• 산업융합연구
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• 제18권3호
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• pp.45-51
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• 2020

본 연구는 간호윤리교육이 간호대학생의 영적 안녕, 죽음에 대한 태도와 호스피스 완화간호에 대한 인식에 미치는 영향을 탐색하기 위한 단일군 사전·사후설계 연구이다. 일개 대학 간호학과 3학년 학생 42명을 대상으로 총 6주간 30시간의 간호윤리교육을 실시하였고 교육 전과 후에 자료를 수집하였다. 수집된 자료는 SPSS 18.0 프로그램을 이용하여 기술통계, Paired t-test로 분석하였다. 연구 결과, 간호윤리교육은 간호대학생의 영적 안녕, 죽음에 대한 태도, 호스피스 완화간호에 통계적으로 유의한 변화를 가져오지는 못하였다. 그러나 한 가지 흥미로운 점은 본 연구의 결과와 마찬가지로 선행연구에서 실시된 다양한 교육 프로그램 또한 죽음에 대한 태도에 유의한 변화를 가져오지는 못했다는 것이다. 따라서 간호대학생이 죽음에 대한 긍정적 태도를 형성할 수 있도록 돕는 교육 프로그램의 개발 연구가 필요할 것으로 생각된다.

• 한국콘텐츠학회논문지
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• 제11권9호
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• pp.372-383
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• 2011

본 연구의 목적은 관상동맥중재술 입원 환자의 재원일수의 변이를 규명하기 위해 중증도 보정 모형을 개발하였다. 2004~2006년 퇴원손상환자 조사자료 중 관상동맥중재술 입원 환자 1,011건을 연구대상으로 하였으며, 재원일수의 변이분석은 t검정, 분산분석을 실시하였고, 중증도 보정 재원일수 모형은 데이터마이닝 기법을 이용하였다. 개발된 다중회귀분석 모형을 이용하여 예측 재원일수를 산출하고 이를 실제 재원일수와 비교한 결과 병상규모별, 보험유형과 지역별로 재원일수의 변이가 존재하는 것으로 나타났다. 환자 특성과 중증도를 통제하고 나타난 재원일수의 변이는 공급자 요인으로 설명될 수 있는데, 진료행태나 의료자원에 대한 후속 연구가 필요한 것으로 보인다. 본 연구는 행정 데이터를 이용하여 중증도 모형을 개발하고 변이를 확인하였다는 점에서 활용의 효용성을 높이는 데 기여할 것으로 사료된다.

• 보건행정학회지
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• 제26권2호
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• pp.95-106
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• 2016

A new manual of System of Health Accounts (SHA) 2011, was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. This offers more complete coverage than the previous version, SHA 1.0, within the functional classification in areas such as prevention and a precise approach for tracking financing in the health care sector using the new classification of financing schemes. This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 1970-2014 constructed according to the SHA2011. Data sources for public financing include budget and settlement documents of the government, various statistics from the National Health Insurance, and others. In the case of private financing, an estimation of total revenue by provider groups is made from the Economic Census data and the household income and expenditure survey, Korean healthcare panel study, etc. are used to allocate those totals into functional classifications. CHE was 105 trillion won in 2014, which accounts for 7.1% of Korea's gross domestic product. It was a big increase of 7.7 trillion won, 7.9%, from the previous year. Public share (government and compulsory schemes) accounting for 56.5% of the CHE in 2014 was still much lower than the OECD average of about 73%. With these estimates, it is possible to compare health expenditures of Korea and other countries better. Awareness and appreciation of the need and gains from applying SHA2011 for the health expenditure classification are expected to increase as OECD health expenditure figures get more frequently quoted among health policy makers.

• 보건행정학회지
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• 제27권3호
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• pp.199-210
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• 2017

Background: This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 2015 constructed according to the SHA2011, which is a new manual of System of Health Accounts (SHA) that was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. Comparison is made with international trends by collecting and analysing health accounts of OECD member countries. Particularly, financing public-private mix is parsed in depth using SHA data of both HF as financing schemes as well as FS (financing source) as their revenue types. Methods: Data sources such as Health Insurance Review and Assessment Service's publications of both motor insurance and drugs are newly used to construct the 2015 National Health Accounts. In the case of private financing, an estimation of total expenditures for revenues by provider groups is made from the Economic Census data; and the household income and expenditure survey, Korean healthcare panel study, etc. are used to allocate those totals into functional classifications. Results: CHE was 115.2 trillion won in 2015, which accounts for 7.4 percent of Korea's gross domestic product. It was a big increase of 9.3 trillion won, 8.8 percent, from the previous year. Government and compulsory schemes's share (or public share) of 56.4% of the CHE in 2015 was much lower than the OECD average of 72.6%. 'Transfers from government domestic revenue' share of total revenue of HF was 17.8% in Korea, lower than the other contribution-based countries. When it comes to 'compulsory contributory health financing schemes,' 'Transfers from government domestic revenue' share of 14.9% was again much lower compared to Japan (44.7%) and Belgium (34.8%) as contribution-based countries. Conclusion: Considering relatively lower public financing share in the inpatient care as well as overall low public financing share of total CHE, priorities in health insurance coverage need to be repositioned among inpatient care, outpatient care and drugs.

• 보건행정학회지
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• 제22권3호
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• pp.427-450
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• 2012

Objectives : This study examined the factors influencing variation by local areas of antibiotics prescription rate in upper respiratory infections (URI) according to the public reporting. Methods : We used the National Health Insurance Claims Data which the clinics claimed for URI (Korean Standard Classification of Disease, J00 ~ J06) in ambulatory care. The period of analysis was from the first quarter (from January to March) of 2005 to the first quarter of 2007. The number of samples was total 242 local areas that included all clinics (N = 7,942), which prescribed antibiotics for URI in ambulatory care. Results : None of the demographic and socioeconomic characteristic indicators was statistically significant. Among the provider factors, An increase in number of doctors and the average annual antibiotics prescription rate (from 2003 to 2004) for URI by local area were significantly related to an increase of antibiotics prescription rate according to the public reporting. And an increase in number of pediatric clinics, the proportion of clinics less than 5 years since has opened and the average annual fluctuation of antibiotics prescription rate (from 2003 to 2005) were significantly related to a decrease in antibiotics prescription rate by local area according to the disclosure of information. Conclusions : According to the public reporting, the antibiotics prescription rate in clinics had decreased sharply. However, the reduction of antibiotic prescription rate varied in different local areas. The factors influencing variation by local areas in antibiotics prescription rate can be used for establishing effective strategies to reduce variation by region in antibiotics prescription rate.

• 한국IT서비스학회지
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• 제16권3호
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• pp.17-45
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• 2017

Health Information Exchange (HIE) is expected to improve the quality and efficiency of care by allowing providers online access to healthcare information generated by other providers at the point of care. However, the adoption of the technology in Korea has been slow since its pilot program in 2007~2010 at Seoul National University Bundang Hospital. The objective of this study was to survey stakeholders on the incentive program for the facilitation of HIE adoption. We surveyed 39 experts representing 6 categories of stakeholders-provider, insurer, government, information service firms, customers, and medical informatics experts for the interviews. Interview questions included program objectives, program participation requirements, incentive payment method, and administrative burden for program participation. Experts indicated that the quality of care was the most important value the program should aim to achieve through the HIE adoption. They suggested that the requirements and administrative burden for participation should be kept at minimum to recruit a large number of providers to the program, which is an indicator of program success. Experts were divided on the payment method whether the incentive should be paid as a part of the fee payment scheme operated by the National Health Insurance (NHI) or should be a payment made independent of the NHI. The source of the divide was conflict of interest among stakeholders as to who pays for the program, and the insurer and consumer groups were against the NHI taking the financial burden. It appeared to be the most significant factor for the successful program launching to resolve the gap in perceptions about benefits of the technology among stakeholders and to win the willingness to pay for the program.

• 보건행정학회지
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• 제16권1호
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• pp.17-40
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• 2006

With the prospect of rapidly growing health insurance expenditures, particularly spending for ambulatory care, the introduction of a case-based payment method is discussed as an alternative to the current fee-for-service based method. A system to measure case mixes of providers is a core component of such payment systems. The objective of this study were to develop a classification system for ambulatory care, Korean Ambulatory Patient Group (KAPG) based on the U.S. APG version 2.0 and to evaluate the classification accuracy of the system. A database of 64,258,386 records was constructed from insurance claims submitted to the Health Insurance Review Agency (HIRA) during three months from August 2002. A total of 41,347,307 records with a single visit was used for the development and 7% random sample of the database was used for the evaluation. Additional groups were defined to include both physician and hospital fees in the classification, age splits were added to classify the entire population as well as the population older than 65, and the definition of medical groups used by the HIRA was adopted. The variance reduction in charges achieved by KAPGs was computed to evaluate the accuracy of classification. A total of 474 KAPGs was defined compare to 290 groups in the U.S. APG. The variance reduction for charges of all visits ranged from 20% to 37% depending on the type of provider, and ranged from 22% to 42% for non-outliers, that were better than those achieved by the system currently used by the .HIRA for its internal review purpose. Although further study is required to improve the classification for complicated care in larger hospitals, the results indicated that KAPGs could be used for better management of costs for ambulatory care.

• 보건행정학회지
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• 제21권1호
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• pp.115-131
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• 2011

Several common issues are encountered by countries - Germany, Japan, and the United States - that adopted long-term care (LTC) system. First, the demand for LTC and its associated costs have steeply risen following the implementation of the LTC policy. Second, ensuring the quality of services have been difficult. Third, the coordination of services among providers and between LTC and medical care has been inadequate. Learning from their experience, we suggest ways to improve the LTC system in Korea. The basic approach aims for efficiency over equity in the system. This would require promoting provider competition and consumer choice. We propose several policy options according to the major stakeholders. For consumers, cash benefits at fixed rates and personal savings accounts are feasible options to self-contain the demand and cost of services. On the insurer's side, creating an environment of multiple insurers will engender competition, leading to cost savings and quality care. For providers, delivery of quality services through competition, cost-containment through capitated reimbursements, and coordination of services through integrated delivery system can be achieved. From the assessors' perspective, establishing an information system to monitor the activities of insurers and providers would be important, empowering consumers with information to choose cost-effective service providers. In summary, the suggested approach would provide cost-effective LTC services by guaranteeing consumer choice and promoting major stakeholder accountability. Further studies are needed to test the feasibility of this model in ensuring quality LTC in Korea.

• 스마트미디어저널
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• 제1권4호
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• pp.52-58
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• 2012

최근 고령화에 따른 사회적인 문제를 해결하기 위한 대안으로 IT와 BT기술을 접목한 U헬스 의료서비스가 주목을 받고 있다. 활성산소는 체내의 불안정한 상태의 유해산소로서 노화의 주원인이 되고, 다른 질병을 유발할 위험성이 크며, 현대인의 질병 중 약 905가 활성산소와 관련이 있다. 따라서 고 연령층과 지병환자들 뿐만 아니라 일반일들도 활성산소 포화도를 체계적으로 관리해야 할 필요성이 있다. 본 논문에서 신체로부터 측정한 활성산소 측정데이터를 의료기관의 데이터 저장소로 전송하여 서비스 제공자로부터 진단을 받을 수 있는 효과적인 U헬스 시스템에 대하여 소개한다. 제안하는 시스템은 사용자의 신체검사정보확인, 의료기기와 모바일 간의 표준에 따른 블루투스 데이터 통신, 의료정보 기능을 지원하고, 또한 모바일의 3G/4G, Wi-Fi를 이용하여 게이트웨이 역할을 수행하도록 설계하였다. 제안시스템의 U헬스 기기와 모바일 간의 표준에 의한 데이터통신을 통해 의료기관으로부터 언제, 어디서든 진단을 받을 수 있는 효과적인 U헬스 서비스 환경을 구축할 수 있다.

• Journal of Korean Medical Science
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• 제33권53호
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• pp.343.1-343.8
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• 2018

Background: Linkage of public healthcare data is useful in stroke research because patients may visit different sectors of the health system before, during, and after stroke. Therefore, we aimed to establish high-quality big data on stroke in Korea by linking acute stroke registry and national health claim databases. Methods: Acute stroke patients (n = 65,311) with claim data suitable for linkage were included in the Clinical Research Center for Stroke (CRCS) registry during 2006-2014. We linked the CRCS registry with national health claim databases in the Health Insurance Review and Assessment Service (HIRA). Linkage was performed using 6 common variables: birth date, gender, provider identification, receiving year and number, and statement serial number in the benefit claim statement. For matched records, linkage accuracy was evaluated using differences between hospital visiting date in the CRCS registry and the commencement date for health insurance care in HIRA. Results: Of 65,311 CRCS cases, 64,634 were matched to HIRA cases (match rate, 99.0%). The proportion of true matches was 94.4% (n = 61,017) in the matched data. Among true matches (mean age 66.4 years; men 58.4%), the median National Institutes of Health Stroke Scale score was 3 (interquartile range 1-7). When comparing baseline characteristics between true matches and false matches, no substantial difference was observed for any variable. Conclusion: We could establish big data on stroke by linking CRCS registry and HIRA records, using claims data without personal identifiers. We plan to conduct national stroke research and improve stroke care using the linked big database.