우리나라는 병상수급은 양적 분포 및 관리 측면에서 많은 문제점을 안고 있는 것으로 지적되고 있다. 특히, 최근 수도권 대형병원들의 병상증설로 인한 급성기병상 공급과잉문제와 장기요양보험제도의 도입으로 인한 장기요양병상 증가문제 등과 관련하여 국가 전체적인 유형별 병상수급과 함께 지역별 병상 수급이 가장 중요한 과제로 대두되고 있다.
이 시점에서 한국의 병상 수급정책에 대한 재검토가 요구되며 동시에 새로운 보건의료 수요에 대응하는 유형별 총량적인 대책과 지역별 수급불균형 문제를 개선하는 대책 마련이 필요할 것으로 판단된다.
이에 따라 본 연구에서는 지역별 병상의 수급불균형 상태를 파악할 수 있는 지표를 개발하고, 이를 토대로 병상수급 불균형 정도와 그에 영향을 미치는 요인을 분석하며, 우리나라의 병상공급의 적정성을 평가하고, 이를 토대로 병상의 수급불균형을 개선할 수 있는 정책방향을 제시하고 있다.
Hospital bed has a dynamically changing nature and the regular documentation of their regional distributions is a persistent policy concern. The aim of the present study is to examine the current status and causes of regional imbalance of hospital beds, estimate its appropriate level and devise plans for solving this problem. With 2012 National Health Care Resources and Utilization Survey data, we investigated the degree of inequality by calculating relative inequality indices. We plotted the Lorenz curves and calculated the Gini coefficients for hospital beds. Also we estimated the causes of imbalance of bed distribution using multi-logit analysis and regression analysis and estimated the appropriate level of beds using panel analysis. The degree of inequality of hospital beds depends on the types of hospital beds. The inequality of total hospital beds including inpatient care beds and special care beds increased slightly during the period from 2008 to 2012. But the Gini indices of inpatient care beds excluding the inpatient care beds of tertiary general hospital slightly decreased, which means the degree of inequality in the geographical distribution appeared ameliorative during the period. According to the results of multi-logit analysis, the factors affecting geographical distribution of hospital beds were found to be the population growth, urbanization, health status, relevance index and concentration index of health care utilization. Although there was a declining trend in the inequality of geographical distribution of hospital beds, there was little improvements in that total number of hospital beds including inpatient care beds and special care beds. Also there were still several regions in which the degree of inequality in the geographical distribution of hospital beds are more serious. So it is important that many medical policies should be developed to minimize and alleviate the inequality of geographical distribution of hospital beds. First of all, it is necessary to develop the monitoring system, which investigates the status of the demand and supply of hospital beds and the principles of its allocation based on the regional properties. The hospital bed allocation policy should include the reconstruction of hospital bed policy, development of the hospital bed allocation formula, reestablishment of self-sufficient catchment area. These plans should be supported by the central government and each region, which performs the consistent and systematic allocation policies for hospital beds.
목차
Abstract 1 요 약 3
제1장 서론 15 제1절 연구필요성 및 목적 15 제2절 연구방법 및 연구내용 17
제2장 이론적인 고찰 23 제1절 보건의료와 정부 23 제2절 보건의료자원배분계획 35 제3절 병상자원 관련 선행연구 44