• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.32 no.4
• /
• pp.334-347
• /
• 2006

The aim of this study is to evaluate the reasonableness of the medical fee on oral and maxillofacial surgery field according to surgeon's opinions and actual conditions. The medical fee has significant influence on hospital income, the supply and distribution of medical manpower, quality and facilities of medical services. Questionnaire survey was sent to 86 oral and maxillofacial surgeons who worked more than 3 years in general hospital. Among them, 25 doctors replied the 109 answers survey and the average of treatment time and physician work relative value on each category was calculated. And the health insurance cost (that has been applied since 2003) was compared with the questionnaire results. And finally we investigated items that health insurance system did not include in oral and maxillofacial field but actually performed in oral and maxillofacial surgery clinic. The result was that the medical fee did not properly reflect physician work relative value of actual treatments. In case of complicated extraction, work relative value needed 3.5 times enhancement of present value. For simple impacted tooth extraction 1.8 times, for impacted tooth extraction including odontomy 1.7 times, and for fully impacted tooth more than 2/3 of it located into the alveolar bone, 1.8 times enhancement needed. In respect of the present physician work relative value, hemimandibulectomy with neck lymph node dissection for the malignancy is appropriated as 3.3 times of open reduction and internal fixation for the mandibular fracture, but the questionnaire result showed 25 times discrepancy. In conclusion, this research shows the need for intervention that health insurance included items and legal relative medical value must act in union with treatment in clinic to reduce the imbalance between them.

• The Korean Society of Law and Medicine
• /
• v.22 no.2
• /
• pp.3-48
• /
• 2021

Among the major rulings handed down in 2020, there were cases involving anaphylaxis, which is timely as a side effect of coronavirus and flu vaccine. And as a rare case, a ruling was handed down that if medical treatment was done so unfaithfully beyond the limit of patience of ordinary people, it can be an independent illegal act and a cause of compensation for emotional distress. Also, there was a ruling in the appellate court that evaluated disability rate applying the Korean Academy of Medical Sciences Guides for the Evaluation of Permanent Impairment, not McBride system. And the supreme court made it clear that telemedicine is illegitimate. In relation to duty of explanation, it is in the process of adding detail criterion on the firm principles in the individual cases. In regard of medical records, there was a case that even when a medical record is strongly suspected to be tampered with, it is not considered to be an obstruction of proof. There were cases that resulted in different conclusion between the court of first instance and the appellate court rulings. Lastly, in the face of a growing number of cases in which doctors are sentenced to prison for malpractice, we reviewed a ruling that sentenced a doctor to prison.

• The Korean Society of Law and Medicine
• /
• v.22 no.4
• /
• pp.185-210
• /
• 2021

On September 24, 2021, the new provisions(Article 38-2 of the Medical Service Act) mandatory CCTV installation in operating rooms where the unconscious patient is operating such as general anesthesia. The revised medical law aims to effectively prevent illegal activities that may occur in the operating rooms and to promote appropriate resolution to medical dispute. According to the law, medical institutions operating unconscious patients, such as general anesthesia, must install CCTVs in the operating rooms by September 25, 2023, and film surgical scenes only at the request of patients and their guardians, regardless of the consent of the medical personnel. The bill delegated the legislative device to minimize infringement of fundamental rights to subordinate statutes without stipulating it in the law.(Article 38-2(10)) The most realistic policy plan to minimize the infringement of the fundamental rights of patients is to prepare specific regulations. Therefore, this study examines the legislative background and main contents of the amended CCTV installation bill, and suggests issues to be reviewed when preparing subordinate statutes by analyzing major issues. It was reviewed based on compliance with the principle of minimizing infringement of fundamental rights of information subjects in the operating rooms. The information subjects of CCTV are health professionals and patients. Suggesting issues should be considered when preparing subordinate statutes so that the purpose of the CCTV installation law can be achieved while minimizing infringement of right of self-determination of personal information, personality rights, and human rights. It is hoped that this paper will be referred when discussing subordinate statutes and regulations to contribute minimizing infringement of fundamental rights.

• Journal of Microbiology and Biotechnology
• /
• v.22 no.3
• /
• pp.378-384
• /
• 2012

In aquatic invertebrates, particularly marine gastropods, organotin compounds induce irreversible sexual abnormality in females, which is termed imposex, at very low concentrations. Organotin compounds are agonists for nuclear receptors such as RXRs and $PPAR{\gamma}$. However, the imposex phenomenon has not been reported to act as an antagonist on estrogen receptors in other species, including vertebrates and invertebrates. In order to gain insights into the antagonistic activity of organotin compounds on estrogen receptors (ERs), we examined the inhibitive effect of these compounds on estradiol-dependent ${\beta}$-galactosidase activity using the yeast two-hybrid detection system consisting of a combination of the human estrogen receptor ($hER{\beta}$) ligand-binding domain and the co-activator steroid receptor co-activator-1 (SRC1). Tributyltin-hydroxide (TBT-OH) and triphenyltin-chlorine (TPT-Cl) exhibited an inhibitive effect on $E_2$-dependent transcriptional activity, similar to antagonistic chemicals such as 4-hydroxytamoxifen (OHT) or ICI 182,780, at a very low concentration of $10^{-14}$ M TBT or $10^{-10}$ M TPT, respectively. The yeast growth and transcriptional activity with transcriptional factor GAL4 did not exhibit any effect at the tested concentration of TBT or TPT. Moreover, the yeast two-hybrid system using the interaction between p53 and the T antigen of SV40 large did not describe any effect at the tested concentration of OHT or ICI 182,780. However, the interaction between p53 and T antigen was inhibited at a TBT or TPT concentration of $10^{-9}$ M, respectively. These results indicate that TBT and TPT act as inhibitors of ER-dependent reporter gene transcriptional activation and of the interaction between $hER{\beta}$ LBD and the co-activator SRC1 in the yeast two-hybrid system. Consequently, our data could partly explain the occurrence of organotin compound-induced imposex on the endocrine system of mammals, including humans.

• The Korean Society of Law and Medicine
• /
• v.23 no.2
• /
• pp.67-96
• /
• 2022

"Aid in Dying" means that when a decision-making patient suffers from an incurable disease, a drug that can speed up death is prescribed by a doctor and used to lead to death. Since the suspension of life-sustaining treatment was institutionalized based on human dignity and patient autonomy, the question of whether assisted death can be legally justified in relation to the right to receive medical help to shorten one's life to die with dignity has recently been actively discussed. In Korea, since the suspension of life-sustaining treatment was institutionalized by the enactment of the Life-sustaining Treatment Decision Act in 2016, an amendment to the Life-sustaining Treatment Act was recently proposed to legalize Aid in Dying. The global trend is that human "Right to Die" is discussed in the division of life and death, from the suspension of life-sustaining treatment to assisted death, and again in the order of euthanasia. In this paper, we started discussing dignified death and institutionalized patients' right to self-determination, looked at the controversy in the United States, which legislated assisted death in many states since the 2000s, and analyzed the main contents of California's End of Life Option Act and the data after enforcement. The strict requirements for Aid in Dying, such as voluntary confirmation of patients' intentions and doctors' obligation to provide information, and the results of California's Aid in dying system, composed of relatively diverse races, were reviewed.

• Journal of Environmental Health Sciences
• /
• v.50 no.4
• /
• pp.282-290
• /
• 2024

Background: In order to evaluate the national effort to improve air quality through the Act on Air Quality Management Regions, an investigation of the current status of air quality in respective regions and the health impact of air pollution should be undertaken. Objectives: This study is a preliminary study on the status of PM_2.5 in the central region of South Korea and its health effects. It can be applied to the evaluation of the effectiveness of the Act on Air Quality Management Regions. Methods: Time series variation of PM_2.5 concentrations in the air quality management region (hereafter referred to as AQMR) and in the non-AQMR area in the central region of South Korea were created. Odds ratios (OR) were calculated based on the survey results of whether the residents of Jeollabuk-do were feeling anxiety caused by air pollution by sex, region, and regional characteristics. Relative risk (RR) values of lung cancer deaths in each city in the AQMR for the central region of South Korea were calculated. Results: During the period from Dec. 2018 to Dec. 2021, the average concentration of PM_2.5 was higher in the AQMR at 26.0 ㎍/m³ compared to 19.5 ㎍/m³ in the non-AQMR. The odds ratio (OR) calculated using data from the Jeonbuk Research Institute (2020) suggested that women were more uncomfortable or anxious about their lives due to air pollutants than were men. The OR evaluation results also showed that in terms of PM_2.5 sensitivity, residents in the non-AQMR were relatively more sensitive than those in the AQMR. The relative risk (RR) was calculated to evaluate the relationship between health hazards (PM_2.5) and diseases (lung cancer). As a result, for super-aged people over 80 years old, compared to the non-AQMR (Muju-gun and Jangsu-gun), the residents in the AQMR (Jeonju, Gunsan, and Iksan) have about twice the relative risk of lung cancer. Conclusions: It is necessary to make efforts to improve residents' health and extend their healthy lives through efforts to reduce air pollutants such as PM_2.5 in areas specially selected as an AQMR.

• The Korean Society of Law and Medicine
• /
• v.20 no.3
• /
• pp.143-174
• /
• 2019

Our Constitution obliges the state to protect the health of the people, and the Medical Law, which embodied Constitution, sets out in detail the matters related to open the medical institution, and one of them is to prohibit the operation of multiple medical institutions. By the way, virtually multiple medical institutions could be opened and operated because the Supreme Court had interpreted that several medical institutions could be opened if medical activities were not performed directly at the additional medical institution which was opened under the another doctor's license. However, some health care providers opened the several medical institutions with another doctor's license for the purpose of the maximization of profit, and did illegal medical cares like the unfair luring of patients, over-treatment, and commission treatment. Also, realistic problems such as the infringed health rights have arisen. Accordingly, lawmakers had come to amend the Medical Law to readjust the system of opening for medical institution so that medical personnel could not open or operate more than one medical institution for any reason. For this reason, the Constitutional Court recently declared a constitutional decision through a long period of in-depth deliberation because the constitutional petition and the adjudication on the constitutionality of statutes had been filed on whether Article 33 paragraph 8 of the revised medical law is unconstitutional. The Constitutional Court acknowledged the "justice of purpose" in view of the importance of public medical institutions, of the prevention from seduction of for-profit patients and from over-treatment, and of the fact that health care should not be the object of commercial transactions. Given the risk that medical personnel might be subject to outside capital, the concern that the holder of the medical institution's opening certificate and the actual operator may be separated, the principle that the human body and life should not be just a means, and the current system's inability to identify over-treatment, it also acknowledged the 'minimum infringement'. Furthermore, The Constitutional Court judged it is constitutional in compliance with the principle of restricting fundamental rights, such as 'balance of legal interests'. In this regard, legislative complements are needed in order to effectively prevent the for-profit management and the over-treatment the Constitutional Court is concerned about. In this regard, consumer groups actively support the need for legislation, and health care providers groups also agree on the need for legislation. Therefore, the legislators should respect the recent Constitutional Court's decision and in the near future complete the complementary legislation to reflect the people's interests.

• The Korean Society of Law and Medicine
• /
• v.20 no.3
• /
• pp.3-45
• /
• 2019

Health insurance is the main instrument to protect the people against sickness. To examine the task of in the future it would be necessary to extract and understand the components formed in its formation and development, benefit related and normative characteristics of the health insurance itself. The health insurance oriented itself to the universal coverage at a law level. Paradoxically this worked positively for the universal development of the health insurance. The task of the health insurance is on the one hand universal, positive and open. On the other hand it has to shape type of allowed method, art and content of the medical treatments into the regulation to ensure the equal benefit as well as the financial stability. That is, the health insurance should check the aberrant medical treatment, and at the same time should be compensated for the their necessity and effectiveness. However there are always some structural differences between both requirements. This article aims to restate and analyse the development of the health insurance, based on the characteristics formed hitherto show the way to reform the health insurance. The problem to enhance the coverage of health insurance, its institutional as well as financial crisis, its peculiar governance would be handled.

• Korean Journal of Health Education and Promotion
• /
• v.25 no.3
• /
• pp.167-181
• /
• 2008

The prevention of life-style related diseases is an increasingly important issue in Japan, because not only have the number of patients with life-style related diseases increased but also medical care costs. This paper gives recent strategies for the prevention of cardiovascular diseases through life-style modification. Health objectives for the year 2010, called "Healthy Japan 21", were established in 2000 by the Ministry of Health, Labour and Welfare and the Health Promotion Act was enacted in 2002 to promote this health policy. However, the prevention efforts for life-style related diseases have not been effective in regard to the evaluation of the strategy objectives. The reform of the medical care system which included a new nationwide prevention strategy for life-style related diseases was presented in 2006. The new strategy starting from April 2008 included a "specific health checkup" and "specific health education" for those with metabolic syndrome. The specific health checkup is used to screen people according to criteria of the metabolic syndrome and divide them into 3 groups. These groups will receive specific health education. The purpose of this strategy is the early detection of those who have cardiovascular risk factors, and the early management of the clustering of cardiovascular risk factors of obese people aged 40-74 years old. It is mandatory for every insurer to conduct a specific health checkup and specific health education under the new Act. The implementation rate of the specific health checkup and the specific health education, and a reduction rate of individuals with metabolic syndrome among insured people will be evaluated every year. The national objective is to increase the rate of those undergoing the specific health checkup to 80% and the rate of those receiving the specific health education to 60% by the year 2015. The national objective also targeted a reduction rate of 25% for those with metabolic syndrome. This new strategy will be the biggest intervention trial in the world, and it will produce a big health care market in Japan. Not only public administrative institutions but also private institutions are now preparing to take part in this new strategy. However, various tasks remain, such as training more professionals in health education, developing more evidence based practices, and encouraging cooperation with various sectors, to enforce this new strategy.

• Tuberculosis and Respiratory Diseases
• /
• v.71 no.2
• /
• pp.106-113
• /
• 2011

Background: While asthma control is defined as the extent to which the various manifestations of asthma are reduced by treatment, current guidelines of asthma recommend assessment of asthma control without consideration of airway inflammation. Our aim was to investigate the relationships between fractional exhaled nitric oxide (FeNO), a reliable marker of airway inflammation, and levels of asthma control in patients treated with inhaled corticosteroids (ICS). Methods: We enrolled 71 adult patients with asthma who had been treated with ICS for more than four months. FeNO was measured and spirometry was performed at the time of enrollment. Asthma control was assessed (a) by the physician based on the Global Initiative for Asthma guidelines, (b) by the patients, and (c) by using the Asthma Control Test (ACT). Statistical analyses were done to analyze the relationships between (i) FeNO and (ii) measures of asthma control and clinical indices for asthma manifestations. Results: There was no significant difference in FeNO levels between the three groups according to levels of asthma control (controlled, partly controlled and uncontrolled) as determined by the physician (p=0.81), or by the patients (p=0.81). In addition, FeNO values were not significantly correlated with the ACT scores (r=0.031, p=0.807), while FeNO showed a correlation with peripheral blood eosinophil counts (p<0.001). Conclusion: These findings demonstrate that FeNO levels are not associated with measures of asthma control in patients treated with ICS. Information on airway inflammation from FeNO concentrations seems to be unrelated to levels of asthma control