Department of Big Data Strategy, National Health Insurance Service, Wonju, Korea.
Task Forces to Support Public Health and Medical Services in Ulsan Metropolitan City, Ulsan, Korea.
J Korean Med Sci. 2023 Apr 24;38(16):e130. doi: 10.3346/jkms.2023.38.e130.
To precisely build a healthcare delivery system at regional levels, local patients' healthcare service utilization patterns must be examined. Hence, this study utilized trend analysis of the relevance index of each disease of each essential medical service field at the municipal and provincial levels.
This study analyzed customized databases released by the National Health Insurance Service from 2016-2020. Diseases defined in the Korean National Burden of Disease (KNBD) study were categorized into the following essential medical service fields: trauma care, cardiocerebrovascular, maternal and neonatal, mental health, infection, cancer, older adults' care and rehabilitation, and others. Relevance index, the percentage of medical service utilization in a region by the residents of that region relative to their total medical service utilization, was examined by region (17 municipal and provincial regions) and disease area. The relevance index was determined based on the number of patients and the total out-of-pocket expenses.
Eight of the 17 regions showed over a 90.0% relevance index in the infection area. In the cancer area, 14 regions (not including Seoul, Daegu, and Busan) had a relevance index lower than 75.0%. Throughout the analysis period (2016-2020), there were no significant variations in the relevance index. Diseases such as bone and connective tissue cancer (39.0%), neural tube defects (16.7%), and autism (57.1%) had low relevance index in the essential medical service fields. In all 17 regions, the relevance index of inpatients was lower than that of outpatients, and that for out-of-pocket expenses was lower than that based on the number of patients.
The relevance index of major diseases of each essential medical service field calculated in this study can provide good indicators for monitoring the level of an independent regional healthcare delivery system.
为了在区域层面精确构建医疗服务体系，必须研究当地患者的医疗服务利用模式。因此，本研究利用趋势分析方法，对市级和省级层面每个基本医疗服务领域的每种疾病的相关指数进行了分析。
本研究分析了国家健康保险服务局在 2016 年至 2020 年期间发布的定制数据库。在韩国国家疾病负担研究中定义的疾病被分为以下基本医疗服务领域：创伤护理、心脑血管、母婴和新生儿、精神健康、感染、癌症、老年人护理和康复以及其他。根据地区（17 个市和省级地区）和疾病领域，以地区居民的医疗服务利用率相对于其总医疗服务利用率的百分比来检查相关指数。相关指数是根据患者人数和总自付费用确定的。
在感染领域，17 个地区中有 8 个地区的相关指数超过 90.0%。在癌症领域，除首尔、大邱和釜山外，14 个地区（共 14 个地区）的相关指数低于 75.0%。在整个分析期间（2016-2020 年），相关指数没有显著变化。在基本医疗服务领域，骨和结缔组织癌症（39.0%）、神经管缺陷（16.7%）和自闭症（57.1%）等疾病的相关指数较低。在所有 17 个地区，住院患者的相关指数均低于门诊患者，自付费用的相关指数均低于基于患者人数的相关指数。
本研究计算的每个基本医疗服务领域主要疾病的相关指数，可以为监测独立区域医疗服务体系水平提供良好的指标。
