• 보건행정학회지
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• 제5권1호
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• pp.31-58
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• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• 간호행정학회지
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• 제8권3호
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• pp.441-456
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• 2002

Purpose : This research is, by investigating the relations between the cultural types of a nursing organization in a hospital and performance, to ascertain the cultural types to be able to improve performance. Method : The data were gathered from 487 nurses and 328 patients who were in eight general hospitals by using the self-report type of questionnaires. The period of data collection was from August 10, 2000 to September 10, 2000. For this research, the following tools were used; the tools for measuring the organizational characteristics, organizational culture, and job satisfaction, the tool for measuring organizational commitment, and the tool for measuring patients' satisfaction. For data analysis the SPSS Win 7.5 program was used. Result : 1) There was a significant difference in the organizational culture type according to the establishment type of hospital. 2) In the relationship between organization characteristics and organizational culture of a hospital were correlated with the type of each culture(p=0.00). 3) In the relation between the organizational culture type of hospital and its performance, there was a strong positive correlation between innovation-oriented culture and job satisfaction. And relation-oriented culture and task-oriented culture showed that they had a weak positive correlation with job satisfaction(p=0.00). There were a positive correlation between affective commitment and relation-oriented, innovation-oriented cultures(p=0.00), and there were no culture type significantly related to continuance commitment and there was a weak positive correlation among normative commitment and innovation-oriented culture, relation-oriented culture(p=0.00). 4) The types to have an influence upon nurses' job satisfaction were innovation-oriented culture and relation-oriented culture. These had 34.5% of influence with job satisfaction.. The type of organizational culture did not influence continuance commitment, but it had an influence on affective commitment and normative commitment. And relation-oriented culture and innovation-oriented culture had 21% of an influence with affective commitment, and they had 9.5% of an influence with normative commitment. Conclusion : As the above mentioned research results, the organizational culture type was found which had an influence upon nurses' job satisfaction and organizational commitment and patients' satisfaction in nursing service. These results are very significant in having showed the persons in charge of nursing administration a basic data for creation of an effective organizational culture.

• 사회복지연구
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• 제47권3호
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• pp.187-221
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• 2016

본 연구는 공급자 측면과 수요자 측면의 관점에서 보훈의료서비스 전달체계의 효과성과 만족도의 영향요인에 대하여 살펴보고자 하였다. 첫째, 공급자 측면의 인식에 초점을 두고 보훈의료서비스 전달체계의 구성요인에 해당하는 조직요인(통합성, 접근성), 인적요인(전문성, 책임성), 재정요인(충분성, 적절성)과 효과성과의 상호연계성을 살펴보았다. 둘째, 수요자 측면의 인식에 초점을 두고 보훈의료서비스를 이용하는 수요자의 만족도에 영향을 미치는 요인을 살펴보고자 하였다. 효과성의 영향요인은 시설단일수준의 다중회귀분석을 실시하였고, 수요자의 만족도의 영향요인은 다층분석을 실시하였다. 실증분석을 위한 설문은 서울 부산 등 5개 보훈병원과 보훈병원을 이용하는 국가유공자를 대상으로 획득하였다. 분석결과 보훈의료서비스의 공급자 측면에서 효과성의 영향요인으로는 조직요인에서는 통합성(${\beta}=.156$), 인적요인에서는 책임성(${\beta}=.376$), 재정요인에서는 충분성(${\beta}=.109$)과 적절성(${\beta}=.367$)이 통계적으로 유의미한 영향을 미치는 것으로 나타났다. 반면에, 보훈의료서비스를 이용하는 수요자의 만족도에 영향을 미치는 요인으로는 전문성(${\beta}=0.99$)과 효과성(${\beta}=-1.09$)이 유의미한 영향을 미치는 것으로 나타났다. 특히, 본 연구의 주요 관심사항의 하나인 효과성(${\beta}=-1.09$)이 부(-)의 방향에서 만족도에 통계적으로 유의미한 영향을 미치는 것으로 나타난 점은 주목할 만한 결과이다. 본 연구는 기존 연구에서는 좀처럼 시도하지 않았던 접근방법을 통해 국가보훈의료서비스의 공급자 측면의 효과성과 수요자 측면의 만족도의 영향요인을 살펴봄으로써 향후 국가보훈의료서비스의 질적인 향상에 실천적으로 기여 할 수 있을 것으로 판단된다.

• 대한임상검사과학회지
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• 제50권4호
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• pp.525-534
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• 2018

본 연구의 목적은 임상병리 전공 유사 취업연계가 가능한 다양한 자격증을 조사하고 취득 방법과 활용 여부를 알아보고자 하였다. 전공 외 취업 연계 가능 자격은 산업보건지도사, 도핑검사관, 청각관리사. 수화통역사, 보건교육사, 손해사정사, 생명보험 언더라이터, 행정관리사, 병원행정사, 보험심사관리사, 병원코디네이터 등이 있다. 임상병리기술학 전공 유사 관련 진출자격 현황으로는 임상시험코디네이터, 임상시험 모니터요원, 해부조직사, 화학분석기사, 위험물산업기사, 생물공학기사, 생물안전관리자, 생명공학기술지도사, 의료기기품질책임자, 실험동물기술원, 동물간호복지사, 선박의료관리자가 있다. 따라서, 임상병리사들이 현재 보유하고 있는 다양한 자격 현황의 사회분석조사가 필요할 것이며, 임상병리사 출신으로 다른 분야에서 근무하고 있는 현황조사도 필요할 것이다. 향후, 임상병리사는 개인의 업무역량 강화의 노력을 통하여 업무적 범위를 확대시키고, 사례를 공유하여 영역 확대와 전문성을 강화해야 할 것이라고 생각한다.

• 보건행정학회지
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• 제28권4호
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• pp.411-422
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• 2018

Background: Whether there is a difference in outcomes for trauma patients transferring to the helicopter emergency medical service (HEMS) according to their previous team composition is controversial. The purpose of this study is to evaluate the effectiveness of trauma team-staffed-HEMS (TTS-HEMS) when transferring to a trauma center. Methods: A retrospective comparison was conducted on patients transported to a trauma center over a 6-year period by the TTS-HEMS and paramedic-staffed-HEMS (119-HEMS). Inclusion criteria were blunt trauma with age ${\geq}15years$. Patient outcomes were compared with the Trauma and Injury Severity Score (TRISS) (30-day mortality) and the Cox proportional hazard ratio of mortality (in hospital). Results: There were 321 patients of TTS-HEMS and 92 patients of 119-HEMS. The TTS-HEMS group had a higher Injury Severity Score and longer transport time but a significantly shorter time to emergency surgery. The prehospital data showed that the trauma team performed more aggressive interventions during transport. An additional 7.6 lives were saved per 100 TTS-HEMS deployments. However, the TRISS results in the 119-HEMS group were not significant. In addition, after adjusting for confounders, the hazard ratio of mortality in the 119-HEMS group was 2.83 times higher than that in the TTS-HEMS group. Conclusion: HEMS was likely to improve the survival rate of injured patients when physicians were involved in TTS-HEMS. Survival benefits in the TTS-HEMS group appeared to be related to the fact that the trauma team performed both more aggressive prehospital resuscitation and clinical decision making during transportation.

• 보건행정학회지
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• 제31권1호
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• pp.114-124
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• 2021

Background: In this study, we aimed to investigate the interaction effects of individual socioeconomic status and regional deprivation on the onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients. Methods: Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 50,954 patients newly diagnosed with type 2 diabetes from 2004 to 2012 and aged 30 years or above were included. We classified patients into six groups according to individual income level and neighborhood deprivation: 'high in advantaged,' 'high in disadvantaged,' 'middle in advantaged,' 'middle in disadvantaged,' 'low in advantaged,' and 'low in disadvantaged.' We calculated hazard ratios (HR) of onset of diabetes complication and diabetes-related hospitalization using the Cox proportional hazard model, with the reference group as diabetes patients with high income in advantaged regions. Results: In terms of the interaction effects of individual income level and regional socioeconomic level, even with the same low individual income level, the group with a high regional socioeconomic level (low in advantaged) showed low HRs for the onset of diabetes complication (HR, 1.04; 95% confidence interval [CI], 1.00-1.08) compared to the 'low in disadvantaged' group (HR, 1.10; 95% CI, 1.05-1.16). In addition, the 'high in advantaged' group showed slightly higher HRs for the onset of diabetes complication (HR, 1.06; 95% CI, 1.00-1.11) compared to the 'low in advantaged' and it appeared to be associated with slight mitigation of the risk of diabetes complication. For the low-income level, the patients in disadvantaged regions showed the highest HRs for diabetes-related hospitalization (HR, 1.29; 95% CI, 1.19-1.41) compared to the other groups. Conclusion: Although we need to perform further investigations to reveal the mechanisms that led to our results, interaction effects individual socioeconomic status and regional deprivation might be associated with on onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients.

• 보건행정학회지
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• 제30권4호
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• pp.479-492
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• 2020

Background: As the prevalence of hypertension is increasing in Korea, the government is seeking policy actions to manage patients with hypertension more efficiently. In this paper, we aimed to identify factors associated with the use of medical care at hospitals among outpatients with hypertension. Methods: We analyzed a total of 15,040 cases of 3,877 outpatients with hypertension obtained from the Korea Medical Panel database from 2010 to 2016. The dependent variable was whether a patient with hypertension visited a hospital or not; and independent variables were the patient's various socio-demographic, health-related, and heath-status characteristics. We conducted a generalized linear mixed model analysis with logit link for all the cases and then conducted it stratified by gender. Results: As a result of a multivariable analysis, women were less likely than to visit at a hospital (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.32-0.61) and people aged 65 years and older than those aged less than 65 years (OR, 0.71; 95% CI, 0.57-0.89). Residents in Busan, Ulsan, and Gyeongnam were more likely than those in than Seoul, Gyeonggi, Incheon, and Jeju to visit a hospital (OR, 1.40; 95% CI, 1.05-1.86). The likelihood of visiting a hospital was high in people belonging to a group of: the highest level of annual household income (OR, 1.73; 95% CI, 1.30-2.29); Medical care aid recipients (OR, 1.94; 95% CI, 1.34-2.83); people having three or more complex chronic diseases (OR, 1.59; 95% CI, 1.19-2.11); people having diabetes (OR, 1.81; 95% CI, 1.41-2.32); or people having ischemic heart disease or cerebrovascular disease (OR, 6.80; 95% CI, 5.28-8.76). Also, we found that factors associated with the use of medical care at hospitals among outpatients with hypertension differed between genders. Conclusion: A variety of factors seem to be associated with the use of medical care at hospitals among outpatients with hypertension. Future research needs to find a way to help patients with hypertension visit an appropriate medical institution between clinics and hospitals.

• 한국산학기술학회논문지
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• 제13권4호
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• pp.1739-1750
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• 2012

본 연구는 의료서비스의 결과지표인 의료기관 중증도 보정 사망비(HSMR)를 산출하고, 비교하여 행정자료를 이용한 의료서비스 결과를 평가할 수 있는 방안을 마련하고자 수행되었다. 이를 위해서 질병관리본부의 2007-2008년의 퇴원손상환자 63,664건의 자료를 분석하였다. 중증도 보정모형 개발을 위해 데이터마이닝을 이용한 의사결정나무와 로지스틱 회귀분석을 실시하였으며, 최종 모형으로 선정된 로지스틱 회귀분석에는 성별, 재원일수, Elixhauser 상병지수, 입원경로, 주상병 변수가 포함되었다. 퇴원시 사망에 영향을 끼치는 이러한 변수를 보정 후 병원간의 중증도 보정 사망비(HSMR)를 비교한 결과 병원간의 중증도 보정 사망비(HSMR)는 차이가 있는 것으로 나타남에 따라 병원의 의료서비스 수준 차이가 있는 것이 확인되었다(HSMR 범위: 55.6-201.6). 본 연구를 통하여 병원간의 퇴원시 사망률을 비교할 수 있는 방법이 개발되었으므로 향후에 이를 이용하여 다양한 의료의 질 향상 활동을 할 수 있는 방안을 마련하여야 할 것이다.

• 한국산학기술학회논문지
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• 제18권6호
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• pp.449-458
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• 2017

본 연구는 요양병원 간호사의 임종간호스트레스, 간호근무환경과 소진 정도를 파악하고, 소진과의 관련요인을 분석하기 위한 서술적 상관관계 연구로, 2016년 10월 1일부터 10월 31일까지 B광역시에 있는 8곳의 요양병원 간호사 195명을 대상으로 임종간호스트레스, 간호근무환경, 소진에 관하여 구조화된 설문지로 자료를 수집하였고, SPSS win 21.0 프로그램을 이용하여 분석하였다. 간호사가 경험하는 대상자의 임종간호스트레스는 평균평점 $3.84{\pm}0.56$이며, 간호근무환경은 평균평점 $3.25{\pm}0.60$이며, 소진 정도는 평균평점 $2.93{\pm}0.52$로 나타났다. 대상자의 임종간호스트레스와 소진과는 상관관계를 보였고 (r=.206, p=.004), 간호근무환경과 소진의 상관관계는 역 상관관계를 보였으며 (r=-.431, p<.001), 소진에 가장 중요한 유의한 변수는 간호직 만족도 (${\beta}=-.302$)이었으며, 간호근무환경 (${\beta}=-.294$), 나이 (${\beta}=.286$), 근무형태 (${\beta}=-.17$), 임종간호스트레스 (${\beta}=.164$)순으로 나타났다. 전체 설명력은 41.2%였다. 따라서 요양병원 간호사의 소진을 최소화하기 위하여 간호사로서의 자긍심과 책임감을 가질 수 있는 지지적인 근무환경 조성 및 인센티브 제공, 효율적인 업무분담과 임종간호교육 프로그램 개발 및 스트레스를 완화할 수 있도록 행정적 차원이 필요하다고 사료된다.

• 한국콘텐츠학회논문지
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• 제19권6호
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• pp.471-480
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• 2019

정상인을 대상으로 체질량지수, 전만각도에 따른 L-spine 3~4, L-spine 4~5, L-spine 5~Sacrum 1의 각각의 추간판각도를 비교 분석하여 입사각을 제시하였다. 체질량지수의 L-spine 3~4, L-spine 4~5, L-spine 5~Sacrum 1의 정면 입사각도는 머리 쪽 방향으로 5.66도, 13.23도, 29.13도였으며, 전만각도의 L-spine 3~4, L-spine 4~5, L-spine 5~Sacrum 1의 정면 입사각도는 머리 쪽 방향으로 6.32도, 16.09도, 35.36도였다. 체질량지수, 전만각도에 따른 정면 입사각도에 따라 적용한 팬텀의 일반 전후방향 영상의 왜곡정도를 면적비율로 비교한 결과 L-spine 4~5, L-spine 5~Sacrum 1의 추간판각도에서 유의미한 차이가 있었고(p<0.05), 전만각도와 추간판각도는 양의 상관관계를 보였다(p<0.05). 팬텀의 전만각도에 따른 추간판각도 계측 값을 머리 쪽 방향으로 입사각을 L4는 11도, L5는 26도로 적용하여 영상의 유용성을 평가한 결과, 왜곡비율면적은 L4에서 14.90%에서 12.11%로 줄어들었고, L5에서는 15.25%에서 13.72%로 줄어들었다. 계측된 추간판 각도에 따른 입사각을 적용한 허리뼈 일반 전후방향 영상에서 허리뼈 4번, 5번을 목적으로 하는 허리뼈 정면 영상에서 왜곡을 줄여, 정확한 구조의 정면 추체상과 인접하는 관절 간 영상을 얻을 수 있었고, 목적하는 부위의 영상의 질과 진단적 정보를 향상시킬 수 있었다.