• 한국직업건강간호학회지
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• 제20권3호
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• pp.299-307
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• 2011

Purpose: The purpose of this study is to establish the standards for duty of Medical Care Client Managers and analyze the extent of accomplishment, importance, and difficulty according to the standards. Methods: The draft for duty of Medical Care Client Managers was formed by the method of developing a curriculum (DACUM) and data were collected from 185 Medical Aid Client Managers in 234 areas to evaluate the actual frequency of accomplishment, importance and difficulty in comparison with the standards for duties. Results: The standard duty draft for Medical Care Client Manager is composed of five separate groups of duties and thirty five tasks. The five duties are Case Management, Extension Approval, External Cause of Injury, Duplicate Claims and Other Administrations. Seven Tasks are allocated to each duty such as Case Management, Extension Approval and External Cause of Injury. Five tasks are allocated to 'Duplicate Claims' duty and nine tasks are allocated to 'Other Administrations' duty. Conclusion: From the results of analysis for duties, it was apprehensive about overburdened responsibilities and carelessness in professional duties. It was necessary to establish specific guidelines for duties because of redundent application or regional variation in frequency of accomplishing other administrative duties. It was necessary to relieve a regional disparity of business charge and also was necessary to propose an alternative plan to relieve the overburdened responsibilities.

• 한국콘텐츠학회논문지
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• 제17권8호
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• pp.610-618
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• 2017

한국에서 의료인에 의한 성범죄가 지속적으로 발생하고 있어 환자뿐만 아니라 일반 국민들은 불안감을 호소하며, 의료계에 대한 불신은 더욱 높아지고 있다. 이에 정부는 사회에서의 성범죄에 대한 엄벌주의 요청에 따라 성범죄 관련 범죄의 형량을 높이는 방향으로 법률의 제 개정을 진행하고 있으며, 성범죄 의료인에 대한 행정처분을 활성화하겠다는 의지를 표명하였다. 이러한 사회적 분위기와 달리 실제 법률을 적용하는 사법부는 의료인의 성범죄 사건에 대해서 그 심각성을 크게 인식하지 못한 것으로 보인다. 2016년 12월, 대법원은 소아과 병원 진료과정에서 의사가 여중생을 추행한 혐의에 대해 무죄를 선고하여 국민의 법감정과 상이한 판결을 하였다. 이에 본 연구에서는 해당 사건을 중심으로 의료인의 성범죄 사건에 대한 판례를 분석하고, 그에 따른 시사점을 제시하고자 한다. 이를 통해 성범죄 의료인에 대한 법적용의 미비점을 보완하여 의료계 전반에 대한 불신을 해소하고, 국민이 보다 안전한 환경에서 양질의 의료서비스를 제공받음으로써 국민의 건강권과 행복권을 담보하는데 기초자료를 제공하고자 한다.

• 의학교육논단
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• 제24권1호
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• pp.18-34
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• 2022

The purpose of this study is to clarify the background of the controversial attempt to establish a new public medical school linked to compulsory service as a means of strengthening public healthcare in Korea, and to raise anticipated problems with possible solutions. In Korea, healthcare is predominantly provided by the private sector focused on medical care, rather than public healthcare, even under the national health insurance system. The government has been mainly in charge of public health and unmet medical services from a residual perspective, but health inequalities still exist. To resolve this issue, the government created the concept of public health and medical service (PHMS) from a universal perspective and tried to strengthen the infrastructure of public healthcare and to foster core PHMS doctors by establishing a new public medical school linked to compulsory service in medically vulnerable areas. This study investigated the reality and concept of the new public medical school planned by the government, and identified problems such as the possibility of obtaining accreditation and evaluation before its establishment, the side effects of dividing doctors' roles, the waste of huge amounts of resources, and insensitive policies. In conclusion, in order to resolve health inequalities in Korea, we need to train doctors through medical school education that strengthens the social responsibility of doctors along with strengthening public healthcare infrastructure, and to provide a better environment for doctors working in medically vulnerable areas through sophisticated policies.

• 의학교육논단
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• 제24권2호
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• pp.156-171
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• 2022

The purpose of this study was to establish a model for constructing longitudinal data for medical school, and to structure cohort and longitudinal data using data from Yonsei University College of Medicine (YUCM) according to the established input-environment-output (I-E-O) model. The study was conducted according to the following procedure. First, the data that YUCM has collected was reviewed through data analysis and interviews with the person in charge of each questionnaire. Second, the opinions of experts on the validity of the I-E-O model were collected through the first expert consultation, and as a result, a model was established for each stage of medical education based on the I-E-O model. Finally, in order to further materialize and refine the previously established model for each stage of medical education, secondary expert consultation was conducted. As a result, the survey areas and time period for collecting longitudinal data were organized according to the model for each stage of medical education, and an example of the YUCM cohort constructed according to the established model for each stage of medical education was presented. The results derived from this study constitute a basic step toward building data from universities in longitudinal form, and if longitudinal data are actually constructed through this method, they could be used as an important basis for determining major policies or reorganizing the curricula of universities. These research results have implications in terms of the management and utilization of existing survey data, the composition of cohorts, and longitudinal studies for many medical schools that are conducting surveys in various areas targeting students, such as lecture evaluation and satisfaction surveys.

• 보건행정학회지
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• 제33권3호
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• pp.253-263
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• 2023

Background: The purpose of this study was to explore the relationship between the local extinction index and total medical service utilization. Methods: A fixed effects model in panel analysis was performed for the 228 administrative districts in Korea. The statistical yearbook on the usage of medical services by region and Korean Statistical Information Service data were used from 2010 to 2019 for analysis. Medical service utilization was represented by the number of visits day, the number of inpatient days, and medical charges. Control variables were selected by using an Anderson model. The local extinction index was calculated using resident registration population data. Results: Descriptive statistics showed that the number of areas at risk of extinction increased from 61 to 95 for the study years. In addition, the number of visits, the number of inpatient days, and medical charges all increased during the study years. After controlling for variables affecting medical service utilization and doing a panel fixed effects model, the result suggested that a one-step increase in the local extinction index was significantly associated with a 12.29% decrease in medical charges of inpatients, a 7.33% decrease in medical charge of outpatient, a 5.21% decrease in the number of inpatient day, and a 5.54% decrease in the number of visits day. Conclusion: This study showed that the higher the region's extinction risks, the higher the region's total medical service utilization. The results of this study suggested that there was a disparity in medical service utilization between areas at risk of extinction and areas not at risk of extinction, so measures should be taken to address this disparity.

• 의료법학
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• 제19권2호
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• pp.139-171
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• 2018

「의료사고 피해구제 및 의료분쟁 조정 등에 관한 법률」(이하 '의료분쟁조정법'이라 한다)에서는 보건의료인이 충분한 주의의무를 다하였음에도 불구하고 분만 중 불가항력적으로 발생한 의료사고에 대하여 국가가 예산의 범위 안에서 그 피해자에게 보상하도록 하고 있다(의료분쟁조정법 제46조). 지금까지 의료사고 피해자가 소송을 통해서만 피해회복을 기대할 수 있었던 것에 비한다면 획기적인 법률이라 할 수 있다. 그런데, 이러한 의료사고보상사업에 드는 비용의 100분의 30은 보건의료기관개설자 중 분만 실적이 있는 자가 부담하고 있는 바(의료분쟁조정법 시행령 제21조), 이 분담금 부과 조항이 분만 과정에서의 산모·신생아 사망 등의 사고가 의사의 과실이 없이 불가항력적으로 발생했음에도, 의사들에게 책임을 묻는 것은 아닌지 문제가 되어 왔다. 그러나 최근 헌법재판소에서 분담금 부과와 관련한 의료분쟁조정법법 제46조 제3항 중 '보건의료기관개설자의 범위' 및 '보상재원의 분담비율' 부분에 대하여 합헌 결정을 내린 바 있다(헌법재판소 2018. 4. 26. 선고 2015헌가13 결정, 이하 '이 사건 결정'이라 한다). 이 사건 결정에서는 법률유보원칙 및 포괄위임입법금지원칙에 의하여만 판단하였으나, 본고에서는 실질적인 판단도 가미하였다. 이 사건 분담금운 과잉금지원칙에 비추어 보더라도 보건의료기관개설자들의 재산권을 침해하지 않는 점을 논증하였다. 불가항력 의료보상제도의 분담금 부과가 민사책임의 중요 원칙인 과실책임원칙에 거스르는 측면이 존재한다. 그러나 의료사고보상사업은 의료사고 피해자를 위한 국가정책으로 합리성이 있으며, 동시에 의료분쟁의 조기종결 효과로 의료계 역시 이익을 얻는 측면이 분명 존재한다. 분담금의 납부를 통한 보상재원의 확충은 이러한 의료사고보상제도를 빠르게 정착시킴으로서 분만과정에서 발생한 의료사고 피해자의 고통과 오해를 경감시키고 의료인의 안정적 진료환경 구축에 큰 도움이 될 것이다.

• 대한한방내과학회지
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• 제31권2호
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• pp.264-272
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• 2010

Objectives : This study was carried out to measure perceptions about Traditional Korean Medicine hospitals and provide data for improvement of TKM hospital management. Methods : We surveyed the general population from 1st to 17th December, 2008, and patients visiting a TKM hospital from 1st June to 9th December, 2008. Results : Result as follows. 1. The response ratio for the generally preferred medical institution was in the order of western medical clinic, pharmacy, general hospital, TKM clinic, TKM hospital. 2. The response ratio for the preferred medical institution for herbal medicine treatment was in the order of TKM clinic, herbal medicine store, TKM hospital, pharmacy. The preferred medical institution for acupuncture treatment was in the order of TKM clinic, TKM hospital, acupuncture clinic, public health center. 3. The most common response to reason for receiving traditional Korean medical care was "traditional Korean medical care is more effective than western medical care." 4. The proportion of first treatment and second treatment of patients visiting at TKM hospital was about 1:1. 5. 72.3% of patients had been to another medical institution. 6. The response ratio for the first visited medical institution for the same disease was in the order of general hospital, western medical hospital, western medical clinic, TKM clinic. 7. The response ratio for the concern about TKM treatment was in the order of expensive charge for TKM treatment, uncertainty of TKM treatment effect. Conclusions : Through this research, we can understand the perception about TKM hospital treatment of the general population and patients visiting TKM hospitals.

• 의료법학
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• 제19권2호
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• pp.3-40
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• 2018

예전부터 일본에서 의료사고가 형사사건으로 취급되는 경우는 드물었다. 하지만 요코하마시립대학병원과 같은 중대한 의료과오가 발생한 이후 검사가 의료과오를 기소하는 태도를 보이고 있다. 의료사고는 의료관계자간 역할분담의 형태가 과실 인정에서 중요한 하나의 요소가 된다. 요코하마시립병원사건에서는 환자의 동일성확인에 관하여 의료관계자 사이에 역할분담이 확립되지 않은 경우에는 관계자 전원이 환자의 동일성을 확인하여야 할 의무가 있다고 하였다. 또 사이타마 의과대학병원사건에서는 치료에 신중할 필요가 있는 중대한 증례에 관해서는 그 증례를 담당하는 주치의 뿐 만 아니라 대학병원의 과장도 치료방침에 관하여 확인할 의무가 있다고 하였다. 현립 오오노병원사건에서 무죄판결이 내려진 이후는 형사소추에 신중을 기할 필요가 있다는 목소리가 강해지고 있다. 이러한 상황 속에서 후생노동성은 의료사고방지를 위해 의료사고조사제도를 도입하여 의료사고에 제3자기관에 의한 검증의 강화를 도모하고 있다.

• 보건행정학회지
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• 제29권1호
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• pp.40-48
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• 2019

Background: As of July 2015, per diem payment was changed from fee for service Therefore, this study aims to analyse changes in medical charges and medical services before and after enforcement of the palliative care, targeting palliative care wards in a general hospital, and provide basic data needed for development of per diem payment. Methods: The subjects of the study were a total of 610 cases consisting of 351 patients of service fee who left hospital (died) from July 2014 to June 2016 and 259 ones of per diem payment at Chosun University Hospital in Gwangju Metropolitan City. Results: The results are summarized as follows. First, after the palliative care system was applied, benefit medical service charges and insurance increased significantly (p<0.001). As benefit medical service charges increased, benefit private insurance payment increased significantly (p<0.001). Second, after the per diem payment was applied, total private insurance payment to medical institutes decreased significantly (p=0.050) and non-benefit also decreased significantly (p=0.001). Conclusion: It is suggested that additional rewards in the obligatory palliative care items should be continuously remedied and monitored to provide good quality hospice palliative care.

• 대한간호학회지
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• 제24권4호
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• pp.545-556
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• 1994

Medical insurance and health care delivery system enabled Korean people to get the necessary medical service, but it caused increased needs for medical service, and resulted in the occurence of some problems such as a lack of manpower and medical facilities. In order to solve these problems, many countries, which already had medical insurance system had developed home care system and it has been regarded effective both in reducing costs and in increasing the rates of turnover of bed. Recently, Korea has included home nursing care in its health care delivery system, and some models of the hospital based home nursing care had been tried and its effects had been evaluated. So, author tried to run a home nursing care for the Cesarean section mothers and evaluate Its effects both in the mother's health and costs. This study was designed as a Quasi-experimental study. Subjects were thirty mothers who got Cesarean section operation in hospital in Seoul. Experimental group consisted of 15 volunteers, and control group were selected by means of matching technique. Data were gathered from February 1st to March 26th by two assistants who were trained by author. Experimental group were discharged on the 4th day after their operation, and got nursing care and assessment about their home three times on the 5th, 6th, and 7th day. Control group stayed in the hospital until 7th day as usual and were checked on the same day as above mentioned To evaluate the state of physiological recovery, vital signs, H.O.F, presence of edema in the legs, bathing, appetite, sleep, presence of pain or discomfort in the breasts, amount of lochia, color of lochia, defecation urination. To compare incidence of complication in experimental group with that in control group, specific assessment was done such variables as smell of lochia, presence of inflammation of operation wound, dizziness, and presence of immobilization in the extremities. The activities of daily living were checked Satisfaction of nursing were checked To calculate costs, author asked subjects to specify expenditure including hospital charge, traffic enpenses, and food expenses. The results were as fellows. 1. On effectiveness of home nursing careThere were n significant differences between experimental and control group in incidence of abnormal symptoms and any complication. The number of taking a bath [POD #5 P=0.001, #6 P=0.0003, #7 P=0.001] and the degree of appetite [POD #5 P=0.03, #6 P=0.02, #7 P=0.013] were significantly higher in experimental group than in control group. Contrary to author's expectation, the degree of the activities of daily living in experimental group was not higher than that of control group. All of the experimental group said they were satisfied with the home nursing care. 2. Cost analysis 1) Hospital charge of experimental group was lower than that of control group. ［P=0.009］ By taking home nursing care, average period of hospitalization was shortened to 3.1 days, and family members could save 22.8 hours. Total amount of money saved by early discharge was 3,443,093 Won. It is estimated that total amount of money saved by early discharge in a year will be 40,398,956 Won. 2) Home nursing care charge of 15 mothers was 1,781,633 Won. It is estimated that total amount of money Saved by it in a year Will be 20,904,493 Won. It was lower altogether than hospital charge of the three days which is 5th, 6th, 7th day of operation. The average cost of single home visit was calculated 10,940 Won. It took 87 minutes per round and it costed 1,017.3 Won. The average hour of home care was 39.0 minutes. 3) It is expected that early discharge can bring forth the increase of hospital income. On the condition that the rate of running bed is 100%, the expected increase of hospital income will be 202,374, 026 Won in a year. Suggestions for further study and nursing practice are as follows : 1. For the welfare of patients and the increased rates of running bed, home nursing care system should be included in the hospital nursing care system. 2. Studies to test effect of home nursing care on the patients with other diseases are needed. 3. Establishment of law on the practice of home nursing care is strongly recommended.