일차 진료의원의 진료수입의 형평성 분석연구

Abstract

Background: Korea’s primary care clinics are seeking increase in consultation fees by expanding supply within the frame of the health insurance system, but inequality of physician income between regions and individuals is exacerbating. The purpose of this study lies in analyzing the distribution of patients of primary care clinics, their specialized field, and the degree of inequality between medical fee income according to region. Data was acquired from the Health Insurance Review and Assessment Service on charged bills made by clinic-size medical institutions from 2008 to 2011. Methods: By comparing the outpatient number per clinic according to the clinic’s specialized field, results showed that ophthalmology, otolaryngology, dermatology, orthopedics, and internal medicine showed high numbers whereas plastic surgery, neuropsychiatry, cardiothoracic surgery had fewer outpatients. The number of outpatients for clinic according to region showed Chuncheonnam-do, Jeju-do, Gangwon-do, Chungcheongbuk-do, Ulsan to have higher numbers of outpatients. For those four years, clinics in the Seoul area had a rather lower number. Results: As a result of comparing the decile hierarchy distribution ratio between specialized fields according to primary care clinics income from National Health Insurance, the inequality degree showed that obstetrics and gynecology and general medicine were each 0.130, 0.280 for the decile distribution ratio, which was the highest degree of inequality within the specialized field. Their Gini coefficient were also relatively high at 0.691, 0.528 respectively. On the other hand, the decile distribution ratio for otolaryngology and orthopedics were 0.510, 0.468, respectively, while their Gini coefficient each at 0.318, 0.314 makes their inequality degree relatively lower than other fields. Conclusion: This study is limited in that the data used was the health insurance charges submitted by clinics, which does not provide total information of the doctors’ income. However, because most clinics are largely dependant on their income to come from health insurance reimbursements. Therefore, the results of this study can be used effectively. In the future, research that includes data on non-covered service income should be conducted to closely examine policy plans with a new medical fee policy which can resolve the medical fee income inequality issue between clinics as well as revitalize primary medical care.