• 의료법학
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• 제15권1호
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• pp.123-164
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• 2014

Under the new system of 'Separation of pharmaceutical prescription and dispensing' in Korea, which was implemented in 2000, physician could not dispense a medicine, and outpatient should have a physician's prescription filled at a drugstore. After pharmacist makes up outpatient's prescription, National Health Insurance Service(NHIS) pay for outpatient's medicine to pharmacist, except an outpatient's own medicine charge. And NHIS only pay for outpatient's prescription fee to physician and, physician doesn't derive profit from dispensing medicine in itself. Nevertheless, if physician writes out a prescription with violation of 'Criteria for the Medical Care Benefits', NHIS clawed back the payment of outpatient's prescription and medicine from the physician or the medical institution which the physician belongs to. In the past, NHIS's confiscation was in accordance with 'the National Health Care Insurance Act, Article 52, Clause 1'. But, since 2006 when the Supreme Court declared that there was no legal basis on the NHIS's confiscation of outpatient's medicine payment, NHIS had put in a claim for illegal prescriptions on the basis 'the Korean Civil law, Article 750(tort)'. So, Many medical institutions filed civil actions against NHIS. The key point of this actions was whether the issuing outpatient prescriptions with violations of Criteria for the Medical Care Benefits constitute of the law of tort. On this point, the first trial and the second trial took different position. Finally the Supreme Court acknowledged the constitution of the law of tort in 2013. In this paper, the author will review critically the decision of the Supreme Court, and consider the relativeness between the legal effect of Criteria for the Medical Care Benefits and the constitution of the issuing outpatient prescriptions with violations of Criteria for the Medical Care Benefits as the law of tort.

• 의료법학
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• 제13권2호
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• pp.45-72
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• 2012

The National Health Insurance Corporation has been retrieving from health care providers the payments made to them by insured patients as a result of the health care providers' arbitrary denial of coverage under the National Health Insurance, and has been disbursing such retrieved monies back to the patients, pursuant to Article 57, Sections 1 and 4 of the National Health Insurance Act. However, such practice is an application of the law that lacks legal exactitude. Another problem with such practice is that there is no legal provision under any laws or notices that expressly prohibits arbitrary denial of coverage. A legislative solution, therefore, is called for to address these issues.

• 운동영양학회지
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• 제25권4호
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• pp.17-23
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• 2021

[Purpose] This study aimed to investigate the effect of education based on the health belief model on the physical activity of the staff of the University of Medical Sciences. [Methods] This semi-experimental study was conducted on 130 university staff aged 25-50 years from the Hamadan University of Medical Sciences. Inclusion criteria were having at least 1 year of work experience, lack of acute and chronic physical and mental illnesses, and not using drugs that affect physical activity. The samples were randomly divided into two groups. The experimental group received three training sessions based on the health belief model. Before and 2 months after training, the control and experimental groups were evaluated via the following questionnaires: (1) demographic information questionnaire, (2) Health Belief Model Questionnaire, and (3) International Physical Activity Questionnaire. Finally, data were analyzed statistically. [Results] The training process resulted in a significant increase in the mean scores of the health belief model constructs in the experimental group, but changes in the control group were not significant. Self-efficacy was the strongest predictor of physical activity. [Conclusion] The health belief model is a useful model for improving individuals' understanding of the benefits of physical activity.

• 가정∙방문간호학회지
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• 제7권1호
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• pp.58-72
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• 2000

This study was an attempt to encourage the development of a rehabilitation delivery system and programs as a substitute service for hospitalization on the case of car accident patients, such as hospital based home health care nursing services. Various substitute services for hospitalization are required to curtail the length of stay for inpatients who were hospitalized with car accident compensation insurance. It focused on developing an estimation an early discharge day for car accident inpatients based on detailed statements of treatment for 111 inpatients who were hospitalized at the General Hospital in 1997. This study had four specific purposes as follows. First. to find out the utilization of medical services. Second, to estimate the time of early discharge and income increasing effect based on early discharge for those patients. Third, to identify the factors affecting total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze the length of stay and medical expenditure for inpatients who were hospitalized due to car accidents, the authors conducted micro- and macro-analysis of medical and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria, such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the test consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, and stable conditions. In addition to identifying variables affecting medical expenditure, and the length of stay and income effect due to early discharge day, the data was analyzed with a multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study were as follows. First. the mean length of stay was 50.3 days. whereas the mean length of stay due to early discharge was 34.3 days at the hospital. The estimation of time of early discharge depended on the length of stay. The longer the length of stay, the longer the length of time of early discharge : for instance a length of stay under 10 days was estimated as correlating to a mean length of stay of 6.6 days and early discharge of 6.5. The mean length of stay was 217.4 days and the time of early discharge was 110.1 respectively. The mean medical expenditure per day was found to be 169.085 Won and the mean medical expenditure per day showed negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to being discharged 16 days early was around 2,244,000 won per bed. However. this sum does not represent the real benefits resulting from early discharge, but rather the income increasing amount without considering medical prime cost in the general hospital. Therefore, further analysis is required on the cost containments and benefits as turn over rate per bed as the medical prime costs. The length of stay was most significant and was positive to the total medical expenditure, as expected. Surgery and patient's residential area was also an important variable in explaining medical expenditure. The level of complications was the most significant variable in explaining the length of stay. There was a high level for need a home health care nursing service which further supports early discharge for accident patients. In addition, when the patient was discharged. they needed follow up care for complications suffered during the car accident. $86.8\%$ of discharged patients responded that they needed home health services after early discharge. From these research findings, the following suggestions have been drawn. Strategies on a health care delivery system must be developed in order to focus on the consumer's needs and being planned for 21 century health policy in Korea. Community based intermediate facilities or home health care should be developed for rehabilitation services as a substitute for hospitalization in order to shorten the length of stay would be. A hospital based home health care nursing service. it would be available immediately to utilize by patients who want rehabilitation services as a substitute for hospitalization with the cooperation of car insurance companies.

• 가정∙방문간호학회지
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• 제6권
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• pp.5-18
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• 1999

This study was attempt to encourage for developing on rehabilitation delivery system and programs as a substitute service instead of hospitalization for accident patients at work, such as hospital based home health care nursing service. It needs vary substitutes service of hospitalization to curtail the length of stay for inpatients who were hospitalized with workers compensation insurance. It focused on developing an estimation of early discharge day of accident inpatients based on a detail statement of treatment for 115 inpatients who were hospitalized at General Hospital in 1997. This study has four specific purpose as follows. First, to find out the status of health service utilization. Second, to estimate the early discharge days and income increasing effect based on the early discharge for those patients. Third, to identify the factors to affect total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze of the length of stay and medical expenditure for inpatients who were hospitalized due to the accident, the authors conducted with micro-analysis and macroanalysis from medical records and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria. such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the tests consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, stable conditions. In addition to identify affected variables for medical expenditure. the length of stay and income effect due to early discharge day, the data was analyzed with multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study as follows. First, the mean length of stay was 37.1 days, whereas the mean length of stay due to early discharge was 28.2 days at the hospital. The estimation of early discharge days were shown that depends on the length of stay. The longer length of stay, the longer length of early discharge days, such as under 7 days length of stay patients was to estimated the mean length of stay was 4.9 days and early discharge days was 4.6. whereas the mean length of stay was 122.6 days and early discharge days was 92.0 respectively. The mean medical expenditure per day were found to be 133.409 Won. whereas the mean medical expenditure per day was shown negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to 11 early discharge days per bed was around 2,150,000 won. However, it means not the real benefits from early discharge, but the income increasing amount without considering medical prime cost in general hospital. Therefore, it needs further analysis on the cost containments and benefits under the considering as well turn over rates per bed as the medical prime costs. The length of stay was most significant and the sign was positive to the total medical expenditure, as expected. Surgery and patient's residential area also an important variable in explaining medical expenditure. The level of complications was most significant variable in explaining the length of stay. The level of the needs on horne health care nursing service which can be used for early discharge accident patients were shown very high. The needs distribution varied from 65.5% of patients and 88.9% of caregivers, to 96.4% of doctors, and 99.1% of nurses. In addition horne health nurse responded that they can be managed the accident inpatients from early discharge. From these research findings. the following suggestions has been drawn it needs to develop strategies on rehabilitation delivery system in order to focused on consumer's side which is planned for 21 century health policy in Korea. Vary intermediate facilities and horne health care would have been developed in the community based for comprehensive rehabilitation services as a substitutes of hospitalization for shortening the length of stay of hospitalizations. In hospital based horne health care nursing service, it's available immediately to utilize for the patients who wanted rehabilitation services as a substitutes of hospitalization under the cooperations with workers compensation insurance company.

• Journal of Gastric Cancer
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• 제19권1호
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• pp.72-82
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• 2019

Purpose: Despite its clinical benefits, enhanced recovery after surgery (ERAS) is less widely implemented for gastric cancer surgery. This nationwide survey investigated the current status of the implementation of ERAS in perioperative care for gastric cancer surgery in South Korea. Materials and Methods: This survey enrolled 89 gastric surgeons from 52 institutions in South Korea. The questionnaire consisted of 24 questions about the implementation of the ERAS protocols in the management of gastric cancer surgery. The survey was carried out using an electronic form sent via email. Results: Of the 89 gastric surgeons, 58 (65.2%) answered that they have knowledge of the concept and details of ERAS, 45 (50.6%) of whom were currently applying ERAS for their patients. Of the ERAS protocols, preoperative education (91.0%), avoidance of preoperative fasting (68.5%), maintenance of intraoperative normothermia (79.8%), thromboprophylaxis (96.5%), early active ambulation (64.4%), and early removal of urinary catheter (68.5%) were relatively well adopted in perioperative care. However, other practices, such as avoidance of preoperative bowel preparation (41.6%), provision of preoperative carbohydrate-rich drink (10.1%), avoidance of routine abdominal drainage (31.4%), epidural anesthesia (15.9%), single-dose prophylactic antibiotics (19.3%), postoperative high oxygen therapy (36.8%), early postoperative diet (14.6%), restricted intravenous fluid administration (53.9%), and application of discharge criteria (57.3%) were not very well adopted for patients. Conclusions: Perioperative management of gastric cancer surgery is largely heterogeneous among gastric surgeons in South Korea. Standard perioperative care based on scientific evidence needs to be established to improve the quality of surgical care and patient outcomes.

• 대한예방한의학회지
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• 제12권3호
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• pp.141-155
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• 2008

Traditional, complementary, and alternative medicine(CAM) constitutes a major source of health care in developing countries. Its therapies, products and practices are increasing used in industrialized countries, typically by around 50% of the population. However, controls on the provider of CAM services and supply and promotion of complementary medicines are weak in these countries. These trends evoke important public health questions relating to benefits and detriments, safety and quality from medical, financial, and social perspectives. In the western counties, investment in research is increasing, and some guideline is now available for ensuring their quality, efficacy, and safety according to the criteria of evidence-based medicine as legally demanded. National policies and legislation are being developed in many countries and often include partnerships between biomedical and traditional health practitioners. The purposes of the study were to review the policies on CAM, to examine the responses of the government to cope with use of CAM in industrialized countries. Lastly, some implications and recommendation are suggested.

• Tuberculosis and Respiratory Diseases
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• 제79권2호
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• pp.74-84
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• 2016

Nontuberculous mycobacteria (NTM) are emerging pathogens that affect both immunocompromised and immunocompetent patients. The incidence and prevalence of NTM lung disease are increasing worldwide and rapidly becoming a major public health problem. For the diagnosis of NTM lung disease, patients suspected to have NTM lung disease are required to meet all clinical and microbiologic criteria. The development of molecular methods allows the characterization of new species and NTM identification at a subspecies level. Even after the identification of NTM species from respiratory specimens, clinicians should consider the clinical significance of such findings. Besides the limited options, treatment is lengthy and varies by species, and therefore a challenge. Treatment may be complicated by potential toxicity with discouraging outcomes. The decision to start treatment for NTM lung disease is not easy and requires careful individualized analysis of risks and benefits. Clinicians should be alert to those unique aspects of NTM lung disease concerning diagnosis with advanced molecular methods and treatment with limited options. Current recommendations and recent advances for diagnosis and treatment of NTM lung disease are summarized in this article.

• Perspectives in Nursing Science
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• 제6권1호
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• pp.67-76
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• 2009

Recently, small and medium-sized hospitals which are located in rural areas have many difficulties in securing high quality nurses. That is because working environments for nurses in small and medium-sized hospitals in rural areas are poor compared with those of big hospitals in urban. As a result, the migration of nurses from small and medium-sized hospitals in rural areas to big hospitals in urban is continuously happening. In general, big hospitals provide nurses with high level of salary and fringe benefits. To prevent the migration of nurses, chief executive officers of small & medium hospitals in rural areas have been interested in improving nurses' working conditions including wages. Also, they have raised nurses' salary and improved working conditions. But, basically these individualized efforts have some limit. In connection with this, medical interest groups have produced various voices in terms of interpretation and solutions for these issues. However, from the future perspectives, it seems evident that two approaches for both manpower supply and demand plans of nurses are necessary. They should contain not only accurate estimation of the supply-demand of nursing manpower but also the improvement of working conditions and wages of nurses. Estimation of nursing manpower supply-demand depends on the standards and criteria being used. Supply and demand may be met or not in accordance with the points emphasized on the decision. In the articles, issues regarding nursing manpower, levels of salary, other working conditions and social support system for child care are discussed. According to Joe's report (2005), most health institutions did not meet the guidelines of nurse staffing in Medical Law. The wages of nurse vary on every hospital and there is a big difference in wages' range. The average starting salary for a nurse is 22 million won a year. In case of tertiary hospitals, it reaches up to 30 million won a year. Nurse as a profession should have a strong responsibility and should take care of the patients for 24 hours with three working shifts. Also, most of them are female who have the burden of child rearing. Therefore, it is suggested to increase the salary, to provide comfortable working conditions, and to have social support system for nurses with household affairs.

• 의료법학
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• 제18권2호
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• pp.195-218
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• 2017

요양병원에 대한 진료비의 증가폭이 비정상적으로 늘어나고 있어 건강보험재정에 막대한 부담을 주고 있다. 이는 요양병원 특수성이 급속한 노령화라는 사회적인 현상과 맞물리면서 나타나게 된 현상인데, 이 중 요양병원에 대하여 입원일당 정액수가제에 의하여 비용이 지급되는 점은 일부 요양병원이 환자를 돈벌이 수단으로 이용하는 유인이 되었다. 이러한 요양병원들은 일당정액수가를 지급받고도 그에 합당한 진료비용의 지출을 줄이기 위해 의도적으로 입원 환자를 타병원에서 정기적으로 진찰을 받게 하거나 주요 약제를 처방받게 하는 등 건강보험재정이 이중으로 지출되게 하였다. 이러한 재정누수를 방지하기 위하여 심사평가원은 위와 같은 환자들에 대하여 기존의 환자군을 부정하고 '신체기능저하군'으로 환자군을 조정한 다음 요양급여비용을 삭감하였다. 그렇지만 위결정은 규정상근거가 없음을 이유로 법원으로부터 취소판결을 받았다. 그러나 위 사건을 계기로 요양병원 수가제도의 문제점을 도출하고 제도를 정비하는 기회가 될 수 있다고 생각한다. 현재의 정액수가제를 수정하여 약제비 및 진료자체에 대한 행위별 청구를 일부 도입하면 요양병원의 의료적 기능을 강화할 수 있다고 생각한다. 또, 현재의 환자군 중 비슷한 군들은 통합하고 신체기능저하군은 입원이 부적절하므로 환자군에서 제외하는 것이 타당하다고 보인다. 다만, 사회적 필요에 의해 신체기능저하군을 입원대상으로 인정하게 된다 하더라도 장기요양대상과의 형평성, 건강보험재정의 건전성 등을 고려하여 건강보험대상에서는 제외되어야 한다고 생각한다.