• 보건행정학회지
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• 제23권1호
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• pp.35-43
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• 2013

Background: Diagnosis procedure combination (DPC) has recently been introduced in Korea as a demonstration project and it has aimed the improvement of accuracy in bundled payment instead of Diagnosis related group (DRG). The purpose of this study is to investigate that the model of end-stage liver disease (MELD) score as the severity classification of liver diseases is adequate for improving reimbursement of DPC. Methods: The subjects of this study were 329 patients of liver disease (Korean DRG ver. 3.2 H603) who had discharged from National Health Insurance Corporation Ilsan Hospital which is target hospital of DPC demonstration project, between January 1, 2007 and July 31, 2010. We tested the cost differences by severity classifications which were DRG severity classification and clinical severity classification-MELD score. We used a multiple regression model to find the impacts of severity on total medical cost controlling for demographic factor and characteristics of medical services. The within group homogeneity of cost were measured by calculating the coefficient of variation and extremal quotient. Results: This study investigates the relationship between medical costs and other variables especially severity classifications of liver disease. Length of stay has strong effect on medical costs and other characteristics of patients or episode also effect on medical costs. MELD score for severity classification explained the variation of costs more than DRG severity classification. Conclusion: The accuracy of DRG based payment might be improved by using various clinical data collected by clinical situations but it should have objectivity with considering availability. Adequate compensation for severity should be considered mainly in DRG based payment. Disease specific severity classification would be an alternative like MELD score for liver diseases.

• 한국산학기술학회논문지
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• 제21권7호
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• pp.146-155
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• 2020

본 연구는 간호사가 지각하는 병원내부마케팅이 직무수행 및 충성도에 미치는 영향을 분석하기 위하여 경기도에 소재한 종합병원 간호사 250명을 대상으로 2018년 12월 26일부터 2019년 1월 4일까지 실시하였다. 본 연구의 결과는 첫째, 병원 내부마케팅이 직무수행에 조직비전 및 미래상, 교육훈련제도, 커뮤니케이션, 조직속성 및 체계에 통계적으로 유의미한 영향을 미치는 것으로 나타났고(F=29.118, p<.001), 충성도는 교육훈련제도, 조직비전 및 미래상, 보상 및 복리후생제도, 근무환경 관리에 통계적으로 유의미한 영향을 미치는 것으로 나타났고(F=38.671, p<.001), 직무수행이 충성도에 미치는 영향은 통계적으로 유의미한 영향을 미치는 것으로 나타났다(F=87.324, p<.001). 둘째, 간호사가 지각하는 병원 내부마케팅과 충성도의 관계에서 1단계 직무수행에 통계적으로 유의미한 정(+)의 영향을 미치는 것으로 나타났고(p<.001), 2단계 충성도에 통계적으로 유의미한 정(+)의 영향을 미치는 것으로 나타났으며(p<.001), 3단계 내부마케팅 회귀계수가 유의미하였고, 직무수행도 유의미하게 나타났다(p<.001). 병원의 내부고객인 간호사가 만족을 하여야 직무수행 및 충성도가 높아질 것이다. 내부직원이 직무만족과 충성도가 높아야 외부고객에게 보다 나은 의료서비스를 제공할 수 있기 때문에 병원 경영진에서는 간호사의 직무수행 및 충성도를 높이기 위해서 내부마케팅을 강화해야 할 필요가 있다고 사료된다.

• 한국콘텐츠학회논문지
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• 제16권2호
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• pp.686-695
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• 2016

본 연구는 청소년소설을 중심으로 소녀들의 자살 심리를 연구하였다. 논의된 결과는 다음과 같다. 첫째, 김려령 작가의 "우아한 거짓말"(2009)은 화연이란 소녀가 자신이 집단 따돌림을 당하지 않기 위해 천지라는 아이를 따돌리는 소설이다. 화연은 '관계적 공격'을 통해 또래 소녀들에게 천지에 대한 나쁜 이미지를 심어준다. 이로 인해 천지는 자기를 투명 인간으로 인식하고 자신이 이 상황을 변화시킬 수 없게 되자 도피 심리를 보여준다. 둘째, 이옥수의 "킬리만자로에서, 안녕"(2008)이란 작품에서 윤성민의 여자 친구 수회는 아프리카에서 태어나서 자라다가 엄마의 죽음을 겪게 되고 이로 인해 트라우마를 안고 살아간다. 새엄마의 성적 압박으로 인해 자신의 애완동물을 돌볼 수 없게 되자 수회는 우울증에 시달리고 에너지가 고갈된다. 부모의 강압과 언어폭력도 소녀들에게는 자기처벌심리가 작동하여 자살에 이르게 하는 것이다. 셋째, 박채란의 "목요일, 사이프러스에서"(2009)란 작품에는 소녀들이 자신이 원하는 것을 얻기 위한 협상도구로 자살을 이용하는 심리가 나타난다. 청소년들은 사소한 요구가 좌절되어도 자존감을 찾기 위한 보복심리가 작용하여 자살을 시도한다.

• 산경연구논집
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• 제9권5호
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• pp.93-104
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• 2018

Purpose - This study is to investigate the relationship among emotional intelligence, self-efficacy and job stress of foreign life insurance consultants focusing on the mediating effect of self-efficacy. Regarding job security, in general foreign life insurance companies in Korea have more severe working conditions in terms of required contract performance. For foreign life insurance consultants, they are assumed to need higher level of emotional intelligence and self efficacy to meet the conditions. In this study, focus is cast on these aspects. Research design, data, and methodology - Basically the research is conducted upon questionnaires responded by foreign life insurance consultants. That is, data are collected from 255 sample of insurance consultants who work for a foreign owned life insurance company. The Questionnaire measure the level of emotional intelligence, self-efficacy and job stress of insurance consultants. The data are analyzed using pearson's correlation coefficient and hierarchical multiple regression, descriptive statistics, t-test, ANOVA, Durbin-Watson test. Results - The general characteristics of respondents are gender, age, marital status, education level, income monthly, career length, change jobs no, working day per week, call no. per week, meeting no. with client per week, contract regularity, contract no. per month and cancellation contract per year. The mean of emotional intelligence is 2.63, self-efficacy is 3.44 and job stress is 2.20. Emotional intelligence is composed with mean value of self emotion appraisal(3.93), other's emotion appraisal(3.78), regulation of emotion(3.29) and use of emotion(3.52). The mean of self efficacy is composed with mean value of self-confidence(3.41), self-regulated efficacy(3.59) and preference task difficulty(3.30). The job stress is composed with mean value of job requirement(2.61), lack of job autonomy(1.99), conflict of personal relations(1.99), job instability(2.38), organizational system(2.19) and inappropriate compensation(2.07). There is a significant positive correlation between emotional intelligence and self-efficacy. The emotional intelligence and self-efficacy are significantly negative correlation with job stress. The self-efficacy is showed a mediating variable between emotional intelligence and job stress. Conclusions - To decrease job stress level, foreign life insurance company should find the factors to improve the emotional intelligence and self-efficacy of life insurance consultants, and develop appropriate plans using a mediating role of self- efficacy between emotional intelligence and job stress.

• 대한환경공학회지
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• 제39권9호
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• pp.534-541
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• 2017

바이오리액터형 매립지는 매립지 내부로 침출수나 폐수 같은 수분의 공급을 통하여 폐기물의 분해를 촉진하기 위하여 운영하며, 이러한 수분 공급은 매립가스를 증산하고 결국 매립지 조기안정화에 기여한다. 최근 바이오리액터형 매립지 운영을 위한 환경법이 제정되었으며 이에 따라 국내 최초로 수도권매립지에 도입하였다. 바이오리액터형 매립지의 안정적인 적용을 위하여는 매립지 내부의 수분분포 파악이 필수적이며 이를 통해 해당 구역에 적정하게 수분이 유지되도록 한다. 이를 위하여 매립지내부 수분분포 파악을 위하여 전기비저항탐사를 실시하였다. 본 연구에서는 수도권매립지 제2매립장 내에 침출수 재순환과 함께 장기간 전기비저항탐사를 수행하였다. 그 결과, 전기비저항값이 계절적 온도 변화에 큰 영향을 받고 있는 것을 확인할 수 있었다. 이에 따라 본 연구를 통해 조사된 온도와 전기비저항값의 상관관계를 통한 보정방법을 이용하여 바이오리액터형 매립지를 안정적으로 운영할 수 있도록 하였다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.4.1-4.10
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• 2019

Background: The mandibular third molar (M3) is typically the last permanent tooth to erupt because of insufficient space and thick soft tissues covering its surface. Problems such as alveolar bone loss, development of a periodontal pocket, exposure of cementum, gingival recession, and dental caries can be found in the adjacent second molars (M2) following M3 extraction. The specific aims of the study were to assess the amount and rate of bone regeneration on the distal surface of M2 and to evaluate the aspects of bone regeneration in terms of varying degree of impaction. Methods: Four series of panoramic radiographic images were obtained from the selected cases, including images from the first visit, immediately after extraction, 6 weeks, and 6 months after extraction. ImageJ software^® (NIH, USA) was used to measure linear distance from the region of interest to the distal root of the adjacent M2. Radiographic infrabony defect (RID) values were calculated from the measured radiographic bone height and cementoenamel junction with distortion compensation. Repeated measures of analysis of variance and one-way analysis of variance were conducted to analyze the statistical significant difference between RID and time, and a Spearman correlation test was conducted to assess the relationship between Pederson's difficulty index (DI) and RID. Results: A large RID (> 6 mm) can be reduced gradually and consistently over time. More than half of the samples recovered nearly to their normal healthy condition (RID ≤ 3 mm) by the 6-month follow-up. DI affected the first 6 weeks of post-extraction period and only showed a significant positive correlation with respect to the difference between baseline and final RID. Conclusions: Additional treatments on M2 for a minimum of 6 months after an M3 extraction could be recommended. Although DI may affect bone regeneration during the early healing period, further study is required to elucidate any possible factors associated with the healing process. The DI does not cause any long-term adverse effects on bone regeneration after surgical extraction.

• 대한지리학회지
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• 제50권3호
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• pp.325-338
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• 2015

원격진료는 정보통신기기를 활용해 의료정보를 주고받는 의료 혁신으로 인식되고 있지만, 사실상 오프라인의 여건에 따라 그 적용이 다양하게 나타난다. 예를 들어, 우리나라에서는 원격진료 시행의 기초 단위인 각 시군의 행정권에 따라 같은 의료권에 내에서도 원격진료는 차별적이다. 이에 본 연구에서는 강원도 원격진료 사례를 통해 원격진료의 지역적 차별성의 원인을 알아보았다. 더 나아가 이러한 차별성은 정보격차와 연관성이 있어 원격진료로 인해 유발되는 정보격차의 문제에 대해서도 고찰하였다. 본 연구의 주요 결과는 다음과 같다. 첫째, 원격진료의 도입과 더불어 행정 인력의 증원, 실질적인 행정 책임자에 대한 경제적 보상, 원격진료 기기에 대한 교육 등이 제대로 마련되지 않아 이를 수용할 수 있는 지역만이 원격진료를 활용하고 있는 것으로 나타났다. 둘째, 원격진료의 차별적 활용은 지역의료의 최고 결정자라 할 수 있는 시장 혹은 군수, 그리고 보건소장의 관심 여부와 연결된다고 할 수 있다. 셋째, 공중보건의는 원격진료의 실질적인 수행자 역할을 하고 있지만, 원격진료에 실시에 반대하고 있는 의사회와의 관계, 실질적인 지역의료 여건의 개선 미비 등으로 원격진료에 대해 회의적 입장인 것으로 드러났다. 넷째, 원격진료 활용의 지역적 차별성으로 인해 나타나는 정보격차는 아직까지 가시적인 것은 아닐뿐더러, 다른 차원의 격차(의료격차, 지역격차 등)로 전이되지 않았다고 판단되나, 앞으로 원격진료를 기반으로 하는 다양한 서비스가 이루어질 것을 예상한다면 이에 대한 적절한 대책이 필요할 것으로 보인다.

• 한국병원경영학회지
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• 제16권3호
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• pp.92-114
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• 2011

The study has its purpose on providing basic resource to enforce the capability of the middle managers by examining the level of performance and the level of awareness about the capabilities of the managers and by understanding the significance of the difference and the reasons for the differences. The source of the study was 195 survey questionnaires that were carried out to the managers of the 9 general hospitals and the method of the analysis was the frequency analysis, analysis of the credibility, matching to sample T-test, independent sample T-test, dispersion analysis, correlation analysis, and multiple linear regression analysis using accumulated variables. The followings are the main result of the study. First, the difference between the level of awareness about the capabilities and the level of performance of the mediator managers in general hospitals had high capability in change management. The following orders were: competence in achievement and behavior, competence in management, competence in recognition, competence in influence, competence in individual effectiveness, and competence in personal relationship service. Second, as the result of the relation analysis in order to understand the correlation between awareness and performance of the mediator managers, everything had significant positive correlation. In the study about the level of importance, the cognitive capability and the management capability had the highest correlation with the correlation number of 0.88. In the study about the level of performance, the cognitive capability, individual capability, and the management capability had the highest correlation with the correlation variable number of 0.79. Third, as the result of studying the reason for the difference between the level of the awareness capability and the level of the performance, lack of the support recognition compensation in the organization level, inappropriate work environment, limit in the regulation were found as the highest reason in the order. As the result of the study, it was concluded that the creation of the efficient capability estimation model and the securement of the system that estimate the capability of the managers should be carried out in order to enforce the capability of the mediator managers in general hospitals.

• 수산경영론집
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• 제18권1호
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• pp.37-57
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• 1987

This article discussed the characteristics of several Pareto-optimal incentive contracts between owner and labor, more specifically, four situations: reporting output jointly observable by labor ana owner; reporting both output and effort; incorporating other endogenous elements (like capital) that affect the production process and Pareto-optimal fee schedules; and ascertaining the effects of private pre-decision information private- decision information, and per-contact informational asymmetries. Also presented were several extensions of the basic contractual model, and the different components of agency costs associated with labor-owner contractual relations. In a single-period model, the agency problem exists because the uncertainty prevents the owner from using the cash flow to determine unambiguously the labor's action. Holmstrom(1979) suggests that "when the same situation repeats itself over time, the effects of uncertainty tend to be reduced and dystunctional behavior is more accurately revealed, thus alleviating the problem of moral hazard. " Under these conditions, if the labor selects the first-best level of effect in each period, the cash flow will be independent and identically distributed over time. As the number of periods increases, the variance of the labows average output, if he selects the first-best level of effort in each period, gets smaller. Note that for this diversification effect to occur, it is necessary that the owner evaluate the labor's effort over the entire history of his employment, rather than evaluate each period's performance separately. Radner(1980) and Rubinstein and Yaari(1980) consider the extreme case in which there are an infinite number of observations. They show that the owner can eventually detect and systematic shirking on the part of the labor by comparing the labor's average output with what would be expected if the labor had been selecting the first-best level of effort in each period. In a dynamic model with incentive problems we have demonstrated that the labor's second-period compensation will depend on his first-period performance. This allows the owner to diversify away some of the uncertainty surrounding the labor's actions. In addition, this allows the owner to smooth the labor's income over time by spreading the risk of the first-period outcome over both periods. At least some unexplored avenves in this area invite future accounting research: situations where owner has different incompatible objectives and negotiates a contract with labor; circumstances in which owner deals with multiple objectives and negotiates contracts with several labors simultaneously; the value of costly accounting information systems and communication in establishing, Pareto-optimal incentive contracts, and the value and effects of inside information, Thorough theoretical or empirical research on each of these topics not only would increase our knowledge about the role and significance of accounting information but could also provide explanations of the inherent differences among various organizations and in their economic behavior. behavior.

• 의료법학
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• 제14권1호
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• pp.85-116
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• 2013

Korea Medical Dispute Mediation and Arbitration Agency, "K-MEDI" in abbr. herein-after, is established on Apr. 9, 2012 according to the law cited in the title above for the purpose of settling medical disputes in a prompt, fair and efficient manner. Two special professional organizations are established in K-MEDI, one of them is Medical Dispute Mediation and Arbitration Committee(hereinafter referred to as the "Mediation Committee") and the other Medical Malpractice Appraisal Board(hereinaf-ter referred to as the "Appraisal Board"), the mission of the latter is to investigate the facts concerning the disputed medical conduct and to research as to and apprai-se whether the medical conduct was negligent and whether a causal relationship exists. Each panel organized in the Mediation Committee or the Appraisal Board shall be comprised of five mediators or appraisers, including necessarily a judge or a prose-cutor respectively and any disputed case regardless of the scale, the importance or the complicacy shall be handled by a panel. As the system is not thought efficient or economic, the number of the members comprising a panel or total members com-prising the Mediation Committee or the Appraisal Board shoud be adjusted, and the process shoud be versified, including the "Rapid Process," for instance. A petition for the mediation of a medical dispute shall be rejected if the respondent fails to notify K-MEDI of his/her intention to accede to the mediation within 14days from the day on which the petition for the mediation was served(Art. 27 Cl. 7). As the option of an arbitrary decision whether the mediation proceedings shall be commenced or not given to the respondent by the clause is thought unfair, making the process unstable, and moreover, diminishing the purpose of the system established by the law cited above for solving the medical disputes, the clause shoud be amended not to allow the respondent the option of such an arbitrary deci-sion. K-MEDI shall conduct the "Program for Compensation of Medical Accidents"(Art 46) according to which unavoidable injuries caused by the medical accidents in the cour-se of childbirth and the "Advances for Damages"(Art. 47) that are the compensating moneys paid to victims in medical malpractice cases who fail to receive money at all or partly from the operator or the professional of a public health or medical institution although he/she has a final and conclusive right to be paid by them. Some operators or professionals of such institutions claim that both the programs violate their fundamental rights assured by the constitution, and that it be a justifica-tion of refusal to accede to the mediation. As any of the programs needs not to be conducted by K-MEDI, it may be a proper solution to change the conductor of the programs to avoid the unproductive controversy.