일부 경,요추부 염좌 환자의 보충형 민영의료보험 가입이 입원에 미치는영향

Abstract

Background : Aggressive market expansion of supplementary private health insurers is one of the hotest issues of healthcare sectors, especially regarding the probability of threatening soundness of National Health Insurance System, and the necessity of proper regulation on them in Korea. But it has been neglected for them to induce externality on NHI by moral hazard. Therefore, we conducted this study to explore the influence of joining private health insurance on admission as a unneccessary medical utilization among some patients with cervical or lumbar sprain. Method : The study population were 449 patients (admission; 384, out-patient; 85) diagnosed with simple cervical or lumbar sprain without neurologic symptoms from Jul. 1 to Aug. 31 2008 at 20 small hospitals or clinics in Gwangju city and Jeollanam province. From them, the data were collected using structured, self-administrated questionnaire, which was composed of measures of whether they admitted or not(as a dependent variable), whether they had private health insurances(PIH) or not(as a independent variable), and covariates such as socio-demographic characteristics, the factors related sprain(severity, onset and so on), characteristics of providers (recommendation of admission). Results : As a result of hierarchical multiple logistic regression analysis, the admission rate of subjects with PIH was higher than that those without it (OR=3.31, 95% CI; 1.14-9.58), which meant joining PIH was an independent factor influencing on admissions. The other determinants of admission were age of patients, recommendation of physicians, which was the most influencial factor. Conclusions : This study was first empirical study to explore that joining PIH induces moral hazard in admission services with targeted the patients with cervical or lumbar sprain. The policy implication of this finding is that it would be necessary to regulate benefits of PIH in that the effect of this moral hazard may mean existence of externality.

＊Key Words: complementary private health insurance, moral hazard, sprain of cervical and lumbar spine, admission