충수절제술과무릎치환술 ) 에대한국가간 DRG 비교, 병원비용과의료의질에대한논문이발표됨 - EuroDRG는여러문제에직면하여있는데각국의배경과상황에서병원의지불제도, 여러지불제도에서발생하는유럽국가들의비용비교를통하여참가국의 DRG 문제를찾아내는것으로현재는 10개질환에대한상세분석을진행함 1. DRG systems, patient classification and DRG-based hospital payment in Europe ; Wilm Quentin (Berlin University of Technology. Department of Health Care Management) 2. The ability of DRG systems to explain variations in resource consumption ; Andrew Street (University of York. Centre for Health Economics) 3. The relationship between quality of care and hospital costs in Europe ; Unto Häkkinen (National Institute for Health and Welfare (THL). CHESS (Centre for Health and Social Economics)) 건강형평성 (Equity in Health) - 복지국가의역할은개인간의건강갭을줄이는것으로이를위한효과적인정책이필요함. 핀란드보건의료제도는세금과전국민건강보험으로운영되고있는데낸보험료대비의료이용환급금에대한집중도를분석함. 소득과관련시켜건강보험환급금을집중지수 (Concentration Index) 를활용하여분석한결과치과진료는집중도가벌어지는경향이며교통비비용은집중도가좁아지며, 의료부분은약간의향상을보여치료종류에따라다르게나타나고사설건강보험의가능성이내재됨 - 타이완의댕기열 (dengue fever) 발생은지역별로큰차이가있고도시화와댕기열발생과의관계를가오슝지역중심으로연구함. 가구조사자료를활용하여사회경제적변수를수집하고도시화와댕기열발생위험을연구한결과댕기열은인구밀도가높고도시화가늦은지역에서발생이많고교육수준에도영향을주는것으로나타나고공공보건의정부개입은개발된국가와도시에서는한계가있음 - 그리스의료서비스미충족을의료의만족도 (acceptability), 접근성 (accessibility), 치료가능성 (availability) 방향에서측정함. 가장큰미충족이유로의료의만족도를들고있고사회경제적인변수로교육수준과의료서비스가미충족에관련이있음 1. Changes in income-related equality of the refunds paid by the National Health Insurance System (NHI) 1990-2008 ; Hennamari Mikkola (The Social Insurance Institution of Finland. Research Department) 2. Urbanization and Health Disparity ; The case of a vector-borne disease in southern Taiwan, Ding-Ping Liu (National Taiwan University. Institute of Health Policy and Management) 3. Assessing the Unmet Health Care Needs in the Greek Health System ; Evelina Pappa (Hellenic Open University. Department of Social Sciences) 4. Measuring inequality of opportunities in health over the life cycle : ex-ante or ex-post perspective? ; Damien Bricard (Université Paris-Dauphine. LEDa-LEGOS) 의료이용 (Utilization of Health Care) - 미국지역보건프로그램 (CHAP) 자료와의료패널 (MEPS) 자료를활용하여응급실이용과비용절감효과를평가함. CHAP 등록환자의인구사회학적변수와건강상태, 의료이용경험, 의료이용접근성변수를활용하여응급의료이용횟수를추정하고의료패널자료를활용하여비용을추정한결과정부의보건의료지원이저소득층, 건강보험미가입자에게사회적자원사용을줄이는효과를나타냄 - 중국농촌지역의외래및입원의료이용격차를분석을위하여 Macro와 Micro 자료를활용하였는데가구조사에의한지역주민의의료선호도, 지역정부의정책등의변수를활용함. 정부가의료이용의격차를줄이고자서부지역과중앙지역에의료자원을배정하여왔으나지역간외래이용격차는감소하지않음 - 유럽보건, 노령, 은퇴패널자료 (SHARE) 자료를활용하여다중질환의료이용을연구함. 다중질환여부에대하여개인특성변수와보건의료시스템관련변수를활용하여분석함. 통합 OLS 모형과국가단위집락표준오차를적용하여분석한결과다중질환환자는외래진료와응급진료에관련성을보이지만병원입원과는역방향의관련성을보임 - 보건의료에서더많은분산정책은비용상승과비효율성을보일수있으나분산은지역의료제공자의활동을조화롭게하고지역주민이선호에더욱부응할수있음. 예를들어건강증진은지방정부와갈등을빗을수있는데지역정책입안자는보건의료전달체계에서제한된권한을갖고지방정부는중앙의결정에따른재정적지원을할수없고무임승차와비효율이발생함. 포르투갈은병원퇴원 micro 자료와지역적으로정의된환경적인 macro 자료 ( 너싱홈수, 아동보호시설수, 학교수, 스포츠시설수등 ) 를활용하여입원기간과건강상태에대한회귀분석을한결과보건의료투자가많은지역환자의입원기간이길고중증도가적은질환환자가입원하며주어진질환에서입원기간이더길게나타남. 건강증진을위한지역정부의더많은투자와사회경제적환경이의료이용증가와직결되지않음 1. Assessment of the Reduction in Emergency Department (ED) Utilization and its Cost Savings Realized Through a Health Subsidy ; Paul Solano (University of Delaware. Public Policy and Administration) 2. Regional disparity in outpatient and inpatient care utilization in rural China ; Zhaobao Jia (Second Military Medical University. Department of Health Service Management) 3. Multimorbidity patterns and their implications for the use of health services in Europe ; Juliane Köberlein (University of Wuppertal. Schumpeter School of Business and Economics) 4. Decentralization of competences to local authorities: measuring vertical externalities on health care use ; Joana Alves (Universidade Nova de Lisboa. Escola Nacional de Saúde Pública) 삶의질측정 (Comparing Quality of Life Measures) 건강관련삶의질측정은국민의건강상태, 건강격차, 보건의료격차를파악하는도구로 EQ-5D 이외에 SF-6D, SF36v2, WQB-SA 등여러도구가사용됨. ECHE 2012에서도삶의질측정방법및측정도구관련논문이발표됨 - 청소년의약물사용에대한치료효과측정은의료적치료효과측정외에가정개입
치료효과로측정할수있는데문헌검색을통하여가정개입치료효과측정을위한다차원적측정도구를제시함 - 삶의질측정 6개도구 (EQ-5D, 15D, SF6D, HUI, QWB, AQoL-8D) 를활용하여우울증, 청력결핍, 천식, 당뇨, 관절염, 뇌졸중, 암환자의삶의질에대하여국가간의측정된결과를비교함. 호주, 노르웨이, 캐나다, 미국, 영국의환자에삶의질을측정하고그결과를비교함. 삶의질측정에는여러도구가사용될수있으나각도구에얻은결과는측정도구간에차이가존재함 - 특정질환을앓고있는환자에대하여 SF-6D와 EQ-5D를사용하여삶의질을비교함. 환자의건강정도에따라서다른값이추정되는데즉건강한일반인을대상으로한경우 ED-5D 척도의사용이바람직하며건강하지못한대상은 SF-6D의사용이더욱감응도가좋음 1. Towards a cost-effectiveness measure of family interventions in delinquent and substance-abusing adolescents: what are relevant effect measures? A systematic review ; Maartje Goorden (Erasmus University Rotterdam) 2. A comparison of 6 multi attribute utility instruments and 3 subjective wellbeing instruments across 8 disease categories ; Jeff Richardson (Monash University. Centre for Health Economics) 3. Extra-welfarist Vs. Welfarist Measures: A Case for WTP ; Sabina Sanghera (University of Birmingham. Health Economics) 4. Assessing the performance of the SF-6D and the EQ-5D in different patient groups ; Lara N. Ferreira (University of the Algarve-ESGHT. CEISUC-Centre for Health Studies & Research, University of Coimbra) 수준모형으로분석함. 그결과평균적으로환자거주지와의료기관간의거리는 10km로추정되며농촌지역의경우더많은거리이동이있음. 암, 심장병과같은중증질환의경우거리적이동이더많고농촌지역은대도시지역보다 16km 더이동을하는것으로나타남. 실증적인자료를활용하여의료이용접근의불평등도를측정함 Ⅴ. 종합적인평가 ECHE는유럽국가중심으로보건의료와사회복지분야의여러문제들을보건경제학적인측면에서각국가들의실증적인자료를바탕으로분석하여발표함 주요주제는인구의노령화에따른장기요양수요가증가하고있어장기요양과소득보장으로사보험, 각국가가당면한의료비상승억제와의료의질향상을위한 DRG 제도의비교와삶의질측정방법에대한발표가많았음 또한건강보험측면에서는개인보험에대한발표가있었고의료에대한분석으로환자의재원일수, 병원의효율성, 치과, 환자의선택, 의사의소득, 제약, 금연등을주제도발표됨 ECHE는아직아시아권국가의참석이활발하지않으나보건, 의료, 사회복지분야에대하여심도있고다양한주제가발표되고있어관심을기울일필요가있음 - 향후 2013년 7월호주시드니에서열리는국제보건경제학회에관심과참가를통하여국제적인연구동향을파악하고국내연구에참고하여야할것임 Ⅳ 한국보건사회연구원 Poster 발표 Ⅵ. ECHE 2012 발표 한국보건사회연구원은 ECHE 2012에 2편의 Poster를발표함 주제 1: Spatial Analysis and Socio-Economic Determinants of Tuberculosis incidence in the Republic of Korea; Hosung Shin and Seongwoo Seo - 결핵은중요한공중보건문제로우리나라에서그동안꾸준히간소하고있으나아직선진국중에서발병률인높은국가임. 결핵은사회적차원의질환으로지역, 소득, 지역의경제상태와관련성이있음. 따라서결핵발병의지리적분포를공간분석을통하여제시하고베이지안계층적방법으로사회인구학적인요인과의관련성을추정함 주제 2: Factors Affecting Spatial Distance to Inpatient Health Services; Suehyung Lee and Seongwoo Seo - 의료서비스의차이의료의접근성은보건의료정책에서중요한문제임. 지리적인관점에서의료서비스의환자거주지와의료기관간의거리적인차이를매트릭스형태로측정하고의료이용에영향을주는변수를수집함. 분석을위한자료는한국의료패널 1,2차조사자료에서 2,651명입원환자자료를활용함. Haversine 방법사용하고다 Foyer KOL-F-101 19 July - 8 a.m. Poster 19 July - 10:15 a.m. 19 July - 11:45 a.m. Getting Health Reform Done: From Health Economics to Politics in SHI Countries Economic Epidemiology of Infectious Diseases in Europe EUROHOPE - Towards Evaluation of Outcomes, Performance and Efficiency of European Health Care Systems Economics and Pharmaceuticals How Can Private Long-Term Care Insurance Supplement State Systems? The UK as a Case Study Preconditions to Achieve Efficiency and Affordability in Competitive Healthcare Markets: Are They Fulfilled in Belgium, Germany, Israel, the Netherlands and Switzerland? Hospital Efficiency Political Economy Approaches to Health Care Financing Public policies and the spreading of health risks: the case of obesity and smoking The Economics and Econometrics of Mixed Public and Private Systems Studies on community-based health insurance: micro-evidence from Kwara State, Nigeria Centers for Health Economic Research in Germany
19 July - 2:30 p.m. 19 July - 4 p.m. 20 July - 8:30 a.m. 20 July - 10:15 a.m. Patient Safety Prescription Medicines and Pharmaceutical Policy Issues in Insurance Markets Dental Economics Drug Adherence Measuring Quality in Hospitals Access to Care Hospital Quality Economic Burden of Illness Education and Health Relationship Intergenerational Transfers Do Physician Incentives Improve Patient Outcomes Economics of Tobacco Use Drug Co-Payments DRG Use in Hospitals Equity in Health Paying Doctors Health Technology Assessment Child Health Treating Mental Health Problems Impact of Health on the Labor Market Out-of-Pocket Payments Impact of Obesity Health Insurance Issues Controlling Tobacco Use Drug Costs Public Hospital Efficiency Physician Costs What Affects Mental Health Effect of Co-Payments Nutrition and Health Effect of Health Insurance Economics of Cancer Screening Primary Prevention Assessing Quality of Life Measures Expenditure Trends Supporting Policy Treatment Cost of Drugs Modelling Costs Patient Preferences Issues in Physician Management Economics of Donations What Affects Health I Institutional Incentives Isssues in Long-Term Care Methodology Prevention Length of Stay Long-Term Care Systems in Europe: What Makes the Difference? Coping with Crisis: The Impact of the Economic Downturn on the Health Systems of Portugal, Ireland and Greece Dynamic Models in Health Econometrics Health Insurance Markets Euro DRG: Final Results on Patient Classification, Payment Rates, System Performance and Quality of Care Across 12 Countries Do You Know What May be Affecting Your TTO? SATURDAY 20 July - 11:45 a.m. 20 July - 2:30 p.m. 20 July - 4 p.m. 21 July - 8:30 a.m. Including Spillover Effects in Informal Caregivers in Economic Evaluations: Relevance and Recent Methodological Developments Multiple Endpoints in Health Care Decision Making in Germany: IQWiG s Efficiency-Frontier Concept and Methods to Elicit Patients Preferences Physical Activity: Time Constraints, Environmental Determinants and Health Outcomes Recent trends and future challenges in the EU pharmaceutical P&R policies The Economics of Epidemics The New Risk Adjustment Formula in German Social Health Insurance: Implementation and First Experiences Primary Care Role of Health Information Long-Term Care Economics of Heart Disease and Stroke Equity and Economics Labor Issues Socio-Economic Status &Health Utilization of Health Care Assessing Policy Economic Evaluation of Treatment Costs Forecasting Health Expenditure Effect of Aging Health Financing in Developing Regions Drug Research and Development Efficiency in Hospitals Maternal and Child Health Economics of Dementia Doctor-Patient Issues Insurance Design Health Screening Obesity and Prevention Secondary Prevention Comparing Quality of Life Measures Health Care Costs and the Elderly Drug Regulation and Policy Hospital Finances Insurance Finance Improving Quality of Life Measures Public Financing of Health Systems Issues in Nursing Physician Performance Information Technology and Health Equity in Health Care Provision What Affects Health II Economic Evaluation Methodology Economics of Vaccines Equality of Opportunity in Health Organization and Provision of Health Care for Rare Diseases: Results from the EIVE-Project Pharmaceutical Markets Hospital Performance Risk &Insurance Using the EQ-5D Practice Design Economics of Home Care Impact of Financial Cycles Health Shocks
SATURDAY 21 July - 10:15 a.m. Universal Coverage Efficiency and Performance Measurement in the Nursing Home Sector Hospital Substitution Private Insurance Valuing Health Prescribing Practices Economics of Cancer Children and Maternal Health Care What Causes Obesity Prioritizing Health Research Pharmaceutical Pricing Smoking Bans Motivating Doctors Health, Health Insurance, and Human Capital Outcomes Among Mothers and Children in the US