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Journal of the Korean Academy of Family Medicine 1993;14(4):265-270.
Published online April 1, 1993.
A study on influence of korea medical insurance and health care delivery system to family practice inpatient care.
Dong Yoon Ko, Hyun Dong Yoo, Young Gyu Park, Jung Yul Oh, Myung Ho Hong
의료보험 및 의료전달체계가 가정의학과 입원환자 진료에 미치는 영향
홍명호, 고동윤, 유현동, 박영규, 오정열
단국의대 내과학교실
: It is expected that Korea Medical Insurance and Health Care Delivery System made change the contents of inpatients in Family Medicine and increased the role of Family Mediine in primary care. We have tried to prove the above hypothesis by comparative study on the inpatient related seeral factors in the year of 1998 and 1991.

Methods : We examined the medical records of the patients who were hospitalized to the department of Family Medicine, Korea University Kuro Hospital from January 1. 1998 through December 31, 1988 and January 1, 1991 through December 31, 1991. We analyzed the number of patients, age, sex, living district, the length of stay, the route of admission, condition at the time of discharge, and diagnosis.

Results : A total of 95 patients were hospitalized in 1988 and those of 183 patients in 1991. The increased rate of total numbers of hospitalized patients was 92.6%. There were no significant difference in age, sex, living district distribution in between those study groups. The length of stay was increased from 5.8±3.8 days to 13.3±8.2 days. In the route of admission, the patients via out patient department was decreased from 97.8% to 91.8% and those via emergency room was increased from 2.2% to 8.2%. In patient's condition at the time of discharge, improved state was increased from 38.9% to 66.7% and unimproved state was decreased from 49.5% to 16.9%. In 1988, the most common diagnosis was chronic hepatitis of 14 cases(14.7%) and the next was neurotic disorder of 8 cases (8.4%). In 1991, the most common diagnosis was diabetes mellitus of 20 cases(11.0%) and the next was acute and subacute necrosis of liver of 12 case(6.6%).

Conclusion : It is concluded that these changes were induced by increased hospitalization for treatment compared to decreased hospitalization for diagnosis due to decreased the amount of money that patient has to pay from their own pocket besides medical insurance coverage. Also, it is believed that the increased role of family medical insurance coverage. Also, it is believed that the increased role of family medicine in primary care affected these changes.
연구배경 : 1989년 7월 1일부터 실시된 전국민 의료보험 및 의료전달체계로 인해 3차병원 가정의학과의 환자 진료 양상 및 질병 구조의 변화가 생기고 일차 진료에서의 비중이 증가되었을 것으로 사료되어 이를 검증하고자 본 연구를 시행하였다.

방법 : 1988년 1월 1일부터 12월 31일까지 및 1991년 1월 1일부터 12월 31일까지 각 1년간에 고려대학교 구로병원 가정의학과에 입원한 모든 환자를 대상으로 환자수, 성별, 연령분포, 주거지역, 재원기간, 입원경로, 퇴원시의 상태, 질병분포를 비교하였다.

결과 : 전체 입원 환자 수는 1988년 95명, 1991년 183명으로 92.6%의 증가를 보였으며 성별, 연령분포, 주거지역의 차이는 없었다. 재원기간은 평균 5.8±8.2일로 증가하였다. 입원 경로는 외래를 통한 입원이 97.8%에서 91.8%로 감소하고 응급실을 통한 입원은 2.2%에서 8.2%로 증가하였다. 퇴원시의 상태는 회복상태가 38.9%에서 66.7%로 증가하였고 미회복 상태는 49.5%에서 16.9%로 감소하였다. 질병 분포는 1988년에는 만성 간염, 신경증적 장애 등의 질환이 진단을 위하여 입원한 것이 각각 14.7%, 8.4%로 1, 2위를 차지하였으나 1991년에는 당뇨병, 급성 간질환 등의 질환의 치료를 위한 입원이 각각 11.0%, 6.6%로 1, 2위를 차지했다.

결론 : 이러한 변화는 의료혜택의 확대로 환자의 부담이 감소되고 의료전달체계의 실시로 3차병원애의 가정의학과의 일차진료에 대한 비중이 증가되어 이전에는 진단을 위한 단기간의 입원을 주로 하였으나 이후에는 질병의 치료를 위한 입원이 증가하였다고 사료된다.
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