• 보건행정학회지
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• 제25권3호
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• pp.240-251
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• 2015

Background: Dentist's income is quite variable. We investigate the factors underlying the distribution of dental revenue and dentist income. Methods: Financial and structural variables of private dental practices(N=13,967) were examined with 2010 Economic Census microdata which include non-insurance revenue. We conducted quantile regression method(QRM) and ordinary least square(OLS) in treating skewness and heteroskedasticity of distributions. The effective estimation for the upper and lower range of distribution becomes possible by QRM. Results: Mid-career dentists are shown to have higher revenue and income. Male dentists achieve the higher revenue and income than female dentists in all quantiles. Group practices show lower income per owner than solo practices significantly. The revenue and income are increased with increasing size of clinics. The high cost in renting the clinic office is found to have a big positive effect on the revenue but a little positive effect on the income. Interestingly the density of dentists shows negative effect on the lowest quantile of the revenue but positive effect on the highest quantile. The lowest quantile of the revenue in the capital areas have the relatively high revenue. The lowest quantile of the income in metropolitan city show higher income than those in other areas significantly. Conclusion: The suggested QRM is shown to have more effective and efficient tool in finding out determinants of dentists' revenue and income of our concern. The results of this study are expected to be employed for dentists preparing for the opening practices in their organizational settings and locational selections. The distributional efficiency of dental human resources could be accomplished if policy makers guide dentists with this knowledge.

• 한국치위생학회지
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• 제19권2호
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• pp.195-206
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• 2019

Objectives: The purpose of this study was to provide the basic data that can help the development and quality management of effective continuing education programs by analyzing the status and demand of continuing education contents for dental hygienists. Methods: The questionnaire had 30 questions, which included 5 questions on general characteristics, 4 on continuing education status, 3 on online continuing education, and 18 on desired continuing education. The survey was conducted for the members attending continuing education programs in 2018. Results: The mean age of the participants was 30.08 years, with an average career of 8.19 years. The continuing education was highly recognized, through the homepage of the association (52.5%); as speakers for continuing education, dental hygienists in the field of specialization were preferred (45.8%). Additionally, the preferred frequency of programs was twice a year (45.7%). For promoting continuing education, the use of mobile phone letter was preferred (65.8%). Moreover, 92.9% of respondents were aware of online continuing education, 49.9% had experience in online continuing education, and 59.9% said that they will actively use smart devices in the future. The requirement for the contents of continuing education was the highest at 4.34 points for health insurance cost and the lowest at 2.75 points for liberal arts classes. Conclusions: To provide effective continuing education, it is necessary to develop a customized continuing education program considering various variables, such as career, work place, and career break experience, thus reflecting the systematic requirement of surveys according to each characteristic.

• 대한장애인치과학회지
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• 제15권1호
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• pp.14-22
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• 2019

The aim of this study was to determine the factors contributing to the barrier of dental treatment for special needs patients perceived by the main caregivers of the patients. A questionnaire was developed with three parts: patient-related factors, caregiver-related factors, and factors for treatment barriers. Patient- and caregiver-related factors were analyzed for correlations with the barrier factors. Fisher's exact test and Chi-square test were used at the level of 0.05. A total of 52 caregivers (mean age [SD]=50.2 [11.5] years) for the patients with intellectual and cognitive disabilities (mean age [SD]=38.9 [21.3]) responded to the questionnaires. Oral hygiene status, need for assistance in tooth brushing, and cooperation for tooth brushing were correlated with the level of treatment cooperation of the patients (p<0.05). The above three factors were also correlated with the treatment barrier despite patients presenting oral symptoms (p<0.05). Two thirds of the caregivers felt the treatment cost as severe or a considerable financial burden. For patients, insurance types and need for assistance in tooth brushing, and for caregivers, education levels and financial status were significant factors contributing to financial burden (p<0.05). There were background factors of the patients and their caregivers associated with access to dental treatment for special needs patients. Deficient cooperative skills and financial burdens were the main obstacles to treatment access. Tooth brushing skills and oral hygiene status can be proxy measures to cooperative ability for dental treatment.

• Journal of Genetic Medicine
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• 제8권2호
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• pp.89-99
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• 2011

유전상담이 왜 국내 의료 현장에서는 필요한 의료서비스로 제공되고 잇지 않은 지에 대한 문제점과 해결책을 모색하고자 미국과 일본에서 유전상담이 필요한 유전 의료 서비스의 일환으로 정착되는 배경과 과정을 비교 고찰하였다. 동시에 국내 유전의료서비스의 현황과 유전상담 서비스 제공에 있어서 장애가 되는 요인들을 고찰하였다. 미국의 경우에는 1970년대 초에 산전 진단이 보편화되면서 유전상담의 수요가 늘게 되어 새로운 직종의 전문 유전상담사를 양성하게 되는 계기가 되었으며, 현재 29개의 양성과정의 교육을 통해서 3,000명에 가까운 전문유전상담사가 배출되어 임상유전 의료팀의 일원으로 임상유전학 전문의의 감독 하에 유전상담을 제공하고 있으며, 21세기 유전의료시대에 요구되는 생명유전정보관리를 위해서 유전상담의 필요성과 그 역할이 확대되고 있다. 일본에서는 정부주도하에 HGP 유전체 연구사업 이후 21세기 유전의료시대의 도래를 준비하는 밀레니엄 프로젝트 차원에서 <유전의료시스템의 구축과 운영> 및 <유전 카운슬링 체제의 구축>을 위한 대규모의 연구단을 구성하여 임상유전 전문의의 제도화와 본격적인 임상유전 전문 분야의 서비스가 의료기관에 개설되는 동시에 비의사를 위한 인정 유전카운슬러의 양성과 자격에 대한 연구를 거쳐서 2003년 7개의 대학원에서 유전상담사 양성 과정이 인정되어 2012년까지 110명의 유전카운슬러 배출을 목표로 현재 100명이 넘는 유전상담사가 인증되었다. 사회적 의료 수요에 부응하는 의학유전 유관학회와 교육기관의 전문가 그룹이 선도한 미국의 유전상담사 양성 프로그램과 정부 주도 하의 시대적 의료 변화에 부응하는 연구에 전문가들의 참여로 체계적인 유전상담 프로그램개발을 정착시킨 일본의 경우, 모두 비의사 유전상담사에 의한 유전상담 서비스에 대한 보험급여 등의 제도적인 보완 없이 선행되었다는 점은 우리에게 시사하는 점이 크다고 본다. 한국의료 현장에서 유전상담 서비스가 시도되지 않는 주 장애요소로는 유전상담에 대한 이해 부족과 무관심, 국내 의료 제도 하에서 의사의 진료 수가가 너무 낮아서 그 결과 외래에서 한 환자의 진료에 할애할 수 있는 시간은 10분을 초가 할 수 없는데, 유전상담 서비스는 장시간이 소요되기 때문이다(최소30분이상). 또한, 건강보험 급여제도에서 '유전상담'을 필요한 의료 행위로 인정하지 않고 있어서 아직 code 조차 생성되어 있지 않기 때문이다. 또한, 무엇보다도 근본적인 요인으로 유전상담 서비스를 제공할 수 있는 임상유전 전문의가 절대 부족하고, 최근까지도 국내 의과대학 교육 curriculum에 유전상담을 실제적으로 이해하고 습득할 기회가 없었기 때문에 일반 의료인에게는 유전상담에 대한 이해 부족과 무관심 등이 유전상담 서비스의 걸림돌로 파악되었다. 그러나, 대한의학유전학회에서 2007년 전문가들을 대상으로 실시한 유전상담과 전문 유전상담사 수요에 대한 전국 조사 연구에서 유전의료 현장과 연구 부분에서 유전상담과 전문 유전상담사가 매우 필요하다는 것이 확인되었다. 또한, 정부는 희귀난치성질환센터 Help Line의 유전질환 정보 제공을 통해서 유전상담을 받을 것을 권고하고 있지만, 실제로 의료 현장에서는 유전상담이 제공되고 있지 않기 때문에, 한국근육장애인협회, 저신장장애인협회, 코헴회등, 유전성환자들로 구성된 국내 자조회 등에서는 유전상담의 필요성을 제기하며, 서비스를 요구해오고 있다. 최근 한국희귀질환재단에서 유전성 희귀질환 환자와 가족들에게 유전상담 교육 강좌를 제공한 후 설문조사에 응한 283명의 81%가 이전에 유전상담에 대해서 접해 본 적이 없었고, 96%에서 유전상담이 희귀난치성질환 환자에게 도움이 될 것이라고 응답했다. 한편, 2009년 실시한 국내 실정에 맞는 유전상담사 양성을 위한 교육 프로그램과 교육기관의 인정 및 전문 자격 인증제도 수립에 대한 연구에서 관련 업무 전문 종사자 총 117명(의사52명, 전문 연구원30명, 간호대학 교수 26명 포함) 중 설문조사에 응한 88%가 대한의학유전학회에서 주관하고 유전상담위원회를 구성하여 교육 프로그램 개발과 인증제도를 구체화 할 것을 촉구하였다. 전문 인력의 양성을 위한 교육 수련 및 인증 프로그램을 개발하고 수행하는 것은 전문학회의 역할인 동시에 "사회적책임"이라고 생각한다. 새로운 분야(신기술)의 전문 임상 인력을 양성하는 데는 시간이 걸리기 때문에(유전상담사의경우, 2년의 대학원 과정과1년의clerkship, 임상수련과정 등으로 적어도 3년) 대한의학유전학회에서는 전문 유전상담사 양성을 위한 선 교육, 후 제도적 보완을 추진하는 것이 바람직한 방향이다. UNESCO에서는 이미 1995년 Report에서 유전상담은 유전자 검사의 보급이 증가하고 있는(21세기 유전의료시대) 의료현장에서 가장 빠르게 성장하고 있는 전문 분야로서 유전정보와 기법을 환자 진료에 연결하는 것을 돕는다고 하였다. 유전상담은 21세기 post-genome의 맞춤의료시대에서 그 역할과 적응범위가 확대되어가는 유전의료서비스의 일환이라는 것을 국내 의료계와 정부 의료 정책 부서에서 인지할 필요가 있다. 특히, 국내 저진료 수가의 의료정책 제도 하에서는 의사가 환자를 위해 충분한 진료시간을 확보하기 힘든데, 비의사전문유전상담사를유전의료팀의일원으로 유전상담에 참여하게 함으로써 환자와 가족들에게 정확한 유전정보에 대한 충분한 이해를 통해서 맞춤 유전 의료 서비스를 원활하고 효율적으로 제공하는데 도움이 될 것이다. 이를 위해서는 국내에서도 종합적인 유전의료 서비스의 구축 사업의 일환으로 유전상담 서비스 공급을 위한 전문 인력(유전상담사포함) 수급에 대한 지원 사업과 유전상담에 대한 건강보험 급여 인정 등 제도적인 뒷받침이 필요하다.

• 치위생과학회지
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• 제6권2호
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• pp.133-138
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• 2006

이 연구는 상수도수불화사업의 경제적 편익에 미치는 영향을 파악하기 위하여 2003년 1월 1일부터 6월말까지 상수도수불화지역인 청주시 상당구, 상수도수비불화지역인 안양시 만안구를 대상지역으로하여, 조사대상지역내의 치과의원에서 진료를 받은 진료지표를 비교 분석한 결과는 다음과 같다. 1. 상수도수비불화사업지역인 안양에서 상수도수불화사업을 실시할 경우 2003년 상반기의 6세에서 18세까지 연령에서 기대되는 치아우식증과 치수 및 치근단 주위조직 질환으로 인한 감소기대진료건수는 1,272건, 저추정시 636건, 고추정시 1,908건이 감소될 것으로 기대된다. 그리고 감소기대진료비는 40,888천원, 저추정시 20,444천원, 고추정시 61,333천원이 감소될 것으로 기대된다. 2. 상수도수불화사업의 전국 확대를 가정한 연간 기대건수는 2,492,018건, 저추정시 1,246,009건, 고추정시 3,738,027건이 감소가 기대되며, 감소기대진료비는 80,105,075천원, 저추정시 40,052,537천원, 고추정시 120,157,612천원이 각각 감소가 기대된다. 3. 급수인원이 48,925명인 영운정수장의 경우 편익/비용 비율이 2.9배이며, 급수인원이 239,751명인 지북정수장의 경우 편익/비용 비율이 9.0배이다. 상수도수불화사업은 급수인원이 증가함에 따라 비용의 증가는 미미하고 규모에 따른 경제 효과가 매우 크게 나타났다. 국민구강건강증진은 아울러 구강건강보험재정의 비용절감과 연관이 있다고 사료되며, 이를 위하여 전국 모든 지역에 상수도수사용을 확대 실시하여, 상수도수와 불소화에 대한 적극적인 홍보와 교육을 통한 신뢰 구축이 추가적으로 필요하다고 생각된다.

• 한국병원경영학회지
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• 제10권1호
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• pp.48-70
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• 2005

The purpose of this study was to make an analysis of the impact of the DRG payment system on medical care pattern and cost of cataract surgery in a general hospital. The subjects were 173 patients whose DRG severity grade was zero, selected from among the hospitalized who underwent cataract surgery before and after the joining to the demonstrational operation of the third year DRG payment system. Their medical records and the details of their medical bills were examined to find out the length of hospital stay, medical care pattern provided to them, the cost of medical care, and the quality of medical care. The length of stay and the amount of medical care supplied during being in hospital dropped significantly for both single-eye and double-eyes cataract surgery groups. The amount of antibiotic use went down during the hospitalization and upon discharge from the hospital, but decreased after discharge. The total medical bills and the rate of basic examination implementation increased in the OPD before hospitalization but after discharge dropped. For double-eyes cataract patients, the rate of double-eyes cataract surgery went down. The total medical bills of DRG payment system converted into the fee-for-service system was greater by 113.3% for the single-eye cataract surgery group and by 102.9% for the doble-eyes cataract surgery group, compared to that by the fee-for-service. The contribution shared by the insurance corporation increased for both single-eye and double-eyes cataract surgery groups, but the copayment by the insured went down. Regarding the treatment outcome, no difference was found in complication rate, resurgery rate and mortality rate before and after the joining to the DRG payment system was implemented. The use of special lens lessened significantly. The amount of medical care supplied during hospitalization decreased but the complication rate didn't increase. But the increased use of low-price artificial cataract and the avoidance of double-eyes cataract surgery was observed. The phenomenon decreased number of OPD visit and the decreased total medical bills of OPD care after discharge in this hospital required further evaluation.

• 대한치과기공학회지
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• 제34권4호
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• pp.433-445
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• 2012

Purpose: In order to validate empirically the theoretical model of this study subjects, who were limited in Andong gun, Youngyang gun, Uiseong gun, Bonghwa gun, Chilgok gun, Cheongsong gun according to residence-specified distribution and over aged 65, were focused to the elderly in rural areas with geographical characteristics where they have difficulties in accessibility of dental facilities and dental care. Methods: The collected data were analyzed by the SPSS 19.0 program. First, the frequency analysis was performed for each independent variable and the dependent variable. Second, reliability analysis and correlation analysis were conducted for daily living skills and Biomedical Vigilance. Third, multivariate analysis was performed in terms of and the post-administration management. Fourth, multiple regression analysis was performed to identify the factors affecting the post-management of dentures and the period of using dentures. Results: By results of the multiple regression analysis, the elder the subjects are(${\beta}$ = 0.03), the lower their income activities are(${\beta}$ = -0.18), the smaller their monthly allowances are(${\beta}$ = -0.16), the worse their daily activity skills are(${\beta}$ = -0.12), the more they were mounted their dentures by an unlicensed contractor(${\beta}$ = 0.07), and the more they cost to their dentures(${\beta}$ = 0.14), the longer the period of use dentures are. And the beneficiaries of Basic Livelihood Security(${\beta}$ = -0.14) who got free denture business are shorten the period of using dentures. According to multiple regression analysis for post management of dentures, the independent variables like the health education(${\beta}$ = 0.24), smoking(${\beta}$ = -0.18), periodic oral examination(${\beta}$ = 0.13), dentures mounted by an unlicensed contractor(${\beta}$ = -0.13) are shown statistically significant results. In that study subjects are taking part in health education and non-smokers, they are likely to have more chances to post management for their dentures like periodic oral examination. However the subjects who were weared their denture by an unlicensed contractor get less chance to post management for their dentures. Conclusion: As the elderly who want to wear denture are increasing due to the denture insurance for the elderly, the need for oral health education for the elderly is an urgent request, especially continuos education for the way of use their dentures and follow-up management for the elderly who were already mounted their dentures. And also, the need for more systematic researches is requested for securing objective data.

• Journal of Preventive Medicine and Public Health
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• 제25권3호
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• pp.303-311
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• 1992

It is very important to estimate the future medical care expenditure, because medical care expenditure escalation is a big problem not only in the health industry but also in the Korean economy today. This study was designed to project the medical care expenditure in view of population age change. The data of this study were the population projection data based on National Census Data(1990) of the National Statistical Office and the Statistical Reports of the Korea Medical Insurance Corporation. The future medical care expenditure was eatimated by the regression model and the optional simulation model. The significant results are as follows : 1. The future medical care expenditure will be 3,963 billion Won in the year 2000, 4,483 billion Won in 2010, and 4,826 billion Won in 2020, based on the 1990 market price considering only the population age change. 2. The proportion of the total medical care expenditure in the elderly over 65 will be 10.4% in 2000, 13.5% in 2010, and 16.9% in 2020. 3. The future medical care expenditure will be 4,306 billion Won in the year 2000, 5,101 billion Won in 2010, and 5,699 billion Won in 2020 based on the 1990 market price considering the age structure change and the change of the case-cost estimated by the regression model. 4. When we consider the age-structure change and inflation compared with the preceding year, the future medical care expenditurein 2020 will be 21 trillion Won based on a 5% inflation rate, 42 trillion Won based on a 7.5% inflation rate, and 84 trillion Won based on a 10% inflation rate. Consideration of the aged(65 years old and over) will be essential to understand the acute increase of medical care expenditure due to changes in age structure of the population. Therefore, alternative policies and programs for the caring of the aged should be further studied.

• Journal of Preventive Medicine and Public Health
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• 제42권6호
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• pp.403-407
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• 2009

Objectives : The amount of medical utilization by Medical Aid recipients was 3.7 times that of patients with Korean Medical Insurance. This study aims to describe the surplus medicine and the medication-related utilization, and to determine factors contributing to surplus medicine. Methods : Among those who used copayment-free Class I Medical Aid in 2005, 146,880 subjects who were $\geq19$ year-old and received >365 days medical treatment per year were studied with their case managers by conducting face-to-face interviews. The analytic methods were description, chi-square, t-tests, ANCOVA and multiple logistic regressions. Results : Most subjects were female (68.6%), the elderly (62.5%), and the separated (61.6%), had an elementary graduation or less (74.8%), and had disabilities (33.2%). The percentage of subjects with surplus medicine was 18.5%. However, the percentage of females, the elderly, those with non-disabilities, the separated, the uneducated, those with a very poor perceived health status and those with an economical burden for medical treatment was 19.3%, 18.9%, 19.0%, 19.3%, 19.0%, 20.2% and 24.3%, respectively. For subjects with surplus medicine, averages for the number of used pharmacies, the pharmacy-visit days and the medication costs were 4.6 drugstores, 34.9 days and approximately 1,124 thousand Won(￦). These values were higher than those without surplus medicine (4.4 drugstores, 33.8 days, and ￦1,110 thousand, respectively). The odds ratios of the contributing factors to surplus medicine were female 1.11 (95% CI=1.07-1.14), the elderly 1.06 (95% CI=1.02-1.10), those with non-disabilities 1.08 (95% CI=1.05-1.12), the separated 1.14 (95% CI=1.10-1.18), the unmarried 1.12 (95% CI=1.07-1.18), the uneducated 1.03 (95% CI=1.01-1.08), those with a very poor perceived health status 1.04 (95% CI=1.01-1.08) and experiencing an economical burden for medical treatment 2.33 (95% CI=2.26-2.40). Conclusions : 18.5% of subjects had surplus medicine with a higher mean of medication cost. Therefore, health education and health promotion programs to prevent surplus medicine and to improve the appropriate usage of medication are necessary.

• Safety and Health at Work
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• 제13권2호
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• pp.163-169
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• 2022

Background: It is estimated that about 13 million artisanal and small-scale miners carry out their activities under harsh, precarious, unfriendly, and risky conditions. Yet, our understanding of the extent to which these workers use personal protective equipment (PPE) and navigate through the various risks and hazards they face is still limited. This article has two main objectives. First, it explores the extent of usage of PPE among artisanal and small-scale miners for the prevention of hazards and risks. Second, it examines the coping strategies used by these miners as a response to experiences of occupational injuries and risks Methods: A cross-sectional survey of small-scale miners was conducted in six communities across three districts in Ghana, West Africa. The mixed methods approach was adopted. A total of 148 small-scale miners participated in the study. Six focus group discussions (FGDs) were held across the six communities. The data were analysed using descriptive statistics. Chi-square tests were used to analyse the relationship between some socio-demographic characteristics (sex, age, and educational background) and the usage of PPE. Open-ended questions and responses from FGDs were analysed based on the content and verbatim quotations from miners. Results: Findings suggest that 78% of the miners interviewed do not use the appropriate PPE citing reasons such as cost, and their personal discomfort associated with use of PPE. There was no significant relationship between socio-demographic characteristics (i.e., sex, age, education and major mining activity) and the usage of PPE. The study further revealed four main coping strategies used by miners to handle the risks. These are rest, taking unprescribed medication and hard drugs, registration with health insurance scheme and savings and investments. Conclusion: This study shows that very few artisanal miners use PPE despite the significant hazards and risks to which they are exposed. The study recommends to the government to put in place measures to ensure that miners adhere to health and safety regulations before undertaking mining activities. This means that health and safety plans and use of PPE should be linked to the license acquisition process for miners.