소아응급 의료이용 및 자원변화와 의료 접근성 분석

Abstract

The pediatric medical infrastructure in Korea has been weakened by a declining pediatric population, low scheduled fees compared to other department and the risk of litigation among other factors. Accordingly, there are concerns about the decline in accessibility to pediatric emergency medical care. but in has not been sufficiently investigated before. Therefore, this research explores the analysis of the utilization, resources and healthcare accessibility of pediatric emergency medical care and proposes improvement measures. We investigated utilization and resources about pediatric emergency medical based on health insurance claim data and medical institution status report data. Additionally we calculated the shortest distance from patient’s residence to the emergency service where the patient received care. The 2SFCA(Two-step floating catchment area) index was computed using data on pediatric population and the number of doctors working at emergency medical institutions. From 2017 to 2019 the number of children decreased but the number of claims increased for all age groups except for 0 years old. The number of pediatric emergency patients was highest for the age groups 2 years old, 1 year old and 3 years old in that order. After the age of 3, as the age increased both the number of claims and the number of patients decreased. The mild and noon-emergency(level 4-5) claims accounted for 53~65% in total pediatric emergency claims, level 3 claims accounted for 33~43%. During the analysis period, the number of pediatricians increased, while the number of medical residents decreased. The average distance in 2022 was 17.58km between patients and the hospital where emergency care was provided, which was longer than in 2017 and 2019. The distance was longer on weekdays compared to weekends. At a threshold distance of 30km, the average 2SFCA value for 249 regions in Korea in 2017 was 2.96, which increased to 3.85 in 2022. To enhance the efficiency of the emergency health care systenm it is essential to establish a delivery system that enables patients to access care baded on their degree od severity and acuity and to encourage appropriate healthcare utilization by patients.