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한국보건행정학회> 보건행정학회지> 영국, 미국, 한국의 줄기세포연구에 관한 정책변동 비교 분석: Advocacy Coalition Framework 모형의 적용

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영국, 미국, 한국의 줄기세포연구에 관한 정책변동 비교 분석: Advocacy Coalition Framework 모형의 적용

Original Article : Comparative Analysis of Stem Cell Research Policy Changes in UK, US, and South Korea: Application of Advocacy Coalition Framework Model

배그린 ( G Reen Bae ) , 강민아 ( Min Ah Kang )
  • : 한국보건행정학회
  • : 보건행정학회지 23권4호
  • : 연속간행물
  • : 2013년 12월
  • : 314-325(12pages)

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Background: Stem cell research competition is accelerating globally since President Obama signed an executive order, repealing Bush-era policy that limited use of federal tax dollars for embryonic stem cell research. Methods: In this paper, we conducted a comparative analysis of stem cell research policy changes in three countries, including the Human Fertilisation Embryology Act (HFEA) of UK, executive order 13,505 (removing barriers to responsible scientific research involving human stem cells) of USA, and Bioethics and Safety Act of South Korea. Debates on stem cell research are based on conflicts of fundamental beliefs that exist in the supporting and opposing coalitions. We compared regional characteristics of the advocacy coalitions in three countries and presented various factors that might be related to the policy changes. Results: The UK government, parliament, and the HFEA have sought expert consultations and public opinions to establish guidelines. UK has made social consensus through continued discussion for a long time. US President`s veto power was one strongest factors influencing policy. South Korean policy was influenced by public opinion and policy brokers. Also, South Korea has not made social consensus. UK had a strong leadership and strong adjustment of coalitions but US and South Korea had not. Dr. Hwang`s scandal has had one of the greatest impacts on policy decision in South Korea. Conclusion: The power of public opinion was critical in all three countries. In particular, the influence of public opinion was noticeable in South Korea. Also it turned out that in US and South Korea, the presence of a policy broker who could pursue his or her goals was the most powerful factor among the advocacy coalition factors.

ECN

ECN-0102-2014-500-001962734


UCI

I410-ECN-0102-2014-500-001962734

간행물정보

  • : 의약학분야  > 예방의학및보건학
  • : KCI 등재
  • : -
  • : 계간
  • : 1225-4266
  • : 2289-0149
  • : 학술지
  • : 연속간행물
  • : 1991-2018
  • : 803


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1보건의료체계의 발전과 성찰

저자 : 이규식 ( Kyu Sik Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 23권 4호 발행 연도 : 2013 페이지 : pp. 303-313 (11 pages)

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During last 65 years, Korea has achieved very rapid economic growth and social reformation including healthcare system. Many foreigners have praised that Korea healthcare system is very good in the respect of ease accessibility to healthcare under the lowest cost among the industrialized countries. Whole population are covered by the National Health Insurance. Also utilizations of healthcare among different income classes are even. However Korea healthcare system faced with several challenges, in terms of the an aging population and a rise in chronic disease problem, new threats of communicable disease due to globalization, the rapid increase of healthcare expenditure and high financial burden of patients even though they are insured. To cope with these challenges, we need reconsider the healthcare system as followings; to set up ideology of healthcare as normative public goods, to rebuild paradigm of healthcare for 21 century, to reform public health for strengthening health promotion, to develop new method for healthcare management including quality improvement and consumer responsiveness, to build new governance for health and to view new perspective on healthcare as a kind of industry.

2영국, 미국, 한국의 줄기세포연구에 관한 정책변동 비교 분석: Advocacy Coalition Framework 모형의 적용

저자 : 배그린 ( G Reen Bae ) , 강민아 ( Min Ah Kang )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 23권 4호 발행 연도 : 2013 페이지 : pp. 314-325 (12 pages)

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Background: Stem cell research competition is accelerating globally since President Obama signed an executive order, repealing Bush-era policy that limited use of federal tax dollars for embryonic stem cell research. Methods: In this paper, we conducted a comparative analysis of stem cell research policy changes in three countries, including the Human Fertilisation Embryology Act (HFEA) of UK, executive order 13,505 (removing barriers to responsible scientific research involving human stem cells) of USA, and Bioethics and Safety Act of South Korea. Debates on stem cell research are based on conflicts of fundamental beliefs that exist in the supporting and opposing coalitions. We compared regional characteristics of the advocacy coalitions in three countries and presented various factors that might be related to the policy changes. Results: The UK government, parliament, and the HFEA have sought expert consultations and public opinions to establish guidelines. UK has made social consensus through continued discussion for a long time. US President`s veto power was one strongest factors influencing policy. South Korean policy was influenced by public opinion and policy brokers. Also, South Korea has not made social consensus. UK had a strong leadership and strong adjustment of coalitions but US and South Korea had not. Dr. Hwang`s scandal has had one of the greatest impacts on policy decision in South Korea. Conclusion: The power of public opinion was critical in all three countries. In particular, the influence of public opinion was noticeable in South Korea. Also it turned out that in US and South Korea, the presence of a policy broker who could pursue his or her goals was the most powerful factor among the advocacy coalition factors.

3정책 전문가의 인식을 통해 본 한국 보건의료정책 거버넌스: 신포괄수가제 사례에 관한 심층면접 결과

저자 : 손창우 ( Chang Woo Shon ) , 권순만 ( Soon Man Kwon ) , 유명순 ( Myoung Soon You )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 23권 4호 발행 연도 : 2013 페이지 : pp. 326-342 (17 pages)

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Background: Engaging and Involving stakeholders who have different interests in changing health care policies are difficult task. As the literature on the governance in Korean health care field is rare, this study aims to provide empirical evidence of 'governing health policy'-the ways health care policy is made, implemented, and evaluated from a political perspective. Methods: The authors of this study conducted interviews with elites in policy and clinical areas, which was considered to be the most effective approach to gather in-depth information about the background of changing payment policy as well as the barriers or contributors for making the policy sustainable. A total of 14 experts (3 government officials, 2 representatives from medical profession, 3 professors form academic field, and 6 healthcare providers from New DRG pilot program hospitals) participated in 2 hour long interviews. Results: There was a perception gap of the feasibility and substantiality of new payment system among elites. The score was higher in government officers than those in scholars or clinical experts. Next, the interviewees indicated that Korean New DRG might not sustain without significant efforts to improving democratic aspects of the governance. It is also notable that all interviewees except healthcare providers provided negative expectation of the contribution of new payment system to increase administration efficiency. For clinical efficiency, every stakeholders perceived there was no increased efficiency after introduction of New DRG payment. Like general perception, there was a wide gap between the perception of stakeholders in quality change after implementing the new payment system. Finally, interview participants negatively assumed about the likelihood of New DRG to remain a case of successful reforms. Conclusion: This study implied the importance of social consensus and the governance of health policy.

4서비스양을 고려한 수가 결정모형에 의한 추정 환산지수와 실제 환산지수의 비교

저자 : 한기명 ( Ki Myoung Han ) , 조민호 ( Min Ho Cho ) , 이수진 ( Soo Jin Lee ) , 전기홍 ( Ki Hong Chun )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 23권 4호 발행 연도 : 2013 페이지 : pp. 343-348 (6 pages)

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Background: Price control alone may not successfully restrain growth in health expenditures. This study aimed to propose fee adjustment model suitable for Korea reflecting health service volume and to clarify applicability of the model by comparing actual conversion factor with estimated conversion factor from simulation of this model. Methods: Fee adjustment model was developed based on Alberta`s fee adjustment formula in Canada and 7 alternatives were assessed according to diversely applied parameters of the model. Results: Estimated conversion factors of the tertiary care hospital and the hospital were lower than actual conversion factors, since the utilization of heath service has been increased. However, there was no big difference between estimated conversion factors and actual conversion factors of the general hospital and the clinic. Eventually this fee adjustment model could estimate proper conversion factor reflecting health service volume. Conclusion: This model may be applicable to the mechanism as determining conversion factor between insurer and provider via negotiation and controling growth in health expenditures.

5우리나라 잠복결핵감염 검진전략의 경제성 분석

저자 : 김상원 ( Sang Won Kim ) , 강길원 ( Gil Won Kang ) , 신삼철 ( Sam Chul Shin ) , 송승은 ( Seung Eun Song )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 23권 4호 발행 연도 : 2013 페이지 : pp. 349-357 (9 pages)

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Background: Although interferon-gamma release assay (IGRA) is now available alternatives to tuberculin skin test (TST) for detection of latent tuberculosis infection (LTBI), the cost of IGRA test is much higher than TST. So economic analysis of LTBI screening strategies have been done in many countries, but there are few reports in Korea. This study examined cost analysis of LTBI screening strategies in Korea. Methods: The economic outcomes were evaluated by five strategies. These were 1) TST alone, 2) IGRA alone, 3) combination of TST and IGRA (TST followed by IGRA) and 4) no testing no prevention, 5) no testing all prevention. Last two strategies were added to compare with three main LTBI screening strategies. Decision analysis model were used to perform economic analysis. A cohort study of Korean Institute of Tuberculosis and the data of published literatures were used to estimate the cost analysis. Results: In a base-case scenario which was assumed that TST specificity was 80%, TST alone was the least expensive strategy. In a alternative scenario which was assumed that TST specificity was 97%, the combination of TST and IGRA was the least expensive strategy. Sensitivity analysis shows that patients adherent rate to LTBI treatment, TST sensitivity, IGRA sensitivity and IGRA specificity did not have a significant impact on the outcomes. Conclusion: In Korea, for the diagnosis of LTBI at the time of child and adolescent, TST alone reduces medical costs compared with IGRA alone or combination of TST and IGRA.

6기혼여성의 자녀특성과 자살생각의 관련성

저자 : 김은정 ( Eun Jung Kim ) , 이선미 ( Sun Mi Lee ) , 임승지 ( Seung Ji Lim ) , 정우진 ( Woo Jin Chung )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 23권 4호 발행 연도 : 2013 페이지 : pp. 358-368 (11 pages)

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Background: There are some data to support the theory of a protective effect of parenthood against suicide, as proposed by Durkheim in 1897. We conducted this study to examine the relationship between children characteristics and suicidal ideation among Korean married women. Methods: The data were obtained from the Korean National Health and Nutrition Examination Surveys IV, conducted in 2007-2009, respectively (3,202 married women aged 20-49 years). The children characteristics are the age of the youngest child and the number of children living with subject. Data were analyzed by using logistic regression with SAS 9.2. Results: The risk for suicidal ideation was higher among married women having a young child (aged <7 years). It had strong effect on suicidal ideation in non-employee subjects. The odds ratio for suicidal ideation of women having a youngest child aged 2-3 years compared with reference groups was 1.673 with statistical significance. But the association of suicidal ideation with number of children shows insignificant. Conslusion: The findings suggest a different result with the theory, the protective effect of being a parent of young child on suicide risk for women, first suggested by Durkheim and supported by previous studies and the need for further prospective investigation that lead to policies according children characteristics aimed at improving married women`s life.

7에코세대의 취업변화와 자살생각

저자 : 라채린 ( Chaelin Karen Ra ) , 이현경 ( Hyun Kyung Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 23권 4호 발행 연도 : 2013 페이지 : pp. 369-375 (7 pages)

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Background: This study aimed to investigate the association between employment transitions and suicide ideation among the echo generation. Methods: This study used survey data from the 2008 and 2010 Seoul Welfare Panel Study (Wave I, II). The sample population was restricted to the echo generation aged between18 and 31, and the total of 882 samples were included in the final dataset. Employment transitions were categorized into four groups. The groups were defined as 'employed-employed', 'unemployed-employed', 'employedunemployed', and 'unemployed-unemployed'. We used logistic regression to find out the association between employment transitions and suicide ideation among the echo generation. Results: 'Employed-unemployed' and 'unemployed-unemployed' groups were likely to have an association with depression (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.46 to 1.51; OR, 1.57; 95% CI, 1.56 to 1.59) accordingly. 'Unemployed-unemployed' group also was related to suicide ideation (OR, 1.39; 95% CI, 1.36 to 1.42). Interestingly, 'unemployed-employed' group showed a strong association with suicide ideation among the echo generation (OR, 3.85; 95% CI, 3.75 to 3.95). Conclusion: Experience in unemployment increases the risk of depression and suicide ideation. Moreover, the precarious job also increases the risk of suicide ideation.

8베이비붐세대가 65세 노인인구로 전환 시의 만성질환 환자 수와 진료비 예측

저자 : 이선영 ( Sun Young Lee ) , 김영훈 ( Young Hoon Kim ) , 김한성 ( Han Sung Kim )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 23권 4호 발행 연도 : 2013 페이지 : pp. 376-386 (11 pages)

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Purpose: The purpose of study is to estimate the number of chronic disease patients and medical care expenditure at the time baby-boomers belong to 65 years old aging population, and compare with current 65 year-old aging population. Methods: Analysis method used an estimating formula devised by the researcher and estimated the number of chronic disease patients and medical care expenditure of each generation. Results: When comparing the estimated number of chronic diseases patients of each generation, 40.6% of the first generation, 76.4% of the second generation, 95.2% of third generation are expected to get chronic disease. When comparing each generation`s total medical care expenditure, based on the estimated number of chronic diseases patients of each generation, the second generation( 1,206,251,224 thousand won) showed higher than other generation. This study compared the number of chronic disease patients and medical care expenditure between the second generation of the elderly and current elder generation. As a result, the second generation patients was higher than the fourth generation in high blood pressure, diabetes, psychological and behavioral disorder, and neurological diseases whereas the fourth generation is only high the number of patients in heart disease. As for total medical care expenditure, the second generation paid more in high blood pressure, psychological and behavioral disorder while the fourth generation in neurological disease and heart disease. Conclusion: It is desired that considering the number of chronic disease patients and medical care expenditure of baby boomers accounting for 14.6% of total population, in-depth follow-up study is carried out that inquires into what are issues with a current chronic disease management project, what business is needed in order to manage these issues, and how to fund to cover increasing medical care expenditure.

9공간효과분석을 이용한 건강보험 환자 관외 의료이용도와 관련된 요소분석

저자 : 노윤호 ( Yun Ho Roh )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 23권 4호 발행 연도 : 2013 페이지 : pp. 387-396 (10 pages)

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Background: The purpose of this study was to analyze the association between areas of Korea Train Express (KTX) region and external medical service use in Korean society using spatial statistical model. Methods: The data which was used in this study was extracted from 2011 regional health care utilization statistics and health insurance key statistics from National Health Insurance Corporation. A total spatial units of 229 districts (si-gun-gu) were included in this study and spatial area was all parts of the country excepted Jeju, Ulleungdo island. We conducted Kruskal-Wallis test, correlation, Moran`s I and hot-spot analysis. And after, ordinary linear regression, spatial lag, spatial error analysis was performed in order to find factors which were associated with external medical service use. The data was processed by SAS ver. 9.1 and Geoda095i (windows). Results: Moran`s I of health insurance patients` external medical service use was 0.644. Also, population density, Seoul region, doctor factors positively associated with health insurance patients` external medical service. In contrast, average age, health care organization per 100 thousand were negatively associated with health insurance patients` external medical service use. Conclusion: The finding of this study suggested that health insurance patient`s external medical service use correlated for seoul region in korea. The study results imply the need for more attention medical needs in the region (si-gun-gu unit) for health insurance patients of seoul region. It is important to adapt strategy to activation of primary health care as well as enhancing public health institution for prevent leakage of patients to other areas.

10병원의 수익성은 무엇으로 결정되는가?: 국내 연구의 동향 분석

저자 : 최재영 ( Jae Young Choi ) , 김지현 ( Jee Hyun Kim )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 23권 4호 발행 연도 : 2013 페이지 : pp. 397-414 (18 pages)

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There have been numerous attempts at finding factors associated with profitability among hospitals in the Republic of Korea. Factors that have been shown to be related to hospital profitability have not yet been systematically reviewed. The purpose of this study was to compile and summarize published works investigating the factors associated with hospital profitability in the Republic of Korea. We searched Research Information Sharing Service, Korea studies Information Service System, Database Periodical Information Academic, Korean Medical Database, KoreaMed, and Google Scholar from 1980 to November 2013. In addition, we manually searched reference lists from eligible studies. Review of 20 peer-reviewed articles revealed that very few of the variables employed in the eligible studies exerted consistent association with profitability, with the exception of personal cost (i.e., employee salaries). Future studies should take our findings into consideration before conducting research on hospital profitability.

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