장애인 건강주치의 시범사업 평가 및 제도 활성화 방안 연구

Abstract

The government has introduced and operated the pilot project for primary care for people with disablities May 2018 to improve the health level and medical accessibility of the disabled. Five years after the introduction of the system, the number of participants in the disabled and the attending physician was very low at less than 1% of the total, raising the need for a comprehensive evaluation of the system and measures to revitalize the system. This study measured the effect of diagnosing the operation level of the pilot project and the participating disabled, and prepared a plan to revitalize the system through a questionnaire for the participating disabled and their doctor. Research Method: This study measured the effectiveness of the pilot project by analyzing the current status of participation in the pilot project, changes in medical use behavior and health outcomes of the disabled after participation. In order to evaluate the effect of the system, we compared the results of the participants with group of non-participants through propensity score matching(PSM) and Difference in Difference(DID). Research results: The number of disabled people and doctors participating in the pilot project is 1,182 and 60, less than 0.2% of the total. About Half of the disabled were at the level of '0 to 2 times'. In the case of the doctor, the imbalance was severe as the service provision was concentrated on a small number of people, and more than half of the disabled and their doctors left the service at each stage of the pilot project. According to the survey, the satisfaction level was high in that it provided visiting medical treatment to the disabled who had difficulty moving, but the disabled had low access to the system due to lack of system awareness, cost burden, and lack of professional services such as rehabilitation services. In the case of medical providers, it was difficult to participate in the system due to the lack of expected profits due to the lack of participants in the system, difficulty in preparing labor costs for visiting medical treatment, and excessive work by the doctor. As a result of the evaluation of the effectiveness of the pilot project, outpatient dependence rate of higher medical institutions reduced and Relevance Index(RI) increased after participation in the pilot project, and the effect was higher in the group that actively participated. Conclusion: The pilot project has effect on medical use behaviors and health, and participants' survey results showed high expectation and satisfaction for the pilot project. In particular, the need for the system is very high at a time when the health care of the disabled is neglected due to COVID-19. In order for the performance of such a system to be visible, it is essential to revitalize the system by expanding the demand for the system for the disabled and creating conditions for the doctor to participate in the system.