OECD OECD 통계로통계로 본본 병원병원 현황현황

2010. 4. 1.2010. 4. 1.

장원모장원모

병원관리학병원관리학 개론개론 발표발표 자료자료

발표발표 순서순서

1.

3.

2.

4.

2

핵심 질문 및 분석 틀

보건의료 재정측면에 대한 병원의 영향

보건의료 자원측면에 대한 병원의 영향

보건의료 서비스측면에 대한 병원의 영향

핵심핵심 질문질문

•• 병원이병원이 보건의료체계에보건의료체계에 미치는미치는 영향의영향의크기는크기는 어떠한가어떠한가??

•• 병원이병원이 보건의료체계에보건의료체계에 미치는미치는 영향의영향의방향은방향은 어떠한가어떠한가??

3

분석틀분석틀

4

Milton I. Roemer. National Health Systems as Market Interventions. Journal of Public Health Policy, Vol. 10, No. 1 (Spring, 1989), pp. 62-77

5

Hospital services, % total current Hospital services, % total current expenditure on healthexpenditure on health

6

25

30

35

40

45

50

55

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Australia

Belgium

Canada

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Ireland

Italy

Japan

Korea

Mexico

Netherlands

New Zealand

Norway

Portugal

Slovak Republic

Switzerland

United States

%

건강보험총진료비중병원 38.6%/병원총진료비중 Big4 12.4% (2008)

inin--patient care, % total current patient care, % total current expenditure on healthexpenditure on health

7

20

30

40

50

60

70

80

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Australia

Austria

Belgium

Canada

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Iceland

Ireland

Italy

Japan

Korea

Mexico

Netherlands

New Zealand

Norway

Poland

Spain

Sweden

Switzerland

United Kingdom

입원서비스총진료비중 병원 80.6%/외래서비스총진료비중병원 19.4% (2008)

%

8

9

Total hospital employment, % Total hospital employment, % head head counts on Total health and social counts on Total health and social employmentemployment

10

0

10

20

30

40

50

60

70

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Belgium

Czech Republic

Denmark

Finland

France

Germany

Greece

Italy

Korea

Netherlands

Norway

Portugal

Slovak Republic

Spain

Switzerland

United Kingdom

United States

%

Acute care nurses staff ratio, Acute care nurses staff ratio, Average number of staff per bedAverage number of staff per bed

11

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Australia

Austria

Belgium

Canada

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Iceland

Ireland

Italy

Japan

Korea

Luxembourg

Mexico

Netherlands

New Zealand

Norway

Poland

Portugal

Slovak Republic

Spain

Sweden

Switzerland

Turkey

United Kingdom

United States

12

Total hospital beds, Per 1,000 Total hospital beds, Per 1,000 populationpopulation

13

0

2

4

6

8

10

12

14

16

18

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Australia

Austria

Belgium

Canada

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Iceland

Ireland

Italy

Japan

Korea

Luxembourg

Mexico

Netherlands

New Zealand

Norway

Poland

Portugal

Slovak Republic

Spain

Sweden

Switzerland

Turkey

United Kingdom

United States

의료기관병상중 병원이 77.7% 차지(2008)

Acute care beds, Per 1,000 Acute care beds, Per 1,000 populationpopulation

14

0

2

4

6

8

10

12

14

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Australia

Austria

Belgium

Canada

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Iceland

Ireland

Italy

Japan

Korea

Luxembourg

Mexico

Netherlands

New Zealand

Norway

Poland

Portugal

Slovak Republic

Spain

Sweden

Switzerland

Turkey

United Kingdom

United States

Acute care occupancy rate, % of Acute care occupancy rate, % of available bedsavailable beds

15

40

50

60

70

80

90

100

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Australia

Austria

Belgium

Canada

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Iceland

Ireland

Italy

Japan

Korea

Luxembourg

Mexico

Netherlands

New Zealand

Norway

Poland

Portugal

Slovak Republic

Spain

Sweden

Switzerland

Turkey

United Kingdom

United States

%

Acute care turnover rate, Cases per Acute care turnover rate, Cases per available bedavailable bed

16

0

10

20

30

40

50

60

70

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Australia

Austria

Belgium

Canada

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Iceland

Ireland

Italy

Japan

Korea

Luxembourg

Mexico

Netherlands

New Zealand

Norway

Poland

Portugal

Slovak Republic

Spain

Sweden

Switzerland

Turkey

United Kingdom

United States

%

LongLong--term care beds, Per 1,000 term care beds, Per 1,000 population aged 65 years old and overpopulation aged 65 years old and over

17

0

5

10

15

20

25

30

35

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Australia

Austria

Belgium

Canada

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Iceland

Ireland

Italy

Japan

Korea

Luxembourg

Mexico

Netherlands

New Zealand

Norway

Poland

Portugal

Slovak Republic

Spain

Sweden

Switzerland

Turkey

United Kingdom

United States

Psychiatric care beds, Per 1,000 Psychiatric care beds, Per 1,000 populationpopulation

18

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Australia

Austria

Belgium

Canada

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Iceland

Ireland

Italy

Japan

Korea

Luxembourg

Mexico

Netherlands

New Zealand

Norway

Poland

Portugal

Slovak Republic

Spain

Sweden

Switzerland

Turkey

United Kingdom

United States

19

Computed Tomography Scanners, Computed Tomography Scanners, Per million populationPer million population

20

0

10

20

30

40

50

60

70

80

90

100

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Australia

Austria

Belgium

Canada

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Iceland

Ireland

Italy

Japan

Korea

Luxembourg

Mexico

Netherlands

New Zealand

Norway

Poland

Portugal

Slovak Republic

Spain

Sweden

Switzerland

Turkey

United Kingdom

United States

병원이 보유한 CT장비수 66.4% 차지(2007)

Magnetic Resonance Imaging Units, Magnetic Resonance Imaging Units, Per million populationPer million population

21

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Australia

Austria

Belgium

Canada

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Iceland

Ireland

Italy

Japan

Korea

Luxembourg

Mexico

Netherlands

New Zealand

Norway

Poland

Portugal

Slovak Republic

Spain

Sweden

Switzerland

Turkey

United Kingdom

United States

PET scanners, Per million populationPET scanners, Per million population

22

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

2000 2001 2002 2003 2004 2005 2006 2007

Australia

Austria

Belgium

Canada

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Iceland

Ireland

Italy

Japan

Korea

Luxembourg

Mexico

Netherlands

New Zealand

Norway

Poland

Portugal

Slovak Republic

Spain

Sweden

Switzerland

Turkey

United Kingdom

United States

23

InIn--hospital casehospital case--f a

tality rates within

fatality rates within 30 days after admission for AMI, 30 days after admission for AMI, 20072007

Singapore

Korea

Slovak Republic

Luxembourg (2006)

Netherlands (2005)

United Kingdom

Spain

Czech Republic

United States (2006)

Average

Ireland

Finland

Poland

Austria (2006)

Canada

Italy (2006)

New Zealand

Norway

Denmark

Sweden

Iceland

24

3.6

6.6

4.6

6.4

5.3

6.9

6.6

7.7

5.6

11.0

8.3

7.8

7.0

7.7

9.2

10.9

9.1

10.7

9.9

9.6

9.6

2.1

2.9

2.9

3.2

3.3

4.0

4.2

4.5

4.5

4.9

5.1

5.1

5.1

5.3

6.1

6.3

6.6

6.6

7.6

8.1

8.7

024681012Rates per 100 patients

Age-sex standardised rates

Crude rates3.3

3.0

2.7

3.0

3.3

3.7

4.0

4.5

4.5

5.6

5.2

5.0

4.9

5.1

5.6

5.8

6.0

8.7

7.0

7.2

7.4

0.9

2.9

3.1

3.4

3.2

4.3

4.4

4.5

4.6

4.2

5.0

5.2

5.4

5.5

6.5

6.7

7.1

4.8

8.1

8.9

9.8

0 5 10 15

Age-standardised rates per 100 patients

Female Male

InIn--hospital casehospital case--fatality rates within 30 fatality rates within 30 days after admission for ischemic stroke, days after admission for ischemic stroke, 20072007

25

5.8

3.6

5.3

5.9

7.4

7.3

7.0

7.7

8.4

6.0

6.3

8.9

10.5

9.4

10.8

10.7

11.4

12.1

11.6

12.9

17.4

2.3

2.4

3.1

3.2

3.3

3.7

3.7

3.8

3.9

4.2

5.0

5.0

5.6

5.9

6.2

6.3

6.5

6.6

7.5

7.6

9.0

0 2 4 6 8 10 12 14 16 18 20

Iceland

Korea

Denmark

Finland

Norway

Italy (2006)

Austria (2006)

Germany

Sweden

United States (2006)

Singapore

Average

Luxembourg (2006)

Netherlands (2005)

Czech Republic

New Zealand

Spain

Ireland

Slovak Republic

Canada

United Kingdom

Rates per 100 patients

Age-sex standardised rates Crude rates

InIn--hospital casehospital case--fatality rates within 30 fatality rates within 30 days after admission for hemorrhagic days after admission for hemorrhagic stroke, 2007stroke, 2007

26

11.1

13.1

11.3

17.2

19.9

19.7

21.3

20.8

22.5

29.2

23.6

27.3

26.8

27.3

28.2

25.8

31.0

26.0

32.1

29.5

32.6

9.5

10.8

11.0

12.8

13.7

14.5

16.7

17.2

19.4

19.8

20.1

23.2

23.8

24.0

24.2

25.2

25.2

25.5

26.3

29.3

30.3

0 5 10 15 20 25 30 35 40

Finland

Austria (2006)

Korea

Sweden

Norway

Germany

Denmark

Italy (2006)

Ireland

Iceland

Average

Canada

New Zealand

Czech Republic

Spain

Singapore

Netherlands (2005)

United States …

United Kingdom

Slovak Republic

Luxembourg (2006)

Rates per 100 patients

Age-sex standardised rates

Crude rates

소결소결

•• 보건의료보건의료 재정재정--약약 40% 40% 병원병원 서비스비용서비스비용, , 입원입원 진료비진료비 증가증가→→질병구조질병구조 변화에변화에 대한대한대응대응 부재부재

•• 보건의료보건의료 자원자원--低低인력인력, , 高高기술기술((장비장비), ), 시설규모시설규모↑↑, , 활용수준활용수준↓↓

•• 보건의료서비스보건의료서비스--불명확한불명확한 병원진료성과병원진료성과

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