Suchergebnisse

Health care (HC) expenditures now account for nearly 10% of the US gross national product, the highest share ever recorded. Concerned that too many resources are being devoted to HC, policymakers are searching for ways to control HC expenses, eg, higher coinsurance & deductibles, measures to increase market shares of health maintenance organizations, & conversion from cost reimbursement to prospective reimbursement. These measures contain many incentives for patients & providers to alter use of HC services. However, aggregate resource use may or may not be lower & more efficient under these new programs. To determine whether limited resources would be devoted to maximizing the nation's health, incentives inherent in each policy option must be examined. A classification of types of disease & HC outputs is developed & used to examine incentives offered to patients & providers by three alternative payment mechanisms -- capitation, fee-for-service, & payment by diagnosis -- regarding types of disease treated & mix of outputs produced. This type of analysis is required to select an appropriate payment mechanism for obtaining a socially acceptable allocation of HC resources. 1 Table, 1 Figure. Modified HA.

Health care expenditures now account for nearly 10 percent of our gross national product, the highest share ever recorded. Concerned that this represents too many resources being devoted to health care, policymakers are searching for ways to control health care expenses. These include higher coinsurance and deductibles, measures to increase market shares of health maintenance organizations, and conversion from cost reimbursement to prospective reimbursement. These measures contain many incentives for patients and providers to alter use of health care services. However, aggregate resource use may or may not be lower and more efficient under these new programs. To determine whether limited resources would be devoted to maximizing the nation's health, incentives inherent in each policy option must be examined. This article describes a classification of types of disease and medical care outputs. The framework is then used to examine incentives offered to patients and providers by three alternative payment mechanisms—capitation, fee-for-service, and payment by diagnosis—regarding types of disease treated and mix of outputs produced. This type of analysis is required to select an appropriate payment mechanism for obtaining a socially acceptable allocation of resources.

보건학과/박사 ; [한글] 1970년대의 급속한 경제성장에 힘 입어, 1977년 부터 시작된 의료보험및 의료보호 사업으로,국민의 의료수요가 크게 증가되었으며,또한 정부는 1991년까지 전 국민에게 의료보 장사업을 시행하기 위한 의욕적인 장기계획을 수립하고 추진중이다. 정부의 병상증설 계획이 추진될 경우 거시적 계획에서는 고려되지 않는 지역실정을 감안한 지역별 계획의 수립으로 일선 행정기관의 시행착오 없는 병상증설이 될 수 있도록 다음과 같은 목적으로 연구하였다. 1) 수개 시군을 포함하는 특정 지역에 대한 의료수요를 적절하게 충족시킬수 있는, 지역실정에 맞는 병상수요 추계를 시도한다. 2)의료전달체계의 확립으로 1차진료를 기초로 하는 더 세분화된 지역에서의 의료전달모형을 개발하고, 병원 배치계획을 시도한다. 그리하여 본 연구에서는 수개 시군을 포함하는 인구 약100만명의 大田중진료권 선정하고, 정부계획과 같이 1990년 까지는 지역주민 전원에게 의료보장사업을 적용하는 것으로가정하였다. 병상수요 추계방법은 1981년의 전국 의료보험 실적을 주축으로 하고, 한국인구보건연구원의 전국보건의료망 편성연구 보고서가 채택한 수식을 활용하여, 지역특성을 감안한 병상수요 추계와, 절약형 의료서비스 체계에 의한 병원시설 배치계획를 시도하였으며, 그결과는 다음과 같다. 1) 1981년의 大田중진료권의 병상수요는 1,241병상으로 그리고 외래방문회수는 6,192,388회로 각간 추계되었다. 그리고 1990년 까지의 병상수요는 2,560병상으로 추계되었으며,大田진료권을 위한 3차진료기관이 大田시에 설치될 것을 함께 감안할 때는 약 3,000병상 으로 추계되었다. 2) 병원별 병상규모를 3차진료기관은 700병상 이상의 모형과 2차진료기관은 400병상, 250병상, 120병상, 그리고 40병상의 모형을 적용한 바, 700 병상 1개 병원, 400병상규모 2개 병원, 250병상규모 2개 병원, 120병상규모 8개 병원, 그리고 40병상규모 1개 병원의 병원시설이 배치계획되었다. 3) 주요 진료과별 병상 배분은 내과·소아과 계열이 약 50%,외과 계열이 약 25%, 산부인과 계열이 약 20%,그리고 정신과 계열이 약 5%로 배분되었다. [영문] Since 1977, the medical insurance and medical aid programs have been implemented throughout the country, which was the first time Korea applied the medical security scheme nation-wide. Eventually, a rapid growth of medical demand was introduced enormously with the governmental support for these programs. At the same time, the Government has set also an ambitious plan to cover the whole population of this country by the medical security scheme by 199l, as one of the important projects of the Five-year Socio-economic Development Plans. However, it must be true that the current situations in the field of public health and medical care will not be sufficient to persuade them. Most researches and studies recently on these problems show a lower level of utilization rate, mal-distri-bution, and tremendous shortage of medical facilities, which were rather concentrated at the national level. There is an increasing need of more practical and useful studies at the lower level than that of the national level. Therefore, the study purpose focused at this level as follows; A. Selecting a certain community consisting of some cities and counties, where the population was rather smaller, and calculating how many hospital beds should be required to fulfill the minimum level of their needs and also to reflect the specific situation of that local community. B. A model development of the health delivery system in that particular community was badly needed, regarding a flow of medical care from the primary care unit to the central hospital, and also regarding the site selection and allocation of planned hospitals. In line with this purpose, the Sub-region of Dae-jon was selected, where the population is about one million. The whole population of the Sub-region was assumed to be fully covered by the medical security scheme as a part of the Government Plan by 1991. In order to provide the better cares under the "effective" delivery system to be applied with the capitation system, group practice and attending system under the health maintenance organization, an estimation of hospital bed needs and an allocation plan of hospitals for the Sub-region was studied. Meanwhile, the study required the selection of variables describing the social,economic, and provider factors in prediction of hospital bed demand. Usually, those variables are so difficult to measure directly that the following materials were used mainly for this study, i.e., (1) the Year-Book of the medical insurance programs in 1981 and (2) the formula in estimation of hospital bed demand found in the research report of the national health care network from the Korean Institute of Population and Health in 1982. The result was summarized as follows ; A. In the Sub-region of Dae-jon, the need of hospital beds was estimated as 1,241 beds in 1981 and 2,560 beds by 1990. Considering the tertiary care level hospital (700 beds), it was also estimated as 3,000 beds by 1990. B. According to the bed size of hospitals, one hospital of 700 beds, two of 400 beds, two of 250 beds, eight of 12O beds, and one of 40 beds were confirmed. It was also studied that those hospitals will be allocated into and set up at selected sites in five Medica1 Districts of the Sub-region. C. Dividing beds by the medical speciality in a hospital, it was found that nearly 50% of them would be needed for internal medicine and pediatrics, 25% for surgery, 20% for obstetrics and gynecology, and 5% for psychiatry. ; restriction