• 사회복지연구
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• 제42권1호
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• pp.31-54
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• 2011

본 논문은 건강보험정책결정과정에서의 참여민주주의를 중심으로 김대중·노무현 정부 복지국가 성격을 연구하였다. 참여민주주의는 한국 민주주의의 질적 발전 보다는 외환위기 이후 자본주의 구조조정을 위한 정치적 정당성 확보 전략에 의해 도입되었다. 따라서 참여민주주의가 복지국가 발전의 한 지표인 보장성강화를 획득해내는데 긍정적인 역할을 하였음에도 불구하고 신자유주의적 이념 추구, 국가재정책임성 미약, 정책결정과정에 가입자의 실질적인 참여 배제로 2007년 보장성강화정책은 결국 실패로 돌아가게 되었다. 과거 복지제도와 마찬가지로 김대중·노무현 정부 참여민주주의제도도 정치적 정당성 확보를 위해 도입되었으나 경제성장우선이데올로기의 제약하에서 운영되었다고 볼 수 있다. 그러나 참여민주주의제도는 '서비스'가 아닌 '권력'형태의 제도라는 점, 참여민주주의제도로 인한 권력의 부여가 보장성 강화요구를 통해 복지국가 발전에 긍정적인 역할을 하였다는 사실로 미루어 볼 때 김대중·노무현 정부가 과거 복지국가와는 차별적이다.

• 한국병원경영학회지
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• 제8권1호
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• pp.1-23
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• 2003

General drug prices involve three stages: shipment stage, wholesaler stage and retail stage. Policies on drug price differ from country to country. Shipment stage prices are tightly regulated in countries like France and Netherlands. They are free in only a minority of advanced countries, even if these include some major players such as the US, Germany and, in a very limited sense, Japan. The situation in the UK is very complex with a semi-free system, where drug companies are free to set their own prices but cannot exceed a predetermined profit ceiling. Mark-up at both wholesaler and retail stages is formally admitted in most countries observed. Apart from the general drug prices, reimbursement price of insured drugs has been major policy concerns. Most countries reviewed in this study has exerted some control over reimbursement prices, but differ both in the way how and in the extent to which prices are admitted or fixed. Price fixing has been used in France and Japan. Some countries have transformed their system over time, particularly to move to reference pricing in the last decade. This mechanism has empowered the customer, and improved price competition on the market. Referring to the drug price policies in the advanced countries, this study makes some suggestions for the redirection of Korean price policy for reimbursement drug in health insurance as follows: to match appropriate policy tools to each policy goal; to maximize market mechanism through effective reimbursement price fixing which admits mark-ups in wholesaler and retail prices; to introduce reference pricing system in order to redirect patient's demand with a financial incentive to choose the best-priced drugs and to save the finance of health insurance; and to strengthen surveillance and monitoring mechanism in the drug market.

• Journal of Preventive Medicine and Public Health
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• 제28권1호
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• pp.153-174
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• 1995

This study was conducted to examine the determinant factors for expenditure of the medical insurance program for self-employeds based on the analysis of 1991 'The Medical Insurance Program for Self-Employeds Statistical Yearbook', and also similar yearbooks in the metropolitan and other provinces. The major findings are as follows : We have divided benefits into these four components such as the utilization rate for out-patients, expenses per claim for out-patients as paid by the insurer, utilization rate for in-patients, and the expenses per claim for in-patients as paid by the insurer, in order to examine the determinant factors for it. The results of the study revealed the following findings, in urban areas, the supply of medical care had more influence on the benefits than other demographic and economic variables, while, in county areas, both the supply of medical care and the rate of those aged over 65 affected the provision of benefits. The determinant factors for financial balance of the medical insurance program for self-employeds are, first, the determinant factor for administrative expenses was the number of households. The more the number of households, the less the administrative expenses per the insured. This shows that the economy of scale is being. And so, the administrative district must be taken into consideration in the incorporation of small regional medical societies and should be re-organized for more efficient management. Second, in urban areas, the supply of medical care had more influence on utilization rate and expenses per claim as paid by insurer, and therefore it is necessary to control it. In county areas, the supply of medical care and the rate of those aged over 65 raised the utilization rate and expenses per claim as paid by insurer. For the financial stability of county areas, a common fund for medical care for the aged and expansion of finance stabilization fund would be necessary. But, in county areas, it would be unnecessary to control the supply of medical care because it was much more insufficient than in urban areas. The vitalization of public health facilities must be carried out in county areas, for they reduced benefits. Sice the more insured in a single household, the less the utilization of the medical insurance program, benefits for habilitation at home should be given consideration. The law of majority and the economy of scale were applied here, and therefore the incorporation of regional medical societies must be taken into consideration. In integrating regional medical societies, it would be absolutely necessary to review the structural differences among all regional medical societies, the medical demand of each region, and also the local characteristics of each region.

• 한국사회복지학
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• 제57권4호
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• pp.321-342
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• 2005

본 논문은 보험료를 중심으로 하는 의료보험 재정방식의 문제점을 파악하고 그 대안으로서 조세를 통한 국고보조의 가능성을 검토하기 위해 작성되었다. 이 목적을 달성하기 위해 의료보험재정과 관련된 근로관계, 소득재분배효과, 기업의 부담, 위험분산 그리고 의료보험의 관리운영권이라는 5가지 관점에서 살펴보았다. 그 결과 보험료 재정방식은 여러 문제들이 있으며 그것들이 조세를 통한 국고보조로 해결될 수 있을 것으로 파악되었다. 이 결과를 기초로 보험료 중심의 의료보험재정을 조세방식으로 전면적으로 전환하자고 주장하는 것은 무리가 있다. 그러한 정책의 시행에 영향을 미치는 다른 변수들을 고려해야 하기 때문이다. 그러나 본 논문은 국가의 재정적 책임의 점진적 확대 또는 유지와 관련된 논의를 좀더 체계적으로 전개하는 데 기여할 수 있을 것이다.

• Journal of Korean Academy of Oral Health
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• 제42권4호
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• pp.145-151
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• 2018

Objectives: The purpose of this study was to interpret regional disparities in the number of teeth sealed with pit and fissure sealants, identify the factors that affect these disparities and find solutions for the same. Methods: Data were collected from the National Health Insurance Service and Korean statistical information service using metropolis-city-rural area dental health infrastructure variables, regional health behavior variables, and local finance-related variables. Results: In 2015, the number of teeth sealed with pit and fissure sealants per 100 people was higher in the metropolis or city than in the rural area. There was a positive correlation between the number of teeth sealed with pit and fissure sealants and the number of dentists, dental hygienists, dental institutions, standardization rate of subjective awareness of well-being, standardization rate of brushing after lunch, and the proportion of welfare budget in the general budget. There was a negative correlation with the annual standardization rate of health institution use, the standardization rate of unused medical services, and the local government's financial independence. According to the final model of the multiple regression analysis, while the impact of infrastructure on dentistry was not statistically significant, the statistical significance of standardization rate of brushing after lunch, the local government's financial independence, and the proportion of welfare budget in the general budget were maintained. Conclusions: To reduce regional disparities in the volume of use of pit and fissure sealants, it was concluded that it may be effective to select regions with a consideration of the level of regional economic power, implement separate and appropriate policies and projects, and improve the awareness in residents.

• Journal of Nutrition and Health
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• 제38권9호
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• pp.786-792
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• 2005

With dramatic transitions from a traditionally food-insecure to a food-sufficient society, over weight and/or obesity are an increasing health concern in Korea. In 2000, $35.9\%$ of Korean adults were over weight (BMI>25) with increasing trends. It is well known that obesity is highly correlated with chronic diseases, such as diabetes, hypertension, cardiovascular disease, cancer and high cholesterol. In 2003, the social cost of obesity is estimated at $529.5\~799.3$ billion won (direct cost) and at $1,200\~1,817$ billion won (including indirect cost). The share of the direct cost is estimated at $2.6\~3.9\%$ of total medical bill 20,742 billion won. These costs are underestimated and would surely be higher if the expenditures outside of the official medical insurance system of Korea were included. Based on the rapid increase of obesity rate among the Korean youth, it is crucial to develop and implement appropriate policies to curb the obesity epidemic.

• 보건행정학회지
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• 제30권3호
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• pp.270-276
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• 2020

Entering the fourth industrial revolution era, health technology is rapidly developing and the people's needs for medical services are gradually increasing. Establishing a life cycle management of health technology has emerged as a new policy agenda to cope with these changes. However, the management of health technology have been conducted without continuity and with several problems pointed out. Therefore, we suggest the reform agendas by stages to establish system for a life cycle management of health technology in the fourth industrial revolution era as follows. In the stage of development, it is important not only to provide research funding, but also consulting by professional about whole cycle of health technologies. In the phase of market entry, there are needs for enhance the system that would expand the early adoption for innovative technology and increase its effectiveness. After the spread of health technology to clinical settings, a reassessment and post management system should be established that have an institutional framework with strong price adjustment and exit mechanism. Furthermore, we hope that discussions will be brisk in macro perspective on the balancing of development in healthcare industry, health of people and national health insurance finance.

• 한국산학기술학회논문지
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• 제10권6호
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• pp.1304-1316
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• 2009

본 연구는 효율성에 기초한 환산지수의 도입 가능성을 알아보기 위한 기초 연구로 시도되었다. DEA 효율성지표와 환산지수가 전공의 수련교육을 실시하고 있는 60 개 병원을 그룹화하는데 얼마나 유용하게 사용될 수 있는가를 고찰하였다. 이러한 목적을 달성하기 위해 자료수집이 가능한 표본병원의 환산지수와 AHP 개념을 도입해 DEA 모형의 투입변수와 산출변수를 선정하였다. 그 결과 병상규모가 클수록 규모적 비효율성이 큰 것으로 나타났으며 기술적으로 또는 규모적으로 비효율적인 병원일수록 환산지수가 더 큰 것으로 나타났다. 환산지수와 효율성지표는 수련병원을 병원의 종별에 따라 종합전문병원과 종합병원으로 구분하는데 유용하게 사용될 수 있었다. 또한 DEA 효율성을 구하는 과정에서 독립변수로 사용된 투입 산출변수를 판별함수에 도입하였음에도 불구하고 환산지수와 효율성지표는 판별함수를 구성하는 주요 변수로 작용함을 확인하였다. 따라서 만약 모집단을 대표할 수 있는 많은 표본을 기초로 보다 명확한 결과를 얻을 수 있다면 건강보험의 수가계약제 하에서 효율성 개념을 바탕으로 한 환산지수계약의 도입을 신중하게 고려해 볼 수 있다.

• 보건행정학회지
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• 제32권3호
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• pp.317-322
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• 2022

Background: Limited access to medical services causes problems in patients' health and life. Also, hospital closures cause concentration towards general hospitals, which leads to worsening National Health Insurance finance. Therefore, hospital closure is an important topic to be analyzed. Methods: This paper analyzed the factors that affect hospital closures using survival analysis with the data of 970 hospitals opened between 2010 and 2019 in Korea. The number of medical personnel, hospital rooms, sickbeds, and medical departments were used as explanatory variables. Results: The number of medical personnel and hospital rooms increased the survival probability while the number of sickbeds and medical departments decrease the survival probability. Conclusion: The results suggest that hospitals have economies of scale and diseconomies of scope in management.

• 응용통계연구
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• 제30권3호
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• pp.475-486
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• 2017

국민 건강의 향상 및 복지의 선진화를 위해 객관적이고 정확한 건강기대수명의 필요성이 대두되었다. 또한 건강기대수명은 삶의 질을 평가하는 주요한 지표이기 때문에 기대수명 및 건강기대수명에 근거한 사회계층간의 삶의 질의 불평등에 대한 논의는 이미 여러 해외연구에서 계속되어 왔다. 이에 본 논문에서는 우리나라 유병률과 사망률에서 모집단에 대한 대표성을 갖고 있는 표본코호트DB를 통해 건강기대수명을 도출하였다. 본 논문에서는 건강기대수명의 산출을 위해 Sullivan (1971)의 단일상태 접근법을 이용하였다. 이때, 사망률과 유병률이 관측되지 않은 연령대의 경우에는 Greville (1945)의 9-order correction factor 방법과 Brass (1971)의 Brass-logit 모형을 통하여 보정하여 주었다. 그 결과 2013년 기준 한국여성의 기대수명은 87세, 남성은 80세 였으나 여성의 경우는 60년, 남성은 61년 동안만 질병이 없는 '건강한 삶'을 영위하는 것으로 나타났다. 본 연구에서는 또한 2003년부터 2013년까지 한국인의 특정 질병으로부터의 건강한 삶의 영위기간을 성별, 소득수준별, 건강보험가입 구분별로 산출하였다. 그 결과 건강기대수명 측면에서 한국의 성별, 소득수준별, 건강보험 가입 구분별 삶의 질의 불평등을 확인하였다.