병원, 의원, 치과의원의 폐업 관련 요인

Abstract

Background: Sustainability of healthcare delivery system of local communities is based on stable supplies of medical institutions such as small hospitals and clinics. Lack of those facilities critically affect healthcare accessibility of local community residents. The objective of this study is to investigate factors associated with closure of small hospitals and clinics in Korea. Methods: The units of analysis are small medical institutions: small hospitals, medical clinics, and dental clinics. This study had a retrospective study design and used the secondary health insurance administrative data. The study pulled out the medical institution data closed from January 1, 2020 to December 31, 2021. A total of 52,809 medical facilities were analyzed as the denominator of study population. For statistical analysis, multi-variate logistic regression was used using the event of hospital and clinic closure. Results: This study found that number of computed tomography (odds ratio [OR], 0.499; 95% confidence interval [CI], 0.316 to 0.790; p=0.003) and magnetic resonance imaging (OR, 0.467; 95% CI. 0.288 to 0.757; p=0.002) were significantly associated with closure of small hospitals, but not in medical and dental clinics. For organizational factors, proportion of medical specialists over generalists and nurses over nurse aids were related with closure of medical (OR, 0.989; 95% CI. 0.978 to 0.999; p=0.04; OR, 0.989; 95% CI. 0.979 to 0.998; p=0.02) and dental clinics (OR, 0.995; 95% CI. 0.993 to 0.997; p<0.001; OR, 0.997; 95% CI. 0.994 to 0.999; p =0.03), respectively. For environmental factors, market competition measured by the Herfindahl-Hirschman Index for hospitals (OR, 0.999; 95% CI. 0.999 to 1.000; p=0.02), the number of medical clinics (OR, 1.001; 95% CI. 1.001 to 1.002; p<0.001), dental clinics (OR, 1.002; 95% CI. 1.002 to 1.003; p<0.001) within local area, and the local population growth rate of clinics (OR, 1.007; 95% CI. 1.001 to 1.013; p=0.03) were significantly associated with medical institution closure. Conclusion: This study found that several factors were associated with closure of small hospitals, clinics, and dental clinics. Healthcare policy makers need to be aware of these factors to prevent unexpected resource allocation in local communities.