민간의료보험 가입이 의료비에 미친 영향:실손의료보험을 중심으로

Abstract

실손의료보험으로 인해 불필요한 의료수요가 유발되어, 개인의료비가증가하고 국민건강보험 재정이 악화된다는 주장이 지속적으로 제기되고 있다. 이 연구는 한국의료패널 7차 년도(조사기간 2012년 2월-7월), 9차 년도(조사기간 2014년 3월-9월) 자료를 이용하여 실손의료보험 신규가입으로개인의료비가 증가하는지를 이중차이모형(difference-in-differences)으로분석하였다. 분석결과, 정액의료보험 신규가입자는 미가입자에 비해 의료비의 유의한 증가가 나타나지 않았지만(p>0.05), 실손의료보험 신규가입자는 정액의료보험 신규가입자에 비해 ‘비급여’(p=0.008), ‘교통비(입원간병비) 포함 처방약값’(p=0.046), ‘총진료비(건보부담금+법정본인부담금+비급여)’(p=0.026)의 유의한 증가가 있었다. 또한 실손의료보험 신규가입자는 미가입자에 비해 추가로 ‘총의료비(건보부담금+법정본인부담금+비급여+교통비(입원간병비) 포함 처방약값)’(p=0.028)가 유의하게 증가하였다. 결과적으로, 실손의료보험의 신규가입은 개인의료비와 국민건강보험 재정지출을 증가시키는 것으로 나타났다. 향후 이러한 의료비 지출 증가가 적절한 것인가에 대한 평가와 민간의료보험 가입에 따른 의료비 증가에 대한 적절한 대처방안이 마련되어야 할 것이다.It is a continued assertion that medical insurance for actual expense causes unnecessary medical demand to increase personal medical expense and worsen the financial condition of national health insurance. The study analyzed if buying new medical insurance for actual expense increased personal medical expense based on the 7th year (study period from Feb. ~ Jul., 2012) and 9th year (study period from Mar. ~ Sep., 2014) data of Korea Health Care Panel Study using difference- in-differences model. As a result of the analysis, no significant increase was found in medical expense of new fixed-return policyholders, compared with non-policyholders (p>0.05). But, new actual- expense-indemnity policyholders were found to experience significant increase in non-payment item (p=0.008), prescription drug expense including transportation expense (hospitalization nursing fee)’(p=0.046), and resin filling treatment expense (national health insurance payment + statutory payment by policyholding patient + non-payment item)’(p=0.026), compared with new fixed-return policyholders. Also, new actual-expense-indemnity policy holders experienced additional significant increase in total medical expense (national health insurance payment + statutory payment by policyholding patient + non-payment item + prescription drug expense including transportation expense (hospitalization nursing fee) (p=0.028), compared with non-policyholders. Consequentially, this study found that buying new medical insurance for actual expense increased personal medical expense and national health insurance spending. Such increase in medical expense will need to be assessed for its appropriateness and a proper measure will be required regarding the medical expense increase caused by private insurance holding.