• Title/Summary/Keyword: 의료비 비중

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The Cosmetic Operation without Healing Purpose - A comparative insight into the ruling of BSG and BGH - (미용성형의료 - 우리 판결례와 독일 판결례의 비교·분석적 소고 -)

  • Ahn, Bup-Young
    • The Korean Society of Law and Medicine
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    • v.16 no.1
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    • pp.3-82
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    • 2015
  • This paper is concerned in the theme of the liability for the breach of duty to inform(Haftungszurechnung der $Aufkl{\ddot{a}}rungspflichtverletzung$) and the malpractice of cosmetic surgery. Here, the terms, treatments for healing purposes and purely medical-technical cosmetic operations are well integrated in the category of "medical conduct(medizinische Handlung)" within the meaning of the public and administrative 'Medical Law'. In the judgment of 6. 13. 2013 Az. 2012DA94865 provides the KHGH(Korean Highest Court of Justice) to inform the patient about the prospects and risks of cosmetic surgery(Infrabrow Excision Blepharoplasty) stringent requirements, similar to the judicature of BGH(cf. BGH, Urt. v. 6. 11. 1990, Az.: VI ZR 8/90). Even in the judgment of 5. 12. 2014 Az. 2013GASO865646 the SZLG(Seoul Central Regional Court) recognizes the physician contract for 'cosmetic septoplasty' as a sort of contract for work. The medical treatment(${\ddot{a}}rztliche$ Heilbehandlung) is still regarded as a prototype of the medical activity, therefore in the meaning of the 'Civil Law(KBGB)', its term needs to be used immediately for healing purposes. The cosmetic operation, desired by a patient, differs from the healing treatment by the element of "indication" and the fact that the "healing purpose(Heilzweck)" itself is missing. In comparative context - methodically fully aware that the unreflective term transfer between different laws might contradict their legal purposes - a series of judgments BSG(BSGE 63, 83, BSGE 72, 96, BSGE, 82, 158, BSGE 93, 252 etc.) and some judgments of LSG are reviewed. In addition, also the dogmatic topic for the "legal natur of a medical treatment contract" is to reconsider by comparative introducing BGHZ 63, 306. Now in view of the current state of greater popularity of artificial cosmetic surgery still indeed is the sentences: The doctor is minister naturae, a helper of nature. A doctor promises regularly only the proper treatment of the patient, but the contractual liability for work should not be excluded in medical conditions for cosmetic surgeries altogether. "With cosmetic operations, seeking to eliminate the external deformities, the doctor may miss the medical profession entirely." - A. Laufs, Medical Law, 5th ed. P. 18.

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Dental implant bottom-up cost analysis (치과 임플란트 상향식(bottom-up) 원가산정)

  • Kim, Min-Young;Choi, Ha-Na;Shin, Ho-Sung
    • The Journal of Korean Academy of Prosthodontics
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    • v.52 no.1
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    • pp.18-26
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    • 2014
  • Purpose: The purpose of this study was to estimate the cost of dental implant using the bottom-up approach with the current data from dental clinics. Materials and methods: In this study, direct and indirect costs required for each treatment were calculated using the bottom-up approach. In the bottom-up costing, the average monthly total cost of dental clinic includes labor and material costs, administrative expenses, medical malpractice costs, and opportunity costs of invested capital. For the dental implant cost components, those include direct costs (labor costs, laboratory costs, material costs, depreciation or other operating costs), indirect costs (administrative costs), and the opportunity costs of investment for dental clinic. Results: Dental implant costs of metal crown, porcelain crown and over-denture were 1,449,000 won, 1,583,000 won, and 2,471,000 won respectively. The proportion of cost components was as follows. The labor cost were 50%, and material, administrative and other cost were 33%, 15% and 2%, respectively. For direct, indirect and investment cost, the ratio were 83%, 15% and 2%, respectively. Conclusion: The labor costs were evaluated to comprise largest proportion (about 50%, 730,000 won). Dental implant cost using Bottom-up costing was 1,450,000 won for metal crown and 1,580,000 won for porcelain crown.

A Comparative Study on the Pattern of Outpatient Department Utilization at a Tertiary Level Hospital before and after Implementation of the Patient Referral System (의료전달체계 실시 전후의 3차 진료기관 외래환자 이용양상 비교)

  • Lee, Kyeong-Soo;Kim, Chang-Yoon;Kang, Pock-Soo
    • Journal of Preventive Medicine and Public Health
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    • v.25 no.1 s.37
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    • pp.88-100
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    • 1992
  • This study was conducted to assess the effects of implementation of the patient referral system started July 1st, 1989. A comparison on the pattern of outpatient services of the Departments of Internal Medicine, General Surgery, and Pediatrics at the Yeungnam University Hospital was conducted for each one year period before and after implementation of the patient referral system. The pre-implementation period was from July 1, 1988 to June 30, 1989 and the post-implementation period was from July 1, 1989 to June 30, 1990. The information used for this study was obtained from official forms, prepared by the Yeungnam University Hospital, and submitted to the Korean Medical Insurance Cooperatives. After implementation of the patient referral system, the number of outpatient cases in the Department of Internal Medicine decreased 36.1% from 9,669 cases to 6,181 cases a year. Cases in the Department of General Surgery decreased 23.7% from 1,864 cases to 1,422 cases a year. The number of cases in the Department of Pediatrics decreased 36.9% from 3,372 cases to 2,128 cases a year. After implementation of the patient referral system, the average age of cases in the Departments of Internal Medicine and General Surgery was 52.5 and 49.7 years old, respectively. This was a significant increase in comparison with the pre-implementation period. After implementation of patient referral system, the proportion of new outpatients in the Department of Internal Medicine decreased from 24.1% to 14.6%, the Department of General Surgery from 36.0% to 23.4%, and the Department of Pediatrics from 15.5% to 8.3%. The number of visits per case decreased significantly in the Department of Internal Medicine(from 1.74 to 1.61), but there was no significant change in the Departments of General Surgery and Pediatrics. The length of treatment per case increased significantly in all three departments(from 16.1 days to 19.3 days in the Department of Internal Medicine, from 12.0 days to 15.2 days in the Department General Surgery, and 8.9 days to 11.2 days in the Department of Pediatrics). The number of clinical tests per case increased significantly in the Department of Internal Medicine (from 2.2 to 2.5), in the Department of Pediatrics(from 0.8 to 1.1) and increased in the Department of General Surgery(from 6.4 to 6.6). The average medical cost per case decreased from 43,900 Won to 42,500 Won in the Department of Internal Medicine, while the cost increased from 75,900 Won to 78,500 Won in the Department of General Surgery and from 12,700 Won to 13,500 Won in the Department of Pediatrics. In case-mix, the chronic degenerative disease(i. e. hypertension, diabetes mellitus, angina pectoris, malignant neoplasm, and pulmonary tuberculosis) ranked higher and acute infectious diseases and simple cases(i. e. gastritis and duodenitis, haemorrhoids, anal fissure, carbuncle, acute URI, and bronchitis) ranked lower after implementation of the patient referral system compared to before implementation.

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A Study on Awareness of the Dental Health Insurance Coverage (치과 건강보험에 관한 인식 조사)

  • Han, Ji-Hyoung;Kim, Yoon-Sin
    • Journal of dental hygiene science
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    • v.8 no.2
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    • pp.65-71
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    • 2008
  • The purpose of this study was to examine people's awareness of health insurance in a bid to help improve the management of dental health insurance coverage. The subjects in this study were 1,036 people who included experts in that field and medical consumers. The findings of the study were as follows: 1. In regard to the demographic characteristics of the expert group including gender and age, the female experts outnumbered the males, as the former accounted for 84.7 percent. And the experts in their 20s made up the largest age group, followed by the 30-39 age group and those in their 40s. As to the demographic characteristics of the medical consumers, the rates of the men and women stood at 49.8 percent and 50.2 percent respectively, which were similar. By age, the largest number of the medical consumers were in their 20s, followed by in their 30s and in their 40s. 2. Concerning opinions on the procurement of finance for health insurance, many respondents in both groups agreed that the health insurance coverage should be enlarged by securing more finance, and that items involved in the coverage should be prioritized again. Regarding a means of securing financial resources, the experts placed the most emphasis on extended budgetary support from the government, followed by establishing a social security system and budget compilation by local governments. The medical consumers attached the most importance to extended budgetary backing from the government, followed by budget compilation by local governments and determining contribution according to income level. 3. As for general view of the dental health insurance, the experts believed that the amounts of copayment and self-payment by the insured were appropriate(2.47), and they found the number of benefitted items to be proper(2.29) as well. The medical consumers thought that the benefit percentage of the dental health insurance in the overall health insurance budget was appropriate(2.26), and they also considered the number of benefitted items adequate(2.16). But this group didn't give a lot of marks to the appropriateness of those things. 4. As to perception about the dental health insurance, both groups took a similar view of it. Specifically, they felt the strong need for a dental health insurance system. In terms of satisfaction level, both groups were dissatisfied with it, and there was a strong tendency for them to be discontented with the health insurance coverage.

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The Change of Health Service before and after the Unification of two Health Subcenters in a Rural Area (한 농촌지역 2개면 보건지소 통합전후 보건의료사업 변화 연구)

  • Sul, Sue-Jeong;Park, Hyang;Sohn, Seok-Joon;Park, Jong;Kim, Ki-Soon
    • Journal of agricultural medicine and community health
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    • v.25 no.2
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    • pp.427-440
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    • 2000
  • A comparative study was made about health resources, medical care service statistics and public health service statistics by health subcenters at Jangdong and Jangpyung townships, Jangheung County, Chollanamdo before and after the unification of two health subcenter to improve their function. 1. While two general physicians, one dentist, 4 nurse aids arid one oral hygienist were working at two health subcenters with simple facility with examination room and public health office in 1997 prior to the unification, in 1999 after the unification of two health subcenters 14 staff including a specialist physician, a general physician, a dentist, a herb hygienist, a radiology technician and a physical therapist were working in the new health subcenters equipped with appropriate facilities in two storey building. 2. In 1997 before the unification the yearly total income of two health subcenters was 78,815 thousand won(about 14,000 won per capita) and the amount was 140,376 thousand won(about 25,000 won per capita) in 1999 after the unification. And the income was used for operation of health subcenters excluding personnel expense. 3. While 90.5% of visitors to the health subcenters came for general medical care, and 91.6% came for the revisit before the unification, after the unification 71.2% came for general medical care, 10.8% for dental care, 16.5% for oriental physician's care, 29.7% for the first visit and 70.3% for revisit. Most common problem cared for was musculoskeletal disorder like arthralgia. Average treatment cost per person per month was 9,363 won before the unification and 8,309 won after the unification. 4. Through the comparison of execution rate of public health services before and after the unification. the practice rate of most health service among target population including visiting service for chronic illness, maternal and child health service and immunization service increased after the unification. The practice rate of tuberculosis control service, hypertension control and diabetes management was a little decreased. In conclusion, continuous effort to satisfy all persons in two townships and evaluation are necessary to coincide with the spirit of unification of two health subcenters.

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The effect of the transition of life course on changes in consumption patterns of Korean Households (한국 가계의 잠재소비유형 변화와 결정요인)

  • Choi, Hong-Cheol;Yoo, Jaeeon
    • Journal of Digital Convergence
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    • v.18 no.5
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    • pp.127-138
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    • 2020
  • This study investigated the patterns of transition of consumption patterns in Korean households in 2010 and 2017, and the impact of the life cycle on the transition of consumption patterns between the two time points. Using information on 4,717 households from the 2010 and 2017 data of the Korean Labor Panel Survey, we examined the effect of the family life cycle on changes in consumption patterns. The results of the latent transition analysis on the change in consumption type showed that the change in consumption type between the two points of time at the household level was relatively active. The logistic regression models reported that the transition of consumption type varies depending on the life cycle, such as changes in marital status, birth and independence of children. These results provide the implication that it is necessary to consider from the perspective of the family life course how the transition between their consumption types occurs when the government establishes consumption policies and companies set marketing target groups.

The Analysis of Patients in Oral Medicine and the Evaluation of Oral Medicine as a Special Field (내원경로 분석을 통한 전문과목으로서의 구강내과의 역할)

  • Chung, Tae-Yong;Ryu, Ji-Won;Kang, Jin-Kyu;Ahn, Hyung-Joon;Choi, Jong-Hoon
    • Journal of Oral Medicine and Pain
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    • v.30 no.4
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    • pp.391-400
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    • 2005
  • Special Practitioner exists based on the need for special fields that are required to manage difficult patients with specialized skills distinguished from General practitioner. The purpose of dental specialist system is to manage patients who are not treatable by general practitioner by training doctors specializing in one specific field, thereby, enhancing health of the public. Oral Medicine deals with orofacial pain, oral soft tissue disease, forensic dentistry, oral diagnosis. In these days, living environments of city life bring about increase in stress which ultimately lead to increase in prevalence of temporomandibular disorder, oral soft tissue disease, neuropathies such as trigeminal neuralgia, and hence, the number of patients seeking help of those symptoms tend to increase. The purpose of this study was to analyze the rate of referrals and the routes of patients seeking help by investigating 3,707 patients who visited Department of Oral Medicine, College of Dentistry, Yonsei University, from August, 2004 to April, 2005. The results were as follows: 1. The types of disease referred to the Department of Oral Medicine were orofacial pain, oral soft tissue disease, forensic dentistry, oral diagnosis. 2. The rate of referrals was 58.51% which implies that more than half of the patients visiting the Department of Oral Medicine were referred. 3. The types of institution which made referrals were analyzed, and as a result, dental clinics made most of the referrals with the rate of 83.23%, while that from medical or oriental medical institutions was 16.78%. 4. Among the patients who visited the Department of Oral Medicine on their own, 30.52% gained the information about the Department of Oral Medicine from internet and mass media, and from neighbors. From the above results, most of the patients visiting the Department of Oral Medicine were found to be referred not only from the field of dentistry but also from the field of medicine. These suggest that Oral Medicine manages patients who are not treatable by general dental practitioners, and medical specialists tend to cooperate with the Department of Oral Medicine to manage diseases associated with Oral Medicine. Therefore, the role of Oral Medicine can be considered to be important as a special field, and the results of this study should be considered when working out a policy of Dental specialist system on demand and supply of residents in the future.

우리나라 직장 정신보건제도의 방향과 전망

  • Baek Do-Myeong
    • 대한예방의학회:학술대회논문집
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    • 2002.05a
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    • pp.73-83
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    • 2002
  • 우리 사회에서 일정 정도 이상의 사회와 가정에서의 기능상의 부적응을 초래하는 정신적 문제는 경제활동인구에 있어 가장 흔한 보건의료상의 문제일 것으로 추측되고 있으나, 현재까지는 정신보건제도 마련에 있어 가장 극심한 부적응을 보이는 정신적 장애를 지닌 환자를 위주로 수용시설과 지역사회에서의 재활과 관리에 그 초점을 두어 왔다. 즉 직업스트레스와 같은 일시적인 사회심리적 갈등으로 인한 신체증상의 호소나 알을 및 약물중독으로 인한 사고의 발생으로부터 일생동안 관리되어야 하는 지능저하나 학습장애와 같은 만성적인 문제에 이르기까지 다양한 스펙트럼을 보이는 사업장과 지역사회에서의 정신적 문제들 중 그 일부만이 제도적으로 관리되어 왔다. 실제 그 동안 직장 내 정신보건문제에 대한 행정적 관심은 일부 장애인의 취업 문제를 제외하고는 없었다고 하여야 할 것이다. 그러나 한편으로 우리 사회의 산업구조와 경제사회적 조건의 변화에 따른 노동내용과 조건상 유연화의 증대가 많은 직장에서 노동강화로 이어진다는 점, 그리고 가족 및 교류집단을 비롯한 전통적인 사회적 지지구조가 와해되고 있다는 점과 정신적 문제로 인한 기능상 부적응의 척도가 한편으로 사회적 가치관의 변화에 따라 계속 그 영역이 넓어지는 방향으로 변화하고 있다는 점등에서 직장 내 정신보건 문제는 앞으로 더욱 그 비중이 커질 것으로 판단되고 있다. 문제의 심각성에 대한 관심이 요구되는 현재의 시점에서 제도적 접근에 대한 검토 또한 시작되어야 할 것으로 판단되고 있다. 현재까지 기업 내에서 이루어지고 있는 정신보건관리의 현황을 단편적으로 파악해 보았을 때, 단지 일부 기업에서 취업시 내지는 부서 배치시 성격검사를 비롯하여 적성검사를 실시하고 있으며, 기업윤리확보 차원에서 비정규적으로 사기앙양을 주목적으로 하는 집단적인 교육이나 단체훈련이 이루어지고 있으나, 정신심리적 문제를 개인적 차원에서 그리고 또한 조직적 차원에서 체계화된 프로그램으로 관리하고 있는 사례는 아직 없다. 앞으로 직장 내 정신보건문제에 대하여 제도적인 접근을 하기 위하여서는 다음과 같은 세가지 조건들이 구비되어야 할 것으로 판단된다. 첫 번째로 문제점 그 자체의 내용과 그 규모에 대한 정확한 파악과 예측이 가능하여야 한다. 즉 제도 전체의 운영을 객관적으로 평가하고 개선할 수 있는 기제가 함께 있어야 제도가 실제적인 기능을 할 수 있다는 최소한의 목적이 달성될 수 있다. 두 번째로 문제점의 관리를 위한 효과적인 개입내용 및 개입지점의 확보가 가능하여야 한다. 특히 직장 내에서 수행할 수 있는 프로그램이 개발되어야 하며, 이는 시범사업과 시장을 통한 소비자, 즉 사업주들의 자발적인 선택을 통하여 검토되고 걸려져야만 한다. 마지막으로 제도 운영의 대상, 특히 정신보건문제를 안고 있는 노동자들의 자발적인 동의가 확보될 수 있어야 한다. 이는 정신적 문제가 안고 있는 편견과 그로 인한 차별이 가져다주는 문제를 함께 고려하면서 제도가 운영되어야 하며, 이에 있어 제도 운영상 노동자들의 주체적인 참여가 필요하기 때문이다. 이상 고려되는 직장 내 정신보건문제에 대한 제도적 접근을 담기 위하여서는 프로그램 개발이나 전문가 집단의 양성과 같은 단순한 기술적 접근과 이들의 인허가 및 사업화에 따른 적용기준 및 의무의 설정과 같은 제도적 접근에 그쳐서는 그 실효성을 담보하지 못할 것으로 판단된다. 보다 중요한 것은 이러한 정신보건문제에 대한 노사의 공감대를 이루어 내는 것이며, 사회 전반적인 인식의 확산과 더불어 바람직한 관리모습에 대한 사회적 가치관을 도출해 내는 것이 제도적인 접근의 성공을 보장할 수 있는 기반 조건이 될 것이다. 이러한 점에 있어 정신보건문제를 바라보는 기존의 가치관이 부정적이고 고착화된 모습만을 강조하였으나, 이제는 점차 긍정적이 사회활동에 수반되는 역동적인 모습으로서 비추어지는 것이 많아진다는 측면에서 그 전망을 밝게 하여 주고 있다.

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A Comparative Analysis on Quality of Life for Coastal and Non-coastal Residents (연안지역과 비연안지역 주민 '삶의 질' 비교분석)

  • Seong, Eun-hye;Kim, Sang-Goo
    • Journal of the Korean Society of Marine Environment & Safety
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    • v.24 no.2
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    • pp.215-222
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    • 2018
  • This study aims to compare and analyze the quality of life of residents between those living in coastal and non-coastal areas. The indicators for the quality of life were divided into three different sectors. First, the economic sector observed the rate of population growth, the number of businesses per 1000 people, the employment and unemployment rate. The second was the environmental sector, which included the number of car registrations per capita, water supply and sewer service ratio, the urban park composition area per 1000 people and the road pavement rate. Thirdly, the social sector comprising data about the number of students per teacher, the number of sickbeds in medical institutions per 1000 people, the rate of traffic accidents per 1000 cars and the portion of social welfare budget in general accounting. The analysis method of standardized indicators and T-Test were carried out in 24 coastal cities and 51 non-coastal cities across the country. Results of the indicator comparison suggested there were significant differences in the number of businesses per 1000 people, the road pavement rate and the rate of traffic accidents per 1000 cars. From the results of each sector comparison, the coastal cities showed a higher value than non-coastal cities only in the economic sector. The quality of life comparison showed that coastal cities were better than non-coastal cities but were not statistically significant.

A Study on the Job Performance of Dental Coordinators and Their Perception (치과코디네이터의 업무수행 및 인식도에 관한 조사연구)

  • Kwon, Soon-Bok;Kim, Young-Nam;Moon, Hee-Jung;Shin, Myung-Suk;Han, Gyeong-Soon;Han, Su-Jin
    • Journal of dental hygiene science
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    • v.5 no.4
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    • pp.211-220
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    • 2005
  • The purpose of this study was to examine the job performance of dental coordinators and their perception of their job to lay the groundwork for utilizing dental personnels more efficiently. The subjects in this study were dental coordinators who worked at selected dental hospitals and clinics in Seoul, Gyeonggi province and Incheon. A survey was conducted to gather data from May 1 to August 8, 2005 and answer sheets from 108 respondents were analyzed. The findings of the study were as follows: 1. As for the length of service, 43.5 percent of the dental coordinators investigated had worked at dental institutes for five years or more, which was followed by less than two years(19.5%) and three years to less than five years(19.4%). Concerning the length of service as dental coordinators, 39.8 percent had served for less than two years, and 19.4 percent had worked for two years to less than three years and for five years or more respectively. Regarding the name of position, 38 percent were called team leaders, and 30.6 percent were called coordinators. As to duties, the largest group of them that stood at 30.6 percent were in charge of receiving, and in regard to department, the largest group, 57.4 percent, belonged to the treatment backup department. 2. Concerning education, the greatest number of them, 45.4 percent, had received education at private institutes, and 73.1 percent found it necessary for dental coordinators to take an authorized qualification test. 43.5 percent, the largest group, looked upon the central government as the best organization to authorize their qualifications and 70.8 percent believed that what they learned enabled them to perform their job successfully. As to the necessity of follow-up education as a means to improve job performance, 96.3 percent consented to it. As for the reason, 63.9 percent considered that necessary to enhance their own ability and 22.2 percent were in want of systematic education. Regarding educational expenses, 29.6 percent were subsidized by the dental institutes where they had worked and 25.9 percent had totally been responsible for that. Regarding a required course, medical service and marketing was most widely pointed out(66.7%), followed by theory and practice(65.7%) and introduction to dentistry(57.4%). As to what sort of education they wanted to receive more, dental service and marketing was selected the most, followed by practical health insurance(35.2%). 3. In regard to what type of job they performed as dental coordinators, 88.9 percent were in charge of appointment in the field of customer service, and 87.9 percent paid attention to having good manners as service providers in the area of self-management. In the field of hospital affairs, 81.3 percent were in charge of receiving. 4. As to their awareness of dental coordinator job, the largest group took pride in the job they performed ($3.99{\pm}0.76$), and the second largest group believed that dental coordinators made a great contribution to hospital management ($3.92{\pm}0.70$). The third largest group gave a great weight to their own job ($3.91{\pm}0.84$) in light of overall dental duties and the fourth largest group found themselves to get along with other employees regardless of position ($3.86{\pm}0.74$). The fifth largest group believed their job was of great use for promoting the oral health of patients ($3.76{\pm}0.75$), and the sixth largest group thought the future of dental coordinators was promising($3.74{\pm}0.86$). 5. In regard to their perception by age group, those who were older had a better opinion on every item of their job in general. Their age made a statistically significant difference to their view of the weight of dental coordinator job(P < 0.001) in light of overall dental duties, of being approved and trusted by managers(P < 0.01), of social awareness of dental coordinator, and of being understood and approved by other employees and dentists. Their pride in current job and their satisfaction with the name of their position were statistically significantly different according to their age as well. Besides, their age made a statistically significant difference to their opinion about whether or not there was an age limit to their occupation and about their contribution to hospital management (P < 0.05). 6. As for their perception by type of job, the dental hygienists were generally most satisfied with their job, followed by nursing aids and others. There was a statistically significant gap among their opinions about whether to make a job-related decision on their own(P < 0.001). the weight of their job in terms of overall dental duties, whether their job improved their ability, whether their job made a great contribution to enhancing the oral health of patients, whether their job was understood and approved by other employees(P < 0.01), social awareness of their job, whether they conflicted with other employees during job performance, and whether dental hospitals or clinics offered a self-development opportunity for them to take their ability to another level(P < 0.05). And their satisfaction with current pay was statistically significantly different as well.

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