보건행정학회지 (Health Policy and Management)

  • 제19권3호
  • /
  • Pages.92-108
  • /
  • 2009
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  • 1225-4266(pISSN)
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  • 2289-0149(eISSN)
한국보건행정학회 (Korean Academy of Health Policy and Management)
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우리나라 만성질환 관리를 위한 질환주치의 모형의 타당성 분석

A National Chronic Disease Management Model and Evaluation of Validity of Primary Care Physician(PCP) Model in Korea

  • 전기홍 (아주대학교 의과대학 예방의학교실) ;
  • 백경원 (백석대학교 사회복지학부) ;
  • 이수진 (아주대학교 의과대학 예방의학교실) ;
  • 박종연 (국민건강보험공단 건강보험정책연구원)
  • Chun, Ki-Hong (Department of Preventive Medicine and Public Health, Ajou University School of Medicine) ;
  • Paek, Kyung-Won (Division of Social Welfare, Baekseok University) ;
  • Lee, Soo-Jin (Department of Preventive Medicine and Public Health, Ajou University School of Medicine) ;
  • Park, Chong-Yon (Research Institute for Health Insurance Policy, National Health Insurance Corporation)
  • 발행 : 2009.09.30
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초록

This study suggests a model for continuing and comprehensive management of hypertension or Type 2 diabetes mellitus (T2DM) in Korea. Moreover, this paper computed the contribution cost of hypertension or T2DM management using the healthcare medical cost, which could have occurred from stroke, myocardial infarction (MI), and end-stage renal disease (ESRD) that were successfully prevented from the effective hypertension or T2DM management. Additionally, these costs were compared with the cost of implementing the hypertension or T2DM management model suggested in this study. This study used the medical fee summary of the health insurance claims submitted to National Health Insurance Corporation by medical facilities for services provided during the period from January 1st 1999 to December 31st 2006. The prevalence rate with treatment referred to cases in which patients submitted their medical claims at least once during the period, along with an accordant diagnosis. The incidence rate with treatment referred to cases in which patients who never submitted claims for the accordant disease during the five years from 1999 to 2003 submitted claims for the accordant disease in 2004 and 2005. The relative risk of the occurrence of stroke, MI and ESRD was 11.0, 13.6, and 30.3, respectively. The attributable risk of hypertension or T2DM for stroke was 0.730, and that for MI and ESRD were 0.773 and 0.888, respectively. Based on these, the contribution cost of hypertension or T2DM is estimated to be 986.3 billion Korean Won(KRW) for stroke patients, 330.5 billion KRW for MI patients, and 561.7 billion KRW for ESRD patients as in 2005. Hence, the total contribution cost of hypertension or T2DM to stroke, MI, and ESRD is 1.878 trillion KRW. The estimate for operational costs included an annual expenditure of 50,000 KRW per each recipient and an annual subsidy of 0.22 million KRW per person for the 1.6 million low.income individuals with hypertension or T2DM to cover their out.of.pocket medical expenses. Under this assumption, it took approximately 0.6 trillion KRW to manage 5 million high.risk patients in the low. and mid.income range, coverings up to 50% of costs. In conclusion, considering the potential benefits of preventing stroke, MI, and ESRD, the costs seems to be reasonable.

키워드

참고문헌

  1. 박이병, 김대중, 김재용, 김화용, 민경완, 박석원 등. 대한당뇨병학회-건강보험심사평가원 공동연구 2004~2007 : 연구보고서 “Diabetes in Korea 2007” 내용을 중심으로. 대한당뇨병학회 임상당뇨 2007; 8(4): 356-360
  2. 박종구, 김기순, 김춘배, 이태용, 이강숙, 이덕희 등. 의료보험청구자료중 뇌혈관질환 상병기 호의 정확도에 관한 연구. 예방의학회지 2000; 33(1): 76-82
  3. 보건복지부. 국민건강영양조사-검진편-. 서울; 보건복지부: 2001
  4. 봉승원, 김태훈, 김신실, 김영식. 주치의제도의 필요성과 내용에 관한 인식도 조사. 가정의학회지 2006; 27(5): 370-375
  5. 성남희. 전 국민 주치의제도에 대한 논의가 필요하다. 서울: 월간 복지동향; 2008
  6. 이범. 주치의제도 시범사업. 가정의학회지 1999; 20(11): 1623-1630
  7. 이혜리, 이덕철, 문유선, 정의식. 가족주치의 시범사업의 효과. 가정의학회지 1996; 17(9):761-774
  8. 전철수. 주치의제도 시행 제안. 가정의학회지 1999; 20(5): 470-486
  9. 전기홍, 윤종률, 백경원, 박종연, 이수진, 김미선. 건강보험 서비스 질 제고방안 연구. 서울: 국민건강보험공단; 2007
  10. 전기홍, 이수진, 백경원, 김미선. 2008년도 경기도 고혈압·당뇨병·이상지질혈증 관리 지원 사업(4차년도) 보고서. 수원: 아주대학교; 2009
  11. 정형진, 황라일, 서수라, 김철웅. 유럽의 일차의료현황과 주치의 제도 개혁-한국에의 함의. 서울: 국민건강보험공단; 2007
  12. 통계청. 2007년 사망 및 사망원인통계결과. 서울; 통계청: 2008
  13. Asayama K, Ohkubo T, Sato A, Hara A, Obara T, Yasui D, et al., Proposal of a risk-stratification system for the Japanese population based on blood pressure levels : the Ohasama study. Hypertens Res 2008; 31(7): 1315-1322 https://doi.org/10.1291/hypres.31.1315
  14. Brownson RC, Remington PL, Davis JR (eds). Chronic disease epidemiology and control. Washington DC: American Public Health Association; 1993
  15. Kannel WB, McGee DL. Diabetes and cardiovascular disease: The Framingham study. JAMA 1979; 241(19): 2035-2038 https://doi.org/10.1001/jama.241.19.2035
  16. Kannel WB. Risk stratification in hypertension: new insights from the Framingham Study. Am J Hypertens 2000; 13(1 Pt 2): 3S-10S https://doi.org/10.1016/S0895-7061(99)00252-6
  17. Najarian RM, Sullivan LM, Kannel WB, Wilson PW, D'Agostino RB, Wolf PA. Metabolic syndrome compared with type 2 diabetes mellitus as a risk factor for stroke: the Framingham Offspring Study. Arch Intern Med 2006; 166(1): 106-111 https://doi.org/10.1001/archinte.166.1.106
  18. Sandvik H, Cho HJ. Attitudes to family practice registration programmes. Survey of Korean and Norwegian family doctors. Fam Pract 2002; 19(1): 72-76 https://doi.org/10.1093/fampra/19.1.72
  19. Satoh H, Nishino T, Tomita K, Tsutsui H. Fasting triglyceride is a significant risk factor for coronary artery disease in middle-aged Japanese men. Circ J 2006; 70(3): 227-231 https://doi.org/10.1253/circj.70.227
  20. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993; 16(2): 434-444 https://doi.org/10.2337/diacare.16.2.434