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인구집단 기반 건강관리모형의 적용가능성 검토: 한 지역의 의료복지사회적협동조합형 의료기관을 중심으로

A Study on the Applicability of the Population-Based Health Care Model: Focusing on Social Cooperative-type Medical Clinics in a Local Area

한국의료질향상학회지 2020년 26권 2호 p.95 ~ 103
이근정, 오주연, 이다희, 함명일, 이진용,
소속 상세정보
이근정 (  ) - Health Insurance Review & Assessment Service HIRA Research Institute
오주연 ( Oh Ju-Yeon ) - Health Insurance Review & Assessment Service HIRA Research Institute
이다희 ( Lee Da-Hee ) - Health Insurance Review & Assessment Service HIRA Research Institute
함명일 ( Hahm Myung-Il ) - Soonchunhyang University College of Medical Science Department of Health Administration and Management,
이진용 ( Lee Jin-Yong ) - Seoul National University College of Medicine Department of Health Policy and Management

Abstract


Purpose: This study was to examine whether a health care model that provides comprehensive medical services based on population groups to members of the medical cooperative is applicable as a policy alternative in terms of medical use and cost.

Methods: Data were derived from National Health Insurance claim data in 2019. We compared the medical volume and expenses of patients who visited social cooperative-type medical clinics with other patients, control group who visited other clinics in a local area.

Results: The average number of visit days was 25.3 days in social cooperative-type medical clinics, more than 24.2 days in the control group (p=.004). However, the average medical cost per visit was KRW 46 thousand in social cooperative-type medical clinics, which was significantly lower than KRW 51 thousand in the control group (p<.001), and the total medical cost was also KRW 16.1 billion in social cooperative-type medical clinics and KRW 16.9 billion in the control group.

Conclusion: We identified that a population-based health care model might change patients' behaviors to health care services and decrease total medical cost. Further population based experiment is needed to develop alternative healthcare model.

키워드

Population health management; Disease management; Cost control

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