醫療傳達體系의 주요 골자는 醫療의 地域化와 階層的 機能分化를 통하여 의료자원의 효율성을 높이고 의료이용의 편의를 추구함에 있다. 본 연구에서는 이상과 같은 두 가지의 목표가 얼마만큼 달성되고 있는지를 3차진료기관의 진료실적을 중심으로 분석하였다. 우선 지역화의 정도를 알아보기 위해서 각 대진료권 단위별 診療實績을 분석하였으며, 의료의 공급과 수요의 지역적 균형분포를 보기위해 地域化 指數 및 Gini系數를 이용하였다. 여기서 地域化 정도가 높음에도 불구하고 3차진료기관에 환자집중이 심화되는 것은 대진료권내의 의료기관간의 계층적 기능분화가 이루어지지 못함이라는 反射的 結論 을 도출하였으며 이를 부연하기 위해서 각급 의료기관의 진료실적과 질병의 危重度에 따르는 3차진료기관의 기능분화에 대하여 검토하였다.

The Government decided to adopt a regulated system of hea1th care delivery as a national health insurance policy in July 1986. Concomitantly, the whole nation was divided into eight health service regions, and each region was further divided into a number of hea1th service districts. The insured are expected to use all health and medical facilities in the health service district without restrictions expect on tertairy hospitals located within the district, but this new system prohibited the insured from random use of health facilities. They were not allowed to use tertiary medical facilities without the approval of primary care physicians. If patients want to see a specialist in another health service region, they should get a permit from their insurance society as well as a primary care physician`s referral request. The new system of health care delivery was designed to change health service utilization patterns and to promote equitable redistribution of health resources among regions. The main aim of the present study is to review the current status of the hea1th care delivery system, analyze the problems, and make recommendations based on the evaluation of tertiary care hospital utilization patterns in eight health care regions. Several findings underscore the impartial distribution of hea1th resources among the regions and the concentration of patients using tertiary care hospitals in particular regions. This raised a serious problem of equity between the metropolital areas and others. First, interestingly, the concentration of health resources in the Gyongin Medical Zone would be an obstacle to sustaining the hierachical structure of the hea1th care delivery system. For example, 52.86 percent of health care manpower in the nation worked in the Gyongin Health Service region in 1992 and 60.3 percent of the beds were in use in that region. Second, the level of in-patient days per c1aim increased from 13.4 days in 1990 to 13.8 days in 1991 for medical treatment in tertiary care hospitals, and from 1.6 to 1.7 days in out-patient volume. The indicators of regionalization in health service regions shows the distribution of health resources and utilization pattern of tertiary care hospitals were moving in the direction of the ne policy`s original intentions. For example, the Gyongin regional indicator decreased from 1,253 in 1990 to 1,246 in 1991. lt was noted that the major barrier to equitable access to the health care system is the lack of a regular health resources in eight health service -66 regions. The success or failure of the present health care delivery system depends on the extent to which patients use medical resources rationally. This requires strengthening the current referral system between primary and secondary care facilities and tertiary care hospitals.