응급의료기관의 기술적 효율성 및 적정 간호인력 비율 추정

Technical Efficiency Measurement and Optimal Combination Ratio of Nurse to Doctor in Emergency Medical Center

본 연구의 목적은 응급의료기관의 생산성을 측정하고, 이에 근거하여 생산성 제고를 위한 적정 간호인력 비율을 산출하여 제시하는 것이다. 생산성의 개념을 기술적 효율성으로 정의하고 자료포락분석(DEA, data envelopment analysis)에 의해 측정하였다. 조사대상은 보건복지부가 지정한 전국응급의료기관 303개이며, 2009년 국립중앙의료센터에서 실시한 ‘전국응급의료기관 평가조사’ 자료를 이용하였다. 분석결과 응급의료기관의 규모가 클수록 기술적 효율성이 증가하였고, 중증환자의 경우에는 병상수, 경증환자의 경우에는 간호인력이 가술적 효율성이 높은 투입변수로 판별되었다. 평균적인 기술적 효율성은 권역응급의료센터 90.69%, 지역응급의료센터 51.69%, 지역응급의료기관 11.54%로 측정되었다. 의사1인당 적정 간호인력은 권역응급의료센터 2.03명, 지역응급의료센터 2.30명, 지역응급의료기관 4.71명으로 나타나, 응급의료기관의 생산성을 제고하기 위해 의사와 간호사의 결합 비를 적정 수준으로 조정하는 정책이 필요함을 시사하였다.

The aim of this study was to measure the technical efficiency of emergency medical centers and investigate the optimal combination ratio of nurse to doctor using data envelopment analysis (DEA). Data were collected from 303 emergency medical centers (EMCs) classified by the national emergency medical service system. The number of doctors, nurses, beds, and ventilators were used as input variables and the number of inpatients and outpatients were selected as output variables. The technical efficiency score (average productivity) of EMCs calculated by DEA was 90.69% in regional EMCs, 51.69% in local EMCs, and 11.54% in local emergency medical facilities. The smaller the scale of EMCs, the lower the productivity. The optimal ratio of nurses to a doctor calculated by DEA was 2.03 in regional EMC, 2.30 in local EMCs, and 4.71 in local emergency medical facilities. To be an efficient EMC, it needs to reduce the more percentage of doctors than nurses. The smaller the scale of EMCs, the lower the technical efficiency. Bed was important factor to intensive care and nurse was a significant factor to mild emergent cases. The optimal combination ratio of nurse to doctor was higher in efficient EMCs for mild emergent cases. To hire nurses up to the optimal level is strongly recommended and it increases not only the technical efficiency of EMCs but also provide high qualified emergency medical services.