주요 감염병 건강보험 진료 현황

2015. 12.

경기도감염병관리본부 연구보고서 2015-02

연구보고서� 2015-02

주요감염병�의료기관�진료현황�조사

발 행 일

발 행 인

발 행 처

주 소

전 화

홈 페 이 지

2015년� 12월� 31일

이� 재� 서

경기도�감염병관리본부

경기도� 성남시� 분당구� 판교대왕로�

670� 2A� 305호

대표전화:� 031)628-6302

http://www.gidcc.or.kr

ⓒ�경기도감염병관리본부� � 2015

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목� � 차

표차례 ······································································································································ 1

그림차례 ·································································································································· 7

I.� 서론 ····································································································································· 8

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� � 1.� 배경 ································································································································ 8

� � 2.� 연구�목적 ······················································································································ 8

� 제2절.� 국민건강보험�청구자료와�법정감염병�전수감시�자료�비교 ······························ 9

II.� 연구�방법 ························································································································ 11

� 제1절.� 분석대상�감염병�선정 ·························································································· 11

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III.� 연구�결과 ······················································································································· 14

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� � 7.� 제1군� A형간염 ··········································································································· 49

� � 8.� 제2군�백일해 ·············································································································· 53

� � 9.� 제2군�파상풍 ·············································································································· 61

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� 11.� 제2군�유행성이하선염 ······························································································ 77

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� 16.� 제3군�말라리아 ······································································································· 119

� 17.� 제3군�한센병 ··········································································································· 147

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� 32.� 제4군�라임병 ··········································································································· 235

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표�차�례

표� 1-2-1.� 국민건강보험�청구자료와�법정감염병�전수감시�자료�비교 ······················································· 10

표� 2-1-1.� 법정감염병�분류체계�및� 신고범위(군분류) ·················································································· 12

표� 3-1-1.� 감염병별�진료현황�요약표 ·············································································································· 14

표� 3-1-2.� 상병분류:� A00.0� (비브리오�콜레리� 01� 콜레라형균에�의한�콜레라) ······································ 17

표� 3-1-3.� 상병분류:� A00.1� (비브리오�콜레리� 01� 엘토르형균에�의한�콜레라) ······································ 19

표� 3-1-4.� 상병분류:� A00.9� (상세불명의�콜레라) ························································································ 21

표� 3-1-5.� 상병분류:� A01.0� (장티푸스) ········································································································· 23

표� 3-1-6.� 상병분류:� Z22.0� (장티푸스�보균자) ····························································································· 25

표� 3-1-7.� 상병분류:� A01.1� (파라티푸스� A) ································································································· 27

표� 3-1-8.� 상병분류:� A01.2� (파라티푸스� B) ································································································· 29

표� 3-1-9.� 상병분류:� A01.3� (파라티푸스� C) ································································································· 31

표� 3-1-10.� 상병분류:� A01.4� (상세불명의�파라티푸스) ·············································································· 33

표� 3-1-11.� 상병분류:� A03.0� (시겔라�디센테리에�의한�시겔라증) ··························································· 35

표� 3-1-12.� 상병분류:� A03.1� (시겔라�플렉스너리에�의한�시겔라증) ······················································· 37

표� 3-1-13.� 상병분류:� A03.2� (시겔라�보이디에�의한�시겔라증) ······························································· 39

표� 3-1-14.� 상병분류:� A03.3� (시겔라�소네이에�의한�시겔라증) ······························································· 41

표� 3-1-15.� 상병분류:� A03.8� (기타� 시겔라증) ····························································································· 43

표� 3-1-16.� 상병분류:� A03.9� (상세불명의�시겔라증) ·················································································· 45

표� 3-1-17.� 상병분류:� A04.3� (장출혈성대장균감염) ···················································································· 47

표� 3-1-18.� 상병분류:� B15.0� (간성� 혼수가�있는� A형� 간염) ······································································ 49

표� 3-1-19.� 상병분류:� B15.9� (간성� 혼수가�없는� A형� 간염) ······································································ 51

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표� 3-1-22.� 상병분류:� A37.8� (기타� 백일해균에�의한�백일해) ··································································· 57

표� 3-1-23.� 상병분류:� A37.9� (상세불명의�백일해) ······················································································ 59

표� 3-1-24.� 상병분류:� A33� (신생아�파상풍) ································································································· 61

표� 3-1-25.� 상병분류:� A34� (산과적�파상풍) ································································································· 63

표� 3-1-26.� 상병분류:� A35� (기타� 파상풍) ····································································································· 65

표� 3-1-27.� 상병분류:� B05.0� (뇌염이�합병된�파상풍) ················································································ 67

표� 3-1-28.� 상병분류:� B05.1� (수막염이�합병된�파상풍) ············································································· 69

표� 3-1-29.� 상병분류:� B05.2� (폐렴이�합병된�파상풍) ················································································ 71

표� 3-1-30.� 상병분류:� B05.3� (중이염이�합병된�파상풍) ············································································· 73

표� 3-1-31.� 상병분류:� B05.4� (장� 합병증이�동반된�파상풍) ······································································· 75

표� 3-1-32.� 상병분류:� B26.0� (볼거리고환염) ································································································ 77

표� 3-1-33.� 상병분류:� B26.1� (볼거리수막염) ································································································ 79

표� 3-1-34.� 상병분류:� B26.2� (볼거리뇌염) ···································································································· 81

표� 3-1-35.� 상병분류:� B26.3� (볼거리췌장염) ································································································ 83

표� 3-1-36.� 상병분류:� B26.8� (기타� 합병증이�있는�볼거리) ······································································· 85

표� 3-1-37.� 상병분류:� B26.9� (합병증이�없는�볼거리) ················································································ 87

표� 3-1-38.� 상병분류:� B06.0� (신경학적�합병증을�동반한�풍진) ······························································· 89

표� 3-1-39.� 상병분류:� B06.8� (기타� 합병증을�동반한�풍진) ······································································· 91

- 2 -

표� 3-1-40.� 상병분류:� B06.9� (합병증이�없는�풍진) ···················································································· 93

표� 3-1-41.� 상병분류:� P35.0� (선천성�풍진증후군) ······················································································ 95

표� 3-1-42.� 상병분류:� B16.0� (간성� 혼수가�있는� 델타-병원체(동시감염)를� 가진�급성� B형간염) ········· 97

표� 3-1-43.� 상병분류:� B16.1� (간성� 혼수가�없는� 델타-병원체(동시감염)를� 가진�급성B형간염) ··········· 99

표� 3-1-44.� 상병분류:� B16.2� (간성� 혼수가�있고� 델타-병원체가�없는�급성� B형�간염) ······················· 101

표� 3-1-45.� 상병분류:� B16.9� (간성� 혼수가�없고� 델타-병원체도�없는�급성� B형간염) ························· 103

표� 3-1-46.� 상병분류:� A83.0� (일본뇌염) ···································································································· 105

표� 3-1-47.� 상병분류:� B01.0� (수두수막염) ································································································· 107

표� 3-1-48.� 상병분류:� B01.1� (수두뇌염) ····································································································· 109

표� 3-1-49.� 상병분류:� B01.2� (수두폐렴) ····································································································· 111

표� 3-1-50.� 상병분류:� B01.8� (기타합병증을�동반한�수두) ······································································· 113

표� 3-1-51.� 상병분류:� B01.9� (합병증이�없는�수두) ·················································································· 115

표� 3-1-52.� 상병분류:� P35.8� (기타�선천성�바이러스질환) ······································································· 117

표� 3-1-53.� 상병분류:� B50.0� (대뇌� 합병증을�동반한�열대열원충말라리아) ·········································· 119

표� 3-1-54.� 상병분류:� B50.8� (기타� 중증�및�합병된�열대열월충말라리아) ············································ 121

표� 3-1-55.� 상병분류:� B50.9� (상세불명의�열대열원충말라리아) ····························································· 123

표� 3-1-56.� 상병분류:� B51.0� (비장파열을�동반한�삼일열원충말라리아) ················································ 125

표� 3-1-57.� 상병분류:� B51.8� (기타� 합병증을�동반한�삼일열원충말라리아) ·········································· 127

표� 3-1-58.� 상병분류:� B51.9� (합병증이�없는�삼일열원충말라리아) ························································ 129

표� 3-1-59.� 상병분류:� B52.0� (신장병증을�동반한�사일열원충말라리아) ················································ 131

표� 3-1-60.� 상병분류:� B52.8� (기타� 합병증을�동반한�사일열원충말라리아) ·········································· 133

표� 3-1-61.� 상병분류:� B52.9� (합병증�없는� 사일열원충말라리아) ··························································· 135

표� 3-1-62.� 상병분류:� B53.0� (난원열원충�말라리아) ················································································ 137

표� 3-1-63.� 상병분류:� B53.1� (원숭이�열원충에�의한�말라리아) ····························································· 139

표� 3-1-64.� 상병분류:� B53.8� (달리� 분류되지�않은�기생충학적으로�확인된�기타�말라리아) ·············· 141

표� 3-1-65.� 상병분류:� P37.3� (선천성�열대열말라리아) ············································································ 143

표� 3-1-66.� 상병분류:� P37.4� (기타�선천말라리아) ···················································································· 145

표� 3-1-67.� 상병분류:� A30.0� (부정� 나병) ·································································································· 147

표� 3-1-68.� 상병분류:� A30.1� (결핵� 나병) ·································································································· 149

표� 3-1-69.� 상병분류:� A30.2� (경계결핵�나병) ··························································································· 151

표� 3-1-70.� 상병분류:� A30.3� (중간� 나병) ·································································································· 153

표� 3-1-71.� 상병분류:� A30.4� (경계나병종나병) ························································································· 155

표� 3-1-72.� 상병분류:� A30.5� (나병종나병) ································································································· 157

표� 3-1-73.� 상병분류:� A30.8� (기타� 형태의�나병) ····················································································· 159

표� 3-1-74.� 상병분류:� A30.9� (상세불명의�나병) ······················································································· 161

표� 3-1-75.� 상병분류:� A38� (성홍열) ············································································································ 163

표� 3-1-76.� 상병분류:� A39.0� (수막구균수막염) ························································································· 165

표� 3-1-77.� 상병분류:� A48.1� (재향군인병) ································································································· 167

표� 3-1-78.� 상병분류:� A48.2� (비폐렴성�재향군인병[폰티액열]) ······························································ 169

표� 3-1-79.� 상병분류:� A41.5� (기타� 그람음성균에�의한�패혈증) ····························································· 171

표� 3-1-80.� 상병분류:� A75.2� (리케차�티피에�의한�발진티푸스) ····························································· 173

표� 3-1-81.� 상병분류:� A75.3� (리케차�쯔쯔가무시에�의한�발진티푸스) ················································· 175

표� 3-1-82.� 상병분류:� A27.0� (황달출혈성�렙토스피라병) ········································································ 177

표� 3-1-83.� 상병분류:� A27.8� (기타� 형태의�렙토스피라병) ······································································ 179

- 3 -

표� 3-1-84.� 상병분류:� A27.9� (상세불명의�렙토스피라병) ········································································ 181

표� 3-1-85.� 상병분류:� A23.0� (브루셀라�멜리텐시스에�의한�브루셀라병) ·············································· 183

표� 3-1-86.� 상병분류:� A23.1� (브루셀라�아보르투스에�의한�브루셀라병) ·············································· 185

표� 3-1-87.� 상병분류:� A23.2� (브루셀라�수이스에�의한�브루셀라병) ····················································· 187

표� 3-1-88.� 상병분류:� A23.3� (브루셀라�카니스에�의한�브루셀라병) ····················································· 189

표� 3-1-89.� 상병분류:� A23.8� (기타� 브루셀라병) ······················································································· 191

표� 3-1-90.� 상병분류:� A23.9� (상세불명의�브루셀라병) ············································································ 193

표� 3-1-91.� 상병분류:� A98.5� (신장증후군을�동반한�출혈열) ·································································· 195

표� 3-1-92.� 상병분류:� A50.0(증상성�조기� 선천매독) ················································································ 197

표� 3-1-93.� 상병분류:� A50.1� (잠복성�조기� 선천� 매독) ············································································ 199

표� 3-1-94.� 상병분류:� A50.2� (상세불명의�조기�선천� 매독) ···································································· 201

표� 3-1-95.� 상병분류:� A50.3� (만기� 선천매독성�눈병증) ·········································································· 203

표� 3-1-96.� 상병분류:� A50.4� (만기� 선천성�신경매독[연소성�신경매독]) ·············································· 205

표� 3-1-97.� 상병분류:� A50.5� (기타� 증상성�만기� 선천매독) ···································································· 207

표� 3-1-98.� 상병분류:� A50.6� (잠복성�만기� 선천매독) ·············································································· 209

표� 3-1-99.� 상병분류:� A50.7� (상세불명의�만기�선천매독) ······································································ 211

표� 3-1-100.� 상병분류:� A50.9� (상세불명의�선천매독) ············································································· 213

표� 3-1-101.� 상병분류:� A51.0� (생식기의�일차매독) ················································································· 215

표� 3-1-102.� 상병분류:� A51.1� (항문의�일차매독) ····················································································· 217

표� 3-1-103.� 상병분류:� A51.2� (기타� 부위의�일차매독) ··········································································· 219

표� 3-1-104.� 상병분류:� A51.3� (피부� 및� 점막의�이차매독) ····································································· 221

표� 3-1-105.� 상병분류:� A51.4� (기타� 이차매독) ························································································ 223

표� 3-1-106.� 상병분류:� A81.0� (크로이츠펠트-야콥병) ·············································································· 225

표� 3-1-107.� 상병분류:� A90� (뎅기열[고전적�뎅기]) ·················································································· 227

표� 3-1-108.� 상병분류:� A91� (뎅기출혈열) ·································································································· 229

표� 3-1-109.� 상병분류:� A78� (큐열) ············································································································· 231

표� 3-1-110.� 상병분류:� A92.3� (서부나일바이러스감염) ··········································································· 233

표� 3-1-111.� 상병분류:� A69.2� (라임병) ······································································································ 235

표� 3-1-112� 상병분류:� A24.0� (마비저) ······································································································· 237

표� 3-1-113.� 상병분류:� A24.1� (급성� 및� 전격성�유사비저) ····································································· 239

표� 3-1-114.� 상병분류:� A24.2� (아급성�및� 만성�유사비저) ····································································· 241

표� 3-1-115.� 상병분류:� A24.3� (기타� 유사비저) ························································································ 243

표� 3-1-116.� 상병분류:� A24.4� (상세불명의�유사비저) ············································································· 245

표� 3-1-117.� 상병분류:� A92.0� (치쿤군야바이러스병) ··············································································· 247

표� 5-2-1.� 상병분류:� A36.0� (인두디프테리아) ···························································································· 251

표� 5-2-2.� 상병분류:� A36.1� (비인두디프테리아) ························································································ 253

표� 5-2-3.� 상병분류:� A36.2� (후두디프테리아) ···························································································· 255

표� 5-2-4.� 상병분류:� A36.3� (피부�디프테리아) ·························································································· 257

표� 5-2-5.� 상병분류:� A36.8� (기타�디프테리아) ·························································································· 259

표� 5-2-6.� 상병분류:� A36.9� (상세불명의�디프테리아) ·············································································· 261

표� 5-2-7.� 상병분류:� A80.0� (백신관련�급성�마비성�회색질척수염) ······················································· 263

표� 5-2-8.� 상병분류:� A80.1� (수입된,� 야생형�바이러스에�의한�급성� 마비성�회색질척수염) ·············· 265

표� 5-2-9.� 상병분류:� A80.2� (토착성,� 야생형�바이러스에�의한�급성� 마비성�회색질척수염) ·············· 267

표� 5-2-10.� 상병분류:� A80.3� (기타� 및� 상세불명의�급성�마비성�회색질척수염) ·································· 269

- 4 -

표� 5-2-11.� 상병분류:� A80.4� (급성� 비마비성�회색질척수염) ·································································· 271

표� 5-2-12.� 상병분류:� A80.9� (상세불명의�급성�회색질척수염) ······························································· 273

표� 5-2-13.� 상병분류:� A16.0� (세균학적�및� 조직학적으로�음성인�폐결핵) ············································ 275

표� 5-2-14.� 상병분류:� A16.1� (세균학적�및� 조직학적�검사를�하지� 않은� 폐결핵) ································ 277

표� 5-2-15.� 상병분류:� A16.2� (세균학적�또는�조직학적�확인에�대한� 언급이�없는� 폐결핵) ··············· 279

표� 5-2-16.� 상병분류:� A16.3� (세균학적�또는�조직학적�확인에�대한�언급이�없는�흉곽내�림프절의�결핵) ··· 281

표� 5-2-17.� 상병분류:� A16.4� (세균학적�또는�조직학적�확인에�대한�언급이�없는�후두,�기관�및�기관지의�결핵) ··· 283

표� 5-2-18.� 상병분류:� A16.5� (세균학적�또는�조직학적�확인에�대한�언급이�없는�결핵성�흉막염) ··· 285

표� 5-2-19.� 상병분류:� A16.7� (세균학적�또는�조직학적�확인에�대한�언급이�없는�일차�호흡기결핵) ··· 287

표� 5-2-20.� 상병분류:� A16.8� (세균학적�또는�조직학적�확인에�대한�언급이�없는�기타�호흡기결핵) ··· 289

표� 5-2-21.� 상병분류:� A16.9� (세균학적�또는�조직학적�확인에�대한�언급이�없는�상세불명의�호흡기�결핵) ··· 291

표� 5-2-22.� 상병분류:� A15.0� (배양� 유무에�관계없이�가래�현미경�검사로�확인된�폐결핵) ··············· 293

표� 5-2-23.� 상병분류:� A15.1� (배양만으로�확인된�폐결핵) ······································································ 295

표� 5-2-24.� 상병분류:� A15.2� (조직학적으로�확인된�폐결핵) ·································································· 297

표� 5-2-25.� 상병분류:� A15.3� (상세불명의�방법으로�확인된�폐결핵) ····················································· 299

표� 5-2-26.� 상병분류:� A15.4� (세균학적�및� 조직학적으로�확인된�흉곽내�림프절의�결핵) ················· 301

표� 5-2-27.� 상병분류:� A15.5� (세균학적�및� 조직학적으로�확인된�후두,� 기관� 및� 기관지의�결핵) ···· 303

표� 5-2-28.� 상병분류:� A15.6� (세균학적�및� 조직학적으로�확인된�결핵성�흉막염) ······························ 305

표� 5-2-29.� 상병분류:� A15.7� (세균학적�및� 조직학적으로�확인된�일차�호흡기결핵) ·························· 307

표� 5-2-30.� 상병분류:� A15.8� (세균학적�및� 조직학적으로�확인된�기타�호흡기결핵) ·························· 309

표� 5-2-31.� 상병분류:� A15.9� (세균학적�및� 조직학적으로�확인된�상세불명의�호흡기결핵) ··············· 311

표� 5-2-32.� 상병분류:� A17.0� (수막결핵) ···································································································· 313

표� 5-2-33.� 상병분류:� A17.1� (수막결핵종) ································································································· 315

표� 5-2-34.� 상병분류:� A17.8� (기타� 신경계통의�결핵) ·············································································· 317

표� 5-2-35.� 상병분류:� A17.9� (상세불명의�신경계통의�결핵) ·································································· 319

표� 5-2-36.� 상병분류:� A18.0� (뼈� 및� 관절의�결핵) ··················································································· 321

표� 5-2-37.� 상병분류:� A18.1� (비뇨생식계통의�결핵) ················································································ 323

표� 5-2-38.� 상병분류:� A18.2� (결핵성�말초림프절병증) ············································································ 325

표� 5-2-39.� 상병분류:� A18.3� (장,복막� 및� 장간막�림프절의�결핵) ························································· 327

표� 5-2-40.� 상병분류:� A18.4� (피부� 및� 피하조직의�결핵) ········································································ 329

표� 5-2-41.� 상병분류:� A18.5� (눈의� 결핵) ·································································································· 331

표� 5-2-42.� 상병분류:� A18.6� (귀의� 결핵) ·································································································· 333

표� 5-2-43.� 상병분류:� A18.7� (부신의�결핵) ······························································································· 335

표� 5-2-44.� 상병분류:� A18.8� (기타� 명시된�기관의�결핵) ········································································ 337

표� 5-2-45.� 상병분류:� A19.0� (하나로�명시된�부위의�급성� 좁쌀결핵) ··················································· 339

표� 5-2-46.� 상병분류:� A75.0� (리케차�프로와제키에�의한�유행성�이매개�발진티푸스) ······················· 341

표� 5-2-47.� 상병분류:� A22.0� (피부� 탄저병) ······························································································· 343

표� 5-2-48.� 상병분류:� A22.1� (폐� 탄저병) ·································································································· 345

표� 5-2-49.� 상병분류:� A22.2� (위장� 탄저병) ······························································································· 347

표� 5-2-50.� 상병분류:� A22.7� (탄저병�패혈증) ··························································································· 349

표� 5-2-51.� 상병분류:� A22.8� (기타� 형태의�탄저병) ················································································· 351

표� 5-2-52.� 상병분류:� A22.9� (상세불명의�탄저병) ··················································································· 353

표� 5-2-53.� 상병분류:� J10.0� (기타� 인플루엔자�바이러스가�확인된,� 폐렴을�동반한�인플루엔자) ······ 355

표� 5-2-54.� 상병분류:� J10.1� (기타�인플루엔자�바이러스가�확인된,�기타�호흡기�증상을�동반한�인플루엔자) ···· 357

- 5 -

표� 5-2-55.� 상병분류:� J10.8� (기타�인플루엔자�바이러스가�확인된,�기타증상을�동반한�인플루엔자) ··· 359

표� 5-2-56.� 상병분류:� J11.0� (바이러스가�확인되지�않은,� 폐렴을�동반한�인플루엔자) ······················· 361

표� 5-2-57.� 상병분류:� J11.1� (바이러스가�확인되지�않은,�기타�호흡기�증상을�동반한�인플루엔자) ···· 363

표� 5-2-58.� 상병분류:� J11.8� (바이러스가�확인되지�않은,� 기타� 증상을�동반한�인플루엔자) ············· 365

표� 5-2-59.� 상병분류:� B20.0� (마이코박테리아�감염을�유발한� HIV병) ··················································· 367

표� 5-2-60.� 상병분류:� B20.1� (기타� 세균감염을�유발한� HIV병) ······························································ 369

표� 5-2-61.� 상병분류:� B20.2� (거대세포바이러스병을�유발한� HIV� 병) ··················································· 371

표� 5-2-62.� 상병분류:� B20.3� (기타� 바이러스감염을�유발한� HIV병) ······················································ 373

표� 5-2-63.� 상병분류:� B20.4� (칸디다증을�유발한� HIV병) ········································································ 375

표� 5-2-64.� 상병분류:� B20.5� (기타� 진균증을�유발한� HIV병) ·································································· 377

표� 5-2-65.� 상병분류:� B20.6� (폐포자충폐렴을�유발한� HIV병) ································································ 379

표� 5-2-66.� 상병분류:� B20.7� (다발감염을�유발한� HIV병) ········································································ 381

표� 5-2-67.� 상병분류:� B20.8� (기타� 감염성�및� 기생충성�질환을�유발한� HIV병) ································· 383

표� 5-2-68.� 상병분류:� B20.9� (상세불명의�감염성�또는� 기생충성�질환을�유발한� HIV� 병) ················ 385

표� 5-2-69.� 상병분류:� B21.0� (카포시육종을�유발한� HIV병) ···································································· 387

표� 5-2-70.� 상병분류:� B21.1� (버킷림프종을�유발한� HIV병) ···································································· 389

표� 5-2-71.� 상병분류:� B21.2� (기타� 유형의�비호지킨림프종을�유발한� HIV병) ····································· 391

표� 5-2-72.� 상병분류:� B21.3� (림프성,� 조혈성�및�관련� 조직의�기타� 악성�종양을�유발한� HIV� 병) ··· 393

표� 5-2-73.� 상병분류:� B21.7� (다발성�암을� 유발한� HIV병) ······································································ 395

표� 5-2-74.� 상병분류:� B21.8� (기타� 암을�유발한� HIV병) ········································································· 397

표� 5-2-75.� 상병분류:� B21.9� (상세불명의�암을�유발한� HIV병) ······························································ 399

표� 5-2-76.� 상병분류:� B22.0� (뇌병증을�유발한� HIV병) ··········································································· 401

표� 5-2-77.� 상병분류:� B22.1� (림프성�간질폐렴을�유발한� HIV병) ·························································· 403

표� 5-2-78.� 상병분류:� B22.2� (소모증후군을�유발한� HIV병) ···································································· 405

표� 5-2-79.� 상병분류:� B22.7� (달리� 분류된�다발성�질환을�유발한� HIV병) ··········································· 407

표� 5-2-80.� 상병분류:� B23.0� (급성� HIV� 감염증후군) ··············································································· 409

표� 5-2-81.� 상병분류:� B23.1� ((지속성)전신림프절병증을�유발한� HIV병) ·············································· 411

표� 5-2-82.� 상병분류:� B23.2� (달리� 분류되지�않은�혈액학적�및�면역학적�이상을�유발한� HIV병) ··· 413

표� 5-2-83.� 상병분류:� B23.8� (기타� 명시된�병태를�유발한� HIV� 병) ······················································ 415

표� 5-2-84.� 상병분류:� B24� (상세불명의�인체면역결핍바이러스병) ························································· 417

표� 5-2-85.� 상병분류:� Z21� (무증상�인체면역결핍바이러스[HIV]� 감염상태) ·········································· 419

표� 5-2-86.� 상병분류:� A82.0� (삼림형�광견병) ··························································································· 421

표� 5-2-87.� 상병분류:� A82.1� (도시형�광견병) ··························································································· 423

표� 5-2-88.� 상병분류:� A82.9� (상세불명의�광견병) ··················································································· 425

표� 5-2-89.� 상병분류:� A20.0� (림프절형�페스트) ······················································································· 427

표� 5-2-90.� 상병분류:� A20.1� (조직염피부형�페스트) ················································································ 429

표� 5-2-91.� 상병분류:� A20.2� (폐렴형�페스트) ··························································································· 431

표� 5-2-92.� 상병분류:� A20.3� (페스트수막염) ····························································································· 433

표� 5-2-93.� 상병분류:� A20.7� (패혈증형�페스트) ······················································································· 435

표� 5-2-94.� 상병분류:� A20.8� (기타� 형태의�페스트) ················································································· 437

표� 5-2-95.� 상병분류:� A20.9� (상세불명의�페스트) ··················································································· 439

표� 5-2-96.� 상병분류:� A95.0� (삼림형�황열) ······························································································· 441

표� 5-2-97.� 상병분류:� A95.1� (도시형�황열) ······························································································· 443

표� 5-2-98.� 상병분류:� A95.9� (상세불명의�황열) ······················································································· 445

- 6 -

표� 5-2-99.� 상병분류:� A96.0� (주닌출혈열) ································································································· 447

표� 5-2-100.� 상병분류:� A96.1� (마추포출혈열) ·························································································· 449

표� 5-2-101.� 상병분류:� A96.8� (기타� 아레나바이러스출혈열) ·································································· 451

표� 5-2-102.� 상병분류:� A96.9� (상세불명의�아레나바이러스출혈열) ······················································· 453

표� 5-2-103.� 상병분류:� A98.0� (크리미아-콩고출혈열) ·············································································· 455

표� 5-2-104.� 상병분류:� A98.1� (옴스크출혈열) ·························································································· 457

표� 5-2-105.� 상병분류:� A98.3� (마르부르그바이러스병) ··········································································· 459

표� 5-2-106.� 상병분류:� A98.4� (에볼라바이러스병) ··················································································· 461

표� 5-2-107.� 상병분류:� A98.8� (기타� 명시된�바이러스출혈열) ································································ 463

표� 5-2-108.� 상병분류:� B03� (마마) ·············································································································· 465

표� 5-2-109.� 상병분류:� A05.1� (보툴리누스�중독) ····················································································· 467

표� 5-2-110.� 상병분류:� U04.9� (상세불명의�중증급성호흡증후군[SARS]) ·············································· 469

표� 5-2-111.� 상병분류:� J09� (특정의�확인된�인플루엔자�바이러스에�의한�인플루엔자) ······················ 471

표� 5-2-112.� 상병분류:� A21.0� (궤양림프절�야생토끼병) ········································································· 473

표� 5-2-113.� 상병분류:� A21.1� (눈림프절�야생토끼병) ············································································· 475

표� 5-2-114.� 상병분류:� A21.2� (폐� 야생토끼병) ························································································ 477

표� 5-2-115.� 상병분류:� A21.3� (위장� 야생토끼병) ····················································································· 479

표� 5-2-116.� 상병분류:� A21.7� (전신� 야생토끼병) ····················································································· 481

표� 5-2-117.� 상병분류:� A21.8� (기타� 형태의�야생토끼병) ······································································· 483

표� 5-2-118.� 상병분류:� A21.9� (상세불명의�야생토끼병) ········································································· 485

표� 5-2-119.� 상병분류:� A84.0� (극동진드기매개�뇌염[러시아봄여름뇌염]) ············································ 487

표� 5-2-120.� 상병분류:� A84.1� (중앙유럽�진드기매개�뇌염) ···································································· 489

표� 5-2-121.� 상병분류:� A84.8� (기타� 진드기매개�바이러스뇌염) ···························································· 491

표� 5-2-122.� 상병분류:� A84.9� (상세불명의�진드기매개�바이러스뇌염) ················································· 493

- 7 -

그�림�차�례

그림� 1-2-1.� 국민건강보험자료�대비�법정감염병�전수감시�자료�분율(법정감염병�신고율) ······················ 9

- 8 -

� 제1절.� 배경� 및� 목적

1.� 배경

◦ 감염병의� 발생과� 관련된� 환자� 자료를� 체계적이고� 지속적으로� 수집,� 분석� 및� 해석하여� 그�

결과를� 제때에� 필요한� 사람에게� 배포하여� 감염병� 예방� 및� 관리에� 사용하도록� 하기� 위해,�

우리나라에서는�감염병�감시체계를�운영하고�있음

◦ 특히,� 법정감염병�제1군~제4군의� 56종� 감염병1)에�대해서는�모든�의료기관에서�환자�등을�

진단했을�때� 환자발생을�보건당국에�신고하도록�하고�있음

◦ 그러나,� 감염병� 유행� 징후를� 조기에� 감지하거나,� 법정감염병에� 속하지는� 않으나� 발생상황

과� 추이에� 대한� 모니터링이� 필요한� 감염병에� 대하여� 능동적이고� 신속한� 대처하기� 위해서

는�법정감염병�전수감시체계�이외의�자료원이�확보되어야�함

◦ 이를� 위한� 대표적인� 자료로서� 국민건강보험� 청구자료가� 있으며,� 높은� 전산청구율2)과� 표준

화된� 질병분류(KCD-6,� 2016년� 1월� 1일부터� KCD-7으로� 개정3))체계를� 통해� 수집된� 자료

로서�법정감염병�전수감시체계를�보완할�수� 있는�자료원임

◦ 국민건강보험� 청구자료를� 활용하여� 경기도의� 지역적� 감염병� 발생� 현황을� 감시하기� 위해서

는,� 청구자료에�평가가�선행되어야�함

� � 2.� 연구�목적

◦ 주요�감염병의�전국/경기도�진료�현황�파악

◦ 주요�감염병의�진료�현황과�전수감시�신고자료�비교

◦ 향후�진행될�진료자료�심층�분석에�대한�시사점�도출

1)� 보건복지부,� 질병관리본부(2016),� 2016� 감염병�감시� 및� 보고지침.2)� 한국보건의료연구원(2013),� 국내� 보건의료�이차자료원�활용.

3)� 통계청�고시�제2015-159호(2015.� 07.� 01.)

서론 <

- 9 -

제2절.� 국민건강보험�청구자료와�법정감염병�전수감시�자료�비교

◦ 국가�감염병�감시사업을�통해�체계적이고�지속적으로�수집되는�자료는�지역�발생현황을�파악

하여� 예방� 및� 관리에� 사용되는� 주요한� 자료이나,� 감염병� 감시� 자료는� 감염병에� 감염된� 환자�

중� 의료기관에서�자발적으로�신고하는�일정�비율에�대해서만�수집되는�속성을�갖고�있음

◦ 지역� 내� 환자� 발생� 현황은� 향후� 해당� 지역의� 감염병� 유행� 규모를� 예측하게� 되는� 중요한�

자료로서,� 도내�의료기관의�감염병�신고�실태�파악이�필요

◦ 감시자료를� 통해서는� 개별� 환자에� 대해� 신고� 실태를� 파악하는� 것은� 불가능하며,� 국민건강

보험법�제55조에� 의해� 요양급여심사�및�요양급여의�적정성� 평가를� 위하여� 의료기관으로부

터� 요양급여를� 청구할� 때,� 의료기관에서� 사용된� 청구상병코드� 상에서� 주상병(chief�

complaints)이� 법정감염병의� 분류에� 해당하는� 경우를� 법정감염병� 전수감시자료와� 비교하

여�간접적으로�의료기관의�신고실태�파악�가능

․ 레지오넬라증과�장출혈성대장균감염증(EHEC)는,� 5개년� 합계�청구건수보다�신고건수가�더�많음․ 치쿤구니야열,� 말라리아,� 뎅기열� 등� 모기에� 의한� 대표적인� 해외유입감염병은� 신고건수가� 청구건수의�80%� 이상

․ 파라티푸스,� 브루셀라,� 일본뇌염,� 신증후군출혈열(HFRS),� 발진열,� 유비저,� 쯔쯔가무시증,� CJD� 등은� 신고건수가�청구건수의� 50%�이상

․ 매독,� 풍진,� 한센병,� 보툴리눔독소증,� 콜레라�등은�신고건수가�청구건수의� 10%�미만․ 디프테리아,� 폴리오(소아마비),� 발진열,� 탄저,� 광견병,� 페스트,� 황열,� 두창,� 야토병,� 진드기매개뇌염� 등은�청구자료�상에서�주상병으로�청구된�적이�있으나,� 법정감염병�감시에는�신고된�적�없음�

그림� 1-2-1.� 국민건강보험자료�대비�법정감염병�전수감시�자료�분율(법정감염병�신고율)

◦ 2010년부터� 2014년까지의�연도별�청구건수와�신고건수의�상관관계를�비교함

․ 국민건강보험� 청구자료와� 법정감염병� 전수감시� 자료를� 분석4)하였을� 때,� 치쿤구니야열,� 홍역,� 말라리아,� 유행성이하선염,� A형간염,� 쯔쯔가무시증,� 풍진,� 브루셀라증,� 뎅기열� 등은� 연도별� 청구건수와� 신고

건수의�상관계수가� 0.9� 이상

․ 장출혈성대장균감염증과�신증후군출혈열은�연도별�청구건수와�신고건수의�상관계수가� 0.7~0.9� 사이․ 매독과�보툴리눔독소증은�연도별�청구건수와�신고건수의�상관계수가� 0.0~0.2� 사이․ 콜레라,� 유비저,� 백일해,� 수두,� 라임병,� 파상풍� 등의� 연도별� 청구건수와� 신고건수는� 음의� 상관관계로,�연도별�증감경향이�서로�반대

4)� Lee� et.� al.,� Using� National� Health� Insurance� Claims� Data� to� Supplement� Notifiable� Infectious� Disease�

Surveillance� System,� 2015� ISDS� poster� presentation.

- 10 -

표� 1-2-1.� 국민건강보험�청구자료와�법정감염병�전수감시�자료�비교

� Case� Definitions� for� Notifiable� DiseasesNHI� claim� data � KNNDSS� data � �

Correlation�ρ�

Notificationrate(%)*`10 `11 `12 `13 `14

�`10 `11 `12 `13 `14

�

� � Confirmed Suspected Asymptomatic�carrier� �

Group� Ⅰ�(6)�

Cholera ○ ○ ○ 246 1,493 512 78 99 � 8 3 0 3 0 � -0.015 0.6Typhoid� fever ○ ○ ○ 414 311 340 302 418 � 133 148 129 156 251 � 0.475 45.8Paratyphoid� fever ○ ○ ○ 200 92 33 24 16 � 55 56 58 54 37 � 0.371 71.2Shigellosis ○ ○ ○ 1,828 1,291 820 696 490 � 228 171 90 294 110 � 0.302 17.4EHEC ○ ○ ○ 56 55 46 43 66 � 56 71 58 61 111 � 0.800 134.2Viral� hepatitis� A ○ × × 38,811 23,314 9,746 5,669 6,222 � - 5,521 1,197 867 1,307 � 0.980 10.6

Group� Ⅱ�(12)�

Diphtheria ○ ○ × 9 10 6 7 6 � 0 0 0 0 0 � - 0.0Pertussis ○ ○ × 1,332 815 527 158 265 � 27 97 230 36 88 � -0.201 15.4Tetanus ○ × × 518 2 1 3 2 � 14 19 17 22 23 � -0.759 18.1Measles ○ ○ × 579 483 376 514 1,108 � 114 42 3 107 442 � 0.995 23.1Mumps ○ ○ × 25,234 25,968 24,023 32,788 38,367 � 6,094 6,137 7,492 17,024 25,286 � 0.984 42.4Rubella ○ ○ × 960 966 843 705 616 � 43 53 28 18 11 � 0.965 3.7Poliomyelitis ○ ○ × 183 147 97 63 71 � 0 0 0 0 0 � - 0.0Japanese�encephalitis ○ ○ × 20 25 26 25 37 � 26 3 20 14 26 � 0.246 66.9Varicella ○ ○ × 140,359 194,283 129,698 110,493 101,984 � 24,400 36,249 27,763 37,361 44,450 � -0.269 25.2

Group� Ⅲ�(19)

Malaria ○ × ○ 1,687 1,002 766 578 681 � 1,772 826 542 445 638 � 0.987 89.6Hansen’s� disease ○ × × 122 196 172 178 144 � � 7 5 7 6 � 0.476 3.1Scarlet� fever ○ ○ × 6,005 12,209 11,290 14,019 10,888 � 106 406 968 3,678 5,809 � 0.408 20.2Meningococcal�meningitis ○ × ○ 16 18 8 14 19 � 12 7 4 6 5 � 0.350 45.3Legionellosis ○ ○ × 34 23 17 12 10 � 30 28 25 21 30 � 0.459 139.6Epidemic� typhus ○ ○ × 26 14 20 8 8 � 0 0 0 0 0 � - 0.0Murine� typhus ○ ○ × 48 64 47 53 26 � 54 23 41 19 9 � 0.283 61.3Scrub� typhus ○ ○ × 12,290 11,693 15,471 16,629 13,739 � 5,671 5,151 8,604 10,365 8,130 � 0.975 54.3Leptospirosis ○ ○ × 199 185 108 109 105 � 66 49 28 50 58 � 0.499 35.6Brucellosis ○ ○ × 53 32 26 21 17 � 31 19 17 16 17 � 0.957 67.1Anthrax ○ ○ × 10 13 8 4 6 � 0 0 0 0 0 � - 0.0Rabies ○ ○ × 60 23 48 30 18 � 0 0 0 0 0 � - 0.0HFRS ○ ○ × 703 608 632 674 520 � 473 370 364 527 344 � 0.794 66.2Syphilis ○ ○ × 6,142 6,861 7,023 6,583 7,281 � - 965 562 566 726 � 0.146 8.3CJD� and� vCJD ○ × × 41 48 62 95 91 � - 29 45 34 65 � 0.482 51.3

Group� Ⅳ�(19)�

Plague ○ × × 20 19 17 19 10 � 0 0 0 0 0 � - 0.0Yellow� fever ○ × × 4 4 6 0 4 � 0 0 0 0 0 � - 0.0Dengue� fever ○ ○ × 144 131 167 276 218 � 125 72 149 252 165 � 0.955 81.5Smallpox ○ ○ × 12 7 10 3 3 � 0 0 0 0 0 � - 0.0Botulism ○ ○ × 4 8 11 8 8 � 0 0 0 0 1 � 0.045 2.6Tularemia ○ ○ × 12 10 7 7 5 � 0 0 0 0 0 � - 0.0Q� fever ○ ○ × 36 25 19 16 23 � 13 8 10 11 11 � 0.460 44.5West� Nile� fever ○ ○ × 3 0 1 1 1 � - 0 1 0 0 � 0.333 16.7Tick-borne�encephalitis ○ × × 5 1 2 4 4 � - 0 0 0 0 � - 0.0Lyme� Borreliosis ○ ○ × 62 40 35 34 35 � - 2 3 11 13 � -0.664 14.1Melioidosis ○ × ○ 2 4 1 1 1 � - 1 0 2 2 � -0.174 55.6Chikungunya� fever ○ × × 0 0 0 2 1 � - 0 0 2 1 � 1.000 100.0

*� Notification� rate(%)=Notified� cases� for� 2010-2014÷Claimed� cases� for� 2010-2014� ×� 100(%)

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� 제1절.� 분석대상�감염병�선정

◦ 한국�표준질병사인분류(KCD)부호에�따라�제1군~제4군�법정감염병�선정(표� 2-1-1)

․ 최근� 5년� 동안�전수감시�대상�감염병이었으며,�경기도�내� 발생이�있는� 감염병․ 법정감염병에�대한�한국표준질병사인분류(KCD-6)� 부호가� 지정된�감염병

◦ 분석대상�감염병

․ 제1군� 감염병� :� 콜레라,� 장티푸스,� 파라티푸스,� 세균성이질,� 장출혈성대장균감염증,� A형간염�․ 제2군� 감염병� :� 백일해,� 파상풍,� 홍역,� 유행성이하선염,� 풍진,� 일본뇌염,� 수두,� B형간염�

(디프테리아,� 폴리오,� b형헤모필루스인플루엔자,� 폐렴구균�제외)

․ 제3군� 감염병� :� 말라리아,� 한센병,� 성홍열,� 수막구균성수막염,� 레지오넬라증,� 비브리오패혈증,� 발진열,쯔쯔가무시증,� 렙토스피라증,� 브루셀라증,� 신증후군출혈열,� 매독,� 크로이츠펠트야콥병�

및� 변종크로이츠펠트야콥병

(발진티푸스,� 공수병,� 인플루엔자,� 결핵,� AIDS� 제외)

․ 제4군� 감염병� :� 뎅기열,�큐열,� 유비저,� 웨스트나일열,�라임병,� 치쿤구니야열(페스트,� 황열,� 두창,� 보툴리눔독소증,� 중증급성호흡기증후군,� 동물인플루엔자인체감염

증,� 신종인플루엔자,� 야토병,� 큐열,� 진드기매개뇌염,� 바이러스성출혈열,� 신종감염병증

후군,� 중증열성혈소판감소증후군,� 중동호흡기증후군� � 제외)

◦ 분석대상� 제외� 감염병� 중� 진료자료가� 있는� 경우,� 「참고자료� 제2절.� 분석대상� 제외� 감염병

별�진료현황」에�제시

연구�방법 <

- 12 -

구분 감염병명 한국표준질병분류(KCD)부호 최근� 5년�경기도�발생여부 비고� � � �

제1군(6종)

콜레라 A00.0~A00.9 Y장티푸스 A01.0� (병원체보유자� Z22.0� ) Y파라티푸스 A01.1~A01.4 Y세균성이질 A03.0~A03.9 Y장출혈성대장균감염증 A04.3 YA형간염 B15.0~B15.9 Y

제2군(12종)

디프테리아 A36.0~A36.9백일해 A37.0~A37.9 Y파상풍 A33~A35 Y홍역 B05.0~B05.9 Y유행성이하선염 B26.0~B26.9 Y풍진 B06.0~B06.9,� � P35.0 Y폴리오 A80.0~A80.9B형간염 B16.0~B16.9 Y일본뇌염 A83.0 Y수두 B01.0~B01.9,� � P35.8 Yb형헤모필루스인플루엔자 A41.3,A49.2,G00.0,J14,J20.1,� &B96.3 ‘13� 전수감시시작

폐렴구균 A40.3,� G00.1,� J13,� � M00.1,� � I30.1&B95.3,� K65.0&B95.3,�M00.8&&B95.3,� O85&B95.3,� P23.6&B95.3,� I33.0&B95.3

Y ‘14� 전수감시시작� � � �

제3군(19종)

말라리아 B50.0~B53.8,� � P37.3,� P37.4 Y결핵 A15.0~A19.9,� � U88.0~U88.1 Y 별도감시체계운영한센병 A30.0~A30.9 Y성홍열 A38 Y수막구균성수막염 A39.0� Y레지오넬라증 A48.1~A48.2 Y비브리오패혈증 A41.5 Y발진티푸스 A75.0발진열 A75.2 Y쯔쯔가무시증 A75.3 Y렙토스피라증 A27.0~A27.9 Y브루셀라증 A23.0~A23.9 Y탄저 A22.0~A22.9공수병 A82.0~A82.9신증후군출혈열 A98.5 Y인플루엔자 J10.0~J11.8� (influenza�A(H1N1)pdm09는� J09) Y 표본감시체계운영후천성면역결핍증(AIDS) B20.0~B24,� � Z21 Y 별도감시체계운영매독 A50.0~A50.9,� � A51.0~A51.4 Y크로이츠펠트-야콥병(CJD)� 및� 변종크로이츠펠트-야콥병(vCJD) A81.0 Y

� � � �

제4군(19종)

페스트 A20.0~A20.9황열 A95.0~A95.9뎅기열 A90,� � A91 Y바이러스성출혈열� A96~A99� � (A98.5� 제외)두창 B03보툴리눔독소증 A05.1중증급성호흡기증후군(SARS) U04.9동물인플루엔자�인체감염증 J09신종인플루엔자 �야토병 A21.0~A21.9큐열 A78 Y웨스트나일열 A92.3 Y신종감염병증후군 �라임병 A69.2 Y진드기매개뇌염 A84.0~A84.9유비저 A24.1~A24.4 Y치쿤구니야열 A92.0 Y중증열성혈소판감소증후군(SFTS) � Y ‘13� 전수감시시작중동호흡기증후군(MERS) � Y ‘15� 전수감시시작

표� 2-1-1.�법정감염병�분류체계�및� 신고범위(군분류)

- 13 -

� 제2절.� 자료수집�및�분석�방법

1.� 기초분석

◦ 의료기관의� 진료건수는� 건강보험심사평가원� 보건의료빅데이터개방시스템� 질병통계5)에서�

2010년부터� 2014년6)까지�요양기관에서�청구한�요양급여비용�명세서에�대해�심사�결정한�

내용을�기준으로�작성된�자료를�이용

․ 질병명은�주상�