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지방의료원의 자체충족률에 영향을 미치는 요인: 수정 진단명기준환자군의 영향을 중심으로

Factors Affecting of Relevance Index of the Regional Public Hospital: Focused on Refined Diagnosis-Related Group Impacts

보건행정학회지 2019년 29권 4호 p.482 ~ 495
윤아리 ( Yoon A-Ri ) - 국립중앙의료원 공공보건의료지원센터

우경숙 ( Woo Kyung-Sook ) - 한양대학교 건강과 사회연구소
신영전 ( Shin Young-Jeon ) - 한양대학교 의과대학 예방의학교실

Abstract


Background: An important function of the regional public hospital is to satisfy the basic medical needs of the community through the stable provision of high-quality medical services. The purpose of this study was to identify the relevance index (RI) of the regional public hospital and to identify the factors that affect the RI.

Methods: Data were obtained from the 2017 regional public hospital operation evaluation report and 2017 medical monitoring report for vulnerable area. RI of the regional public hospital was a dependent variable, and multiple regression analysis was performed with observed variables of medical supply-demand condition, medical supply, and medical supply structure. Direct effects and indirect effects were confirmed by the analysis of structural equation models (SEM) to see if there were mediating effects.

Results: The RI was 13.1%, and the average of all percentage refined diagnosis-related group (RDRG) was 29.4%. Factors affecting RI were medical supply-demand conditions, medical supply, and medical supply structure. As a result of multiple regression analysis, RI was higher when high percentage RDRG of the regional public hospital (t=4.117, p <0.05), the size of regional public hospital location (t=-2.554, p<0.05), and the population of regional public hospital location (t =-2.415, p<0.05) were smaller. The results of the SEM analysis show that the higher the medical supply-demand conditions, the more direct effect of decreasing the RI and the indirect effect of decreasing the effect of reduction through the medical supply (direct effect=-1.322, total effect=-0.573, p<0.01). The higher the medical supply structure, the more direct effect on the RI (direct effect=1.047, p<0.05) and the higher the medical supply, the more indirect effect of RI through the medical supply structure (total effect=direct effect=0.619, p<0.05).

Conclusion: It has been confirmed that the provision of medical services can affect the RI the regional public hospital which should be considered in carrying out future policies.

키워드

Regional public hospital; Relevance index; Refined diagnosis-related group; Structural equation models
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