• Journal of Hospice and Palliative Care
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• 제20권1호
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• pp.8-17
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• 2017

종합적인 보건시스템을 지원하기 위한 완화의료정책의 개발과 강화가 세계적으로 강조되고 있다. 우리나라에서는 암정복 10개년 계획과 국가암관리종합계획의 기틀 하에 암정책의 일환으로, 호스피스완화의료정책이 시행되어왔고, 2003년 암관리법(Cancer Control Act)을 제정하여 법적 근거를 마련하였으며, 최근 호스피스 완화 의료 및 임종과정에 있는 환자의 연명의료결정에 관한 법을 제정하여 시행할 예정이다. 호스피스완화의료정책의 대상은 최근 관련법의 제정에 따라, 말기암환자에서 암(Cancer), 후천성면역결핍증(Acquired immune deficiency syndrome, AIDS), 만성 폐쇄성 호흡기질환(Chronic Obstructive Pulmonary Disease, COPD), 만성간경화(Chronic Liver Disease/Live Cirrhosis) 등으로 확대되었고, 급여체계는 2015년에 모든 의료기관에 일당 정액수가와 행위별 수가의 복합지불방식으로 완화의료 건강보험제도가 시행되었다. 전달체계관련 건강보험제도는 입원형과 자문형, 그리고 가정형으로 구분되고, 완화의료전문기관의 지정 평가 지원제도가 운영되고 있으며, 재원체계는 건강보험기금과 국가지원금으로 조달되고 있다. 호스피스 완화의료 관련법의 시행에 앞서, 정책대상의 사회적 합의가 요구되며, 낮은 급여체계의 현실화, 민관협력을 통한 호스피스완화의료 표준설정과 전문요원양성, 질 관리 및 평가체계정립, 그리고 장기요양보험과 호스피스기금 등을 활용한 안정적인 재정체계를 마련해야 할 것이다.

• 약학회지
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• 제49권6호
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• pp.449-458
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• 2005

There have been rapid changes in the pharmaceutical environment after the separation of Dispensing and Prescribing practice. In the early stage of this system, outpatients had few options to choose their pharmacies due to various obstacles. Under these circumstances, this study on the defection tendency of long-term care patients was performed through the analysis of outpatients who quit visiting a pharmacy nearby general hospital. PowerBuilder ver 9.0 program was used to extract significant data, and SPSS package was employed for statistic analysis. 3,308 outpatients who visited a pharmacy nearby hospital for a month (in January, 2004) were studied. Patients' sex, age and location of residence, the class of medical insurance, the characteristic type of medication (powder, split form, medication for external use/injection), waiting time, disease (department) were considered as variable factors. It turned out that the patient revisit ratio was 80.8$\%$ and the patient defection ratio was 32.4$\%$. As was expected, those factors mentioned above influenced on the revisit and defection ratio considerably. In terms of patient factors, it proved that there was no relationship among sex, location of residence, the class of medical insurance and revisit (defection) ratio. Only age factor influenced the ratio; the older, the higher revisit ratio and the less defection ratio. In respect of dispensing factors, there were obvious relationships among the factors and the ratio: bill (money they had to pay individually), waiting time, number of medications, splitting of tablets, unit price of drug and revisit (defection) ratio showed significant relationship. The result of this study revealed an aspect of outpatients' behavior and it could be used as a reference for better patient service and customer relationship management.

• 성인간호학회지
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• 제25권4호
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• pp.409-421
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• 2013

Purpose: This qualitative study was designed to explore and describe the nursing staff reported experiences of managing the medical needs of nursing home residents in South Korea. Methods: Using a focus group interview method, qualitative data were collected from March to May 2012. Twenty five registered nurses and nurse aids working in nursing homes were recruited through a convenient sampling method. Participants participated in one of four focus group interviews lasted up to two hours in which their day-to-day experiences of taking care of the medical needs of the elderly residents. All interviews were recorded and transcribed in verbatim, and analyzed according to the qualitative thematic analysis method using MAXQDA software. Results: The overriding theme was 'experiencing differences between the requirements of the regulatory system and the actual reality of the work place.' The findings of differences between what were true and what is required was based in four subcategories. The nursing home residents had far more medical needs than what were reported. Another finding was that the family members were seen as non-supportive and negligent towards the residents. Conclusion: The findings of the study support the need for changes in the regulatory system. The regulatory limitations of current system with a shortage of resources pushed the participants to experience discrepancies between the required regulation and the reality. Additional research could contribute more exemplars to support changes.

• 보건행정학회지
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• 제28권3호
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• pp.195-196
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• 2018

The Korean Academy of Health Policy and Management (KAHPM) has shown remarkable achievements in the field of health policy and management in Korea for the last 30 years. The KAHPM consists of experts in various fields of health policy and management, and has been the leading academic discussion forum for health policy agendas of interest to the public. Health Policy and Management (HPM), the official journal of the KAHPM, published the first issue of volume 1 in October, 1991 and is publishing the second issue of volume 28 as of 2018. Currently, it is one of Korea' main journals in the field of health policy and management. HPM has published a special issue in commemoration of the 30th anniversary of the KAHPM. The HPM invited authors, including former presidents of the KAHPM and current board members, to write about main issues in health policy and management. Although the HPM tried to set up an invited author on all subjects in the health policy and management field, 19 papers are published, that completed the peer review process by August, 2018. The authors of the special issue of the 30th anniversary of the KAHPM include six former presidents, a senior professor, and 12 board members. The subjects of this issue are reform of the healthcare delivery system, health insurance and medical policy, reform of health system governance, the role of National Health Insurance Service (NHIS), the Korea Institute for Health and Social Affairs (KIHASA) and the National Evidence-based healthcare Collaborating Agency (NECA), ethical aspects of health policy change, regional disparities of healthcare, healthcare accreditation, new healthcare technology evaluation system, globalization of the healthcare industry, the epidemiological investigator system, the quarantine system, safety and disaster, and official development assistance. There are some remaining topics to deal with for the KAHPM: aged society, anti-smoking, non-infectious disease, suicide, healthcare resources, emergency medical care, out-of-pocket money, medical fee payment system, medical aid system, long-term care insurance, industrial accident compensation insurance, community-centered health welfare system, and central government and local government of health. The HPM will continue to publish review articles on the main topics in health policy and management. This is because the KAHPM, which has been the leading academic society of Korea's health policy and management for the last 30 years, feels responsible for continuing its mission for the next 30 years.

• 한국콘텐츠학회논문지
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• 제12권12호
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• pp.282-290
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• 2012

현재 우리나라의 재가간호서비스는 보건소의 맞춤형 방문건강관리사업과 의료기관 가정간호사업, 그리고 노인장기요양보험의 방문간호서비스의 독립성과 전문성을 인정하면서, 각 영역간의 연계를 통해 사업의 중복성을 최소화하는 연계방안이 필요한 상황이다. 이에 본 연구는 재가간호서비스의 연계방안을 도출하기 위해 전문가들의 의견을 바탕으로 합의를 이끌어내는 델파이 기법을 활용하였다. 그 결과 제도적 차원의 연계와 의료적 차원의 연계라는 두 영역 안의 총 24개 항목이 연계방안으로 도출되었다. 재가간호서비스의 연계방안으로 도출된 24개의 항목은 재가간호사업 체계의 개선과 제공되는 서비스 질의 향상, 대상자의 만족도 증대 효과를 가져 올 수 있을 것으로 기대되며, 서비스의 중복을 최소화할 수 있는 방안을 모색함으로서 국가적 차원에서 복지 및 국민 건강관리의 효율성을 증대할 것으로 보인다. 이를 통해 궁극적으로 국민의료비의 절감과 더불어 재가간호서비스 증진에 기여할 것으로 여겨진다.

• 한국콘텐츠학회논문지
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• 제19권11호
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• pp.603-618
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• 2019

본 연구는 재가장기요양기관 방문간호사의 간호 경험의 의미와 본질을 탐구하기 위해 van Manen의 해석학적 현상학 연구방법론을 적용하였다. 연구 참여자는 방문간호 경력 1년 이상인 10명의 방문간호사들로 목적적 표집과 편의 표집, 눈덩이식 표집 방법을 통해 선정하였다. 자료 수집은 2017년 1월 7일부터 2018년 10월 12일까지 진행되었으며, 연구 참여자와의 면담은 총 23회에 걸쳐 이루어졌다. 자료 분석은 van Manen이 제시한 해석학적 현상학 방법론에 근거를 두고 전체론적(holistic) 방법과, 선택적(selective) 방법, 그리고 세분법(detailed)을 사용하였다. 연구 결과, 재가장기요양기관 방문간호사의 간호 경험은 6개 본질적 주제와 20개 하위주제로 도출되었다. 본질적 주제는 '대상자 및 보호자와 친밀한 관계를 형성함', '주도적 간호수행으로 방문간호의 기반을 다져감', '지원체계 미비로 원하는 만큼의 간호를 제공하기 어려운 현실에 직면함', '간호의 진정성이 전달되지 않을 때 속상함', '내 환자라는 책임감을 가지고 돌봄의 소명을 다함', '방문간호사로서 보람과 의미를 느끼며 오래도록 일하고자 함'이다. 본 연구는 재가장기요양기관 방문간호사들의 간호 경험을 탐색함으로써 지역사회 내에서 노인장기요양보험 방문간호사의 역할과 중요성을 이해하였다는데 의미가 있다.

• 가정과삶의질연구
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• 제27권1호
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• pp.61-71
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• 2009

The purpose of this study was to resolve the issues of inferior housing environment and the population decrease in rural community by improving the environment and attracting urban inhabitants. A simulation on the costs and the local programs was operated from a point of view that Pension Insurance House with Long-term Lease and a plan for the program in connection with local resources should be accompanied to attract urban inhabitants. The study was carried out through mainly documents analysis and specialists' opinions. The simulation results are as follows. Firstly, the pre-existing rural housing development projects have only emphasized the hardware, while underestimated the post-management with operating programs. The software should be underlined when Pension Insurance House is developed. Secondly, as a result of the simulation on construction expenditure and the operating and maintenance cost for 30 years, about 82.3 million Wons are necessary residential expenses for 15 years per unit. Thirdly, in case of MUJU County, it has made the most of its pre-existing institutions. It's medical institutions provide medical care system with health education, facilities related leisure and culture offer recreational programs and the local community center and its program of each town helps new habitants adopt to the rural life. Additionally, the employment project of a local welfare center allow people living in a rural community to continue their careers with their talents and interests through local class programs for a life worth living. Lastly, guide for getting information of rural life, local community gathering and preliminary education should be carried out to reduce expectant tenants' incompatibility and assist them settle down early. The community program expansion is also required at the local government level.

• 보건행정학회지
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• 제33권1호
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• pp.40-54
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• 2023

Background: Based on the increase in the needs for convalescent rehabilitation medical services in Korea, this study aims to calculate the needs for rehabilitation services and examine its determinants for 229 regions. Methods: Claim data from the Health Insurance Review and Assessment Service were used to estimate patients who need to receive rehabilitation services, and data from various sources were also used for analysis. The number of cases and incidence rates of hospitalization related to convalescent rehabilitation were calculated to estimate the needs for services by region, and the results were visualized via a map. Multivariate regression and fixed effects regression using panel data were performed to identify the determinants of regional variation of the incidence rate. Results: First, the incidence rate of rural areas such as Jeolla-do, Gyeongsang-do, and Chungcheong-do was higher than urban areas (metropolitan cities). Second, the population, proportion of the elder, medical aid recipients, financial independence, traffic deaths, smoking, diabetes rate, and medical infrastructure correlated significantly with the incidence rate. Third, 'rho' values which mean the fraction of variance due to individual terms in panel data regression models were 0.965 and 0.976, respectively. Conclusion: The incidence rate of hospitalizations was correlated with most independent variables in this study and there is a gap between urban and rural areas. These regional disparities are fixed in our society. An improved regional convalescent rehabilitation system is suggested to cover the entire area including rural areas with a high rate of aging.

• 한국콘텐츠학회논문지
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• 제15권12호
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• pp.560-571
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• 2015

본 연구는 국민의료비의 재원별 공급 분석뿐만 아니라 수요를 결정하는 주요 요인인 연령별과 소득계층별을 동시에 고려한 모형을 설정하고 GARCH 모형을 활용하여 실증분석을 수행하였다. 실증분석 결과에 의하면 포괄적인 형태의 의료보험제도는 보장성이 양호하게 구축되어 있지만, 연령별 및 소득계층별 지원정책을 보다 구체화해야 하는 것으로 나타났다. 그리고 잠재적 취약계층을 지원하기 위해서는 민간재원을, 취약계층을 지원하기 위해서는 공공재원의 확충이 필요한 것으로 분석되었다. 즉, 이와 같은 재원별 확충의 우선순위를 통해 국민의료비 지출의 효율성을 제고할 수 있는 것으로 나타났다. 인구 고령화와 관련해서 살펴보면 보건정책이 적절하게 대응하고 있는 것으로 분석되어, 노인보건의료 관련법이나 노인장기요양보험 등이 양호하게 운용되고 있는 것으로 분석되었다.

• 동서간호학연구지
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• 제21권1호
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• pp.18-27
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• 2015

Purpose: The purpose of this study was to investigate the relationship between health knowledge and health promoting behavior in the elderly. Methods: The participants of this study were 114 men and women over 65 years at P-myeon, Yeongju-si, Gyeongsangbuk-do. Data were collected from March 1st to April 9th in 2011. The survey was carried out via the face to face interview using structured questionnaires. Results: Eighty nine percent of the participants responded that they were aware of the types of healthcare service. The most desirable service was 'long term care insurance system'. The average of health knowledge was 7.94 (${\pm}1.51$) out of 10 and average of health promoting behavior was 2.81 (${\pm}0.30$) out of 4. Health promoting behavior showed a positive correlation with health knowledge (r=.189, p=.044). Conclusion: The health promoting behavior in the elderly was related with health knowledge. Therefore, the enhancement of health knowledge is needed to improve health promoting behavior in the elderly. Education for self care and providing information for health care are needed for health maintenance and improvement in elderly. In addition, program development for providing health knowledge and nursing intervention for supporting health promoting behavior are in need.