농촌·도시 건강실태 및 의료비용 효과 비교와 정책과제

Abstract

농촌 주민은 도시 주민에 비해 다양한 형태의 불편을 겪고 있다. 대표적으로 농촌은 도시에 비해 보건·의료 자원이 부족하고, 교통이 불편하여 보건·의료 서비스 접근성이 낮아서 겪는 어려움이 크다. 사회경제적 요인과 지리적 요인으로 농촌 주민이 건강상 겪는 어려움은 건강불평등으로 이해되며, 국제적으로 건강불평등에 관심이 높고 이를 해소하기 위한 연구와 노력이 이루어지고 있다. 하지만 우리나라에서는 농촌 주민이 겪는 건강불평등이 어느 정도인지, 도시와 비교해서 어떤 차이가 있는지 실태를 구체적으로 보여주는 연구는 부족하다.

현재 보건·의료 정책은 건강불평등을 개선하기 위해 정부의 공공성과 책임성 강화를 통해 필수 의료의 지역격차를 해소하고 전 국민이 일정 수준의 의료서비스를 받을 수 있도록 하려고 한다. 이러한 흐름 속에서 부족한 농촌의 보건·의료 관련 연구로 인한 정보 부족을 보완하고자, 이 연구는 농촌의 건강실태와 의료서비스 이용에 관한 기본적인 정보를 제공하고 향후 더 많은 연구들의 방향을 제시하고자 하였다.

이 연구에서는 농촌과 도시의 의료 자원의 차이를 살펴보고, 농촌 주민과 도시 주민의 건강과 의료비용 및 의료서비스 이용 형태 등을 비교·분석해서 농촌 주민이 겪는 구체적인 건강불평등을 확인하였다. 또한 농촌 관련 보건·의료 정책의 문제점을 파악하고 향후 정책의 방향성을 제안하였다.

This study investigated the extent of the medical and health gaps between rural and urban areas through the perspective of health disparity and suggested policy directions to improve the disparity which rural residents have experienced. For this purpose, we analyzed the disease prevalence, mortality rate, and other relevant health indices of rural and urban residents by using the national health insurance data provided by the National Health Insurance Data Sharing Service (NHISS) along with existing data sets regarding health in South Korea. Also, we compared health service use and health cost between rural and urban residents. The medical gap appears to be the difference in the number of medical facilities and medical professionals. Based on the analysis, only 12.9% out of all medical institutions in South Korea are distributed in rural areas, and 23% of rural areas do not have emergency medical facilities. Also, 5.7% of doctors are working in rural areas, while half of the doctors treat patients in the capital area. The health indicators including disease prevalence and mortality rates, confirmed that there was a health gap between rural and urban residents. Rural areas had higher disease prevalence and mortality rates of circulatory, respiratory, digestive and digestive disorders, urinary diseases, metabolic syndrome (cancer), pneumonia, heart disease, musculoskeletal diseases, dementia and hypertension than urban areas did. Although rural areas showed the lower age-standard prevalence rates of infectious diseases and cancers, they had higher mortality rates. There were different hospital utilization patterns by disease between rural and urban areas. For chronic diseases, rural patients were more likely to use medical institutions, in particular in-town hospitals and clinics, than urban patients were. However, they used out-of-town medical institutions more often than in-town clinics for serious disease such as cancer. In other words, rural residents tended to visit out-of-town medical facilities due to the big difference in medical service qualities between rural and urban medical institutions. Rural patients were likely to pay more medical costs when they visited advanced hospitals located mainly in urban areas than urban residents were. One interpretation of this fact is that rural patients are apt to delay visiting the health care institutions until their diseases get worse. Also, the cost-effectiveness analysis revealed that the effectiveness of medical services in rural areas was less than that in urban areas. The more medical expenses insurance paid for rural patients, the more mortality rates and life expectancy losses they experienced. The Korean government has not considered the characteristics of rural areas while designing health plans, which resulted in critical inequality of the medical service quality and health status between rural and urban areas. Even though health authorities made an effort to improve the quality of medical care by expanding medical resources, the health disparity has not significantly improved. For better medical and health services, this study suggests that the government should implement health and medical policies of rural areas targeting to address health inequalities. For this purpose, it should expand medical infrastructure, improve medical access, provide more medical professionals, and establish a medical system to reflect rural characteristics deviating from the urban point of view.

Researchers: An, Sok; Kim, Namhoon; Kim, Yuna Research period: 2019. 5. ∼ 2019. 12. E-mail address: ansok@krei.re.kr