• Journal of Preventive Medicine and Public Health
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• 제55권2호
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• pp.125-133
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• 2022

Objectives: No systematic review has explored the challenges related to worldwide universal health coverage (UHC). This study reviewed challenges on the road to UHC. Methods: A systematic electronic search of all studies that identified the challenges of worldwide UHC was conducted, without any restrictions related to the publication date or language. A hand search and a bibliographic search were also conducted to identify which texts to include in this study. These sources and citations yielded a total of 2500 articles, only 26 of which met the inclusion criteria. Relevant data from these papers were extracted, summarized, grouped, and reported in tables. Results: Of the 26 included studies, 7 (27%) were reviews, 6 (23%) were reports, and 13 (50%) had another type of study design. The publication dates of the included studies ranged from 2011 to 2020. Nine studies (35%) were published in 2019. Using the World Health Organization conceptual model, data on all of the challenges related to UHC in terms of the 4 functions of health systems (stewardship, creating resource, financing, and delivering services) were extracted from the included studies and reported. Conclusions: This study provides a straightforward summary of previous studies that explored the challenges related to UHC and conducted an in-depth analysis of viable solutions.

• 의료법학
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• 제8권2호
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• pp.9-35
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• 2007

The Health care program in Korea has now been systemized after 30 years of declaring the inauguration of the national health insurance system by the current government. The national health care covering all Korean citizens was achieved after 12 years of implementing the national health insurance and the health care program since 1977. Hundreds of multiple operational agencies managing the insured individually had undergone the amalgamation process from 1998 to 2000, and had been restructured as one agency, the National Health Insurance Corporation. In 2003, the community/area based financial management was also merged together with the employment based financial management. The National health care system of Korea offer various merits, compared with that of other countries, such as health care provision covering all Koreans, low insurance premium, accessibility of medical services/facilities etc. However, there are still some weak features which need to be addressed for improvement; below expectation insurance cover system, mistrust on the medical services, low medical charges resulted from excessive restrictions, and unstable financial status of the national health insurance etc. Therefore, the National health care system should continue to evolve to re-establish itself as more effective national health care system by further strengthening its merits, and by improving its weaknesses; with adopting the positive system to optimize the costs of prescribed medicines/drugs, applying simpler insurance coverage system to calculate the optimum medical charges, promoting private medical insurances, and increasing insurance premium etc.

• 융합보안논문지
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• 제11권4호
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• pp.77-83
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• 2011

의료정보 기술의 빠른 발전과 더불어 새로운 의료정보 서비스 개발에 대한 연구가 많이 진행되고 있다. 의료서비스를 향상시켜 환자들에게 많은 도움을 주는 방법이다. 하지만 정보보안에 대해 대비없이 기술만 발전한다면 의료서비스 체계에 위험과 위협의 요소를 만드는 것이다. 오늘날 현안과제인 공중망을 통한 안정적인 접근문제, Ad hoc을 이용한 센서네트워크 보안, 비통합 의료정보 체계의 보안취약성과 같은 보안의 취약성을 해결하지 않을채 의료정보시스템은 발전과 활용에 큰 제한을 받게 된다.. 서로 다른 보안 정책을 가진 의료정보시스템 환경에서 보안정책이 출동할 경우 해결할수 있는 매커니즘이 필요하다. context-aware와 융통성있는 정책을 통해 의료정보의 통합성과 비밀성이 보장되어야 한다. 다른 도메인간 원거리 통신시 접근제어 정책이 보호 되어야 한다. 본 논문에서는 의료정보시스템의 접속자가 다양화, 다변화 되는 환경에서 Security agent 역할 기반의 보안시스템 아키텍쳐 설계방안을 제안한다. 제안된 시스템아키텍쳐는 현장에서 설계작업에서 하나의 모델로 활용이 가능할 것으로 기대한다.

• Clinics in Shoulder and Elbow
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• 제21권3호
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• pp.120-126
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• 2018

Background: Treatment of distal humerus fractures in osteoporotic elderly patients is often challenging. For non-reconstructible fractures with open reduction and internal fixation, total elbow arthroplasty (TEA) is an acceptable alternative. However, the relatively high complication rates and lifelong activity restrictions make TEA less ideal for elderly or low-demand patients. Efforts to identify or develop alternate procedures that benefit relatively young, high-demand patients have resulted in increased interest in hemiarthroplasty. This systematic review reports the clinical outcomes of hemiarthroplasty for distal humeral fractures. Methods: We systematically reviewed the databases of PubMed, Ovid MEDLINE, and Cochrane Library. All English-language studies published before June 2017 were considered for possible inclusion. Search terms included 'distal humerus fracture' and 'hemiarthroplasty'. Studies reporting outcomes (and a minimum of 1 year clinical follow-up) in human subjects after hemiarthroplasty (Latitude system) for distal humeral fractures were assessed for inclusion. Patient demographics, clinical and radiographic outcomes, and complications were recorded, and homogenous outcome measures were analyzed. Results: Nine studies with a total of 115 patients met the inclusion criteria. Among the included studies, the weighted mean follow-up time was 35.4 months. Furthermore, the weighted mean of the postoperative range of motion ($107.6^{\circ}$ flexion-extension, $157.5^{\circ}$ for pronation-supination) and functional outcomes (Mayo elbow performance scores: 85.8, Disabilities of the Arm, Shoulder and Hand score: 19.6) were within the acceptable range. Conclusions: Our study indicates that hemiarthroplasty is a viable option for comminuted distal humerus fracture. Satisfactory functional outcomes were observed in most patients.

• Journal of Preventive Medicine and Public Health
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• 제53권5호
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• pp.307-310
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• 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has placed unprecedented pressure on healthcare systems, even in advanced economies. While the number of cases of SARS-CoV-2 in Africa compared to other continents has so far been low, there are concerns about under-reporting, inadequate diagnostic tools, and insufficient treatment facilities. Moreover, proactiveness on the part of African governments has been under scrutiny. For instance, issues have emerged regarding the responsiveness of African countries in closing international borders to limit trans-continental transmission of the virus. Overdependence on imported products and outsourced services could have contributed to African governments' hesitation to shut down international air and seaports. In this era of emerging and re-emerging pathogens, we recommend that African nations should consider self-sufficiency in the health sector as an urgent priority, as this will not be the last outbreak to occur. In addition to the Regional Disease Surveillance Systems Enhancement fund (US$600 million) provided by the World Bank for strengthening health systems and disease surveillance, each country should further establish an epidemic emergency fund for epidemic preparedness and response. We also recommend that epidemic surveillance units should create a secure database of previous and ongoing pandemics in terms of aetiology, spread, and treatment, as well as financial management records. Strategic collection and analysis of data should also be a central focus of these units to facilitate studies of disease trends and to estimate the scale of requirements in preparation and response to any future pandemic or epidemic.

• Clinical and Experimental Pediatrics
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• 제64권7호
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• pp.341-346
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• 2021

Background: The results differ among published studies regarding exposure to meconium and the risk of developing autism spectrum disorders (ASDs). Purpose: The present study pooled all of the epidemiologic studies retrieved from broader databases on the association between meconium exposure and risk of developing ASD in children. Methods: The Web of Science, PubMed, Scopus, and Google Scholar databases were searched without language restrictions for articles published between their inception to February 20, 2020, using relevant keywords. The pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated as random-effect estimates of the associations among studies. A subgroup analysis was conducted to explore any potential sources of heterogeneity among studies. Results: The pooled estimate of OR reported a weakly significant association between meconium exposure and ASD development in children (OR, 1.13; 95% CI, 1.03-1.24). There was low heterogeneity among the articles reporting risk for ASD among children (I²=19.3%; P=0.259). The results of subgroup analysis based on meconium exposure showed a significant association between a meconium-stained neonate and ASD development (OR, 1.18; 95% CI, 1.11-1.24). Couclusion: Meconium exposure was weakly associated with an increased risk of ASD. However, more evidence based on large prospective cohort studies is required to provide conclusive evidence about whether meconium exposure is associated with an increased risk of ASD development.

• 한국중재학회지:중재연구
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• 제30권4호
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• pp.121-138
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• 2020

The O2O services in the healthcare sector have only been in full swing for about three years, and unlike existing O2O consumer goods, the scale and scope of the dispute are more complicated due to restrictions on medical treatment. In this study, O2O service platform operators and medical institutions' roles and responsibilities were redefined as a countermeasure for resolving disputes in healthcare O2O services and the laws for changing the transaction environment. A change in institutional mechanisms was proposed. This study looked at the types of consumer disputes related to healthcare O2O services as insufficient information problems, problems in the course of medical service implementation, problems with immunity provisions for platform operators, cancellations, and non-compliance with refunds. All the information generated during transactions in the healthcare sector was extensive in scale and included the most sensitive information among personal information, stressing the importance of ensuring security. The area that started in the O2O range before the medical institution visit also proposed a plan to establish a system for the delivery of proven information as a pre-medical person. The scale and growth will grow faster, given that consumers can experience the information they want anytime, anywhere they want. However, the platform broker's role, a link player, will become more important because consumers who use the service will have their first meeting with non-face-to-face product providers. On the other hand, service providers may have side effects of misleading consumers by providing false information or misleading consumers through exaggerated advertisements. The O2O service market is expected to expand beyond distribution and dining out to the entire industry. However, since it is challenging to check accurate statistics on the detailed market, various disputes and consumer protection measures will be required for each detailed market, and comprehensive leading solutions will be essential in the future.

• 한국산업정보학회논문지
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• 제27권5호
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• pp.119-128
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• 2022

본 연구는 물리적 환경에 대한 의료서비스를 대상으로 QR코드를 활용한 정보서비스가 고객의 서비스품질 인식과 이후 충성행동에 미치는 영향관계를 검토하였다. 연구결과 의료기관이 QR코드의 유용성과 신뢰성 등을 활용하여 물리적 환경에 대한 위치정보서비스를 제공할 경우 고객들의 QR정보에 대한 지각된 품질이 강화되며, 더 나아가 향후 의료서비스에 대한 충성행동도 증가될 수 있음을 확인하였다. 오늘날 대중적 디지털 매체로서 스마트폰의 보급이 활성화되고 있음을 고려할 때, 마케터들은 QR코드를 활용하여 시간과 장소의 제약없이 4차원적 정보서비스를 연계하여 제공함으로써 고객과의 상호작용적 체험성을 강화시킬 수 있다. 그리고 이러한 노력은 기업들에게 단순한 서비스정보의 제공에서 더 나아가 서비스이미지 향상과 충성도 강화에 기여할 수 있음을 시사해주고 있다.

• 한국콘텐츠학회논문지
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• 제17권9호
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• pp.39-49
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• 2017

본 연구는 질적 연구를 통하여 의료급여환자들의 의료이용 경험을 이해함으로써 의료급여환자와 건강보험환자 간 의료이용량의 통계적 차이현상의 원인과 과정을 파악하기 위해 수행되었다. 주요 분석결과는 다음과 같다. 첫째, 의료급여환자의 과잉의료는 대체로 존재하지 않으며, 복합적 질병을 가지고 있어서 발생하는 것이다. 그러나 물리치료와 한방 침에 있어서 일부 과잉이용이 발생하고 있는 것으로 판단된다. 둘째, 의료급여환자들은 의료비를 마련하기 위하여 생계급여에서 일부를 활용하거나 주변 가족이나 이웃의 도움을 받고 있었다. 그러나 과도한 의료비 부담으로 비급여 의료서비스와 대형병원 의료이용은 실제 의료필요만큼 이용하지 못하고 있었다. 또한 일부 환자는 아파도 우선 참고 견디고 있었다. 한편, 일부 의료기관에서는 의료급여환자에 대한 차별적 진료행위를 여전히 하고 있었다. 셋째, 공무원과 의료기관 모두는 의료급여환자에게 의료비 지원정책에 대한 미흡한 정보 제공 등 충분한 도움을 주지 못하고 있었다. 넷째, 정부가 수행하고 있는 의료급여정책인 선택병의원제도, 의료급여사례관리제도, 진료연장승인제도 모두는 불필요한 의료이용을 감소시키는데 기여하고 있는 것으로 판단된다. 그러나 의료급여환자들에게 필요한 의료이용을 제한하는 문제를 초래할 수 있어 이에 대한 대책마련이 요구되었다. 이상의 연구결과를 살펴보면 건강보험환자와 의료급여환자의 의료이용량의 차이를 통계적으로 검증한 선행연구와는 달리 의료급여환자들은 의도적인 과잉이용을 하지 않고 있으며, 오히려 필요한 의료서비스 이용에 제한을 받는다고 생각하고 있었으므로, 이에 대한 대책마련이 요구된다.

• 보건행정학회지
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• 제20권1호
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• pp.137-154
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• 2010

This study empirically analyzed the effects of the Top Management Team (TMT) on organizational performance. We verified whether the age heterogeneity, job heterogeneity (core career, core function and major), and process (communication and integration) of the TMT affect organizational performance (management performance and healthcare service quality evaluation level). We collected data about 473 members of the 2006 TMT in 81 medical institutions. We also utilized statistics of organizational performance from the Ministry for Health, Welfare and Family Affairs and the Korean Institute of Hospital Management. Results of the study showed that the age heterogeneity of TMT exerted a negative effect on the healthcare service quality evaluation level, while the process exerted a positive effect. However, the age heterogeneity, job heterogeneity, and process had no influence on management performance. We discussed the implications of such outcome of the investigation in comparison with the former studies on TMT and organizational performance, and presented its restrictions and future plans.