Journal of the Korean Medical Association (대한의사협회지)

Korean Medical Association (대한의사협회)
권호 표지
DOI QR코드

DOI QR Code

Factors influencing medical institution selection for outpatient services

외래 의료 이용에서 종별 의료기관 선택에 영향을 미치는 요인

  • You, Chang Hoon (Institute of Health Insurance Research, National Health Insurance Corporation Ilsan Hospital) ;
  • Kwon, Young Dae (Department of Humanities and Social Medicine, The Catholic University of Korea College of Medicine)
  • 유창훈 (국민건강보험공단 일산병원 연구소) ;
  • 권영대 (가톨릭대학교 의과대학 인문사회의학과)
  • Published : 2012.09.10
⟨ Previous Next ⟩

Abstract

This study analyzes determinants of patients' choice of healthcare providers in outpatient services and identifies their effects. Data were collected from two waves of the Korean Health Panel. The unit of analysis was an outpatient visit (n=189,739). Various types of medical institutions were grouped into general hospitals (including tertiary hospitals), hospitals, and clinics. A multinomial logit model was used to examine the determinants of medical institution selection. Clinics were the most frequent (82.2%) medical institution selected, followed by general hospitals (10.9%) and hospitals (6.9%). Males and beneficiaries of Medical Aid were more likely to choose the upper-level institutions. The upper-level institution selection was also positively associated with the level of education, household income, and severe diseases, while negatively associated with the level of health status. The medical institution selection was significantly different by region. Not only enabling factors for healthcare utilization, such as family and community resources, but also the users' characteristics were strong determinants of the type of medical institution selected. We, therefore, recommend that patients' characteristics and needs, in addition to the sharing of roles and functions among medical institutions, should be considered in making healthcare policies for efficient medical utilization and an effective medical delivery system.

Keywords

References

  1. Park HG, Park YS. The change of hospitals bed supply and hospital utilizations of patients after the mid-1990s. Korean J Health Econ Policy 2011;17:145-172.
  2. Kim YK, Kim JS. A study on healthcare institution selection of healthcare consumers using theory of consumption values: focusing on relations among clinics or small sized hospitals, general hospitals, and large-sized hospitals. J Korean Soc Qual Manag 2009;37:71-86.
  3. Oh YH, Do SR, Son CK, Park DS, Kim JW, Yoon KJ, Moon JW, Lee KJ, Hong MY. Development and management of monitoring system to improve the efficiency of health care resources allocation: health care resources, Korea, 2010. Seoul: Korea Institute for Health and Social Affairs; 2010.
  4. National Health Insurance Corporation; Health Insurance Review and Assessment Service. 2010 National health insurance statistical yearbook [Internet]. Seoul: National Health Insurance Corporation; Health Insurance Review and Assessment Service [cited 2012 Aug 13]. Available from: http://www.nhic.or.kr/portal/site/main/menuitem.74b68c0b767ded38b31148b4062310a0/.
  5. Ha CL. Four major hospitals: black hole for patients [Internet]. Seoul: Yonhap News Agency; 2009 Jun 22 [cited 2012 Aug 13]. Available from: http://app.yonhapnews.co.kr/YNA/Basic/article/new_search/YIBW_showSearchTotalList_New.aspx?searchpart=total&searchtext=%uD658%uC790%20%uBE14%uB799%uD640%204%uB300.
  6. Ministry of Health and Welfare. Basic plan for re-setting role and function of medical providers [Internet]. Seoul: Ministry of Health and Welfare; 2011 [cited 2012 Aug 13]. Available from: http://www.mw.go.kr/front/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&BOARD_ID=140&BOARD_FLAG=00&CONT_SEQ=249986&page=1.
  7. Choi YS, Baek SJ, Lim ES, Lee HY, Chang HJ. 2009 Survey of medical expenditure of National Health Insurance beneficiaries. Seoul: National Health Insurance Corporation; 2010.
  8. Im GJ. Reorganization of the medical delivery system; a cause for the patients. J Korean Med Assoc 2010;53:442-444. https://doi.org/10.5124/jkma.2010.53.6.442
  9. Kim KH, Lee JC, Kim HN. A study on the re-establishment of functions of health care institutions. Public Policy Rev 2011;25:161-177. https://doi.org/10.17327/ippa.2011.25.4.007
  10. Jung SH, Kim HJ. Impacts of implementation of patient referral system in terms of medical expenditures and medical utilization. Korean J Prev Med 1995;28:207-224.
  11. Kim SH. Increase of pharmacy expenses paid by patients in general hospitals [Internet]. Seoul: Yonhap News Agency; 2011 Aug 2 [cited 2012 Aug 13]. Available from: http://app.yonhapnews.co.kr/YNA/Basic/article/new_search/YIBW_showSearchArticle_New.aspx?searchpart=article&searchtext=%ec%95%bd%ec%a0%9c%eb%b9%84+%eb%b3%b8%ec%9d%b8+%eb%b6%80%eb%8b%b4&contents_id=AKR20110802063800017.
  12. The Korean Society for Preventive Medicine. Preventive medicine and public health. Seoul: Gyechukmunwhasa; 2010.
  13. Cho WH, Kim HJ, Lee SH. A study on the criteria for selection of medical care facilities. Korean J Prev Med 1992;25:53-63.
  14. Yu SY, Kim EH. A study on factors in selecting of hospital; focus on medical advertising implication. Korean J Advert 2006;17:201-214.
  15. Youn KI, Doh SR. An analysis of the diseases specific medical service organization selection factors of patients. Korean J Hosp Manage 2007;12:1-21.
  16. Jung EK. Choosing patterns for dental clinic among community people. J Dent Hyg Sci 2010;10:323-327.
  17. Shin YH, Suh CJ. A study on WOM and determinants of hos-pital choice. Korean J Hosp Manage 2011;16:31-52.
  18. Lim DG, Jaegal D. A study on factors in selecting hospital of the elderly in Andong. Soc Sci Res Rev 2011;27:121-139.
  19. Jung SH, Jung HY, Kim EH. A study on the factors related to the choice of dental clinics for worker in Seoul. J Dent Hyg Sci 2011;11:427-439.
  20. Choi MI, Kim CA, Yoo JW. An AHP study on priority factors affecting healthcare consumers' selection of hospitals: focused on marketing strategies of hospital services. Advert Res 2011;89:155-176.
  21. Han WH, Park JH, Son SB, Hong HP, Jung SC, Kim MR, Kim YJ, Lee HS, Cho WS. Clinical analysis of characteristics of patients who visit otorhinolaryngology clinic in secondary general hospital. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:203-207. https://doi.org/10.3342/kjorl-hns.2011.54.3.203
  22. Lee JC, Kim KH, Kim HN, Park YH. Factors associated with the hypertension outpatients' choice of healthcare providers in Korea. J Korean Med Assoc 2011;54:961-970. https://doi.org/10.5124/jkma.2011.54.9.961
  23. Park SB, Jung KH. The determinants of private health insurance and its effects on medical utilization in Korea. Korean Insur J 2011;88:23-49.
  24. You CH, Kang SW, Kwon YD, Oh EH. The effects of supplementary private health insurance on healthcare utilization and expenditures: indemnity vs. fixed-benefit. Korean Soc Secur Stud 2011;27:277-292.
  25. Bolduc D, Lacroix G, Muller C. The choice of medical providers in rural Benin: a comparison of discrete choice models. J Health Econ 1996;15:477-498. https://doi.org/10.1016/S0167-6296(96)00492-4
  26. Habtom GK, Ruys P. The choice of a health care provider in Eritrea. Health Policy 2007;80:202-217. https://doi.org/10.1016/j.healthpol.2006.02.012
  27. Adams EK, Houchens R, Wright GE, Robbins J. Predicting hospital choice for rural Medicare beneficiaries: the role of severity of illness. Health Serv Res 1991;26:583-612.
  28. Lane PM, Lindquist JD. Hospital choice: a summary of the key empirical and hypothetical findings of the 1980s. J Health Care Mark 1988;8:5-20.
  29. Maddala GS. Limited-dependent and qualitative variables in econometrics. Cambridge: Cambridge University Press; 1983.
  30. Lee SH. A study of hospital choice on the basis of consumption values theory. J Prev Med Public Health 1997;30:413-427.
  31. National Health Insurance Corporation; Health Insurance Review and Assessment Service. 2009 National health insurance statistical yearbook [Internet]. Seoul: National Health Insurance Corporation; Health Insurance Review and Assessment Service [cited 2012 Aug 13]. Available from: http://www.nhic.or.kr/portal/site/main/menuitem.9046c7b1fca1aa404bf15151062310a0/.
  32. Jeon GS, Choi ES, Lee HY. Gender-related difference in the utilization of health care services by Korean adults. J Korean Acad Public Health Nurs 2010;24:182-196.
  33. Shin YS, Choi BH, Shin HY, Hwang DK, Yun SJ. A policy report for the current situation of medical aid expenditure and improvement direction. Seoul: Ministry of Health and Welfare; Korea Institute for Health and Social Affairs; 2005.
  34. Kim ES, Kim MY, Ko IS, Lee DM, Kim KS, Choi JS. The current situation of medical aid utilization and improvement direction in long-term utilizers. Seoul: Ministry of Health, Welfare and Family Affairs; 2007.
  35. Shin SM, Kim ES, Lee HW. The contributing factors to surplus medicine by long-term users of medical aid in Korea. J Prev Med Public Health 2009;42:403-407. https://doi.org/10.3961/jpmph.2009.42.6.403
  36. Lee DH, Park EC, Nam CM, Lee SG, Lee DH, Yu SH. Comparing difference of volume of psychiatric treatments between the patient with health insurance and those with medical assistance: for inpatients of Korean psychiatric hospitals. Korean J Prev Med 2003;36:33-38.
  37. Chang H, Kwon YD, Yoon SS. Impact of health insurance type on health care utilization in patients with acute cerebral infarction. J Korean Neurol Assoc 2011;29:9-15.

Cited by

  1. Factors associated with diabetes outpatient use of tertiary or general hospitals as their usual source of care in Korea vol.55, pp.12, 2012, https://doi.org/10.5124/jkma.2012.55.12.1215
  2. 농촌 환경ㆍ건강 지표의 변화 추이(2001~2010년) -농촌 거주 농업종사자와 비농업종사자의 비교- vol.25, pp.1, 2012, https://doi.org/10.7856/kjcls.2014.25.1.99
  3. 진료과별 적정 외래 진료시간에 관한 연구 vol.24, pp.3, 2012, https://doi.org/10.4332/kjhpa.2014.24.3.254
  4. 상용치료원 보유가 의료기관 종별 선택에 미치는 영향: 대형병원 환자집중현상 완화방안을 중심으로 vol.26, pp.3, 2012, https://doi.org/10.4332/kjhpa.2016.26.2.195
  5. 공간적 접근성이 내과환자의 내원일수에 미치는 영향 분석: 대도시 일개 병원을 대상으로 vol.26, pp.3, 2012, https://doi.org/10.4332/kjhpa.2016.26.2.233
  6. 종별 의료기관 외래 경증질환 약제비 본인부담 차등정책 효과분석 vol.27, pp.2, 2012, https://doi.org/10.4332/kjhpa.2017.27.2.128
  7. 종합병원 정신건강의학과에 대한 공간적 접근성과 외래 의료이용 분석 vol.27, pp.4, 2017, https://doi.org/10.4332/kjhpa.2017.27.4.315
  8. Effect of providing drug utilization review information on tricyclic antidepressant prescription in the elderly vol.42, pp.10, 2012, https://doi.org/10.1007/s10916-018-1061-z
  9. The Effect of Outpatients’ Perceived Service Quality on Satisfaction with Treatment and Willingness to Recommend Hospital vol.44, pp.4, 2012, https://doi.org/10.21032/jhis.2019.44.4.349
  10. Sex Differences in Factors Affecting Hospital Outpatient Department Visits: Korea Health Panel Survey Data from 2009 to 2016 vol.16, pp.24, 2019, https://doi.org/10.3390/ijerph16245028
  11. Association of illness understanding with advance care planning and end-of-life care preferences for advanced cancer patients and their family members vol.28, pp.6, 2020, https://doi.org/10.1007/s00520-019-05174-5
  12. 우리나라 고혈압 환자의 병원급 의료기관 외래이용 관련 요인: 한국의료패널자료(2010-2016)를 이용하여 vol.30, pp.4, 2020, https://doi.org/10.4332/kjhpa.2020.30.4.479
  13. Relationship between hospital specialization and health outcomes in patients with nonsurgical spinal joint disease in South Korea : A nationwide evidence-based study using national health insurance da vol.100, pp.32, 2021, https://doi.org/10.1097/md.0000000000026832
  14. Gender Differences in the Risk of Ischemic Heart Disease According to Healthcare Utilization and Medication Adherence among Newly Treated Korean Hypertensive Patients vol.18, pp.3, 2012, https://doi.org/10.3390/ijerph18031274
  15. Healthcare-Seeking Behavior among Chinese Older Adults: Patterns and Predictive Factors vol.18, pp.6, 2021, https://doi.org/10.3390/ijerph18062969