• 의료법학
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• 제19권2호
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• pp.139-171
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• 2018

「의료사고 피해구제 및 의료분쟁 조정 등에 관한 법률」(이하 '의료분쟁조정법'이라 한다)에서는 보건의료인이 충분한 주의의무를 다하였음에도 불구하고 분만 중 불가항력적으로 발생한 의료사고에 대하여 국가가 예산의 범위 안에서 그 피해자에게 보상하도록 하고 있다(의료분쟁조정법 제46조). 지금까지 의료사고 피해자가 소송을 통해서만 피해회복을 기대할 수 있었던 것에 비한다면 획기적인 법률이라 할 수 있다. 그런데, 이러한 의료사고보상사업에 드는 비용의 100분의 30은 보건의료기관개설자 중 분만 실적이 있는 자가 부담하고 있는 바(의료분쟁조정법 시행령 제21조), 이 분담금 부과 조항이 분만 과정에서의 산모·신생아 사망 등의 사고가 의사의 과실이 없이 불가항력적으로 발생했음에도, 의사들에게 책임을 묻는 것은 아닌지 문제가 되어 왔다. 그러나 최근 헌법재판소에서 분담금 부과와 관련한 의료분쟁조정법법 제46조 제3항 중 '보건의료기관개설자의 범위' 및 '보상재원의 분담비율' 부분에 대하여 합헌 결정을 내린 바 있다(헌법재판소 2018. 4. 26. 선고 2015헌가13 결정, 이하 '이 사건 결정'이라 한다). 이 사건 결정에서는 법률유보원칙 및 포괄위임입법금지원칙에 의하여만 판단하였으나, 본고에서는 실질적인 판단도 가미하였다. 이 사건 분담금운 과잉금지원칙에 비추어 보더라도 보건의료기관개설자들의 재산권을 침해하지 않는 점을 논증하였다. 불가항력 의료보상제도의 분담금 부과가 민사책임의 중요 원칙인 과실책임원칙에 거스르는 측면이 존재한다. 그러나 의료사고보상사업은 의료사고 피해자를 위한 국가정책으로 합리성이 있으며, 동시에 의료분쟁의 조기종결 효과로 의료계 역시 이익을 얻는 측면이 분명 존재한다. 분담금의 납부를 통한 보상재원의 확충은 이러한 의료사고보상제도를 빠르게 정착시킴으로서 분만과정에서 발생한 의료사고 피해자의 고통과 오해를 경감시키고 의료인의 안정적 진료환경 구축에 큰 도움이 될 것이다.

• 보건행정학회지
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• 제34권2호
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• pp.120-128
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• 2024

2024년 2월부터 현재까지 의과대학 입학정원 확대를 두고 논란이 계속되고 있다. 이런 논란은 현재와 미래의 시점의 문제가 혼합되어 논란을 더 가중하고 있다. 현시점에서 의사의 인력부족 여부에 대한 논란은 다양하다. 동일한 근거가 의사 부족 또는 부족하지 않은 근거로 제시되기도 한다. 부족하다는 근거로 제시하는 것에 대해서도 이견이 많으며 그 반대의 근거도 이견이 많다. 현시점에서 의사 부족 여부를 둘러싼 이런 논란은 합의될 가능성이 그리 크지 않다. 10년 후에는 노인인구의 급격한 증가로 인해 의사가 더 필요하게 될 것이므로 의과대학 입학인원을 늘려야 할 것이다. 그러나 그 숫자는 의학교육의 질이 저하되지 않을 수준이어야 한다. 이를 위해 의학교육의 질이 높은 의과대학에 더 많은 입학인원을 배정해야 하며, 그 대안으로 대규모 의과대학은 입학인원을 20%-30% 늘리고, 소규모 의과대학은 입학인원을 40%-50% 늘리면 전체 증가인원은 760-1,066명이 되는 것이다. 2,000명 증원이 강행된다면 의학교육의 질을 면밀히 평가해 그 결과를 의과대학 정원 조정에 반영해야 할 것이다. 20년 후에는 의과대학 입학정원을 줄여야 한다. 이는 의사공급이 1차함수로 증가할 것인데 반해 의사수요(의료수요)가 꼭지점이 있는 2차함수로 변화하고 있기 때문이다. 현재의 인원을 유지하더라도 2048년부터는 의사가 과잉되기 때문에 의과대학 입학인원을 줄여야 하며, 규모는 현재보다 1,000명이 적은 2,000명 정도로 축소해야 할 것이다. 정원 축소 시 모든 의과대학에 일률적으로 축소한다면 소규모 의과대학이 많아지기에 M&A (mergers and acquisitions) 전략을 적용해야 할 것이며, 그 대상은 40개의 의과대학과 12개의 한의과대학이어야 할 것이다. 우리나라의 경우 의사수요 추정에 가장 큰 영향을 미치는 요인은 인구 변화이다. 합계출산율의 급격한 감소로 인해 향후 인구 전망은 불확실성이 상당 수준 있으며, 최근 의료이용률의 급격한 증가가 반영된 수급추계는 재검토되어야 한다. 의사 수급추계의 불확실성으로 인해 의사 수급추계는 최소한 5년 단위로 지속적으로 실시되어야 하며, 이를 위해 보건의료인력검토위원회를 설치 운영해야 한다.

• Journal of Acupuncture Research
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• 제23권6호
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• pp.239-254
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• 2006

The 3rd Japan-Korea Workshop on Acupuncture and EBM was held at Kanazawa on June $16^{th}$. From Korea team, 4 papers were presented. Dr. Hahn introduced a new approach of data analysis on series of n-of-1 trials using the Bayesian statistics. It offered important information for the future n-of-1 trials. Dr. Park clearly demonstrated the significance of various sham devices proposed and stressed the importance of research questions when we choose the control intervention in RCT. Dr. Lee reported the results of survey in Korean Medical Doctors (KMD) for their point selection and techniques to the distal and local points. Dr. Kim presented the results of face to face survey on the KMD with 28 items for acupuncture treatment on the knee OA. Finally, a draft of protocol was introduced by Dr. Kim. The title was "multi-center, a randomized, single blinded, two arms, parallel-group study to compare the effectiveness and safety of 'individualized acupuncture' and 'standardized minimal acupuncture' in Korean and Japanese patients with knee osteoarthritis (Phase IV)". From Japan team, 7 speakers presented their comments and proposals on the protocol. Dr. Takahashi introduced several issues regarding n-of-1 trials and pointed out the importance of obtaining generalizability from n-of-1 trials. Dr. Shichidou pointed the importance of research design, selection of outcome measures and reduction of biases. Dr. Itoh presented the results of point selection for the knee OA based on the literature survey. Dr. Sumiya introduced several differences between KMD and Japanese acupuncturists based on the questionnaire used in KMD survey. Dr. Furuya demonstrated a result of press tack needle and its sham device on shoulder stiffness. Dr. Yamashita introduced the results of literature survey regarding adverse events occurred by acupuncture on knee OA. Dr.Tsukayama stressed the importance of responsibility of Institutional Review Board (IRB) for the conduction of clinical trials. After several issues were discussed, the need of continued meeting for final protocol development was agreed, then the workshop was closed.

• 보건행정학회지
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• 제16권4호
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• pp.48-67
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• 2006

The aim of the study was to examine levels of satisfaction with health care in North Korea and to identify factors associated with it using a convenience sample of North Korean refugees in China. Data from the 2004 Survey of Health Seeking Behavior of North Korean Households conducted by the Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health were used. The study subjects were 273 North Korean refugees whose length of stay in China was less than 3 months. Factor analysis was used to extract factor dimensions from the 12 satisfaction items. Bivariate (t test and ANOVA) and multiple regression analyses were used in examining factors associated with satisfaction with health care use in North Korea Overall, satisfaction level was low ($2.36{\pm}0.36$, score range: 1-5). Of the three-factor dimensions, physician skills scored the highest $(2.93{\pm}0.36)$, followed by drug availability $(2.51{\pm}0.07)$ and general cleanliness $(1.66{\pm}0.55)$. In the multiple regression analysis, having a usual source of care was significantly associated with patient satisfaction. Respondents who identified primary care (section) doctors as their usual source of care tended to be less satisfied than those with the city or county hospital as their usual source of care. County residents tended to report a lower degree of satisfaction with general cleanliness than city residents. Among socioeconomic characteristics, the number of household assets positively predicted satisfaction with drug availability. North Korean residents appear to be dissatisfied with their medical care. It may reflect some inadequacies in the North's universal health care system to meet the healthcare needs of its people.

• Journal of Acupuncture Research
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• 제17권1호
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• pp.27-41
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• 2000

The meridian system is the most essential and basic connecting structure that maintains the vital activities of viscera and bowels by connecting them with each part of body's surface. Doctors can understand the healthy condition, and the region and deficiency-excessiveness of disease by observing the condition of Qi flowing. Deficiency and excessiveness could be differentiated by various symptoms expressed in meridian system. Especially there could be several clues like pain, heat-cold, protuberance-depression, change of color and shine in the line of channel leads to the judgment of deficiency-excessiveness The diagnosis of deficiency and excessiveness can be generalized by quantification of elastic status in skin surface along the meridian system. By comparing data from measurement of elastic condition with those from traditional deficiency and excessiveness, it could be utilized for the development of oriental medicine. All biological activities in the human body are based on meridian system according to the oriental medicine. Also the meridian system is viewed as basic and essential structure connecting internal viscera and each part of body. The areas of expressed channel phenomena are muscle to bone, muscle to muscle and bone to bone. These areas are called depression where meridian system is present and any changing state on those points can be measured. It could be difficult in diagnosing the reaction of meridian system because doctor can depend on his own judgment. Therefore, it is necessary to quantify and indexate channel reactions. To quantify the channel reactions, specially manufactured instrument was used to quantify the protuberance and depression to differentiate the deficiency and excessiveness. The results follow as below; 1. The elastic index measurement by the equipment proved a pattern of agreement showing the values that ranged within standard deviation 0.05kgf/cm throughout the experiment except few cases' measurement in CV-17. 2. To evaluate the state of deficiency & excessiveness of elastic index measurements in frontal point, elastic index measurements in the front paint were compared to the elastic index measured surrounding the point within 2.5 cm. Such result of indexing procedure was closely matched to the concept of palpitation. 3. If the elastic index values in the surrounding front point closely located to the elastic index values in the front point, the judgement on the state of deficiency and excessiveness was delayed. Otherwise, it was judged as deficiency or excessiveness. 4. Out of total 12 cases of comparing the elastic index values to the elastic index values in the surrounding front point, Three to nine front points were judged as either in the state of deficiency or excessiveness. 5. Among the nine front points judged as either in the state of deficiency or excessiveness, Four cases were matched to the electric index measured by EAV that evaluating the internal organs by five different phases. If more clinical cases are accumulated, it is expected to systematically theorize and improve the concept of deficiency and excessiveness in the internal organs using the front point.

• 한국의료질향상학회지
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• 제7권1호
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• pp.118-131
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• 2000

Background : A continuous healthcare quality improvement is needed to provide high quality healthcare service as well as to maintain trust in terms of satisfying the needs of the patients. Recently it also became an essential issue. in hospital management, recognized for it's competitive potentiality among healthcare organization groups. This study was conducted to analyze patient complaints and issues received by the Quality Improvement Department. Its purpose is to improve healthcare qualities within the hospital, as well as establish policies and appropriate strategies in hospital management. Method : From July 1st to September 30th of the year 1999, we analyzed all complaints and issues made by various patients and their families, which were received through 24 hour phone consultation, numerous suggestion boxes, letters and E-mails, The issues were classified into 16 different categories based on a Patient Satisfaction Assessment Tool. All data were segregated according to the departmental frequencies and their contents. To come up with for environmental and patient satisfaction improvement, all complaints or issues were communicated with hospital administrators, medical and nursing staff and employees. Comprehensive customer satisfaction activities including improving phone etiquette were discussed in Customer Satisfaction Team, CQI Team and each Department. All opportunities for improvement were implemented. Feedback actions were discussed. Results : A total of 317 cases were collected. Issues regarding parking and other accommodation facilities were most common complaints that were 14.5% of total. Issues regarding admission rooms (10.7%), admission procedures (10.7%), waiting room environment (8.8%), nurses and nurse assistants (7.6%), physicians (6.6%) and others (23%) followed. Thirteen of 45 departments received more than 8 complaints. The Nursing Department had the most complaint, receiving 9.8% of total complaints. Complaints regarding the Nursing Department were predominantly related to the environment of patient rooms. The Department of Psychiatry for phone etiquette (4.7%), Department of Otolaryngology for the nursing staff's attitude and phone etiquette (4.4%), and the Admission Department followed. As a part of efforts to improve patient satisfaction, a new parking structure was built and reallocation of the parking space was done. Renovation of other accommodation facilities were carried out by hospital administration, Monthly phone call and answering attitude survey was done by QI Department. Based on this survey we made a phone etiquette manual and distributed throughout the hospital. Compare to the last year, Patient Satisfaction Index measured by Korea Productivity Center using National Customer Satisfaction Index was improved 7 points. According to our organization's own study, we confirmed the phone etiquette was improved 11% than last year. Conclusions : Issues related to parking and other accommodation facilities ranked first followed by complaints made regarding the patient care area, the admission and cashier process, and nurses' and doctors' attitude. The Nursing and Psychiatry Departments need improvement regarding phone etiquette. Results were shared and played a vital role in policymaking and strategic planning of the hospital. It is imperative that we keep our database updated by listening to and solving the needs of each patient. The CQI activities can be achieved only by full commitment of the hospital top management supported by related personal.

• Journal of Hospice and Palliative Care
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• 제17권3호
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• pp.170-178
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• 2014

목적: 섬망은 말기암환자에서 생길 수 있는 중요한 합병증으로 임상적으로나 삶의 질 적인 측면에서 매우 중요한 문제이다. 이에 호스피스 병동에 입원한 말기암 환자에서 섬망 발생과 관계된 위험 요인들을 알고자 연구를 시행하였다. 방법: 2011년 5월부터 2012년 9월까지 일개 지역 두개의 종합병원 내 호스피스 병동에 입원한 환자 중 의식이 명료하고 다른 정신과적 질환이나 약물 중독이 없는 환자를 대상으로 전향적으로 추적하여 섬망 발생 여부를 확인하였다. DSM-IV 진단기준에 맞게 2명의 의사에 의해 진단된 경우 섬망군으로 분류하였다. 입원 시 인지기능(mini-mental status examination, MMSE), 우울 점수(Beck depression inventory, BDI), 불안 점수, 불면 척도(Insomnia Severity Index, ISI), 혈액검사 결과와 섬망 발생 여부를 로지스틱 회귀분석으로 비교하고, 유의한 항목에 대해 Cox의 비례위험모형으로 교차비를 구하였다. 결과: 선정기준에 부합하는 연구 대상자 96명 중 41명(42.7%)에서 섬망이 발생하였다. 로지스틱 회귀분석 결과 일차 암 위치, 인지기능 장애(MMSE < 24), 우울($BDI{\geq}16$), 불면($ISI{\geq}15$)의 Odds ratio (OR)이 통계적으로 유의한 결과를 보였다. 이들 4가지 인자에 대해 입력 방법을 이용해 시행한 Cox 회귀분석 결과, 우울의 OR 5.130(95% CI 2.009~13.097), 인지기능저하의 OR 5.130 (95% CI 2.009~13.097)로 나타났다. 결론: 호스피스 병동에 입원한 말기암환자에서 우울하거나 인지기능 장애가 있을 경우 섬망 발생의 위험이 유의하게 높았다. 호스피스 환자에게 우울이나 인지기능에 대한 주의 깊은 관찰이 필요할 것이다.

• Journal of Preventive Medicine and Public Health
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• 제1권1호
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• pp.9-23
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• 1968

A survey was conducted by the staff of the College of Medicine and School of Public Health, Seoul National University in cooperation with Seoul Special City from 1 December 1967 through 28 February 1968, on such events as delivery, death, abortion and pregnancy. The survey directed to a total population of 47,811 residing in 9,157 households led us to the following findings: 1. Two year averages of crude birth rate, crude death rate and natural increase rate were 30.1, 5.6 and 24.5, respectively. 2. Of all deliveries, home and hospital deliveries constituted 61.1 per cent and 35.5 per cent, respectively. 3. Deliveries other than hospital deliveries were found to be attended more often by mother-in-laws (26.5 per cent) than by doctors or midwives(23.4 per cent). 4. About 51 per cent of all women having experiences in pregnancy during the last two years had an experience of consulting a doctor at least one time throughout whole period of pregnancy. 5. In most cases scissors were used to cut umbilical cords, of which 71.0 per cent were not sterilized and only 20.3 per cent sterilized. 6. In many cases placenta was incinerated(48.2 per cent) and on many other occasions it was thrown away into water(28.3 per cent). 7. Cement bags(37.4 per cent), gauze and absorbent cotton(29.8 per cent) were found to be most frequently used to receive new-born babies. 8. In 1966 8. 8 per cent of the women had at least one abortion induced and in 1967 the percentage was 9.2 per cent. 9. Nearly all(95.8 per cent) of the induced abortions reportedly were done at doctor's clinics. 10. Of all the abortions induced 65.3 per cent were done by specialists in obstetrics, 30.3 per cent by general practitioners and 2.7 per cent by midwives. 11. Those who experienced spontaneous abortions were 1.9 per cent of all women both in 1966 and 1967. 12. About 9.2 per cent of women investigated were found to be currently pregnant. 13. Age specific death rate turned out to be highest among those under 1 year of age. 14. Ten major causes of death in their order of frequency were: 15. Places of death can be classified into homes(75.3 per cent) and hospitals(13.2 per cent). 16. Method of disposing of corpses comprised burials(54.2 per cent) and cremations(44.6 per cent). 17. Infant, neonatal and hebdomadal mortality rates have been computed at 32.2, 18.9 and 13.7, respectively. 18. Infants were found to have died either at homes(81.5 per cent) or at hospitals(18.5 per cent). 19. Birth registrations had been done for about 18.5 per cent of the dead infants.

• Pediatric Infection and Vaccine
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• 제22권3호
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• pp.136-142
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• 2015

대한소아감염학회는 2015년 우리나라에서 처음으로 중동호흡기증후군(Middle East Respiratory Syndrome, MERS, 메르스) 환자가 발생하여 보건의료 응급 상황 발생의 긴박했던 시기에 이에 대한 대처에 참여하였다. 우리 학회는 메르스 발생 시 학회 홈페이지에 관련 공고문을 즉시 게시하였고 소아청소년에서의 메르스 환자의 발생시 의심 환자의 검사와 진단 및 국민안심병원 운영을 위해 소아청소년 MERS (중동호흡기) 검사 지침, 국민안심병원 소아청소년과 운영지침을 발빠르게 배포하였다. 이는 메르스 의심환자에 대한 접근에서 소아청소년에서 흔한 호흡기 질환 환자들이 메르스로 오인되어 불필요한 공포, 검사 및 격리를 당하지 않도록 하기 위함이었다. 이를 통해 소아청소년 환자를 진료하는 의사들과 이들의 보호자들을 안심시켰고 결국 많은 심리적 공포와 의료 비용을 감소시켰으며 메르스 종식 시 돌이켜보니 이는 결국 적절한 조치와 가이드라인이었음이 증명되었다. 앞으로 대한소아감염학회와 회원이 유관기관과 긴밀한 협조와 소통을 할 수 있는 체계 시스템을 구축해야 하며 상급의료기관의 소아청소년 감염전문의 필수 상주 및 이에 의한 감염관리료 제도 장착과 수가 신설 및 개선을 유도하는 등의 추진이 필요하다.

• 핵의학기술
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• 제22권1호
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• pp.98-102
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• 2018

소화기계 Leakage환자 검사 시 Planar 영상만으로 담즙누출 및 출혈여부와 위치감별이 쉽지 않다. SPECT-CT를 이용하여 담즙누출 및 위장관출혈 확인과 위치 감별을 통한 유용성을 평가하고자 한다. 본원에 내원한 환자 중 담즙누출 의심 환자 8명 및 위장관출혈이 의심되는 환자 5명, 총 13명을 대상으로 Planar영상 획득 후 판독실요청에 따라 SPECT-CT를 진행했다. 장비는 SIEMENS사의 Symbia T16과 GE사의 Discovery 670을 사용했다. Planar 및 SPECT-CT 영상은 4명의 경험 있는 핵의학 의사에 의해 1~10점의 점수로 평가했다. 민감도 및 특이도를 이용하여 ROC 곡선에 의한 검사 평가를 시행했다. 최종 진단은 재수술 결과 및 추적 관찰을 통해 확인했다. SPECT-CT의 민감도, 특이도 및 정확도는 각각 91.7%, 100% 및 94.2%였다. Planar영상은 각 각 83.3%, 68.8% 및 78.8%였다. Planar영상은 SPECT-CT와 비교하여 낮은 진단 정확도를 보였다(78.8%, 94.2%, p<0.05). 또한 ROC곡선 분석에서 SPECT-CT의 진단 신뢰도는 Planar영상보다 유용한 결과를 나타냈다(p<0.05). SPECT-CT는 담즙누출 및 위장관출혈 진단과 위치 감별에 민감도와 특이도가 높게 나타났다. Planar영상과 함께 SPECT-CT를 추가로 시행한다면 담즙누출 및 위장관출혈 환자의 진단과 위치 감별평가를 향상 시킬 것으로 사료된다. SPECT-CT는 다른 장기와의 중첩으로 진단이 어려울 경우 유용성이 있지만 추가적인 CT피폭에 대한 고려는 충분히 이루어져야 할 것이다.