Relationship between health insurance premium charges and medical service use : 국민건강보험공단 강서지사 가입자를 대상으로

보건정책관리학과/석사[한글] 이 연구는 2004년 12월말 현재, 국민건강보험공단 강서지사에 소속된 지역 및 직장가입 169,816세대 463,378명의 2004년도 1년간 보험료부과 및 세대별 보험급여자료를 이용하여, 보험료부담과 의료이용의 관계를 분석함으로써 소득재분배 효과가 있는지를 살펴보았다. 피보험자의 특성으로 성, 연령, 직역, 피부양자수를, 부담 능력으로는 세대당 연간보험료를, 의료이용은 입원, 외래의 의료 이용일수와 진료비를 이용하여 분석하였다.분석결과, 보험료 수준은 피보험자가 남자일수록, 연령이 높을수록, 피부양자가 많을수록, 지역보다는 직장가입자가 높은 경향을 보였으며, 보험료 수준이 높을수록 세대구성원 1인당 의료이용도 많았다. 의료이용에 영향을 미치는 요인으로는 보험료, 직역, 성, 연령, 피부양자수가 유의한 영향을 미치는 것으로 나타났다. 보험료부담에 있어서는 계층간 수직적 소득재분배가 이루어져 형평성이 확보되어 있었고, 의료이용은 보험료 수준이 낮을수록 의료이용이 적고, 보험료 수준이 높을수록 의료이용이 많아, 불균등 분배가 이루어지고 있었으며, 의료이용의 형평성은 미흡한 것으로 보인다. 보험료부담과 의료이용을 동시에 고려한 형평성분석에서도 의료이용의 불균등 분배로 소득재분배의 상쇄효과가 일어남에도 불구하고 여전히 보험료부담의 계층간 수직적 소득재분배는 이루어져 형평성은 존재하였다. 지역세대와 직장세대의 계층내 분배정도를 보면, 보험료부담에서는 지역세대의 형평성이 더 크게 확보되어 있었고, 의료이용에 있어서는 직장세대가 더 균등하게 분배되어 형평성이 확보되어 있었으며, 보험료부담과 의료이용을 동시에 고려할 경우에는 지역세대보다 직장세대의 소득재분배 효과가 더 크게 나타났고 형평성도 더 확보되어 있었다. [영문]This study aims to examine the relationship between premium charges and medical service use, based on the data of premium charges and benefits of 463,378 individuals in 169,816 households who are insured at the Gangseo branch local or company group insurance for the year 2004 so as to grasp whether it has income redistribution effect. Gender, ages, occupations, and the number of dependents were examined as the holders'' traits, yearly premium of each household to grasp solvency, and lastly, hospitalization records, the number of medical service uses, and medical treatment fees to analyze their medical service use actual conditions.The result of this study presents that male, older age, employees, households with more dependents, and higher level of premiums, user more medical service. As for the factors affecting service use, premiums, occupations, gender, and the number of dependents turned out to have significant effects. As for premium charges, vertical income redistribution according to social stratums was in operation, which shows secured equity. On the other hand, the level of premiums was in inverse proportion to the number of service use, which shows inequity in this regard. In the analysis of equity considering both premium charges and medical service use too, even though there is offset effect to income redistribution through uneven distribution of medical service use, there still remains equity by vertical income redistribution according to social stratums in premium charges.As to the comparison of the extent of distribution between local and company group insurance households, it turned out that in the matter of premium charges, higher level of equity was secured for local insurance households, as for service use, for company group insurance households, and when both factors are considered, company insurance households turned out to benefit from better income redistribution effect and higher level of equity.The result of this study indicates that there is more need to resolve controversies on equity in premiums by establishing unified health insurance system. To solve the problem of limited access to medical services due to the low level of guarantee at around 60% in 2005, extension of the coverage and benefits for the lower level class should be concentrated on so as to secure the finance, in the long run, and 80% of guarantee for diversification of risks, income redistribution, and social solidarity reinforcement, which makes possible social integration.ope