• 의료법학
• /
• 제18권2호
• /
• pp.75-103
• /
• 2017

국민건강보험법상 급여에는 요양급여와 법정비급여가 있지만, 그 이외에도 임의비급여가 있다. 임의비급여는 법정 비급여가 아님에도 불구하고 의료기관이 비급여로 처리하고 환자로부터 진료비를 받는 것을 말하지만, 이러한 임의비급여에 대해서는 국민건강보험법령에서는 아무런 규정을 두지 않고 있다. 대법원 2012. 6. 18. 선고 2010두 27639, 27646 전원합의체 판결은 종전의 부정적인 법리를 폐기하면서, 민법상 기본원칙인 사적자치의 원칙에 기초한 민사법적 쟁점이 임의비급여에 기본적 전제로 포함되어 있음을 확인하였다. 대법원에서 제시한 (1) 편입 또는 조정절차 부존재, 존재하면 회피 불가피성, (2) 의학적 안전성과 유효성 및 필요성, (3) 충분한 설명과 동의 요건은 예외적 요건으로서 그 해석에 있어서 매우 신중을 기해야 할 것이다. (1)의 요건은 임의비급여에 해당하는 질병 중 치명적이거나 이환속도가 매우 빠른 질환에 해당하는 경우에는 그 해석을 엄격하게 하는 것은 매우 부적절하다고 생각된다. (2)의 요건은 그 적용의 구체적 판단을 의료계의 전문가적 감정에 일임하는 것이 합리적이고, 법원은 그 의료계의 감정이 적절하였는지 여부를 판단하는 것에 그칠 수밖에 없다. (3)의 요건은 의사의 충분한 설명과 그에 따른 환자의 동의이지만, 그 중에서 가장 중요한 것은 의사의 충분한 설명에 있다. 2010두27639, 27646 판결 이후에 선고된 대부분의 판결에서는 위 3개 요건의 불비를 이유로 기각하는 사례가 많았다.

• 한국직업건강간호학회지
• /
• 제4권호
• /
• pp.5-29
• /
• 1995

Occupational health services in Korea have been operated as dual types : one is operated by occupational health care manager and the other is health care agency without their own personnel. The performance of occupational health service should be different due to the variety of characteristics of health care manager and workplace, qualification of health care manager. This study is to analyze performance of occupational health care services with a particular consideration of job performance shape and efficiency, based on comparing those two types of health care management to show on the basic data for the settlement of more qualitative health care management system at workplace. For this study, total 391 places in Seoul and Inchon city area ; 154 places (39.4%) managed by designated health care manager and 237 places (60.6%) by the agency with their commission are selected as research samples. Tools for data collection are questionnares that have been investigated during the period of 20 September 1993-20 December 1993. Those data are compared with percentiles, mean, standard deviation and B/C ratio using SPSS PC program. Conclusions observed from the tests and each comparison could be summerized as follows : 1. Occupational health care have been accomplished at workplaces with designated people than with agencies people, and coverage rate of the occupational health care services has differences, due to management types. The reason of these results is due to visit only one or two times monthly by the agencies, while their own health care manager obsess, at the workplaces all the times. 2. Most of the expense for environmental control of all health care services expenditures shows that there is almost no fundamental improvement because more expenses are needed for procuring personal protective equipment and measuring work environment instead of environmental improvement. 3. It is investigated how much the cost of occupational health care services needs per worker, and calculated how much the cost needs per service hour per worker. The results from this show that the cost of occupational health services at workplaces with their own managers used less than the cost of health care agencies, eventually the former gives better services with less cost than the latter. 4. Benefit/Cost ratio is also produced by total benefit/total cost. The result from the above way reads 4.57 as a whole, while their own manager having workplaces reads 4.82 and the agencies do l.56. Even if their own manager performing workplaces spent more cost, this system produces more benefit than the agencies management. 5. The B/C ratio for medical organization such as local clinic, health care center and pharmacy shows more than or equal to at the workplaces controlled by the agencies. It is inferred that benefit would be much less than the cost used, with so being inefficient. 6. It is assumed that the efficiency ratio of health education is equal to reduction rate of workers medical organization visit. Estimated reduction rate 5%, 10%, 15%, show that the efficiency ratio of health education have an effect on producing benefits. It is estimated that more benefit can be produced if more qualitative education will be provided for enhancing health care efficiency. 7. Results of this study cannot be generalized because there are large scale of deviation in case of workplaces with less than 300 full time workers, but B/C ratio reads 2.69 as a whole and 3.25 at workplaces with their own health care manager are higher than 1.63 at the workplaces manged by the agencies. Finally, all the benefit concerning health care services could not be quantified, measured and shown on the value of money. This is a reason that a considerable part of benefits are so underestimated. This is also thought that measurement tools should be developed for measuring benefits of health care services with a comprehensive quantification. in the future. It is also expected that efficiency of occupational health care services should be investigated using cost-effectiveness analysis.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권22호
• /
• pp.9603-9606
• /
• 2014

Background: Endometrial cancer is the fourth most common cancer among women in developed countries. Patients with endometrial cancer may benefit from systemic chemotherapy alone or in combination with targeted therapies if the disease is clinically diagnosed prior to spread and metastasis to other organs. The aim of this study was to evaluate the prognostic role of p53 polymorphism and its correlation with tumor grade in human uterine endometrial carcinomas. Materials and Methods: A total of 75 patients with endometrial carcinomas were studied for possible mutations in exon 4 of the p53 gene using polymerase chain reaction and restricting fragment length polymorphism techniques and sequencing. Results: In recent study, The rate of homozygote genotype of pro/pro or Arg/Arg in high grade group was higher than in comparison with low grade one. In addition samples that were undigested in RFLP, showed mutation in exone 4. Conclusions: Our findings showed that high grade endometrial carcinomas are highly associated with TP53 polymorphisms in comparison with low grades.

• 의학교육논단
• /
• 제22권3호
• /
• pp.163-172
• /
• 2020

Medical treatments as universal care have been turning into delivering medical technology. Coping with death, which is prevalent in all medical circumstances, without comprehensive understanding results in missing out on significant aspects between life and death. This makes doctors surrender easily to a conventional and binary division of life and death and reduces the chance of including death as a part of the medical realm. Furthermore, in terms of medical education, we need to have the opportunity to consider such subjects that can benefit from special planning and consideration. Through reviewing articles in a variety of disciplines such as medicine, philosophy, psychology, literature, and anthropology, we can better understand death, condolences, and the relevance between them in a contextual way. In order to seek a better approach, this study also aims to survey and review the recent state of death education in diverse fields of medicine in Korea. In conclusion, if it is complicated for us to explain or understand death in general, focusing on condolences as a human response to death could be one meaningful way that deserves contemplation. It is possible to regard condolences as a touchstone and a prerequisite in death education itself.

• Journal of Breast Disease
• /
• 제6권2호
• /
• pp.46-51
• /
• 2018

Purpose: Endocrine therapy is the preferred treatment for hormone receptor (HR)-positive metastatic breast cancer (MBC). We investigated the efficacy of combined aromatase inhibitor (AI) and luteinizing hormone-releasing hormone (LHRH) agonist in premenopausal patients with HR-positive MBC. Methods: We retrospectively analyzed the medical records of 21 HR-positive premenopausal MBC patients treated with combined AI and LHRH agonist therapy. Results: The median follow-up period was 32.9 months. The overall response rate was 47.6%, with three complete responses (14.3%) and seven partial responses (33.3%). Nine patients (42.9%) achieved stable disease lasting more than 6 months; thus, the clinical benefit rate was 90.4%. The median time to progression was 45.4 months. No patients experienced grade 3 or 4 toxicity. Conclusion: Combined AI and LHRH agonist treatment safely and effectively induced remission or prolonged disease stabilization, suggesting that this could be a promising treatment option for HR-positive premenopausal patients with MBC.

• 보건의료산업학회지
• /
• 제4권1호
• /
• pp.145-156
• /
• 2010

The purpose of this study is one of high price medical equipment wished to grasp propriety factor about the MRI introduction, analyzing payability through cost accounting into compensation. It was investigated from January 1 to December 31, 2007 about the MRI of a General Hospital. Expectation availability was 23.2 cases, but actual availability did achievement more than 196.1% with 45.5 items. It is estimated that there are a lot of occurrence cases because great reasons that actual availability increases more than expectation availability is excellent resolving power than a CT, and is device that prefer to reason back that radiation damage is less in person body. The followings show the main results of this study. 1. The MRI was construed in order of cost accounting, wave and personnel expenses 45.4%, administrative expenses 53.0%, and material costs 1.6%. 2. According to CVP (Cost-volume-profit) analysis, BEP (Break Even Point) profit is 173,931,428 won for 11 months, and break even usage number of items are 37.5 cases, and separation usage number of items were confirmed by 1.4 cases. Therefore, was construed that can achieve BEP within 11 months though usage number of items keeps 1.4 items day to create the MRI's hospital operation profit. 3. Estimated limit profitability appears high by 96.7%, exceed fixed charges even if when is non-benefit and when it is benefit consider variable, is judged that the MRI's addition induction helps in hospital management enhancing earning rates.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권6호
• /
• pp.2935-2937
• /
• 2014

Studies of the causes of cancer, early detection, prevention or treatment need accurate, comprehensive, and timely cancer data. The clinical laboratory provides important cancer information needed for physicians which influence clinical decisions regarding treatment, diagnosis and patient monitoring. Poor communication between health care providers and clinical laboratory personnel can lead to medical errors and wrong decisions in providing cancer care. Because of the key impact of laboratory information on cancer diagnosis and treatment the quality of the tests, lab reports, and appropriate lab management are very important. A laboratory information management system (LIMS) can have an important role in diagnosis, fast and effective access to cancer data, decrease redundancy and costs, and facilitate the integration and collection of data from different types of instruments and systems. In spite of significant advantages LIMS is limited by factors such as problems in adaption to new instruments that may change existing work processes. Applications of intelligent software simultaneously with existing information systems, in addition to remove these restrictions, have important benefits including adding additional non-laboratory-generated information to the reports, facilitating decision making, and improving quality and productivity of cancer care services. Laboratory systems must have flexibility to change and have the capability to develop and benefit from intelligent devices. Intelligent laboratory information management systems need to benefit from informatics tools and latest technologies like open sources. The aim of this commentary is to survey application, opportunities and necessity of intelligent clinical laboratory as a tool to increase cancer care management productivity.

• 의료법학
• /
• 제10권2호
• /
• pp.287-307
• /
• 2009

A person is injured in car accident caused by his/her slight negligence except he / she causes accident by his / her willfulness or gross negligence. Because the National Health Insurance Corporation (hereinafter called "Corporation") shall not provide any insurance benefit "when he has intentionally or through gross negligence caused a criminal conduct or intentionally contributed to the occurrence of an accident" referred to in Article 48 (1) 1 of the National Health Insurance Act. So, if he / she is insured by his / her own bodily injury coverage, he / she can be compensated for his / her medical expenses. The injured have the rights to file either National Health Insurance claim and Automobile Insurance claim but there is no clear and definite adjustment clause. The claim disputes between National Health Insurance (hereinafter called "NHI") and Automobile Insurance (hereinafter called "AI") in the own bodily injury coverage makes some problems. Firstly, there are some differences in co-payments which he / she chooses between NHI and AI. Profit per a patient is higher in the NHI than in the AI. Secondly, it can provoke criticism that people shall unnecessarily pay double contributions. Lastly, it can raise moral hazards. For example, if he / she can cover the compensations when the insured receives the compensations from his / her insurer, the Corporation can be claimed by medical care institution payment of the health care benefit costs. In conclusion, first of all, to improve the national health and preserve the insured's rights the Corporation shall keep notice these facts.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권13호
• /
• pp.5343-5348
• /
• 2014

Background: A meta-analysis was performed to examine the benefit/risk ratio for the addition of anti- HER MoAbs to chemotherapy in patients with advanced gastric and gastroesophageal cancer from six randomized phase II/III trials. Materials and Methods: We searched relative trials from Pubmed, EMBASE, Cochrane library databases, China National Knowledge Infrastructure databases, Google Scholar and the NIH ClinicalTrials. Primary outcomes were overall response rate (ORR), progression-free survival (PFS), overall survival (OS). Secondary outcomes were toxicities. All analyses were performed using STATA 12.0. Results: This meta-analysis included six randomized controlled trials (RCTs) with 2, 297 patients and we demonstrated that the anti-HER MoAbs arm did have a positive effect on ORR in the anti-HER MoAbs arm (OR 1.28, 95% CI 1.00-1.64, p=0.01). There was an increasing benefit regarding OS (HR 0.74, 95% CI 0.60-0.88, p<0.05) and PFS (HR 0.72, 95% CI 0.60-0.84, p<0.05) in the anti-HER2 subgroup, but a reduction of OS (HR 1.11, 95% CI 0.87-1.36, p<0.05) and PFS (HR 1.13, 95% CI 0.98 -1.28, P<0.05) in anti-EGFR subgroup. Some grade 3-4 toxicity had a significantly higher incidence in the anti-HER MoAbs arm. There was no significant publication bias for all endpoints. Conclusions: The addition of trstuzumab MoAb to chemotherapy for gastric and gastroesophageal cancer significantly improved outcome of OS and PFS endpoints, while other MoAbs led to no improvement in results. Some adverse events were increased in anti-HER MoAbs arm compared with the control.

• 한국방사선학회논문지
• /
• 제16권4호
• /
• pp.463-470
• /
• 2022

본 연구의 목적은 공군 인력자원의 방사선에 대한 인식도를 분석하고자 하였다. 대상은 항공우주의료원에 방문한 공군 인력자원(군무원, 장교, 부사관, 병사) 남녀 259명이었다. 방법은 방사선 인식도 (위험성, 이익성, 관리성)에 대한 총 14문항의 설문지를 이용하여 조사연구로 진행 하였다. 통계적 분석은 독립표본 T-test와 일원분산분석(one-way analysis of variance, ANOVA)을 사용하여 집단 간의 유의한 차이를 확인하였다. 변수 간의 상관관계는 피어슨(Pearson) 및 스피어만(Spearman) 상관계수로 검정하였다. 그 결과, 방사선 위험성은 여성 공군 인력자원이 남성보다 유의하게 높은 인식도를 보였다. 방사선 이익성은 기혼자와 군무원, 장교, 부사관에서 유의하게 높았다. 방사선 관리성은 남자와 기혼자, 16년 이상의 군 경력자가 유의하게 높은 인식도를 가지고 있었다.