건강형평성 강화를 위한 의료서비스 전달체계 개선방안

제목
건강형평성 강화를 위한 의료서비스 전달체계 개선방안
Healthcare delivery reform for reducing health inequality
저자

신호성; 이수형; 박봉희

키워드
건강형평성 제고; 환자중심 일차의료; 통합의료 전달체계
발행연도
2012
발행기관
한국보건사회연구원
초록
통합의료(care coordination)는 대상과 목적, 의료기관의 위치에 따라 다양한 정의가 존재한다. AHRQ의 2007년 조사에 따르면 40여 가지의 정의가 존재하나 모든 정의를 아우르는 5가지 주요 핵심요소는 다수의 서비스 제공자, 환자의 진료에 분절적으로 참여하는 진료진간 협력, 자신뿐만 아니라 다른 서비스제공자의 역할이나 사용가능 자원들에 대한 이해와 지식, 환자 관리를 위해 서비스제공자들 간의 정보교환, 가장 적절한 보건의료서비스 전달 목적

Care Coordination refers to care delivery system or service programs which involved multi-providers work in coordinated manner not only to improve care quality and patients satisfaction but also to use resources efficiently. The objectives of this study are to suggest a new primary care oriented coordination system based on the previous research evidence and data analyses.
For the purpose, the study analyzed patients' perception and patients care utilization pattern using interview survey and 2004~2008 insurance claim data. To conclude, care coordination is limited and patient satisfaction is higher in the group which have the family doctor. We learn from OECD countries and study several care coordination model or schemes such as chronic care model, medical home model, and polyclinic.
Main characteristics of new system the study proposed, are as following. First, new scheme is based on the idea of patient centeredness. Patient-centeredness means to put priority on patients' perception, belief, value, and cultural background in making a decision of care service. Second, patients participated in the scheme have own a family doctor as a main service provider and care coordinator. Third, the scheme includes chronic disease management program as a part of care coordination. To efficient approaches, patient classification is needed based on case-mix. Fourth, the intergration of organizations would provide better seamless services because care fragmentation usually occurs in interface between the care organizations. Fifth, information technologies act on primary infrastructure, and shared patient information would not only enhance the communication efficiency among service providers but also the effects of care coordination. Finally, carefully organized reimbursement plans for providers would increase the effectiveness of new scheme. For payments, a variety of method can be introduced including mixed payment with incentives. Paralleling with providers, recipient's incentive system also improve the participation rate and patients corporations.
Introducing a new system may be hampered by the obstacles from several stakeholders, especially providers' organization. Low level of care coordination would be a starting point, such as a family doctor for the chronic patients. Care coordination is getting a main policy issue for the health system performance improvement. First priority is the policy resolution for achieving the goals.
목차
Abstract 1

요 약 3

제1장 서론 11
제1절 연구의 배경 및 목적 11
제2절 연구 내용 및 방법 14
제3절 연구추진체계 15

제2장 현행 보건의료체계의 문제점 및 통합의료의 필요성 19
제1절 현행 보건의료체계상의 문제점 19
제2절 통합의료의 필요성 27

제3장 의료생활협동조합을 통한 통합의료 39
제1절 통합의료와 의료생활협동조합 39
제2절 통합의료에 대한 환자인식조사 44
제3절 통합의료에 대한 환자의 인식 정도 63
제4절 의료생활협동조합을 중심으로 한 의료전달체계 구축방안 76

제4장 외국사례(사회보험체계에서 통합의료의 실현) 81

제5장 결론 및 정책제안 107
제1절 통합의료의 일반적 원칙 107
제2절 통합의료서비스 형태 112
제3절 결론 및 제언 122

참고문헌 125

부록 : 통합의료에 대한 환자 인식도조사 설문지 135
보고서 번호
연구보고서 2012-08
ISBN
978-89-8187-936-5
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