의료 서비스 제공의 전문화 수준이 병원 경영 성과에 미치는 영향

Abstract

국문요지

병원간의 경쟁이 심화되는 환경 변화 속에 병원은 서비스 제공방식에 대한 변화를 점진적으로 시도하였다. 여러 종류의 진료 서비스를 나열해 가며 제공하는 방식에서 탈피하여 발생건수가 많지 않은 서비스의 제공을 중단하고 선택적인 의료 서비스를 제공하기 시작하는 차별화, 집중화 전략을 취하기 시작하였다. 이러한 전략은 의료 서비스를 전문화 하는 것으로 전문화는 상대적인 강조로 병원 혹은 병원의 부서가 특정 진료과목을 제공하는 것을 뜻한다. 병원 서비스의 전문화 정도를 위와 같이 정의하고 전문화 수준을 측정할 수 있다면 전문화된 병원들의 경영 성과를 알아보는 것은 전문화 전략의 선택 결정에서 매우 중요한 부분이라 할 수 있다. 이에 선행 연구들을 살펴보고 선행 연구에서 제시하고 있는 전문화 수준 측정 방법의 하나인 정보화 지수 (Information Theory Index) 이론을 바탕으로 진단명 기준 환자군 ( Diagnosis Related Groups)을 이용한 병원의 전문화 지수 (Specialization Index)를 산출해 보았다. 더불어 의료서비스 제공의 전문화가 병원 경영 성과에 미치는 영향을 알아보기 위해 건당 재원일수와 건당 총 진료비를 성과 지표로 삼아 다중 회귀 모형을 구축하여 분석해 보았다. 건강보험심사평가원에서 제공하고 있는 환자표본 자료 중 2011년 입원환자 청구 자료를 이용하여 두 가지 병원 분류 방법을 통해 연구를 진행하였다. 첫째, 광역시 소재의 상급 종합병원, 종합병원, 병원의 전문화 수준을 측정하여 병원 경영 성과를 살펴보는 것이다. 각 병원의 전문화 수준은 각 병원에 속해 있는 환자들의 입원청구 자료를 분석하여 주 진단명인 진단명 기준 환자군(DRGs)을 기반으로 개발된 지수인 병원 전문화지수 (Hospital Specialization Index)를 이용하여 측정하였다. 둘째, 광역시 소재의 병원들만을 다시 분류하여 전문병원 선정 대상 진료과인 척추 및 정형외과, 산부인과, 알코올 전문 정신과, 안과 등에 특화된 병원과 일반 병원들을 구분하여 이들 병원의 전문화 수준이 병원 경영 성과에 미치는 영향을 살펴보았다. 이를 바탕으로 다중 회귀모형 구축 결과 모두 유의하게 모형이 구축되어 전문화 수준이 높아질수록 건당 재원일수가 올라가며 건당 총 진료비가 올라간다는 결론을 얻게 되었다. 이는 전문화 수준이 올라 갈수록 생산 비용이 감소한다는 선행 연구(Farley ,1990 : Eastaugh ,2002 )를 전제로 한다면 병원 이익구조에서 고정 생산비용은 감소하고 진료 수입은 증가하여 전체 수익이 증가했음을 결론지을 수 있는 것이다. 따라서 병원들이 경쟁우위를 확보하기 위하여 선택한 차별화, 집중화된 의료 서비스 전문화 전략이 병원 경영 성과에 긍정적인 효과가 있음을 말 할 수 있게 되었다. 그러나 본 연구에서 사용된 청구 자료는 매우 공신력이 있는 자료 임에도 불구하고 보험심사 청구 자료인 만큼 비급여 항목이 배제되어 있다는 문제점을 가지고 있다. 하지만 국내에서 거의 연구되지 않는 병원의 전문화 수준을 측정하여 이에 대한 경영 성과를 살펴봄으로써 보건의료체계의 효율성 측면에서 병원의 전문화 수준을 재검토 해보았다는 점에서 의의를 갖는다. |ABSTRACT

Effects of medical services specialization on operational performance in hospital

Yoo, Hae Won Dept. of Business Administration The Graduate School Hanyang University Dissertation under direction of professor Suh, Chang Jin

Hospitals have made an attempt to gradually change service provision methods in response to the severe hospital competition. They started taking differentiation and focused strategy by stopping provision of scarcely demanded services and providing selective medical services, instead of providing a variety of different care services. Such strategy brings about specialization of medical services in hospitals or special departments of hospitals. If specialization of medical services is defined such as, and its level can be measured, it is very important to figure out special hospitals’ management performance. Accordingly, this study examined previous research and calculated specialization index using diagnosis related groups. In addition, multiple regression analysis was used based on total hospitalization length and medical treatment cost in order to understand the effect of specialization which medical service has on the hospital management performance. Among patient sample data provided by the health insurance investigation institute, this study carried out a study by two hospital classification methods for 2011 in-patient. Firstly, the hospital management performance is calculated by measuring the specialization levels of tertiary hospital, general hospital and hospital. The specialization level was examined by analyzing in-patient claim data in each hospital using hospital specialization index developed based on DRGs. Secondly, specialized hospitals such as spine and orthodontic hospitals, obstetric hospitals, alcohol rehabilitation hospitals, eye hospitals, and general hospitals were divided to figure out the effect of specialization level on hospital management performance. The multiple regression model was constructed based on such analysis. It concluded that if specialization level increases, in-patient days will increase per case with increase of total medical cost. Based on the previous studies that increase of specialization level leads to the decrease of fixed production cost (Farley, 1990 : Eastaugh, 2002), it is concluded that reduction of the fixed production cost and increase of treatment income make overall profit increase. Therefore, differentiated and focused strategy in medical care specialization taken for the competitive advantages had a positive effect on hospital management performance. However, while the data used in this study is very reliable, the problem is that it is meant for insurance review excluding non-payment items. However, this study is significant because it reviewed specialization level of hospitals in terms of medical system efficiency by measuring hospital specialization level which has been rarely studied before.

Key words: medical service, specialization level, hospital management performance, length of stay per case, total cost per case; ABSTRACT

Effects of medical services specialization on operational performance in hospital

Yoo, Hae Won Dept. of Business Administration The Graduate School Hanyang University Dissertation under direction of professor Suh, Chang Jin

Hospitals have made an attempt to gradually change service provision methods in response to the severe hospital competition. They started taking differentiation and focused strategy by stopping provision of scarcely demanded services and providing selective medical services, instead of providing a variety of different care services. Such strategy brings about specialization of medical services in hospitals or special departments of hospitals. If specialization of medical services is defined such as, and its level can be measured, it is very important to figure out special hospitals’ management performance. Accordingly, this study examined previous research and calculated specialization index using diagnosis related groups. In addition, multiple regression analysis was used based on total hospitalization length and medical treatment cost in order to understand the effect of specialization which medical service has on the hospital management performance. Among patient sample data provided by the health insurance investigation institute, this study carried out a study by two hospital classification methods for 2011 in-patient. Firstly, the hospital management performance is calculated by measuring the specialization levels of tertiary hospital, general hospital and hospital. The specialization level was examined by analyzing in-patient claim data in each hospital using hospital specialization index developed based on DRGs. Secondly, specialized hospitals such as spine and orthodontic hospitals, obstetric hospitals, alcohol rehabilitation hospitals, eye hospitals, and general hospitals were divided to figure out the effect of specialization level on hospital management performance. The multiple regression model was constructed based on such analysis. It concluded that if specialization level increases, in-patient days will increase per case with increase of total medical cost. Based on the previous studies that increase of specialization level leads to the decrease of fixed production cost (Farley, 1990 : Eastaugh, 2002), it is concluded that reduction of the fixed production cost and increase of treatment income make overall profit increase. Therefore, differentiated and focused strategy in medical care specialization taken for the competitive advantages had a positive effect on hospital management performance. However, while the data used in this study is very reliable, the problem is that it is meant for insurance review excluding non-payment items. However, this study is significant because it reviewed specialization level of hospitals in terms of medical system efficiency by measuring hospital specialization level which has been rarely studied before.

Key words: medical service, specialization level, hospital management performance, length of stay per case, total cost per case