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Health Policy and Mangemnet

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수록정보
수록범위 : 1권1호(1991)~31권4호(2021) |수록논문 수 : 977
보건행정학회지
31권4호(2021년 12월) 수록논문
최근 권호 논문
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KCI등재

120대 대통령선거, 보건의료정책 변혁의 기회

저자 : 이선희 ( Sun-hee Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 4호 발행 연도 : 2021 페이지 : pp. 385-386 (2 pages)

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The 2022 Presidential election is approaching. Because health policies are intimately connected to other policies and involve multiple stakeholders, it is difficult to promote policy changes. Hence, the presidential election, during which policymakers are replaced, is a great timing for making policy improvements. Several important policies have been introduced and promoted throughout the presidential election process. However, these policies have been implemented without going through sufficient discussion among the experts but rather through the voices of minority groups with stronger political will. This eventually posed an obstacle to the balanced development of the entire health care system. The current medical system faces challenges that need to be addressed in the medium and long term. In particular, we should be wary of the populistic approach. We look forward to seeing more policy commitments, proposed through the evidence-based policy process and sufficient amount of discussion among the experts.

KCI등재

2문재인정부의 보건의료정책 평가와 차기 정부의 과제

저자 : 최병호 ( Byongho Tchoe )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 4호 발행 연도 : 2021 페이지 : pp. 387-398 (12 pages)

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Moon Jae-in Care can be seen as a 2.0 version of Roh Moo-Hyun Care. Just as Roh Care failed to achieve its coverage rate goal and 30% share of public beds, Moon Care also failed to achieve its expected goal. The reason is that it followed Roh Care's failed strategy. Failure to control non-covered services has led to a long way to achieve a 70% coverage rate and induced the expansion of voluntary indemnity insurance, resulting in increased public burden. The universal coverage of non-covered services caused an immediate backlash from doctors. And Moon government also failed to control the private insurance market. The expansion of publicly owned beds has not become realized and has not obtained public support. Above all, it failed to overcome the resistance of doctors and failed to obtain consent from budget power groups in the cabinet for public investment. It was also insufficient to win the support of civic groups. Communication with interested groups failed and the role of private health care providers was neglected. The next government should also continue to strengthen health care coverage, but it should prioritize preventing medical poor and create a consensus with both medical providers and consumers for the control of non-covered services. Ahead of the super-aged society, the establishment of linkage between medical services and long-term care and visiting health care or welfare services is an important task. All public and private provisions and resources should be utilized in the view of a comprehensive public health perspective, and public investment should be input in sectors where public medical institutions can perform more effective functions. The next government, which will be launched in 2022, should design a new paradigm for health care in the face of a period of transformation, such as the coming super-aged society in 2026 and the Fourth Industrial Revolution, and recognize that the capabilities of the health care system represent the nation's overall capacity.

KCI등재

3권역외상센터의 질 관리와 수가 개선 현황

저자 : 서은원 ( Eun-won Seo ) , 임지혜 ( Jeehye Im )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 4호 발행 연도 : 2021 페이지 : pp. 399-408 (10 pages)

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The emergency medical service system in Korea was built upon the Emergency Medical Service Act, 1995 to respond adequately to be much in demand for emergency medical services. In addition, the government recognized the importance of the trauma care system and set out to plan for the designation and establishment of the regional trauma center by 2012. This study aimed to investigate features of quality management and trauma fee schedule on better understanding of trauma care system. First, quality management of the regional trauma center has been implemented by several quality programs involved in quality assessment, committee on trauma quality management, and mortality and morbidity conference. Second, the trauma fee schedule has reflected a specific quality of severe traumatic conditions and added the result to it, which are graded A, B, and C according to quality assessment. Although the government has contributed to instituting a trauma quality assessment program and trauma fee schedule for the regional trauma center, it could not lead to such a fixed standard for quality management of them. Therefore, it will promote discussion on the sustainability of the regional trauma center that requires reducing preventable trauma death rate and the way to apply comprehensive quality management.

KCI등재

4통증완화를 위한 오피오이드 사용의 교훈: 경제협력개발기구 회원국의 경험을 중심으로

저자 : 임지혜 ( Jeehye Im ) , 조재영 ( Jae Young Cho )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 4호 발행 연도 : 2021 페이지 : pp. 409-422 (14 pages)

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The growing use of prescription analgesic opioids has rapidly escalated the treatment of chronic pain since the 1990s; however, it is also highly needed to control opioid-related issues, including opioids misuse, abuse, and addiction. In 2018, Organization for Economic Cooperation and Development (OECD) secretariat administered the survey on opioids use and policies to OECD countries and presented it at the Health Committee meeting of December 2018. This study aimed to review the opioids use in OECD countries and their policies to prevent and reduce associated harms, also seek the available policy lessons from OECD countries. More recently, opioids prescribing rate have been increased 14.7% between 2011-2013 and 2014-2016 and steadily focused on the main substance misused and abused in Korea. In addition, policy efforts have contributed to developing a guideline for prescribing opioids to steer the appropriate use of prescription analgesic opioids since 2000 in Korea, so it is not enough to control opioids compared with other OECD countries. Therefore, taking a people-centered and public health perspective, it will consider the health system policies and interventions at a national level to improve their preparation and approach to control opioid-related issues.

KCI등재

5중국 민간의료보험의 발전경로와 의료보장체계에서의 역할

저자 : 정기택 ( Kee Taig Jung ) , Jian Cheng Fan , Wan Yun Chen

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 4호 발행 연도 : 2021 페이지 : pp. 423-436 (14 pages)

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This article summarizes the structure of China's current social health insurance system and reviews the development status of China's private health insurance (PHI). China's medical security system is mainly composed of two parts: basic medical insurance (BMI) and PHI. Among them, the BMI provides reimbursement of basic medical expenses for the insured persons according to different proportions. PHI is a necessary supplement to the BMI and provides assistance to the insured persons in the event of illness or accident. By having PHI, people can obtain medical protection outside the coverage of BMI. In the development of PHI in China, the total medical cost is high and the insurance market size is large, but the proportion of PHI expenditure is low and the personal burden is high. Through this Chinese case, it will be helpful for mutual development between Korean PHI and national health insurance, for Korean insurance companies to enter the Chinese market, and for removing the medical burden on the people.

KCI등재

6한국과 미국의 보건의료정보관리 교육인증제도 및 교육과정 운영현황 비교 분석

저자 : 김시우 ( Siwoo Kim ) , 박지원 ( Jiwon Park ) , 이시은 ( Sieun Lee ) , 이한솔 ( Hansol Lee ) , 이유리 ( Yuri Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 4호 발행 연도 : 2021 페이지 : pp. 437-450 (14 pages)

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Background: With the development of the information technology industry and the increasing importance of health information, there is a need to analyze the current certification system for health information management education. This study compared and analyzed the health information management education accreditation system between the Republic of Korea and the United States.
Methods: Descriptive analysis and quantitative methodologies were used to compare the education accreditation system and understand the current status of health information management curriculum run by universities in the Republic of Korea and the United States.
Results: Regardless of the academic year, the Republic of Korea had one certification system based on subject-based criteria. However, the United States had a certification system for associate, baccalaureate, and master's degree programs with competency-based criteria. The accreditation system was different in terms of the way the curriculum is certified and the options for the different levels of university degree programs.
Conclusion: Accordingly, it is necessary to consider improving the quality of health information management personnel at different levels by improving the current accreditation system and differentiating the curriculum according to the degree program levels in the Republic of Korea.

KCI등재

7회복기 재활환자의 재입원에 영향을 미치는 요인: 건강보험 청구자료를 이용하여

저자 : 신요한 ( Yo Han Shin ) , 정형선 ( Hyoung-sun Jeong )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 4호 발행 연도 : 2021 페이지 : pp. 451-461 (11 pages)

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Background: Readmissions related to lack of quality care harm both patients and health insurance finances. If the factors affecting readmission are identified, the readmission can be managed by controlling those factors. This paper aims to identify factors that affect readmissions of convalescent rehabilitation patients.
Methods: Health Insurance Review and Assessment Service claims data were used to identify readmissions of convalescent patients who were admitted in hospitals and long-term care hospitals nationwide in 2018. Based on prior research, the socio-demographics, clinical, medical institution, and staffing levels characteristics were included in the research model as independent variables. Readmissions for convalescent rehabilitation treatment within 30 days after discharge were analyzed using logistic regression and generalization estimation equation.
Results: The average readmission rate of the study subjects was 24.4%, and the risk of readmission decreases as age, length of stay, and the number of patients per physical therapist increase. In the patient group, the risk of readmission is lower in the spinal cord injury group and the musculoskeletal system group than in the brain injury group. The risk of readmission increases as the severity of patients and the number of patients per rehabilitation medicine specialist increases. Besides, the readmission risk is higher in men than women and long-term care hospitals than hospitals.
Conclusion: “Reducing the readmission rate” is consistent with the ultimate goal of the convalescent rehabilitation system. Thus, it is necessary to prepare a mechanism for policy management of readmission.

KCI등재

8중고령층 집단의 사회활동 참여와 사망률의 연관성 분석

저자 : 김영근 ( Young Guen Kim ) , 양정민 ( Jeong Min Yang ) , 김재현 ( Jae Hyun Kim )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 4호 발행 연도 : 2021 페이지 : pp. 462-471 (10 pages)

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Background: The purpose of this study was to identify the association between participation in social activities and mortality rates for those aged 45 aged and older in Korea.
Methods: In this study, the 1st to 6th Korea Longitude Study of Aging was used to analyze 10,217 people excluding missing values among middle and old age groups aged 45 or older. The scope of social activities was classified into “religious gatherings,” “religious gatherings,” “leisure/cultural/sports-related organizations,” and “clubs/hometowns/religious associations,” and analyzed using a chi-square test and Cox proportional risk model.
Results: In the case of non-participating groups in religious activities, the mortality rate was 1.24 times higher (hazard ratio [HR], 1.24; p=0.000) than those of the participating group. The non-participating group of social gatherings had a 1.27 times higher mortality rate (HR, 1.27; p<0.0001) than the participating group. In addition, the mortality rate of non-participating groups related to leisure/cultural/sports was 1.79 times higher (HR, 1.79; p=0.000). The mortality rate of the group that did not participate in the alumni association/festival/folklore society was 1.51 times higher than that of the participating group (HR, 1.51; p<0.0001). As a result of correcting the control variable to analyze the relationship between the number of participants in social activities and the mortality rate, the mortality rate of the group participating in one or less social activities was 2.26 times higher (HR, 2.26; p<0.0001) compared to the four or more social activity participating groups, and the mortality rate of the 1-3 social activities was 1.64 times higher (HR, 1.64; p<0.0001).
Conclusion: As a result of the study, it was found that participation in social activities of the middle-aged and elderly groups was effective in reducing mortality, and in particular, it was found that there was a strong relationship with mortality in less than one social activity group. Therefore, it is intended to provide an academic basis for lowering the mortality rate of the group in line with the continuous improvement of domestic social activity participation conditions, and through this, this study can be expected to serve as a policy and institutional basis for lowering the mortality rate of the group.

KCI등재

9The Severity of COVID-19 in Patients with Nonalcoholic Fatty Liver Disease in Korea

저자 : Hyeki Park , Hyun Joe

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 4호 발행 연도 : 2021 페이지 : pp. 472-478 (7 pages)

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Background: Early identification of patients who are highly likely to develop severe illness among confirmed cases of coronavirus disease 19 (COVID-19) can be expected to lead to effective treatment. This study therefore aimed to determine whether the presence of nonalcoholic fatty liver disease (NAFLD) has an impact on the exacerbation of COVID-19 symptoms.
Methods: The study used the Korean National Health Insurance claim data for treatment of COVID-19 patients in 2020. NAFLD includes nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). The outcome variables used were hospitalization and the use of medical devices. Hospitalization was defined by a length of stay exceeding one day and the use of medical devices was defined as one or more uses of a ventilator or extracorporeal membrane oxygenation. Multivariable logistic regression analysis was performed to determine if there was a difference in the hospitalization and use of medical devices of COVID-19 patients depending on the presence of NAFLD.
Results: The odds ratio of hospitalization was 1.059, indicating slightly higher odds of hospitalization for patients with NAFL or NASH compared to those without the conditions, but it was not statistically significant (0.969-1.156). On the other hand, the odds ratio of use of medical devices was high at 1.667 and was statistically significant (1.111-2.501).
Conclusion: The study results found NAFLD to be a risk factor that can exacerbate symptoms in COVID-19 patients. Accordingly, it is necessary to identify NAFLD patients through preemptive screening and provide them with appropriate treatments.

KCI등재

10의과대학생 국가시험 거부 사태에 대한 고찰: 신호게임 이론을 중심으로

저자 : 현승효 ( Seung Hyo Hyeon ) , 김다영 ( Da Young Kim ) , 이민규 ( Min Kyu Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 4호 발행 연도 : 2021 페이지 : pp. 479-490 (12 pages)

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Background: Conflict in the medical world in 2020 led to the rejection of the national examination for doctors. This study explained the process until the end of the national test refusal situation triggered in 2020 through the signaling game theory. The government has succeeded in requiring medical students to take the national exam.
Methods: To explain the rejection of the national examination, we first compose and show an example of two small non-signaling games where medical students know which type the government is of, then combine them to play a signaling game.
Results: The behavior of the government and medical students was examined through the signaling game model. In the context of the coronavirus disease 2019 (COVID-19) pandemic, the government makes an ultimatum, whatever the type. And the medical students accept it. They judged that the government could not be expected to abolish the policy. If COVID-19 had not occurred, medical students would have been able to continue the confrontation.
Conclusion: The government instilled in the other party the perception that the government would not bend its policies because it was the surly type and would not be afraid of a strong confrontation. Through the image created in this way, the government was forced to accept the ultimatum by medical students. Academically, this study is to deal with the policy-making process through the signaling game theory. In the area of health care policy, this study suggests that various situations such as the type of government or the spread of COVID-19 can become important in addition to the rationality of the policy itself.

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