• 한국산학기술학회논문지
• /
• 제11권9호
• /
• pp.3336-3340
• /
• 2010

2007년1월1일부터 12월 31일까지 퇴원환자조사에서 제외되었던, 100병상미만 의료기관을 조사대상으로 선정하였다. 퇴원환자조사를 위해 조사 기반자료인 의무기록을 토대로 손상퇴원환자의 일반적 특성, 진료비지불방법, 질병 및 수술 양상과 의료이용 실태를 파악하였다. 2007년 한 해 동안 전국 100병상미만의 급성기 의료기관을 퇴원한 추정 환자 수는 총 4,697,095명으로 이는 전체 인구의 9.7%에 해당한다. 인구 10만 명당 퇴원 율은 9,693명이며 평균재원일수는 9.8일이었다. 퇴원후 귀가한 퇴원환자수는 전체 4,538,861명이었고 이중 남성은 1,784,041명, 여성은 2,754,821명이었다. 타병원으로 이송된 환자는 119,378명이었으며 의뢰병원으로 회송된 환자도 8,970명 이었다.이상과 같은 결과는 특정 손상에 대한 고위험군을 파악하고 중재가 필요한 곳을 확인하여 손상을 예방함으로써 공중보건비용을 줄이는 사업계획에 활용할 수 있으며, 지속적으로 수집되는 손상감시자료는 손상예방프로그램의 효율성을 감시 하고 평가하는데도 활용될 수 있다.

• 보건행정학회지
• /
• 제20권4호
• /
• pp.19-44
• /
• 2010

This study was conducted to investigate the changes in patterns of Daegu- and Gyeongbuk-based patients' use of medical care facilities located in Seoul. The 'Patient Survey' data issued by the Ministry of Health and Welfare for 2002, 2005, and 2008 were used. Among all discharged patients residing in Daegu and Gyeongbuk, 133,456 who used medical facilities in Daegu, Gyeongbuk, and Seoul were selected. Among patients residing in Daegu, 2.2% used medical facilities in Seoul in 2002, 3.7% in 2005, and 3.5% in 2008. The corresponding rates among patients living in Gyeongbuk were 5.6%(2002), 7.1%(2005), and 7.3%(2008). Regarding the ICD-10 disease groups, the use of medical facilities in Seoul by patients residing in either Daegu or Gyeongbuk increased in 2005 right after the introduction of the KTX high-speed train service, covering various disease groups, but decreased again in 2008. 'Neoplasm' cases, however, showed a progressive rising trend during the years studied. Multivariate data analysis for the three years showed that sex, age, payment type, hospital type, residence, year, and disease groups were all significantly associated with the utilization of medical facilities in Seoul. The major results are : First, use of medical facilities in Seoul by Gyeongbuk patients was 2.4-fold higher than that by Daegu patients, but with respect to 2005 and 2008 vs. 2002, use of medical facilities in Seoul by Daegu resident patients' showed a larger increase than that by Gyeongbuk's patients. Second, for patients residing in the two regions, use of medical facilities in Seoul was highest for 'congenital malformations, deformations and chromosomal abnormalities', followed by 'neoplasms'. Third, for patients residing in the two regions, general hospitals comprise the primary factor in the use of medical facilities in Seoul. The study shows that local medical facilities should individually exert more efforts to improve the quality of their medical services. Relevant authorities should likewise help these facilities develop their own unique services and respective specialization.

• 보건행정학회지
• /
• 제29권3호
• /
• pp.374-378
• /
• 2019

After the announcement of Moon Jae-in Government's plan (Moon's Care) for Benefit Expansion in National Health Insurance in August 2017, it is necessary to monitor the effects of the policy, especially household out-of-pocket payments (OOP). This paper aims to observe the current status and trend of OOP in Korea. Current health expenditure (CHE) was 144.4 trillion won in 2018, which accounts for 8.1% of gross domestic product (GDP) increased 9.7% from the previous year. Although GDP's share of CHE has been close to the average of the Organization for Economic Cooperation and Development (OECD) countries, the public fund's share was 59.8% of the total in 2018, which was lower than the OECD average of 73.5%. OOP's share was 32.9% in 2018, which decreased from 37.4% in 2008. The share of OOP of non-covered services was 20.0% in 2018, which decreased from 22.9% in 2008. The share of cost-sharing with third-party payers was 12.9% in 2018, which decreased from 14.5% in 2008. The OOP of non-covered services was significantly decreased in hospital and inpatient curative care, but the OOP of non-covered services was significantly increased in the medical clinic. The effect of Moon's Care was not showed in OOP through the results of 2017 and 2018, but further monitoring is needed because the Moon's Care is progressing and the observational period is short.

• 보건행정학회지
• /
• 제20권1호
• /
• pp.103-124
• /
• 2010

산재보험의 목표는 업무상 재해 및 질병으로 인한 수입상실에 대한 실질적 보상이 이루어지도록 하는 데 있으나 실제 산재환자들이 요양급여를 제공받는 과정에서 환자본인부담을 지불해오고 있었다. 그럼에도 불구하고 이제까지 산재환자의 본인부담에 대해서는 주의를 기울이지 못하였다. 따라서 본 연구에서는 산재환자 본인부담 발생률 및 본인부담률에 어떤 요인이 영향을 미치는지 파악하고자 하였다. 본 연구는 2009년 5월 퇴원 또는 외래방문 환자 중 의료기관 종별과 지역의 도시화정도를 고려하여 추출된 총 204개(양방 187개 치과, 한방 17개) 의료기관을 대상으로 조사하였다. 회수율이 57.8%(양방 57.2%, 치과, 한방 64.7%)로 총 24,826건(입원 2,457건, 외래 22,369건)이 분석에 이용되었다. 분석결과 본인부담의 발생률은 9.9%였고 본인부담률은 전체건 중에서는 3.5%, 본인부담 발생건 중에서는 8.3%로 나타났다. 본인부담률은 의료기관 종별로 차이를 보였다(산재의료원 : 전체건 0.5%, 본인부담 발생건 2.5%, 종합병원 : 전체건 4.4%, 본인부담 발생건 9.5%, 한방 : 전체건 24.4%, 본인부담 발생건 25.2%). 다수준 분석결과 본인부담의 발생은 주로 종합병원급 이상의 규모가 큰 의료기관과 서울 등 대도시에 소재한 의료기관에서 주도되는 경향을 보였고, 환자의 입원일수가 증가함에 따라 본인부담의 발생이 증가하는 것으로 나타났다. 종합병원급 의료기관에서 발생한 본인부담은 주로 입원료와 선택진료료의 비중이 큰 것으로 나타났다. 따라서 대도시에 소재한 규모가 큰 의료 기관을 우선으로 하여 본인부담 발생률 및 본인부담률을 줄이기 위한 대책이 마련되어야 한다.

• 한국환경보건학회지
• /
• 제48권1호
• /
• pp.1-8
• /
• 2022

Objectives: The purpose of this study is to reveal the circumstances under which the cases of harm to health caused by humidifier disinfectant were neglected and show the points where the number of victims and the degree of damage could have been reduced. In addition, it attempts to describe how damage management proceeded immediately after the incident and actually exacerbated the damage. Finally, it explores the unfortunate aspects of the recent trial. By doing so, it attempts to take this as an opportunity to consider whether a tragic event such as the humidifier disinfectant incident could occur in the future. Methods: This study collected and analyzed data on chemical material characteristics related to humidifier disinfectants, data on health effect characteristics, data on related laws and regulations from the Ministry of Environment, data related to the damage investigation by the Korea Environmental Industry and Technology Institute, and current contents. Results: The lack of related systems and laws is the area where the greatest responsibility for the cause of the humidifier disinfectant disaster falls, so it is difficult for the government to escape this responsibility. Establishing a dedicated department to identify the prevalence of certain diseases within the functions of the Health Insurance Review and Assessment Service to monitor health can greatly contribute to the prevention and management of diseases through early detection and management of group outbreaks caused by harmful factors. Humidifier disinfectant damage relief should have been expanded earlier beyond HDLI (humidifier disinfectant lung injury) to include non-specific diseases such as asthma, pneumonia, and interstitial pneumonia. The scope of relief benefits should have also been expanded earlier to include the payment of disability benefits. Fortunately, with the 2020 revision of the Special Act, the conditions for estimating causal relations were eased and individual screening systems such as health impact assessment were reorganized along with the introduction of a rapid screening system. Conclusions: The management system for chemical substances in a country is clearly of paramount importance, and the ministry in charge must have a response system in case of damage to health effects. Administration that looks at the victims' situation from their point of view is needed, and technical countermeasures are required to quickly recognize the prevalence of certain diseases.

• Journal of Preventive Medicine and Public Health
• /
• 제22권4호
• /
• pp.555-577
• /
• 1989

각급 의료기관에서 정상분만 개조와 제왕절개 분만시 시행하는 임상병리 검사 와 시술 그리고 투약의 종류, 입원기간, 의료비를 비교하여 봄으로써 적정진료에 대한 평가와 적정의료비에 대한 연구의 방향 설정에 필요한 자료를 얻고저 1989년 1월 15일부터 2월 15일 사이에 1개직할시내 2개 대학병원, 2개 종합병원, 3개 병원, 2개 개인산부인과의원 그리고 2개 조산소에서 분만한 산모 789명을 대상으로 의무기록지와 의료비 계산서를 이용하여 임상병리검사, 투약, 입원기간, 입원비 등을 비교분석 하였다. 총 분만건수 중 정상분만은 606명(76.8%)이었고 제왕절개분만은 183명 (23.2%)이었다. 정상분만의 경우 CBC, Hb/Hct, 혈액형검사, 매독검사(VDRL), B형 간염 항원 및 항체검사, 그리고 소변검사는 각 의료기관에서 일률적으로 시행하였으나 개인의원과 조산소에서는 B형간염 검사와 Hb/Hct 검사를 전혀 하지 않은 곳도 있었다. 그 외 1개 대학병원에서는 71.4%에서 초음파 검사를 하였고 또 1개 종합병원에서는 76.7%에서 간기능 검사를 시행하였다. 제왕절개분만의 경우는 정상분만시 실시하는 검사 이외에 대부분 흉부X-선 촬영과 출혈시간 및 혈액응고시간 그리고 간기능 검사를 일률적으로 시행하였다. 시술에 있어서는 각 의료기관이 정상분만시 97.2%에서 회음부절개를 시행하였다. 정상분만 및 제왕절개분만시 투여한 수액과 항생제의 종류와 기간에도 의료기관 사이에 큰 차이를 나타내었다. 즉, 어떤 대학병원은 제왕절개 분만 후 전혀 항생제를 쓰지 않는 반면 어떤 종합병원과 병원에서는 모든 환자에게 1-2종의 항생제를 평균 1주일 정도 투여하였다. 또 어떤 의원에서는 제왕절개 분만시 모든 환자에게 전혈을 수혈하는 곳도 있었다. 이 외에도 의료기관에 따라 비타민제제, 지혈제, 자궁수축제, 진통제, 해열제, 소염제, 진정진경제, 소화제, 변비완화제, 항히스타민제, 이뇨제 등을 투여하는 빈도와 약품종류가 다양하였다. 입원기간에 있어서는 정상분만의 경우 평균 입원기간이 초산은 2.6일, 경산은 2.4일로 초산이 경산보다 약간 길었으며 어떤 병원에서는 3.5일로서 약간 긴 경우도 있었으나 대체로 비슷한 양상이었다. 제왕절개 분만에 있어서는 평균 입원기간이 초산 7.5일, 경산 7.6일로 별다른 차이는 없었다. 그러나 의료기관에 따라 가장 짧은 것은 6.5일에서 가장 긴 것이 9.4일로 차이가 났다. 평균 입원비는 일반환자인 경우 정상분만의 초산 비용은 182,100원이었고, 경산은 167,300원이었다. 의료보험인 경우 본인 부담액이 초산은 82,400원, 경산은 75,600원이었으며 제왕절개분만은 일반환자 초산인 경우 946,500원, 경산은 753,800원이었고, 의료보험인 경우 초산은 256,200원, 경산은 253,700원이었다. 대학병원간에도 정상분만 비용이 268,000원과 350,000원으로 큰 차이를 보이며 제왕절개 분만의 경우에도 각 의료기관별로 차이를 나타내고 있다. 이와 같이 의료기관에 따라 정상분만과 제왕절개분만시 임상병리검사, 투약 등에 큰 차이를 나타내고 입원기간에도 차이가 있어 결과적으로 의료비에도 큰 차이를 나타내고 있으며 어떤 기관에서는 포괄수가제를 적용하고 있는 곳도 있었다. 따라서 적정의료 제공을 위해 진료의 내용을 어느 정도 표준화 할 필요가 있다고 생각한다.

• 지역사회간호학회지
• /
• 제13권1호
• /
• pp.182-196
• /
• 2002

The purpose of this study was to provide the basic resources for developing a parish nursing program. We did this by investigating what demands were made on the parish nursing service by the parishes or churches under review. The subjects of this study were 96 pastors located throughout the City of Busan. NP (New paragraph) $\gg$ We conducted our research by utilizing a modified version of the study created by Hwang (2000) and by using the help of prior research and professionals gathered from the parish nurse questionnaire by Djupe (1990). The data in this study were collected from July 1 to Oct. 31, 2001, using the questionnaire method. The Data were analyzed by: (a) frequency: (b) percentage: (c) mean: (d) standard deviation, and x^2-test$ with SPSS/PC program. The study has found the follows: 1. For subjects making demands on the parish nursing service, 95.8% were in need of using the services of parish nurses. On the demands of parish nursing service for the subjects, 95.8% the necessity of parish nursing services. And they answered by their intention of asking for parish nursing service practice. 2. Of the subjects under review, 71.9% were part-time workers and 28.1% were full-time employees 71.9% of part time and 28.1% of full times duty. In terms of the method of pay for work, 41.8% were pay free or freelance while 51.2% were on salary. And engagement intention of parish nurse as preacher was 88.5%. 3. The demand for nursing services in various categories were as follows. (a) hospice care: (4.02 1.11), (b) health screening: (3.98 1.09), (c) home visiting: (3.97 1.16), (d) group health education: (3.81 1.12), (e) organization of volunteer groups: (3.75 1.12), (f) individual health education: (3.75 1.14), (g) advice on choosing hospital or hospital consultation: (3.69 1.21) and (h) individual counseling: (3.51 1.31). 4. In terms of the specific services rendered by parish nurses. our study found that services were needed for the following: physical symptom management; preparation before death in spiritual preparation for death, blood pressure check in health examination, home visiting where the patient makes phone call, management of chronic disease in group health education, disease management in individual health education, advice on choosing hospital, or hospital consultation: and physical problems in individual counseling. 5. With respect to whether there was a correlation between what church a pastor came from and the types of demands made, there was NO significant difference found. 6. In relation to the characteristics of the subjects and their church and the hope demands (duty pattern and method of payment and engagement intention of parish nurse as preacher) for parish nurses, these had non significant differences. In conclusion, the perception of parish nursing service is very high. Moreover, we found that there is a great demand for well ordered parish nursing services to promote the health of each congregation. Before doing so, it would be better to make things known and to consider the relevant characteristics shown in the researched results.

• 한국보건간호학회지
• /
• 제12권1호
• /
• pp.132-146
• /
• 1998

This Study was attempted to provide the basic data necessary in the development and introduction of Home Health Nursing System by investigating the recognition and attitude level of Home Health Nursing System. The data were collected by means of questionaires presented to 74 patients who had been admitted in C general hospital in Chon Ju, from June 30, 1997. As the tool for this study, the questionares developed by Kim Yong. Soon, et al (1990) and Han Bok Hee(1993) were modified and supplemented for the aim of this study. The computer was used for data analysis. The items about the charateristics of the subjects and the attitude to the management plan of Home Health Nursing System were represented as the frequency and percentage. The standard deviation and calculation average were produced on the items related to definition, recognition, necessity, expected effect of the attitude of Home Health Nursing System and the items related to admission. The ANOVA test was .used according to the characteristics of variables to analyze the necessity and difference of Home Health Nursing System. The results of this study were as follows 1) The general characteristics of the subjects were as follows ; for sex, man, $58.1\%$ ; for age, 50-59 years, $29.7\%$ ; for the level of education, high school, $51.4\%$ ; $79.7\%$ of them were married; for the family forms, small family, $73.0\%$ ; and $68.9\%$ of them take the monthly income over 100 million won. 2) The characteristics related to admissions of the subjects were as follows ; for clinic, surgical department, $78.4\%$ ; addmission not more then 7days, $47.3\%$ ; for the operation-performance $71.6\%$ of them were experienced; for the admission route, via outpatients clinic, $54.1\%$ ; for waiting period to the admission day, 1-2 days, $71.6\%$. 3) The difficulties comming from the hospitalization were related mostly to the factor that they felt hospital life more inconvenient than home.(3.66) The reasons for the difficulties in the admission which was due to insufficient beds in the hospital was related to the concentration to the general hospital because of 'The Whole National Medical Insurance System'(4.05). 4) On the previous informations about the Home Health Nursing System, those who have heard of only the name were 42 $(56.8\%)$, and on the recognition of it, they thought that it is periodic treatment by the licenced nurses for the recovering pateints after early discharge(3.73). On the attitude about the necessity of Home Health Nursing System, they thought that it is necessary because of the increasing trend of a psychological disease by the change of environment and complexity of the social structure(4.24). On the expected effect of Home Health Nursing System, they answered that it is convinient for the family of the patient to take care of them(4.l8). 5) On the attitude to the management plan of the Home Health Nursing System, those who had intention to participate in the system in the case of systemic support were 42(56.8). In the visiting time, 'visit periodically' and 'visit when the patient needs' were $28(37.8\%)$ respectively. For the application of medical insurance, if possoble, they will use $(91.9\%)$; for the method of payment for the treatment, 'pay by the time required' was $23(31.1\%)$, for the subject of management, 'National public institute must operate' was $33(44.6\%)$. 6) The relationship between the general characteristics of the subjects and the necessity of Home Health Nursing System showed the notable difference in the age (F=3.508, P<0.05) and marrage state (F=5.402, P<.023).

• 간호행정학회지
• /
• 제2권1호
• /
• pp.125-139
• /
• 1996

Organizational commitment is characterized by a strong belief in and acceptance of the organization's goal and values ; a willingness to exert considerable effort on behalf of the organization ; a strong desire to maintain membership in the organization. The purpose of this study was to identify the variables which influence the organizational commitment and to test the relationship between the clinical nurses' organizational commitment and turnover intention. The subjects were 412 nurses who were working on general wards at three General Hospitals in Chounbuk. The data were collected by self-reporting questionnaire from Sept. 20 to Sept. 31, 1995. The instruments used in this study were Likert-type scale which were Organizational Commitment Scale by Mowday et al, and Turnover Intention Scale by Mobley et al. The questionnaire of organizational characteristics was made through reviewing literature. The data were analyzed by frequency, percentage, t-test, one-way ANOVA, Scheffe test, Pearson's correlation coefficient, and stepwise multiple regression with $SPSS-PC^+$ program. Major findings are as follows : 1. Mean scores for organizational commitment were 3.008 and turnover intention 3.167 on a 5 point scale. 2. Age and clinical experience were positively related to organizational commitment(r=.4806, p=.000; r=.4792, p=.000). 3. In the personal variables, hospital type(F=21.374, p=.000), education level(F=5.481, p=.001), position(F=30.867, P=.000), and marital status(t=-5.63, p=.000) of the nurses showed significant differences in organizational commitment. 4. The variables to the organizational characteristic were statistically significant in organizational commitment : formalization(r=.3458, p=.000), human-centered organizational characteristic(r=.4302, p=.000), performance- centered organizational characteristic(r=-.1502, p=.000), payment(r=.2234, p=.000), promotion(r=.2710, p=.000), benefit & service(r=.2325, p=.000), and resource inadequacy(r=-.2172, p=.000). 5. For the purpose of identifying the predicting variables in organizational commitment, stepwise multiple regression is conducted. The results show that age, human-centered organizational characteristic, formalization, hospital type, resource inadequacy, promotion, and benefit & service were significant variables and explained 46% of the variance. 6. Organizational commitment was significantly negatively correlated with turnover intention(r=-.6442, p=.000). As a result of stepwise multiple regression analysis, organizational commitment is the most powerful variable predicting turnover intention and explained 41.5% of the variance. In conclusion, this study shows that the higher the organizational commitment level, the lower the turnover intention. Therefore, for effective turnover management, it is important to improve the organizational commitment among clinical nurses. In order to enhance the organizational commitment by the clinical nurses, it will be useful to consider significant organizational characteristics variables identified in this study.

• 대한간호학회지
• /
• 제30권6호
• /
• pp.1455-1466
• /
• 2000

The purpose of this study was to develop the framework of community-based home care nursing delivery system, and to demonstrate and evaluate the efficiency of it. The study was carned out over a period of 3years from September 1996 to August 1999. The researchers developed Standards for operations, this was all aimed toward a home care recording system, and an assessment intervention algorithm for various diseases quality control and standardization. In the center, 185 patients enrolled, and of the enrollments cerebrovascular disorder and cancer were the most prevailment diseases. Also, a home care nursing activity classification was developed in six domains. Those domains were assessment, medication, treatment, education and consultation, emotional care, and referral or follow-up care. Ten sub-domains were divided according to the systematic needs. Among these nursing activities, treatment, assessment, and education and consultation were frequently performed. In sub-domain classification, skin integrity, respiration, circulation, and immobility related care were provided most frequently. The cost of home care nursing per visit was also suggested. The cost include direct and indirect nursing care, management, and transportation cost. Also, the researchers tried to overcome the limitations of hospital-based home care to provide more accessible, efficient, safe, and stable home care nursing. Therefore, clients were referred from other patients, families, public health care centers, industries, and even hospitals. As a result of this study, several limitations of operation were found. First, it was difficult to manage and communicate with doctor in the emergency situations. Second, there was too much time spent for transportation. This was because they are only five nurses, who cover all of the areas of Seoul and nearby cities. Third, preparation for special care of home care nurses was lacking. Fourth, criteria for the termination of care and the frequency of home visits were ambiguous. Finally, interconnection with home care machinery company was so yely needed. New paragraphs' strategies for solving these problems were suggested. This study will be the basis of community-based home care nursing, and the computerized information delivery system for home care nursing in Korea.