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한국보건행정학회> 보건행정학회지> 의사 업무량 측정 및 분석 -내과 및 일반외과 서비스를 대상으로-

KCI등재

의사 업무량 측정 및 분석 -내과 및 일반외과 서비스를 대상으로-

Measurement and Analysis of Physician Work

주우현 ( Woo Hyun Cho ) , 손명세 ( Myong Sei Sohn ) , 박은철 ( Eun Cheol Park ) , 김한중 ( Han Joong Kim ) , 김양균 ( Yang Kun Kim ) , 허영주 ( Young Joo Heo ) , 강형곤 ( Hyoung Gon Kang )
  • : 한국보건행정학회
  • : 보건행정학회지 5권2호
  • : 연속간행물
  • : 1995년 12월
  • : 213-229(17pages)
보건행정학회지

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The work that Physicians perform represents major resource input to medical services and procedures. In this article we describe the concepts of work and its dimensions, as well as the methods that measure total work which includes intra-service work and pre-/ post-service work We also present the survey results of physicians in internal medi-cine and general surgery for selected services. Our findings indicate that physicians can give reliable and valid ratings of work and that we can model this work as a function of four dimension: time, mental effort and jud-gement, technical skill and physical effort, and Analyzing the complex functional relationship between work and these four dimensions show that all four dimensions are import and statistically significant in predicting work. Technical skill and physical effort is a more important dimension in predicting work. Finally we found that an exponential equation of the four dimensions precisely describes work.

UCI(KEPA)

I410-ECN-0102-2014-500-001961691

간행물정보

  • : 의약학분야  > 예방의학및보건학
  • : KCI등재
  • :
  • : 계간
  • : 1225-4266
  • : 2289-0149
  • : 학술지
  • : 연속간행물
  • : 1991-2022
  • : 1001


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32권2호(2022년 06월) 수록논문
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KCI등재

1새정부 보건의료정책 개선을 기대한다

저자 : 이선희 ( Sun-hee Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 32권 2호 발행 연도 : 2022 페이지 : pp. 123-124 (2 pages)

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With the inauguration of a new government, expectations for policy changes are also rising. In the hope that this will serve as an opportunity to improve health care policy, I would like to outline the principles strategies. First, considering the growing socioeconomic impact of the health care sector, the government's policy priorities should be notably increased compared to the past. Second, policy improvement measures based on evidence should be sought instead of dwelling on presidential pledges. While easing regulations, we should improve the quality of regulatory approaches. Therefore, it is a time when efforts are needed to strengthen the stability of policies in response to economic crises.

KCI등재

2미국의 혁신의료기술 지불보상제도: 인공지능 의료기기를 중심으로

저자 : 이보람 ( Boram Lee ) , 임재준 ( Jaejun Yim ) , 양장미 ( Jangmi Yang )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 32권 2호 발행 연도 : 2022 페이지 : pp. 125-136 (12 pages)

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The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

KCI등재

3공공 및 민영의료보험의 비급여 관리정책에 대한 국가별 비교

저자 : 김하윤 ( Ha Yun Kim ) , 장종원 ( Chong Won Chang )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 32권 2호 발행 연도 : 2022 페이지 : pp. 137-153 (17 pages)

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In the process of promoting policies to strengthen health insurance coverage, the relationship between public health insurance and private health insurance, along with the management of non-benefit, is also emphasized as a policy issue. First, the concept and scope of non-benefit were comparatively analyzed by country. Second, the interaction between the public and private health insurance was classified as 'large or small,' and the government's regulation and management policy on private health insurance was classified as 'strong or weak.' Korea has relatively smaller benefits covered by public health insurance, higher copayment expenses, and more areas and scope of non-benefits. In countries where the interaction between public and private health insurance is small, private health insurance-related policies are weak. And in countries with large interactions had public-private partnerships and the government's management policies were also strong. On the other hand, Korea has a large interaction, but the actual structure of cooperation between public and private insurance and management policies were weak. Because the non-benefit sector in Korea is relatively wide, it is difficult to manage compared to other countries where the concept of non-benefit is limited. In addition, the health authorities rarely perform the role of supervision over private health insurance, and they have so few linkages and cooperation for public-private insurance. Therefore, practical policy enforcement is necessary to achieve the easing of the burden of national medical expenses through linkage and cooperation of public-private health insurance with reference to relevant other countries' cases.

KCI등재

4진료비 고가도 지표의 한계와 개선 방향

저자 : 장호연 ( Ho Yeon Jang ) , 강민석 ( Min Seok Kang ) , 정서현 ( Seo Hyun Jeong ) , 이상아 ( Sang Ah Lee ) , 강길원 ( Gil Won Kang )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 32권 2호 발행 연도 : 2022 페이지 : pp. 154-163 (10 pages)

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Background: The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit.
Methods: We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method.
Results: In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated.
Conclusion: High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

KCI등재

5코로나19 전·후 응급실로 내원한 소아청소년 호흡기계 환자의 유사점과 차이점

저자 : 허영진 ( Young-jin Huh ) , 박윤숙 ( Yun-suk Pak ) , 김은아 ( Eun-ah Kim ) , 오미라 ( Mi-ra Oh )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 32권 2호 발행 연도 : 2022 페이지 : pp. 164-172 (9 pages)

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Background: The purpose of this study was to the impact of the coronavirus disease 2019 (COVID-19) outbreak on emergency departments (EDs) in patients under the age of 18 years with respiratory disease. Also, we analyzed similarities and differences in patients including revisit before and after the COVID-19 outbreak.
Methods: This study population was respiratory patients under the age of 18 years who visited all 403 EDs in Korea between January 1st, 2019 and December 31st, 2020, using the National Emergency Department Information System Database. The primary outcome was the number of respiratory patients according to age, sex, the type of EDs, season, Korean Triage and Acuity Scale (KTAS) levels, the result of ED, and length of stay. The secondary outcome was the number of revisit respiratory patients within 72 hours. We calculated the risk-adjusted revisit rates according to the KTAS level using a multiple logistic regression model.
Results: The number of ED visits decreased from 274,526 in 2019 to 79,007 in 2020; this number was 71.2% lower than that before COVID-19. In spring 2020, this number was 90.1% lower than during the same period in 2019. For the revisit rate in the study population, the adjusted odds ratio (95% confidence interval) was 1.22 (1.05-1.41) in 2019 and 1.39 (1.07-1.81) in 2020.
Conclusion: Implementing appropriate emergency care policies in severe respiratory patients would have contributed to improving the safety of reducing in revisit rate.

KCI등재

6요양병원에서 응급실로 전입된 노인환자의 경향분석, 2014-2019

저자 : 고성근 ( Sung-keun Ko ) , 김선지 ( Seonji Kim ) , 이태영 ( Tae Young Lee ) , 이진희 ( Jin-hee Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 32권 2호 발행 연도 : 2022 페이지 : pp. 173-179 (7 pages)

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Background: This study aimed to identify patterns of elderly patients who transferred from long-term care hospitals to emergency rooms and provide the evidence of emergency medical systems to prepare for a super-aged society.
Methods: The data source was the National Emergency Department Information System database from January 2014 to December 2019 in Korea. We performed a cross-sectional study among elderly patients (≥65 years) who transferred from a long-term care hospital to an emergency room. Trend analysis was conducted by year.
Results: We identified 225,765 elderly patients who were transferred from long-term care hospitals to emergency rooms between January 1, 2014 and December 31, 2019. The proportion of the study population and their mean age were recently increased (p<0.001, respectively). The proportion of elderly patients being re-transferred (p=0.049) and the patients re-transferred to long-term care hospitals is significantly increased (p=0.005).
Conclusion: The establishment of efficient emergency medical services for an aging society is important. It is necessary to develop a healthcare network with the government, long-term care hospitals, and medical institutions in the community suitable for preventing disease deterioration.

KCI등재

7산업재해 근로자의 사회적 지지가 주관적 건강에 미치는 영향

저자 : 김지은 ( Ji Eun Kim ) , 함명일 ( Myung-il Hahm )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 32권 2호 발행 연도 : 2022 페이지 : pp. 180-189 (10 pages)

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Background: Social support contributes directly and indirectly to maintaining physical, mental, and social well-being. The aim of the study was to identify the impact of social support on self-rated health among Korean industrial accident workers.
Methods: This study used data from the panel study of workers' compensation insurance (PSWCI). The final subjects were 2,759 workers who responded to a 2018 to 2020 PSWCI. Social support was defined as social contact with friends, neighbors, family, and social participation activities like religious activity, social activity, and club activity. Multivariate logistic regression analysis was performed to investigate causal relationships between social support and self-rated health using a generalized estimating equation model.
Results: Proportion of workers' good self-rated health steadily increased (2018: n=1,447, 63.2%; 2019: n=1,542, 66.2%; 2020: n=1,653, 67.3%). Higher levels of social contacts with friend (worse: reference; same: β=0.442) and higher levels of social activity (yes: reference; no: β=-0.173) were especially associated with good self-rated health.
Conclusion: This study confirmed social support positively influenced self-rated health among the self-rated health of industrial injured workers. The results of this study suggested that recovery policies that the government served should include programs enhancing social support for improving health among industrial injured workers.

KCI등재

8우리나라 노인의 가구형태와 주관적 건강상태의 관련성: 2017년 노인실태조사 자료를 이용하여

저자 : 최민지 ( Minji Choi ) , 주혜진 ( Hye Jin Joo ) , 김태현 ( Taehyun Kim ) , 백상숙 ( Sang Sook Beck ) , 정우진 ( Woojin Chung )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 32권 2호 발행 연도 : 2022 페이지 : pp. 190-204 (15 pages)

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Background: In Korea, the population is rapidly aging, and the types of households for the elderly are also diversifying. The self-rated health of the elderly is a valuable health indicator that can comprehensively represent the overall quality of life along with physical, mental, and functional health. On the other hand, studies on the association between household type and self-rated health of the elderly are still insufficient. Thus, this study analyzed the association between household type and self-rated health by gender in Korean older adults.
Methods: Using data from the analysis of the National Survey of Older Koreans 2017, 10,299 elderly people aged 65 and over were targeted. For the accuracy of the analysis data, 9,910 people were selected as the study sample by excluding proxy responses, those diagnosed with dementia, and non-response. And technical analysis, univariate analysis using the Rao-Scott chi-square test, and logical regression analysis involving survey characteristics were conducted by gender.
Results: According to the adjusted model with all variables, in both men and women, the odds ratio of self-rated health 'bad' in 'couple (with ill spouse)' was significantly higher than 'couple (with spouse)'. It was 2.54 (95% confidence interval [CI], 2.05-3.15) for men and 2.11 (95% CI, 1.70-2.62) for women. In addition, the odds ratio of self-rated health 'bad' in 'living with adult children' was 1.43 (95% CI, 1.09-1.87) for men and 1.42 (95% CI, 1.15-1.75) for women, which was more significant in women than men.
Conclusion: This study states that there is an association between gender, household type, and self-rated health of the elderly, and the health of a spouse and cohabitation with children have a significant effect on self-rated health. As a result, in order to improve the health status of the elderly, health promotion and health care policies involving the characteristics of the elderly's gender and household type are needed.

KCI등재

9지역쇠퇴 유형별 의료이용행태 영향요인: 도시쇠퇴 지표와 의료취약지 지표를 활용하여

저자 : 정지윤 ( Ji Yun Jeong ) , 정재연 ( Jae Yeon Jeong ) , 윤인혜 ( In Hye Yoon ) , 최화영 ( Hwa Young Choi ) , 이해종 ( Hae Jong Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 32권 2호 발행 연도 : 2022 페이지 : pp. 205-215 (11 pages)

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Background: The purpose of this study is to identify the factors infecting the medical care utilization from a new perspective by newly classifying the categories of administrative districts using the urban decline index and medical vulnerability index as indicators.
Methods: This study targeted 150,940 people who used medical services using the 2015 cohort database (DB), 2010-2015 urban regeneration analysis index DB, and 2014-2015 public health and medical statistics DB. The decline of the region was classified using the urban decline index typed using k-means clustering and the medical vulnerability index typed using the quantile score calculation. Regression analysis was performed 3 times with medical expenditure, length of stay, and the number of outpatient visits as dependent variables.
Results: There were 37 stable region (47.4%), 29 health vulnerable region (37.2%), and 12 decline region (15.4%). The health vulnerable region had lower medical expenditure, fewer outpatient visits, and a higher length of stay than the stable region. The decline region was all higher than the stable region but had no significant effect.
Conclusion: The factors that cause the health disparity between regions are not only factors related to individual health behavior but also environmental factors of the local community. Therefore, there is a need for a systematic alternative that properly considers the resources within the community and reflects the characteristics of the population.

KCI등재

10가구 식품불안정 상태와 정신건강 및 건강 관련 삶의 질과의 연관성

저자 : 김유진 ( Yu-jin Kim ) , 박종은 ( Jong Eun Park ) , 김소영 ( So Young Kim ) , 박종혁 ( Jong-hyock Park )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 32권 2호 발행 연도 : 2022 페이지 : pp. 216-227 (12 pages)

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Background: Food insecurity may contribute to mental health indicators such as stress, anxiety, or depression. We investigated whether food insecurity was associated with mental health indicators and health-related quality of life (HRQoL) in a representative sample of the Korean population.
Methods: This study enrolled 12,987 adults without a history of medically serious disease from the 2012, 2013, and 2015 Korea National Health and Nutrition Examination Survey. Household food security status was categorized as “food security,” “mild food insecurity,” and “moderate/severe food insecurity.” The association between mental health and HRQoL was evaluated using a multivariate logistic regression model with food security as the reference group.
Results: The adjusted odds ratio of adverse mental health or low HRQoL increased significantly in mild or moderate/severe food insecurity compared to food security. In the moderate/severe food insecurity group, it was 1.98% (95% confidence interval [CI], 1.31- 2.99) higher for perceived stress, 3.58% (95% CI, 2.44-5.26) higher for depression symptoms, 4.16% (95% CI, 2.68-6.45) higher for suicidal ideation, and 2.81% (95% CI, 1.91-4.15) higher for quality of life.
Conclusion: Food insecurity was strongly associated with negative mental health status and poor HRQoL. There is a need for a dietary support program that provides psychosocial support to those experiencing food insecurity.

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KCI등재

1선진산업국가에서의 공공의료규모 결정요인에 관한 실증분석

저자 : 김흥식 ( Heung Sik Kim )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 5권 2호 발행 연도 : 1995 페이지 : pp. 1-17 (17 pages)

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This paper porports to explicate the factors determining the scope of public health in advanced capitalist countries. A few studies have been conducted for such a purpose, yet even these studies show the deficiency of failing to consider a very important factor: the influence of medical profession. Since medical profession has played a significant role in the health policymaking, it is necessary to incorporate the hypothesis that assumes the causal links between the differing medical professional power and the varying scope of public health. Following this view, this paper examined the various hypotheses, including the power of medical profession, and found that the variables related to medical pro-fessional power as well as social democratic perspectives are its significant factors. In par-ticular, our result shows that the power of medical profession is the most important deter-minant, thereby supporting the hypothesis developed in this paper.

KCI등재

2의료의 공급량과 병상이용량과의 관계에 관한 국제비교연구

저자 : 정형선 ( Hyoung Sun Jeong )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 5권 2호 발행 연도 : 1995 페이지 : pp. 18-36 (19 pages)

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To clarify the relationship between the medical supply (medical persons and goods) and the use of bed, the author has made comparison among OECD 24 countries. Per Capita Bed-days can be divided into Average Length of Stay and Admission Rate, and these three variables were regressed upon both In-patient Care Beds of all medical institutions including acute somatic, psychiatric, special, nursing homes and other long-term care and Share of Total Health Employment in Total Employment. The result of regression analy-sis shows a statistically significant positive relationship between In-patient Care Beds and Average Length of Stay, and negative relationship between Share of Total Health Em-ployment and Admission Rate. In addition to Ordinary Least Square (OLS) estimation, amended Bounded Influence Estimation (BIE) was also made to adjust the influence of outliers. Japan shows a very large number of In-patient Care Beds and a very low Share of Total Health Employment, and this medical situation is judged to have close relation to her long Average Length of Stay and low Admission Rate.

KCI등재

3병원서비스별 원가분석모형의 개발과 적용

저자 : 박하영 ( Ha Yong Park )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 5권 2호 발행 연도 : 1995 페이지 : pp. 35-69 (35 pages)

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The managerial environment of hospitals in Korea characterized by low levels of medical insurance fees is worsening by increasing government regulations as to the utilization of medical services, rising costs of labor, material, and medical equipments, growing patient expectations concerning the quality of services, and escalating competitions among large hospitals in the market. Hospitals should seek for their survival strategies in this harsh environment and they should have information about costs of their products in doing so. However, it has not been available due to the complexity of the production process of hospital services. The objectives of this study were to develop a service-based cost accounting model and to apply the developed model to a study hospital to obtain cost information of hospital services. A model commonly used for the job-order product cost accounting in the manufacturing industry was modified for the use in hospitals in Korea. Actual costs, instead of standard costs, incurred to produce a unit of services during a given period of time were estimated in the model. Data required to implement the model included financial information, statistics for the allocation of supportive cost center costs to final cost centers, statistics for the allocation of final cost center costs to services, and the volume of each services charged to patients during a study period. The model was executed using data of a university teaching hospital located in Seoul for the fiscal year 1992. Data for financial information, allocation statistics for supportive service costs, and the volume of services, most of them in electronic form, were available to the study. Data for allocation statistics of final cost center costs were collected in the study. There were 15 types of evaluation and management service, 2, 923 types of technical service, and 2, 608 types of drug and material service charged to patients in the study hospital during the fiscal year 1992. Labor costs of each of seven types of personnel, material costs of 611 types of drugs and materials, and depreciation costs of 212 types of medical equipments, miscellaneous costs, and indirect costs incurred in producing a unit of each services were estimated. Medical insurance fees for basic services such as evaluation and management of inpatients and outpatients, injection, and filling prescriptions, and for operating procedures were found to be set lower than costs. Infrequent services which use expensive medical equipments showed negative revenuse as well. On the other hand, fees for services not covered by the insurance such as CT, MRI and Sonogram, and for laboratory tests were higher than costs. This study has a significance in making it possible for a hospital to obtain cost information for all types of services which produced income based on all types of expenses incurred during a given period of time. This information can assist the management of a hospital in finding an effective cost reduction strategy, an efficient service-mix strategy under a given fee structure, and an optimum strategy for within-hospital resource allocations.

KCI등재

41차 보건의료사업의 비용-효과분석을 통한 보건소 기능의 확대 방안 연구

저자 : 김종인 ( Jong In Kim ) , 윤치근 ( Chi Keun Yoon )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 5권 2호 발행 연도 : 1995 페이지 : pp. 70-103 (34 pages)

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The aim of this study sets out to discover a desirable form of public centers among the alternative ones and make a health center model. Especially, this study attempts; (i) to investigate factors that affect the performance of health centers; (ii) carry out cost-effectiveness analysis (CEA) for the various type of health centers; (iii) identify innovative strategies to increase the use of health center. Cost-effectiveness analysis is used to compare the performance of all the centers. The following is taken to create the index. Wi = Ti Mi Eij Wi: weight for service item i, Ti: time spent for service i, Mi; number of health personnel involved in service i, Eij: years of schooling for personnel j in providing service i). As a result of these analyses, policy options as follows are recommended; (i) proper manpower, especially public health physician (Oriental medical doctor), should be enough to provide health care adequately; (ii) facilities and equipments in the health center should be provided sufficiently. (iii) the utilization of health centers should be raised by active operation of mobil service, community participation and health education program. Ultimately health centers in public sector are to be fostered for the promotion of health care by enhancing the financial and quality, continuity and efficiency of health services.

KCI등재

5도시 보건소 보건의료서비스 이용의 결정요인

저자 : 강복수 ( Pock Soo Kang ) , 이경수 ( Kyeong ) , 김천태 ( Cheon Tae Kim )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 5권 2호 발행 연도 : 1995 페이지 : pp. 104-126 (23 pages)

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대구시와 경주시의 2,630가구 (대구시 1,880가수, 경주시 750가구)를 대상으로 1994년 3월 28일부터 8일간 및 7월 2일부터 8일 동안 가정방문하여 면접조사를 실시하였다. 3차에 걸친 방문으로 2,394가구(대구시 1,674가구, 경주시 720가구, 조사완료율 91.0%)의 자료를 분석하여 다음과 같은 결과를 얻었다. 60세이상의 연령군이 대구시에 비해 경주시에 많았으며, 30대와 40대에서 보건소 이용 경험률이 높았다. 월평균 소득은 대구시가 1,483,000원으로 경주시의 745,000원보다 많았고, 소득이 낮을수록 보건소이용 경험률이 높았다. 평균거주기간은 경주시가 30.0년으로 대구시의 9.9년보다 많았으며 거주기간이 길수록 보건소 이용경험률이 높았으나 유의한 차이는 아니었다. 대구시는 영·유아, 노인, 만성질환자가 가족 중에 있는 경ㅇ 보건소를 많이 이용하였으나 경주시는 영·유아, 만성질환자, 보건의료인이 있는 경우 보건소를 많이 이용하였다. 보건소 및 병 ·의원의 접근성은 대구시가 경주시보다 좋았고, 두 도시 모두에서 보건소 접건소 접근성이 병 ·의원의 접근성에 비해 낮게 나타났다. 보건소를 이용한 이유는 ``가격이 저렴해서``와 ``거리가 가까워서``가 가장 많았고, 이용하지 않은 이유는 ``한번도 방문한 적이 없기 때문에``와 ``시설·진료의 질이 낮다고 생각해서``가 가장 많았다. 보건소 업무에 대해서 영 ·유아 예방접종, 전염병 예방, 외래진료 등은 잘 인식하고 있었다. 보건소 이용을 종속변수로 한 지수형 회귀분석에서는 대구시의 경우 가구주의 연령, 거주기간, 영·유아 및 만성질환자 여부, 보건소 위치에 대한 인지 여부 등이 유의한 변수였고, 경주시의 경우는 거주기간과 노인동거 여부 및 보건소 위치에 대한 인지 여부가 유의한 변수였다. 이상의 결과 볼 때, 도시지역 보건소에 대한 주미의 인식은 시설이나 근무자의 태도 및 진료의 질에 대해서는 부정적인 인식을 가지고 있었으며, 서비스 가격에 대해서는 긍정적인 인식을 가지고 있는 것으로 나타났다. 또한 보건소 활동에 대한 지역사회의 홍보에 보다 많은 관심을 기울여야 할 것으로 생각된다.

KCI등재

6(경쟁시대)競爭時代의 (병원)病院마케팅(전략)戰略: 포지셔닝과 고객만족을 중심으로

저자 : 이훈영 ( Hoon Young Lee ) , 정기택 ( Ki Taig Jung )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 5권 2호 발행 연도 : 1995 페이지 : pp. 127-154 (28 pages)

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The Korean hospital industry is rapidly changing along with the competition among hospitals. Until recently it was easy for hospitals to profit even without efficient management and competitive strategies. However, the increasingly intensive competition endanger their profits but also their survivals. Hospital managers have no choice but to seriously consider competitive management and marketing strategies to remain alive and prosper. This study introduces a useful methodology--perception map drawn using multidimensional scaling--for developing competitive strategies, and illustrates its application to developing a perception map of 9 Seoul-based general hospitals. We also suggest the concepts and examples of positioning strategies and patient satisfaction management system. One of the interesting findings is that the Samsung medical center which opened less than a year ago is ranked first in most aspects such as kindness, facilities, waiting time, and parking, and the second in clinical performance just after the Seoul National University Hospital

KCI등재

7의료이용의 형평성에 관한 실증적 연구 -공,교 의료보험 피부양자를 대상으로-

저자 : 명지영 ( Ji Yong Myoung ) , 문옥륜 ( Ok Ryun Moon )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 5권 2호 발행 연도 : 1995 페이지 : pp. 155-172 (18 pages)

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본 연구는 우리나라 의료보장제도하에서 의료이용의 형평성이 달성되고 있는지 알아보기 위해 93건 강진단을 수검한 공·교 의료보험 피부양자 41,828명을 대상으로 의료이용량의 소득계층별 차이를 파악하고, 소득계층간 의료이용의 불평등 정도를 파악하기 위해 시도되었다. 주요 연구 결과는 다음과 같다. 1. 소득계층별 상병 및 의료비 지출 분포에 의한 불평등도를 측정한 결과 3개 상병지표 모두에 있어서 하위 3개 소득계층의 상병점유비율이 대상인구점유비율에 비해 높고, 상위 2개 소득계층은 그 반대의 결과를 보임으로써 저소득층에 건강상의 불평등이 존재함을 알 수 있었다. 이 사실은 소득과 사망율이 음의상관관계를 가질뿐아니라(Wilkinson, 1987), 계층간 건강상의 상당한 불평등이 있다는 종래의 연구 결과(Black, 1980; Whitehead, 1987)를 뒷받침하고 있다. 또한 의료비점유비율 역시 상위 2개 소득계층군에 편중되어 있으며, 이 사실은 불평등지수 HI(LC)가 3개 상병지표 모두에 있어 양의 값을 보이고 있다는 데서 확인할 수 있었다. 그 중에서도 건강진단결과를 의료필요지표로 하였을때의 불평등지수가 가장 큰 수치를 보였다. 그러나, 동일의료 필요군으로 분류된 대상중에서도 보통 소득이 낮은 계층이 질병의 위중도가 높다는 기존의 연구결과에 비추어 본다면 저소득층의 의료필요도가 과소평가되었다고 할 수 있으며, 따라서 실제의 불평등도는 여기서 계산된 것보다 더욱 클 가능성이 있다. 2. 거주지역별로 대도시, 중소도시 및 농어촌지역의 소득계층간 의료이용의 불평등도를 비교한 결과, 농어촌 지역의 불평등지수 HI(LC)가 사용된 모든 의료필요지표에서 가장 큰 값을 보였다. 따라서 농어촌지역이 다른 지역과 비교해 보았을 때 소득계층간에 의료 수혜의 불평등이 상대적으로 크다고 할 수 있다. 3. 성별, 연령 등 인구학적 변수나 의료필요 수준의 차이가 의료비지출액에 영향을 미친다고 할 수 있다. 따라서, 소득계층별로 성별, 연령구조 및 의료필요율을 표준화시킨 다음 소득계층간 의료 이용의 불평등지수 HI(LG)를 구한 결과 역시 양(+)의 값을 가졌으며, 고소득층에 유리한 의료 이용의 불평등이 존재하는 것으로 드러났다. 4. 각 소득계층별 의료이용자료를 로지스틱 희귀분석모형으로 적합시켰으며, 소득변수가 의료이용 여부에 영향을 미치는지를보기 위해 로그우도비 검정(LR test)을 한 결과, 99.5% 신뢰도에서 소득계층에 따른 의료기관 이용의 불평등이 존재함을 알 수 있었다. 5. 의료비 지출액을 반응변수로 하고 건강상태, 소득, 연령, 성별 및 교호작용인자를 설명변수로 하는 의료비지출모델을 각 소득계층별로 적합시켰으며, 소득계층간 귀속의료비지출액에 차이가 있다고 할 수 있는지 F검정한 결과 사용된 의료필요지표에 무관하게 유의수준 5%에서 유의한 차이가 인정되었다. 그 중 특히 자기건강평가를 의료필요지표로 했을때가 가장 유의한 차이를 보였다. 결국 본 연구의 결과에 따르면, 의료기관 이용자율이 대체로 고소득층에서 높고, 의료비 지출액 또한 통계저으로 유의한 정도로 소득이 높은 층에 편중되어 있어, 아직도 의료비 지불능력이 의료 이용에 영향을 미치고 있음을 알 수 있다. 그러나, 소득계층간 의료 이용의 형평성이 달성되었다고 보기는 힘들지만 불평등지수의 크기로 보아 우려할 만큼의 큰 차이는 보이지 않았다. 그 이유는 현행 의료보험관리운영체계가 소득형태, 의료이용도 등이 유사한 집단으로 구분되어 운영되는 조합방식임으로 인해 조합내보험급여 이용상의 형평성이 어느 정도 이루어지고 있기때문으로 보여진다. 형평성을 어떻게 정의하느냐에 따라서 형평성을 추구하고자 하는 정책 목표의 설정 및 접근방법이 달라지고 그에 대한 평가 역시 엇갈릴 수 있다는 점을 고려한다면, 본 연구의 결과만으로 향후 의료제도상의 형평성 추구를 위한 정책방향을 제시하기는 어렵다. 다만, 연구 결과로 미루어 볼 때 동일 의료보험을 적용받고 있으며, 성별, 연령이 같고, 의료에 대한 동일 필요를 가진 대상이라 할지라도 실제 의료이용 및 의료비 지출액 수준이 소득수준에 영향을 받고 있어 소득계층간 형평성이 달성되고 있다고 보기 힘들므로 저소득층에 보다 혜택이 돌아가는 의료보험 정책상의 보완이 필요하다 하겠다. 또한 농어촌 지역이 소득계층간 의료 이용의 불평등도가 가장 높은 것으로 볼 때 농어촌 지역에 거주하는 저소득 층에 의료 이용의 상대적인 제한이 있다고 할 수 있으므로 그 장벽이 무엇인지를 밝혀내는 것과 함께 의료시설 및 자원의 지역간 편재를 해소하고 동등한 접근을 보장해 줄 수 있는 방안 마련이 시급함을 알 수 있다.

KCI등재

8병원근무자의 직장애착에 관한 연구 -한 인과모형의 검증을 중심으로-

저자 : 서영준 ( Yong Joon Seo )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 5권 2호 발행 연도 : 1995 페이지 : pp. 173-201 (29 pages)

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A causal model of organizational commitment on the basis of Western literature was tes-ted with a sample of 1,164 employees from two university hospitals in Korea. The model contains three groups of determinants : environmental variables(job opportunity, spouse support, and parent support), psychological variables(met expectations, work involve-ment, positive affectivity, and negative affectivity), and structural variables(job auton-omy, work unit control, routinization, supervisor support, coworker support, role ambi-guity, role conflict, workload, resource inadequacy, distributive justice, promotional chan-ces, job security, job hazarda, and pay). The data were colleted with questionnaires and analyzed with the LISREL maximum likelihood method. It is found that (1) the following variables, listed in order of size, have significant total effects on organizational commitment : job satisfaction, met expectations, supervisor sup-port, job security, routinization, job opportunity, negative affectivity, work involvement, distributive justice, and promotional opportunity, (2) the model explains fifty-nine percent-t of the variance in organizational commitment, and (3) the link with expectancy theory is justified by the results for met expectations. Two conclusions can be drawn from these findings. First, the model of organizational commitment appears to be generalizable to Kor-ean hospitals. Second, the model of organizational commitment should include such theor-etical variables as environmental, psychological, and structural factors.

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9상대가치 개발의 총괄

저자 : 김한중 ( Han Joong Kim ) , 손명세 ( Myong Sei Sohn ) , 조우현 ( Woo Hyun Cho ) , 박은철 ( Eun Cheol Park ) , 이선희 ( Byung Yool Cheon ) , 강형곤 ( Sun Hee Lee ) , 허영주 ( Hyoung Gon Kang ) , 원종욱 ( Young Joo Heo ) , 김양균 ( Yang Kun Kim )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 5권 2호 발행 연도 : 1995 페이지 : pp. 202-212 (11 pages)

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In Korea, Resource-Based Relative Value Scale (RBRVS) is suggesting to the alterna-tive of Korean Medical Fee Schedule. This study developed to methodology of RBRVS applicable to Korean situation and applied to services of internal medicine and general sur-gery. Our methodology of RBRVS is basically same to Hsiao`s. But there are some differ-ences between our method and Hsiao`s because Korean medical situation differs to Amer-ican. The first difference is method of measurement of work. The Unit of work in our study is total work including intra-service work and pre-/post-service work. Secondly, in extrapolation, we use primary data gathered to small group of physician. Tertially, in measurement of practice cost, we directly survey to budget data of hospitals and analyse practice costs by service. Some results are presented in a companion article.

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10의사 업무량 측정 및 분석 -내과 및 일반외과 서비스를 대상으로-

저자 : 주우현 ( Woo Hyun Cho ) , 손명세 ( Myong Sei Sohn ) , 박은철 ( Eun Cheol Park ) , 김한중 ( Han Joong Kim ) , 김양균 ( Yang Kun Kim ) , 허영주 ( Young Joo Heo ) , 강형곤 ( Hyoung Gon Kang )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 5권 2호 발행 연도 : 1995 페이지 : pp. 213-229 (17 pages)

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The work that Physicians perform represents major resource input to medical services and procedures. In this article we describe the concepts of work and its dimensions, as well as the methods that measure total work which includes intra-service work and pre-/ post-service work We also present the survey results of physicians in internal medi-cine and general surgery for selected services. Our findings indicate that physicians can give reliable and valid ratings of work and that we can model this work as a function of four dimension: time, mental effort and jud-gement, technical skill and physical effort, and Analyzing the complex functional relationship between work and these four dimensions show that all four dimensions are import and statistically significant in predicting work. Technical skill and physical effort is a more important dimension in predicting work. Finally we found that an exponential equation of the four dimensions precisely describes work.

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