소득계층과 주관적 계층인식에 따른 의료이용

Health Care Utilization according to Income class and Subjective Income class : Measurements Based on Korea Health Panel

이 연구는 한국보건사회연구원과 국민건강보험공단에서 수집한 한국의료패널(Korea Health Panel) 의 원자료 중 2009년 연간통합데이터를 분석자료로 이용하였다. 의료이용에 영향을 미치는 요인을 파악하기 위하여 다중 회귀분석을 실시하였고, 계층요인과 건강상태요인에 따른 영향을 좀 더 명확하게 분석하기 위하여 Model 1,2,3을 개발하였다. 외래의료비의 경우 소득계층과 주관적 계층인식이 낮을수록, 연령이 낮을수록, 외래와 입원상병진단을 받을수록 의료비지출이 높았으며, 입원의료비의 경우 배우자가 있는 경우, 사업주 및 자영업자, 임금근로자에 해당하지 않는 경우, 경제적인 어려움으로 인한 스트레스를 받는 경우, 입원진단상병을 받은 경우 의료비 지출이 높은 것으로 분석되었다. 이러한 결과는 상위계층에 비해 하위계층의 의료이용과 의료비 지출이 상대적으로 증가하고 있다는 것으로 의료보장의 목적에 바람직한 일이라고 할 수 있지만, 한편으로는 하위계층일수록 주관적 건강상태가 나빠지고, 급여 및 비급여 의료비부담률 등이 증가하고 있는 것으로 판단된다. 객관적 지위가 되는 소득계층뿐만 아니라 일상적인 삶에서 생활양식과 나와 남을 처지를 구분하는 주관적 계층인식에 따른 범주형 분석을 시행하고 의료이용에 미치는 영향을 비교 분석함으로써 소득계층뿐만 아니라 주관적 계층인식에 따른 건강보험의 보장성 강화, 의료보장정책 및 전달체계, 서비스, surveillance 등 보건의료서비스 체계개발이 필요할 것이다.

The study used the ‘2009 annual total data as an analysis material among other raw data of Korea Health Panel collected by Korea Institute for Health and Social Affairs and National Health Insurance Corporation. In order to understand causing factors to the medical use, the multiple regression analysis was conducted with Model 1, 2 and 3 designed to get social stratification factors and health condition factors analyzed even more thoroughly. In terms of the outpatient medical expenses, more money would be spent on the medical service as the perceptions of income class and subjective income class are low, as the age is low, and as the outpatient care and inpatient diagnosis are frequent. Regarding the inpatient medical expenses, more money would be spent as a patient has a spouse, as the patient is not regarded as a business owner, an owner-operator and a paid worker, as the patients get stressed by financial difficulties and lastly as the patient gets diagnosed while in hospital. As the results confirmed, it is good to see how the purposes of the medical security are being satisfied here while more medical uses and more medical expenses spending are conducted by the lower class than the upper class. However, at the same time, the results also argued that subjective health conditions of the lower class are getting worse constantly and that such phenomenon would, in return, increase the paid and unpaid medical benefit rates and others. In order to deal with such problems, a categorical analysis should be conducted not only on the income class, the objective position, but also on the regular life styles and the subjective income class perception that would distinguish one’s own situations from others. Not only that, with results from the categorical analysis, health and medical care system such as health insurance guarantee, medical social security and information delivery system, service and surveillance shall be developed.