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상복부초음파검사 급여확대에 따른 의료이용의 변화: 이중차이 혼합효과모형 추정방법을 이용하여

Effect of Coverage Expansion Policy for an Ultrasonography in the Upper Abdomen on Its Utilization: A Difference-in-Difference Mixed-Effects Model Analysis

보건행정학회지 2020년 30권 3호 p.326 ~ 334
손예나, 이용재, 남정모, 김규리, 정우진,
소속 상세정보
손예나 ( Son Ye-Na ) - Health Insurance Review & Assessment Service
이용재 ( Lee Yong-Jae ) - Yonsei University Graduate School of Public Health Department of Health Policy and Management
남정모 ( Nam Chung-Mo ) - Yonsei University College of Medicine Department of Preventive Medicine
김규리 ( Kim Gyu-Ri ) - Yonsei University College of Medicine Department of Internal Medicine Division of Endocrinology and Metabolism
정우진 ( Chung Woo-Jin ) - Yonsei University Graduate School of Public Health Department of Health Policy and Management

Abstract


Background: Korea has gradually expanded the coverage of medical care services in its national health insurance system. On April 1, 2018, it implemented a policy that expanded the coverage for an ultrasonography in the upper abdomen. In this study, we aimed to investigate the effect of the policy on the utilization of the ultrasonography in the upper abdomen in tertiary care hospitals.

Methods: Using the dataset of the Health Insurance Review and Assessment Service, we explored changes in the utilization of the ultrasonography in the upper abdomen in tertiary care hospitals from July 1, 2017 to November 30, 2018 through the difference-in-difference (DID) mixed-effects-model method. Facility factor, equipment factor and personnel factors, type of hospital, the total amount of medical care expenses, and geographic region were considered as control variables.

Results: On average, the utilization of the ultrasonography in the upper abdomen increased by 228% after the coverage expansion policy. However, the results of DID mixed-effects-model method analysis showed that the utilization increased by 73%. As for the number of beds, the utilization was higher with a group of 844?930, 931?1,217, and 1,218 or greater compared with a group of 843 or fewer, while the utilization of the number of ultrasonic devices was lower with a group of 45?49 compared with a group of 44 or fewer. The utilization decreased with the number of interns and the number of nurse assistants. Besides, relative to Seoul, the utilization was lower in the other metro-cities and provinces.

Conclusion: The coverage expansion policy in the national health insurance system increased service utilization among people. Future research needs to investigate the degree to which such coverage expansion policy reduces the unmet medical care needs among the deprived in Korea.

키워드

Health insurance coverage expansion; Upper abdomen; Uultrasonography; Difference-in-difference; Mixed model; Republic of Korea

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