한국 의료시스템의 혁신 성과 평가

제목
한국 의료시스템의 혁신 성과 평가
Assessment of Korea Health Care System Performance
저자

김수진(Kim, Sujin); 김현규; 이재은; 배재용

저자(타언어)
Kim, Sujin
키워드
의료시스템; 의료 질; 의료시스템 성과
발행연도
2020
발행기관
한국보건사회연구원
초록
비용 대비 가치를 높이는 보건의료 개혁의 핵심은 단순한 재정 절감이 아니라 환자 및 사회의 건강결과의 향상에 있다. 따라서 건강결과를 중심으로 의료 시스템의 질과 성과를 평가하는 것이 중요하나, 한국은 성과를 평가하고 추적, 보고하기 위한 국가 차원의 기전이 부재한 상황이다.

본 연구는 「한국 의료시스템의 혁신 성과 평가」 5년 차 연구로, 건강결과를 중심으로 국가 의료 질과 시스템 성과를 살펴보고, 우리나라 의료 질 관리시스템의 현황을 진단하고 개선이 필요한 영역을 확인하였다. 본 보고서의 연구결과는 우리나라 의료시스템의 점검 및 확인하고 의료 질 개선활동을 추진하기 위한 근거자료로 활용될 것이다.

As medical expenses increase rapidly, countries are facing the challenge of providing valuable services for the cost. It is necessary to evaluate the quality and performance of medical care centering on health outcomes at the system level. This study is to examine the health outcomes of the healthcare quality and system at the national level and to analyze Korea’s medical quality management system.
As the first part, a medical quality report was designed by benchmarking the NHS Outcomes Framework in the UK. Our results show that number of years of potential life loss due to avoidable causes, a general indicator of early death prevention (effectiveness), has been shown to have improved steadily over the past 10 years. The quality of life of people with patients was not significantly improved, and emergency readmission within 30 days of hospital discharge deteriorated recently. In the patient-centered area, inpatient service was not significantly improved. Although Korea's health care system has made considerable results in acute medical services, it shows that it does not play a sufficient role in responding to chronic diseases that are increasing along with an aging population and lifestyle changes.
As the second part, we analyzed medical quality management system. The first problem in the area of ​​effectiveness is the segmentation of the system. Strategic plans are divided into diseases, and there is no comprehensive strategy or plan at the healthcare system level. It shows that the current Korean healthcare system remains ‘disease-centered’, which may lead to the result of the healthcare system focusing on the clinical effectiveness of individual services rather than seeking improvement of health outcomes centering on people. The segmented system is also confirmed in the quality management system for medical institutions. The standard setting function is insufficient. In particular, as the importance of preventing and managing chronic diseases is emphasized, it is necessary to establish a standard for providing evidence-based treatment in the areas of primary and secondary prevention. In addition, quality standards can be effectively used when they are created through cooperation and social consensus between related organizations based on evidence, but this process is insufficient.
The analysis results provide implications for the areas in which Korea's medical system needs innovation. First of all, as a problem that has been continuously mentioned in several studies, it is necessary to move from acute disease treatment center to chronic disease prevention and management. Temporary results can be achieved by individual specialists or procedures, but the results themselves are achieved through comprehensive care for the patient's condition. Chronic diseases are not the quality of individual outputs, especially in that short-term treatment does not achieve health outcomes. An approach is needed in terms of system quality. Next, it is necessary to diagnose and invest in areas where sufficient investment is not being made in terms of system quality. Comprehensive and systematic continuous monitoring is needed to confirm this.
It is necessary to develop strategies at the national level to improve medical quality. How to set standards, monitor and improve quality in each stage of medical service (prevention, treatment, rehabilitation, terminal care) to improve the effectiveness, patient-centeredness, and responsiveness of medical services through the establishment of an integrated national medical quality strategy. Long-term planning is needed. Next, In terms of strengthening the accountability of the medical system, it is necessary to prepare a system-level performance monitoring and reporting system. Reinforcing the accountability of the medical system is to disclose to the public so that the public can understand where the Korean medical system is performing and what is insufficient. National-level health care quality strategies, performance reporting and monitoring should be linked to quality management activities in the health care field. For this, quality standards must be developed consistently in all areas. It acts as a kind of standard library.
목차
Abstract 1
요 약 5
제1장 서론 11
제1절 연구의 배경 및 목적 13
제2절 연구의 내용 및 방법 17
제3절 개념적 고찰 21

제1부 한국 의료 질 보고서

제2장 한국 의료 질 보고서 설계 35
제1절 국외 의료 질 보고 현황 검토 37
제2절 영국 국가보건서비스(NHS) 결과 보고체계 47
제3절 한국 의료 질 보고서 설계 63
제3장 우리나라 의료 질 현황 67
제1절 효과성: 조기사망 예방 69
제2절 효과성: 장기 질환자의 삶의 질 88
제3절 효과성: 질병으로부터 회복 101
제4절 환자 중심성 110
제5절 안전성 138
제6절 소결 140
제4장 국제 비교로 본 한국 의료 질 143
제1절 효과성 148
제2절 반응성/환자 중심성 175
제3절 안전성 176
제4절 소결 178
제5장 코로나19 유행 동안 의료시스템의 반응성: 노인의 의료이용 경험 181
제1절 연구 방법 183
제2절 분석결과 187
제3절 소결 203
제6장 한국 의료 질 향상 성과 종합 및 제언 205
제1절 한국 의료의 질 향상 성과 종합 207
제2절 국가 의료 질 측정과 보고 개선을 위한 과제 237

제2부 의료시스템 성과 제고를 위한 의료 질 관리 체계

제7장 우리나라 의료 질 관리체계 분석 243
제1절 효과성 개선 영역 246
제2절 환자 중심성 강화 영역 270
제3절 안전성 개선 영역 273
제4절 소결 281
제8장 주요 선진국의 의료 질 관리체계 285
제1절 영국 287
제2절 네덜란드 300
제3절 미국 313
제4절 소결 332
제9장 의료 질 관리체계 개선 과제 335
제1절 의료시스템 성과 제고를 위한 정책 과제 337
제2절 제언 341
참고문헌 343
부록 359
[부록 1] 건강결과를 중심으로 본 우리나라 의료 질 지표 산출 방법 359
[부록 2] 국제 비교로 살펴본 우리나라 의료 질 지표 산출 방법 375
[부록 3] 코로나19로 인한 노인의 의료이용 경험 조사표 377
보고서 번호
연구보고서 2020-36
ISBN
978-89-6827-758-0
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