자연분만과 제왕절개분만의 입·퇴원 특성 및 진료비 분석 -심사평가원 청구 자료를 중심으로, 2009~2011 (An Analysis on The Characteristics of Hospital Admission and Discharge for Vaginal Delivery and Cesarean Section and Their Medical Expenses -With Special Focus on Health Insurance Review Assessment Da)

서지정보

· 발행기관 : 한국모자보건학회
· 수록지 정보 : 한국모자보건학회지 / 19권 / 1호 / 82 ~ 94페이지
· 저자명 : 송혜숙, 정준식, 이난희, 이병현, 김윤신

초록

낮은 출산율은 우리나라의 대표적인 사회문제 중 하나이다. 이에 최근 3개년 동안 심사평가원에 청구한 분만자료를 분석하여 출산장려정책의 기초자료로 활용 되고자 한다. 연구는 2009년부터 2011년의 3개년 동안의료기관에서 심사평가원에 분만으로 청구한 자료를 이용하여 분만유형별 입퇴원 특성과 진료비 분석을 하였다.
연구결과 분만유형은 자연분만율 64.3%, 제왕절개분만율 35.7%였고, 연령별로는 35세 이상의 고연령화될수록 제왕절개분만이 높았다. 평균 입원일수는 자연분만 3.3일, 제왕절개분만 6.7일, 퇴원약 수령여부는 기존연구에서는 언급된 바 없는 것으로 자연분만 90.1%,제왕절개분만 65.4%로서 자연분만이 24.7% 높았다.
퇴원약 일수는 3일분 이내가 자연분만 60.0%, 제왕절개분만 49.3%로 자연분만이 10.7% 높았다. 상병분석결과 주상병은 자연분만은 단일자연분만(O80)이 83.3%, 제왕절개분만은 선택적(반복적)제왕절개분만 49.2%, 응급제왕절개분만 35.7%였다. 부진단 포함건은 자연분만 72.7%, 제왕절개분만 82.7%로서 제왕절개분만이 10% 높았다. 건당 평균 진료비 분석결과 자연분만은 요양급여비용총액 828,571원, 본인부담금 16,423원, 제왕절개분만은 요양급여비용 총액 1,173,769원,본인부담금 235,522원으로 제왕절개분만이 자연분만대비 요양급여비용 총액은 345,198원, 본인부담금은219,099원 높았다. 결론적으로 출산율 제고와 자연분만 홍보, 보육지원 확대등 정부주관 하에 전담대책반 또는 위원회 설립 등의 제도적인 정책이 뒷받침 되어야할것이다.

영어초록

Purpose: Low birth rate is one of the major social problems in Korea. This study is aimed atproviding Korea’s birth promotion policy with evidence derived from the analysis of the deliverydata available from the Health Insurance Review & Assessment Service (HIRA).
Methods: We conducted an analysis on the characteristics of hospital admissions and dischargesby types of delivery using the data on claims for deliveries made to HIRA for the period of 2009to 2011.
Results: Of all deliveries analyzed, 64.3% were normal spontaneous vaginal deliveries and 35.7%were deliveries by cesarean section, and among women above the age of 35, the higher the age,the higher the rate of women who had cesarean sections. On average, those who had vaginaldelivery were hospitalized for 3.3 days while those who had cesarean section were for 6.7 days.
At hospital discharge, 90.1% of those who had vaginal delivery received medicine while 65.4% ofthose who had cesarean section did so. These findings were never mentioned in the previousstudies. 60% of those who had vaginal delivery were prescribed medicine for less than 3 days’use, while 49.3% of those who had cesarean section were given medicine for the same period. Interms of disease code classification, 83.3% of vaginal deliveries were categorized as single spontaneousdelivery (O80), and 49.2% of c-section deliveries were categorized as optional c-sectiondelivery with 35.7% as emergency c-section delivery. 72.7% of vaginal deliveries were includedin sub-diagnosis while 82.7% were included for cesarean section. As to the medical expensesincurred, the total medical fee and the co-payment by patients were ₩828,571 and ₩16,423 respectively for vaginal delivery and ₩1,173,769 and ₩235,522 respectively for cesarean sectionwith the expenses incurred for c-section were ₩345,198 higher for the total medical fee and₩219,099 higher for co-payment than for vaginal delivery.
Conclusion: In conclusion, policy efforts should be made to support fertility raising, promotion ofvaginal delivery, and child care expansion, for example, a task force or a committee organized bythe government.

참고자료

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