농촌주민 보건복지서비스 연계의 경제적 효과 분석

Abstract

최근 들어 정부와 민간에서 보건서비스와 복지서비스를 보다 효율적이고 효과적으로 제공하기 위한 노력이 일어나고 있다. 대표적인 예로 보건서비스와 복지서비스를 서로 연계하여 통합적으로 제공하는 것을 들 수 있다. 특히 노인들의 비중이 도시지역에 비해 높은 농촌의 경우, 보건서비스와 복지서비스의 정책대상자는 중복되어 나타나는 경우가 많다. 이와 관련하여 보건서비스와 복지서비스를 어떻게 연계하여 제공할 것인가에 대한 많은 연구가 최근 진행되고 있다. 그러나 이에 반해 보건서비스와 복지서비스를 연계했을 때 발생하는 효과를 평가한 연구는 매우 미미하다. 지금까지 대부분의 연구는 개개인의 만족도 조사를 통한 평가에 머물고 있는 한계가 있다. 이에 이 보고서는 기존의 만족도 조사를 통한 보건복지서비스 연계의 평가에서 벗어나 서비스 연계의 경제적 효과를 정량적으로 제시하고 있다. 특히 기존에 연구되지 않았던 보건복지서비스 연계의 경제적 평가를 위한 모형 구축과 함께 설문조사 자료를 이용한 실증분석 결과도 제시하고 있다. 더불어, 이 보고서에서는 농촌지역 노인들의 보건서비스, 복지서비스 욕구(needs)와 보건복지서비스 연계 현황과 실태도 다루고 있다.

This paper is aimed towards evaluating the role of integrated care, which couples health care and social welfare programs, for the elderly in rural areas in Korea. This integrated care system can reduce the cost through eliminating the unnecessary cost that appears when two programs (i.e. health care and social welfare programs) are separately considered. Moreover, this integrated care system is highly required since elderly recipients of a health care program mostly have needs of social welfare services coincidentally or vice versa. Though those two programs are traditionally provided separately in Korea, some efforts to integrate health care and welfare programs have recently been made. Empirical studies in the U.S. and European countries show that the integrated care system improves care recipients’ satisfaction on services and quality of life. Moreover, the empirical studies suggest that the integrated care system is able to decrease the utilization of hospitals and the cost of services. However, it is still controversial that this system is effective and efficient in terms of costs and mortality. Despite recent studies reporting the integrated care system in the United States or European countries, it has still remained elusive how to evaluate the integrated care system for the elderly in rural areas in Korea. Until recently most of previous studies evaluated the effect of an integrated care program by only measuring the care recipients’ satisfaction. The evaluation of recipients’ satisfaction is not sufficient to judge the effectiveness and efficiency of an integrated care program because the care recipients’ satisfaction is very subjective and contains limited information. This implies the necessity to establish a standard, which may allow for evaluating the efficiency and effectiveness of the integrated care program, by estimating not only the care recipients’ satisfaction but also economic evaluation. To quantitatively understand the role of the integrated care system on the economy of Korea, I consider the datasets such as costs, hospital utilization, health conditions, mortality, considering or excluding an integrated care program. These datasets need to be based on randomized controlled trials. However as these datasets are not available publicly to be utilized in Korea, I take into account an alternative method to evaluate the economic effect of an integrated care program. In particular, in this paper, I employed the cost-effectiveness method with alternative methods to the design of traditional randomized controlled trial in order to evaluate the economic effect of an integrated care program, which combines health care and social welfare programs, for the elderly in rural areas in Korea. The data were collected directly from two rural provinces where an integrated care program for the elderly is implemented. Specifically, I used the collected data such as integrated care recipients' satisfaction, integrated care recipients' demographic and socio-economic characteristics, frequency (or hours) of integrated care services to receive, and integrated care recipients' health status. Based on the analysis using aforementioned data, this study suggests the incremental cost-effectiveness of the integrated care program, which combines health care and social welfare programs, and also provides the optimal trajectory of cost for an integrated care program for the elderly. This work sheds light on the integrated care program which allows for effectiveness of economic cost and improving the life of the elderly. Researchers: Eom Jinyoung, Nam Seunghui, Kim HagyeongResearch period: 2015. 1. ~ 2015. 10. E-mail address: jeom@krei.re.kr