• 문화기술의 융합
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• 제3권2호
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• pp.21-30
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• 2017

본 연구는 뇌혈관질환자의 년간 총직접비용에 대하여 조사하였다. 본 연구를 위하여 2012년 한국의료패널 조사자 중 2012년 한 해 동안 뇌혈관질환으로 응급, 입원, 외래서비스를 1건 이상 이용하였다고 응답한 265명을 대상으로 하였다. 뇌혈관질환자 일반사항은 2012년에 한국의료패널 응답자 중 뇌혈관질환으로 응급, 입원, 외래서비스를 이용한 응답자의 비율이다. 연구방법은 응급, 입원, 외래서비스의 평균의료비와 가중평균을 적용하여 직접비용을 산출한 후 년간 총직접비용을 산출하였다. 연구결과는 뇌혈관질환자가 1인당 연 평균 본인부담 의료비 지출액은 약 561,934원이고, 남성은 669,557원, 여성은 448,696원이다. 건강보험 가입자의 경우 뇌혈관질환으로 인한 1인당 본인부담액은 평균 634,459원이고 의료급여 수급자는 160,236원이었다. 뇌혈관질환자가 265명의 연 평균 총직접비용은 약 162,165,690이고, 남성은 193,223,955원, 여성은 129,486,685이다. 건강보험가입자의 경우 뇌혈관질환으로 인한 1인당 총직접비용은 평균 183,095,125원이고 의료급여 수급자는 46,241,705원이었다. 가구소득별로 보면, 가구 소득 3분위에 속한 환자는 672,268원으로 가장 높게 나타났으며, 5분위에 속한 환자는 108,970,650원 으로 뇌혈관질환자의 총직접비용이 가장 낮았다.

• 한국의사학회지
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• 제31권1호
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• pp.13-22
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• 2018

Understanding the purpose and results of a Korean Envoy's medical bureaucrat (attendant) travel to China. Unlike other Envoy's medical bureaucrats, envoy's trade made profits for those who participated. This article investigates the protocols of a Korean Envoy's medical attendant which include: (1) A prominent family member or high-ranking official does not participate in the Envoy's medical bureaucrat, either himself or his descendants. This denies the general theory that the medicinal material trade helped the economic status of medical officials. (2) Envoy's medical bureaucrat is a high percentage of interpreter bureaucrat in the households of father, mother, and wife. This suggests that the information about the envoy schedule and the benefit of the envoy may have been exposed in advance. This is related to the fact that the interpreter bureaucrat is the center of the envoy trade. (3) In the nineteenth century, envoy's medical bureaucrats were more frequent among close relatives, such as father-son relationship, than in the previous century. This study restored the lineage and purpose to the medical bureaucrat's travel to China, and provides a list of Envoy's medical bureaucrat through historical data, and analyzed the household and previous office. In this regard, it can be seen that some households, which are not dominant medical bureaucracies, have pursued profit through medicinal material trade. However, it is difficult to generalize to the whole of the medical bureaucracy.

• 의료법학
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• 제14권1호
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• pp.117-144
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• 2013

After several bills for the reasonable medical dispute resolution had been proposed for over twenty years, "Act on Remedy for Damage from Medical Accident and Medical Dispute Mediation" was eventually enacted on April 7, 2011 and came into effect from April 8, 2012. This study evaluates the achievements and results of the past year, suggesting the future improvements or tasks. The main issue of Act on Medical Dispute Mediation is Korea Medical Dispute Mediation and Arbitration Agency. Therefore, the success of the Act depends on the outcomes of Korea Medical Dispute Mediation and Arbitration Agency. Although the Act has been enforced for only one year, this paper examines the outcomes of the Agency with limited materials for its development. Korea Medical Dispute Mediation and Arbitration Agency was established for rapid, fair, and effective medical dispute resolution. Thus, the evaluation of the performances of the Agency is based on the 1) rapidness, 2) fairness, and 3) effectiveness of the dispute resolution. To sum up, the system earned positive evaluations as for the rapidness and fairness, but some problems were indicated with regard to the effectiveness. As the system of medical dispute mediation and arbitration in Korea has no parallel in the world, other countries show many interests in it. The rapid and fair medical dispute resolution is of benefit in both patients and medical institutes and decreases social costs. As the Act had a difficult passage through Parliament, it should be maintained and improved continuously.

• 의료법학
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• 제8권2호
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• pp.69-118
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• 2007

In providing general medical treatments, the medical service contract between the patient and the doctor is the mutually responsible onerous contract. However, the nature of the mutually assumed contract standings of the patient and the doctor has been changing since the implementation of the national health insurance program. For instance, besides the cases of beyond excessive medical charges and medical negligence, if the doctor charged for his/her medical treatments violating the post-treatment/nursing cover criteria, the overpaid medical charge, regardless of being collected with the patient's consent, has to be refunded back to the patient. Medically needed aspects, treatment results, and unfair benefits favoring the patient are not at all taken into consideration in the health insurance scheme. This makes it easier for patients to get refunds for their share of the medical payments by involving the Health Insurance Review & Assessment Service or the National Health Insurance Corporation, without engaging in civil law suits (for reimbursement claim) against doctors. In other words, the doctor's responsibility to provide medical treatments and the patient's responsibility to pay for the medical treatment provided within the contractual realm are being demolished by the administrational arbitration of the National Health Insurance system. The basic rights of medical service providers, and the patient's right to choose are as important constitutional rights, as the National Health Insurance program, which is essential in the social welfare system. Furthermore, the development of the medical fields should not be prevented by the National Health Insurance system. If the medical treatment services can be divided into necessary treatments, general treatments, and high quality treatments, the National Health Insurance is supposed to guarantee the necessary and general treatments to provide medical treatments equally to all the insured with limited financial resources. However, for the high quality treatments, it is recommended that they should not be interfered by the National Health Insurance system, and that they should be left to the private contract between the patient and the doctor.

• 의학교육논단
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• 제14권2호
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• pp.64-68
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• 2012

Learning in medical school is usually regarded as a very specialized type of learning compared to that of other academic disciplines. Medical students might have general beliefs about their own learning. Beliefs about learning have a critical effect on learning behavior. There are several factors that affect medical students' learning behavior: epistemological beliefs, learning styles, learning strategies, and learning beliefs. Several studies have addressed epistemological beliefs, learning styles, and learning strategies in medical education. There are, however, few studies that have reported on medical students' beliefs about learning. The purpose of this study was to determine what learning beliefs medical students have, what the causes of these beliefs are, and how medical educators teach students who have such beliefs. In this study, the five learning beliefs are assumed and we considered how these beliefs can affect students' learning behaviors. They include: 1) medical students are expected to learn a large amount of information in a short time. 2) memorization is more important than understanding to survive in medical schools. 3) learning is a competition and work is independent, rather than collaborative. 4) reading textbooks is a heavy burden in medical education. 5) the most effective teaching and learning method is the lecture. These learning beliefs might be the results of various hidden curricula, shared experiences of the former and the present students as a group, and personal experience. Some learning beliefs may negatively affect students' learning. In conclusion, the implications of medical students' learning beliefs are significant and indicate that students and educators can benefit from opportunities that make students' beliefs about learning more conscious.

• 의료법학
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• 제9권2호
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• pp.11-52
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• 2008

Based on foreign examples and past debates, the minimal conditions for passive euthanasia can be suggested as following; (1) The patient is incurable by modem medical practice and his death is impending (less than 6 months), (2) Euthanasia is practiced solely to relieve physical pain of the patient, (3) If the patient can express his will, there should be a clear and sincere request or consent, (4) More than 2 doctors including doctor in charge should consent, (5) Euthanasia should be practiced in ethical way, (6) Patient family should agree(when the patient will is assumed.) It is hard to resolve issues regarding euthanasia based on past rulings and cases without concrete law. As in United States and Germany, clear and objective provisions of euthanasia and definitive method for patient's advanced directive should be legislated to resolve medical conflict and to relieve patient and family from agony. And death with dignity debate will not be able to proceed if it is only substantively approached because of unclear definition of euthanasia and benefit comparison way of thinking. Thus it is important to establish definitive process to decided legislation of euthanasia act and resolving conflicts arising from each step of the process among interested parties exchanging medical/ethical opinions.

• 의료법학
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• 제11권1호
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• pp.117-143
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• 2010

Along with the development of digital technologies, the information obtained during the medical procedures was working as a source of valuable assets. Especially, the secondary use of personal health information gives the ordeal to privacy protection problems. In korea, the usage of personal medical information is basically regulated by the several laws in view of general and administrative Act like Medicine Act, Public institutions' personal information protection Act, Information-Network Act etc. There is no specific health information protection Act. Health information exchange program for the blood donor referral related with teratogenic drugs and contagious disease and medical treatment reporting system for income tax convenience are the two examples of recently occurred secondary use of health information in Korea. Basically the secondary use of protected health information is depend on the risk-benefit analysis. But to accomplish the minimal invasion to privacy, we need to consider collection limitation principle first. If the expected results were attained with alternative method which is less privacy invasive, we could consider the present method is unconstitutional due to the violation of proportionality rule.

• 보건의료산업학회지
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• 제11권1호
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• pp.43-53
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• 2017

Objectives : In this paper, we proposed a method to comprehensively examine the roles of medical insurance review nurses' by analyses of task importance and task performance. Methods : For the analyses, we used the responsesof 268 nurses who completed a questionnaire for members of the Medical Insurance Review Nurses Association in 2015, and analyzed task importance and task performance using the IPA method and the standard task guide. Results : There were significant differences in task importance and task performance according to task position. In the category of 'Keep up the good work,' 'Calculate benefit standard' was indicated only in administrative positions, and in the category of 'Concentrate here,' 'Manage hospital resources' and 'Process after appeal results' was demonstrated only in general positions. There were differences in the 'Low priority' and 'Possible overkill' categories by task performance according to task position. Conclusions : Our results indicate the necessity of a new education system and task reassignment according to task importance and task performance as perceived by medical insurance review nurses.

• Archives of Reconstructive Microsurgery
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• 제9권2호
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• pp.158-163
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• 2000

Over the past several years, countless patients have benefitted from the use of leeches in microsurgery. As we know, leeches are used to overcome the problem of venous congestion by creating prolonged localized bleeding uniquely characteristics of leech bite. Venous congestion, a common complication of digital replantation, often has been treated through surgical repair like arteriovenous anastomosis. The leech produces a number of important substances which contribute to the special property of the bite, including an anticoagulant, a local vasodilator and local anesthetics. The bite usually bleeds for 1 to 2 hours and under special circumstances may bleed for up to 24 hours. So venous congestion is relieved. However, leeches increase the possibility of infection through their gut content. Infection associated medical leech application is significant risk. Other risk include allergic reaction, adverse psychologic reaction and blood loss requiring transfusion. The 65 cases of medical leech application were performed between August, 1997 and May, 2000 according to an established protocol. The complication were 18 cases ; infection (13 cases), hemorrhage (2 cases), allergic reaction (1 case), psychologic problem (1 case) and hypochromic anemia (1 case). Then our study was performed on the base of indication. As a result, Aeromonas hydrophilia was cultured from gut of medical leech and Klebsiella, Staphylococcus and Pseudomonas were cultured from media. We present the clinical risk-benefit of the medical leech therapy through several cases following digital replantation.

• 의료법학
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• 제9권1호
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• pp.461-503
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• 2008

The right to live is the most valuable benefit and protection of the law. And Medical science is the study considering value of life as the top priority. As modern medical science has progressed and expanding lifespan skills have developed, the number of symptom, called a human vegetable, has been also increased. As a result, people concerns whether euthanasia should be permitted. (1) Active euthanasia is prohibited and a doctor who conduct it is punished. (2) Indirect euthanasia can be permitted unless it is against a patient's intention. (3) Permission of passive euthanasia depends on intention of a patient. In other words, when a patient accepts, a doctor respects the right of self determination of patient and irreversible situation such as brain death happens, treatment stop is permitted. Even a patient who is in the last stage of cancer has a right to die in the dignity and elegance. Solutions for ceasing medical treatment are as follows; First, establishment of 'Bioethics Committee'. Second, setting procedures to empower a court a right to decide whether medical treatment is ceased. Third, setting procedure a government to assist treatment fees. In this paper, direction for social agreement of legal policy regarding the ceasing treatment is provided.