• 한국콘텐츠학회논문지
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• 제17권4호
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• pp.585-595
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• 2017

본 연구는 의료급여와 건강보험환자의 의료이용량의 차이를 분석하여 의료급여환자의 도덕적 해이로 인한 진료비 증가문제를 평가하고 합리적 의료급여 정책결정의 근거를 제시하기 위한 것이다. 이를 위하여 서울시민대상 건강보험과 의료급여 급여자료를 성별 연령별 의료기관 종별로 비교 분석하였다. 분석결과는 다음과 같다. 첫째, 상급종합병원의 입원 외래이용 모두 의료급여환자가 건강보험환자에 비해서 적어서 도덕적 해이가 존재하지 않았다. 오히려 의료급여환자들이 고비용 의료서비스를 이용하고 못하고 있었다. 둘째, 종합병원의 입원이용은 건강보험환자가 많은 반면 외래이용은 의료급여환자가 많아서 의료급여환자들이 본인부담이 적은 외래서비스 이용을 많이 이용하고 있었다. 셋째, 병원 의원은 의료급여환자의 이용이 입원과 외래이용 모두 건강보험환자에 비해서 많았다. 따라서 의료급여환자들은 병원 의원의 입원과 외래이용, 종합병원의 외래이용시 적은 본인부담으로 인해 불필요한 의료이용을 할 가능성이 있는 반면에 상급 종합병원 입원과 외래이용, 종합병원의 입원이용시 비급여 의료비 등 과도한 의료비 부담으로 인해 필요한 의료서비스 이용을 하지 못할 가능성도 있었다. 따라서 중증질환을 가진 의료급여환자들의 의료비 부담을 경감시키기 위한 정책은 지속하고, 의원 병원을 이용하는 의료급여환자들이 불필요한 의료서비스를 이용하지 않도록 관리해야 할 것이다.

• 한국의료질향상학회지
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• 제2권2호
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• pp.112-129
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• 1996

Background : A small number of high cost patients usually spend a larger proportion of scarce health resources. Aged, long-term care and readmitted patients usually belong to these high cost patient group. Among others, long length of stay and readmission can be reduced by checking its cause, and these are the areas needed most of quality improvement activity. Characteristics of high cost medical users between health insurance program and medical assistance program were reviewed. Methods : The inpatient claims of health insurance and medical assistance program were analyzed. Patients were divided by 6 groups; long-term, mid-term, short-term, readmitted, cancer and aged. We defined high cost patients as those who had spent one and half million won and over per 6 months. Characteristics of high cost patients for each group were reviewed. Results : medical assistance patients used much more resources than the insured members in the average hospital cost per case but less in daily hospital cost. The former had a longer length of stay and had much heavier diseases. Major diseases of both group were cancer, diseases of circulatory system and chronic degenerative diseases. Gallstone and schizophrenia were more in the insured program. However, pulmonary tuberculosis, asthma were more common among the medical assistance patients. Early readmission before 2 weeks were 28-30% of the total readmission. Readmission rate in the malignat neoplasm and renal failure were 80% and more. Q.A program should be installed to prevent unnecessary readmissions. Conclusion : Almost 30% of early readmissions and admissions due to complications and long length of stay should be reviewed carefully to keep cost down and to enhance the quality of hospital care.

• 치위생과학회지
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• 제21권1호
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• pp.70-78
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• 2021

Background: The aim of this study was to analyze the public demand for information about the job of dental hygienists by mining text data collected from the online Q & A section on an Internet portal site. Methods: Text data were collected from inquiries that were posted on the Naver Q & A section from January 2003 to July 2020 using "dental hygienist job recognition," "role recognition," "medical assistance," and "scaling" as search keywords. Text mining techniques were used to identify significant Korean words and their frequency of occurrence. In addition, the association between words was analyzed. Results: A total of 10,753 Korean words related to the job of dental hygienists were extracted from the text data. "Chi-lyo (treatment)," "chigwa (dental clinic)," "ske-illing (scaling)," "itmom (gum)," and "chia (tooth)" were the five most frequently used words. The words were classified into the following areas of job of the dental hygienist: periodontal disease treatment and prevention, medical assistance, patient care and consultation, and others. Among these areas, the number of words related to medical assistance was the largest, with sixty-six association rules found between the words, and "chi-lyo," "chigwa," and "ske-illing" as core words. Conclusion: The public demand for information about the job of dental hygienists was mainly related to "chi-lyo," "chigwa," and "ske-illing" as core words, demonstrating that scaling is recognized by the public as the job of a dental hygienist. However, the high demand for information related to treatment and medical assistance in the context of dental hygienists indicates that the job of dental hygienists is recognized by the public as being more focused on medical assistance than preventive dental care that are provided with job autonomy.

• 한국콘텐츠학회논문지
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• 제17권5호
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• pp.366-375
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• 2017

본 연구는 의료급여환자와 가족 3인, 요양병원에 4년 이상 근무한 경험이 있는 종사자 5인에 대한 심층면접조사를 통하여 도덕적해이가 우려되고 있는 의료급여환자의 요양병원 이용과정과 입원, 의료서비스, 퇴원과 전원 등에 대하여 분석하였다. 주요 분석결과와 함의는 다음과 같다. 첫째, 요양병원 입원은 의료급여환자의 선택보다는 의료기관간의 연계와 유치를 위한 경쟁적 홍보에 의해서 이루어지고 있었다. 둘째, 의료급여환자의 요양병원 장기입원의 원인은 본인부담이 적어서 도덕적 해이를 유발할 수도 있었지만 거주지 부재, 간병인 부재 등 퇴원 후 사회적인 보호수단이 없는 것도 주요 원인이었다. 셋째, 대다수 의료급여환자들이 치료가 필요한 상태이지만, 건강보험환자에 비해 필요성이 높지 않음에도 입원을 유지하는 경우가 있었다. 넷째, 요양병원의 의료서비스는 재활서비스가 주를 이루고 있으며, 간호인력과 간병인의 역할이 중요하였다. 다섯째, 의료급여환자들은 요양병원 의료비를 수급비와 가족지원 등으로 부담하고 있지만, 일부 환자들은 병원에서 간병비나 본인부담을 면제 혹은 감면받고 있었다. 여섯째, 공공기관과 사회복지기관은 요양병원에 환자를 의뢰한 이후 지속적인 관리를 하지 않고 있으며, 퇴원 후 지역사회서비스 연계가 필요한 것으로 나타났다.

• 한국보건간호학회지
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• 제5권1호
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• pp.70-95
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• 1991

The ageing problem of the population has been emerging in Korea since 1970's so that it is expecting the elderly 65 years and over among the total population from $4.5\%$ in 1988 to be $6.3\%$ in year 2000. This study was conducted to provide secure policy development in coming years for the aged on medical and health care aspects based on the examining current status of the aged problems and health care policies and systems. The study divided into four parts; The first part examined the medical insurance program and public assistance program of the health services in relation to the aged. The second part emphasized on reduction of medical care cost for the aged. The third part studied the regular health check-up program and health education for the aged. The fourth part examined the chronic disease management programs for the aged and strategies of the health care service quality improvement and specialized programs. The following recommendations made as the results of the study. 1. At present, the medical insurance program and public assistance program for the medically indigent is not appropriate to the elderly because it is a part of general medical insurance program so that Health Security Law for the Aged is proposed. 2. Medical cost will be increased due to the high occupancy rate of hospital beds and long stay of the elderly so that it is recommended to develop an early discharge program, home health care program, Health hospice and an althernative programs. 3. At present, a regular health check-ups for the elderly is not included in medical insurance program so that it is recommended to be included in the insurance program and at the same time health education program thoroughly developed for the aged. 4. To make proper medical and nursing services on chronic diseases for the elderly, it is recommended manpower development, specialized clinics or hospitals, nursing homes and an equivalent long term care facilitices should be established on the community based and a research institutions also to be related to supper the care programs.

• 의료법학
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• 제15권2호
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• pp.195-223
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• 2014

Nurses are medical care providers most closely associated with the national health. Their works are subdivided and specialized, and it is such a factor making nurse's role more important, and with the appearance of specialized nurses, they have secured a position as an independent medical care provider. As the domain of nurse's service becomes broader, there are more accidents and disputes related to nurses. However, there are not many studies conducted on such problems, and even when medical disputes take place related to nurses, the court does not make consistent judgments as a matter of fact. Besides, as the ambiguity of nurse's range of service and the lack of nursing workforce work as a factor causing nurse's medical malpractice, more legal discussions and studies are required to seek proper solutions to such problems. Thus, as a plan to clarify legal issues likely to occur due to nurse's medical practice, this study classified nurse's work into medical assistance practice and other jobs based on their own independent judgments, and proposed establishing concrete regulations on the range of their work, while reviewing common problems extracted from precedents related nurse's medical malpractice. Moreover, while examining Japanese precedents related to the Act of Medical Service Personnel, Nurses and Midwives, which is the sole act of nurses in Japan, this study reviewed the necessity of revising the present nurse-related regulations in Medical Service Act, or enacting a sole act of nurses.

• 지역사회간호학회지
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• 제8권1호
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• pp.116-132
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• 1997

The purpose of the study is to find out how laws related to the nursing profession can be improved by analyzing the rules and regulations concerning nursing. Furthermore, to help settle legal matters in the process of doing nursing work. The data used for the study are the Health and Medical Act, the Maternal and Child Health Act, the School Health Act, the Special Act for Health and Medical Service in Rural Areas, the Industrial Health & Safety Act and the Notice on Nursing Professional Courses analyzed by age and content. The results of the study are as follows : First, basic nursing practice includes 'nursing care for recuperation and assistance in medical treatment and in special areas including the pre-vention of disease, maintenance of health, control of environment, and other therapeutic activities. It is suggested that the phrase 'assistance in medical treatment' should be eliminated as it limits the basic nursing practice to the assistance of the medical treatment. Second, Article 56 of the Health & Medical Act prescribes a special nurse but it does not prescribe a specific job. Accordingly, the new provison concerning the specific jobs of a special nurse should be added or a job guide should be inseated. Third, it is prescribed that those who have completed the training course after obtaining a license are qualified to be a midwife, a special nurse and a nurse practitioner working in special areas. However, school nurses, occupational health nurses and maternal and health workers are required to obtain a nurse license, but not to take an additional training course. Nurses working in special areas should be legally recognized as nurse specialists. The regulations to control various qualification standards consistently should be established. Fourth, the qualifications and types of nurses by area prescribed by Article 54 of the Health and Medical Act are not consistent with those of special nurses as recognized by affiliated organizations of the Korean Nurse Association and some hospitals. Accordingly, the qualifications and types of special nurses should be adjusted in consideration of special nurses. Fifth, as Article 16, Paragraph 2 of the Health and Medical Act does not prescribe the type and scope of first - aid treatment that nurses can provide, the first-aid treatment of nurses might be considered as an unlicensed practice. The specific regulations regarding these matters should be established. Sixth, the contents of the nursing record, which are prescribed by Article 21 of the Health and Medical Act as a duty, include 1) matters concerning body temperature, pulse, breath and blood pressure 2) matters concerning drug prescription 3) matters concerning input and output 4) matters concerning the treatment and nursing care (Article 17 of the Enforcement Regulations, Health and Medical Act). However, these matters are limited to basic nursing care and assistance in medical treatment. The new recording methods on nursing process are suggested to be adopted legally. Seventh, the prescription right entrusted to nurses which are prescribed by the School Health Act, the Special Act on Health and Medical Service for Rural Areas, and the Industrial Health and Safety Act are not consistent with the rights of nurses as prescribed by the Health and Medical Act. New regulations prescribing the partial right for medical treatment entrusted to nurses in consideration of the restraint of time and place in emergency situations should be established.

• 한국치위생학회지
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• 제19권6호
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• pp.875-890
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• 2019

Objectives: This study aims to establish the concept of "dental assistance" within the dental field and to identify the scope of dental assistance, which can be utilized in order to distinguish the scope of work between jobs. Methods: The literature on dental hygienist work and dental assistance was reviewed, and the laws and precedents related to dental assistance were examined. Results: The criteria for judging the legitimacy of dental assistance included the following: whether the performance was conducted under the guidance and supervision of a doctor; whether there was a possibility of an aftereffect or side effects of the procedure; whether education was conducted within the curriculum; and whether it was evaluated in the national licensing examination. In addition, the work of the assistant in dental surgery and treatment is judged comprehensively by considering the type of dental surgery and treatment, invasive degree, necessity of expertise, and work proficiency of the dental hygienist. Therefore, it is suggested that dental hygienists may be of assistance for dental treatment/surgery because they meet the requirements of dental professionals, such as dental hygiene curriculum, national licensing examination, duties in the field of dentistry, and work proficiency. Conclusions: Dental assistance (including assistance in dental surgery) for dental treatment, dental/medical history taking, taking vital signs, and blood glucose monitoring should be permitted within the realm of dental hygienist work. Therefore, the actual expertise of dental hygienists should be reflected legally and the work of dental hygienists should be realized.

• 의료법학
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• 제21권1호
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• pp.69-105
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• 2020

의료보장제도에서 진료수가는 의료보장체계의 근간을 이루는 매우 중요한 요소이다. 국민건강보험법은 진료수가의 결정방식에 관하여 계약제를 채택하였고, 그 계약의 내용은 상대가치점수에 대한 점수당 단가를 정하는 것이다. 그에 따라 건강보험 요양급여비용은 매년마다 물가상승이나 경제 상황의 변화에 따라 조정된다. 반면, 의료급여의 경우, 의료급여법에서는 진료수가의 결정방식에 관한 내용을 규정하지 않고, 모든 사항을 보건복지부 장관에게 위임하고 있다. 그에 따라 보건복지부 장관은 2001년부터 혈액투석 치료에 관하여 정액수가제를 채택하고 있다. 이러한 혈액투석 정액수가제에 대해서 2017년 헌법소원이 제기되었고, 헌법재판소는 2020년 헌법소원 심판 청구를 모두 기각하였다. 이 글에서는, 위 헌법소원 사건을 중심으로 진료수가제도의 의미와 내용을 살펴보고, 이에 대한 헌법적 한계로 3가지 원칙을 제시한다. 그 원칙의 첫째는 법률유보의 원칙, 둘째는 포괄위임금지의 원칙, 셋째는 비례의 원칙이다. 그러한 관점에서 검토해 보면, 혈액투석 정액수가제는 상당히 위헌적인 제도로 판단된다.

• 한국인구학
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• 제5권1호
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• pp.167-186
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• 1982

Financial barrier is well known as a determinant of the perceived need for and utilization of medical care in urban areas. This study aims to; a) estimate the levels of the perceived need for and utilization of medical care, b) analyze the reasons for not receiving medical care, and c) determine factors affecting the levels of need and utilization, and major reasons for not receiving medical care. The data of household interview survey in urban areas collected for a National Survey on Reorganization of Nationwide Health Care Delivery Network is used. An interview was conducted with a total of 2, 538 households in urban areas during a 28 day period of October through November, 1981, giving an overall response rate of 99 percent. The results show a factor of third-party payer is most influential to utilization (physician visits by patient), and living standard is a determinant to explain the variance of major reasons for not receiving medical care. Therefore, financial burden is still a major determent in utilization of medical care in urban areas. Improved level of living standard and expanded coverage of the third-party payer such as health insurance and public medical assistance will increase both an overall levels of utilization of and the need for medical care in urban areas in the future. The major statistics are as follows; a) rate of the need for medical care during a 15 day period per 100 persons was 33 percent: the differential rates appeared in sex, age, living standard, and third- party payer variables, b) percent of treatment employed per 100 persons who are wanting medical care was 82: the percents were high in young ages, high levels of living standard and education, and persons covered by third-party payer, and c) economic reasons for not receiving medical care per 100 persons who are wanting medical care were occupied with 60 percent: the rates are high in old ages, low levels of living standard and persons not covered by third-party payer.