요양병원과 요양시설의 역할정립 방안 연구
-연계방안을 중심으로-

김진수; 선우덕; 이기주; 최인덕; 이호용; 김경아

A Study on the Reinforcing Medical service linkage between Nursing home facilities and Health care institutes = 요양병원과 요양시설의 역할정립 방안 연구 -연계방안을 중심으로-

제목: A Study on the Reinforcing Medical service linkage between Nursing home facilities and Health care institutes = 요양병원과 요양시설의 역할정립 방안 연구 -연계방안을 중심으로-

저자: 김진수 ; 선우덕 ; 이기주 ; 최인덕 ; 이호용 ; 김경아

키워드: 요양병원 ; 요양시설

발행연도: 2013

발행기관: 한국보건사회연구원

초록: 우리나라의 인구구조 변화를 감안할 때 노인환자가 대부분을 차지하고 있는 요양병원의 환자수와 의료비 지출이 증가할 것이라고 예상할 수 있다. 그러나 그 증가 폭이 지나치게 높은 것으로 보도되고 있다. 이러한 원인으로 필요 이상으로 많은 병원이 운영되고 있고, 과대경쟁은 의료나 간호 처치가 필요하지 않은 환자에게도 과도한 서비스를 제공하려는 유인을 제공 할 수 있다. 또한 노인
요양시설에서 시설입소자의 경우 노인성 질환자의 비율이 높음에도 불구하고 제대로 된 의료서비스 연계체계가 마련되지 않은데서 그 원인을 찾을 수 있다.
위에서 제기된 문제를 바탕으로 본 보고서에서는 입소자 특성에 따라서 요양시설과 요양병원 간 의료서비스 연계강화방안을 고민하고자 하였다. 이를 위해입소자의 상태에 따른 의료 욕구도를 판단하고 요양병원 과 요양시설의 의료 처치 관련 판단기준마련이 시급한 것으로 판단된다. 또한 이러한 판단기준을
근거로 요양병원의 경우 의료 요구도에 따른 의료최고도와 경도 간에 수가차이를 확대하는 방안과 관련 적극적 검토가 필요하다. 이외에도 통합된 정보시스템 구축, 응급의료체계 확충 등이 필요하다고 보여 진다.

In Korea, population of the aged over 65 increased from 4,320,000 person in 2005 to 5,510,000 person in 2010, showing an increase of an average of 5.0% per year. In view of the increasing population of the aged, in case of a health care institute where most of patients are the aged over 65, the number of patients would be expected to increase to some extent. However, it is being reported that the increasing number is too high. According to materials, it was revealed that the number of inpatients of health care institute increased from 30,661 person in 2005 to 172,809 in 2010, up by an annual average of 41.3%. If we take the fact into consideration that, owing to influence of Long-term care insurance for the aged introduced in July, 2008, the certain portion of service demand for the geriatric patients is met through the aged nursing home facility, community care benefits, etc., this phenomenon is deemed to be a special one.
For such a cause, various analytical results are being proposed. First of all, in relation to a nursing home facilities, in case of inmates in a nursing home facilities, it seems to be because that proper medical service linkage system has not been prepared in spite of high ratio of geriatric patients. Also, because the status of a relevant old person is not so bad, that even if he/she is classified into a nonrated person from the long-term care insurance for the aged, it would be possible that he/she must use a hospital according to the degree of income or support of his/her family. Another cause can be found in that, in case of a health care institute, too many hospitals are operated in consideration of medical demand of increasing patients and such excessive competition is inclined to excessive service to patients who do not need medical treatment or care.
Theoretically, in spite that, in medical treatment and long-term care service for the aged, mutually linked service must be provided instead of segmental service, but it is true that actually organic linkage has not been realized.
Considering problems proposed above, the author, in this report, intended to seek a method for reinforcing medical service linkage between nursing home facilities and health care institutes. The study was conducted through study of literature, analysis of foreign cases, analysis by NHIC of basic statistics related to health care institutes and nursing home facilities, a survey targeting managers and users, and in-depth interview related to medical situations of nursing home facilities users per diseases.
To put analytical result together, first, it is judged, in view of the fact that about 32% of patients admitted to health care institutes per year are the subjects for the aged long-term care, the aged need to be screened prior to their entering a nursing home facilities whether or not they really need long-term care at the time of decision of their degrees, even if they received decision of a relevant degree. Second, according to results obtained through in-depth interview, the situation of inmates who need to receive medical service at a nursing home facilities can be classified into three cases: ① In case medical service is provided at a nursing home facilities in spite that medical treatment is unavailable at a nursing home facilities. ② In case inmates are transferred to health care facilities owing to lack of expert nursing manpower in spite that management is possible at a nursing home facilities. ③ In case inmates must receive treatment at an acute hospital for an urgent disease and return to a nursing home facilities. So, it is judged that a decision basis related to medical treatment for dividing inmates in a nursing home facilities and health care institutes is urgent. Also, on the basis of such a decision basis, in case of a health care institutes, it is necessary to positively examine a way for expanding fee differences between the highest medical degree and the light medical degree according to a medical demand degree. In addition to that, establishment of integrated information system, and expansion of urgent medical system, etc. seem to be necessary.

목차: Abstract 1
요 약 5
제1장 서론 17
제1절 연구의 필요성 19
제2절 연구의 목적 및 방법 21
제2장 선행연구 고찰 및 운영 체계‧현황 25
제1절 선행연구 고찰 27
제2절 요양병원‧요양시설의 운영 체계 및 현황 48
제3장 주요국의 장기 요양서비스와 의료 서비스 연계 현황 59
제1절 장기요양 제도 서비스 연계의 필요성 62
제2절 장기요양 서비스의 통합적 케어(Integrated Care) 정의와 운영 현황 68
제3절 장기요양서비스와 케어 매니지먼트(Care management) 92
제4장 요양병원 및 장기요양시설 급여실적 분석 105
제1절 분석 자료 및 분석방법 107
제2절 분석결과 108
제3절 시사점 141
제5장 설문 및 심층 면접 분석 143
제1절 요양시설 종사자 및 입소자 대상 설문조사 145
제2절 요양시설 대상 심층 면접조사 174
제6장 결론 및 정책제언 193
제1절 결론 195
제2절 정책제언 198
참고문헌 203
부 록 215
요양기관 역할 정립에 관한 설문지(시설 종사자) 215
요양기관 역할 정립에 관한 설문지(시설 이용자) 223