• 의료법학
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• 제7권2호
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• pp.219-268
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• 2006

In July 1989, Korea had achieved the national medical insurance system comprehensively covering the whole population since its inception of 12 years before, and subsequently the plural medical insurers had integrated to the unique health insurer system in July 2000. But there yet remain some problems to be improved under low contributions rates and poor benefit packages, especially the shortage of assuring beneficiaries' rights. The Health Insurance Appeal System is composed of a two-tiered system of committee. The Formal Objection Committees built in the National Health Insurance Corporation and in the Health Insurance Review Agency respectively examine the formal objections to the decisions of the Corporation, or the Review Agency. And the Dispute Mediation Committee built under the command of the Minister of Health and Welfare reviews the protests against the decisions on the formal objections by each Formal Objection Committee. To cope with the appellant in relation to the administration on the qualification of the insureds, contributions, and insurance benefits etc, is found to be unsatisfactory. There's the reason of poor function on right-relief caused by the loose composition of the Appeal Committee, the deficit of people's recognition and P.R., the lack of professional manpower and the Committee's independency, and time lag in making decisions and so on. Consequently the Appeal System should be improved to secure the rights-relief function, to empower the professionalism of the Appeal Committee, to strengthen P.R. for the beneficiaries, to build up the staff's proficiency through training, and to develop the quality of administrative services.

• 보건교육건강증진학회지
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• 제26권3호
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• pp.75-83
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• 2009

Objectives: This study aims to examine if the follow-up management service by National Health Insurance (NHI) for obesity persons leads to significant modification of the lifestyle and change of health status. Methods: Of persons who underwent health screening and were classified as obesity after periodic health screening by NHI in 2004, persons who took the follow-up management service were selected as case group and persons who took no service were selected as control group. The DW database of NHI was used to explore the effect of the follow-up management service on the modification of lifestyle and health status. Chi-square tests and t-tests, pairs t-tests were conducted with SAS 9.1 to examine the differences of health promotion effect between case vs. control group. Results: It was shows that of lifestyle behaviors, only exercise is significantly improved for case group compared with control group as the effect of the follow-up management service by NHI (2.11%p) (p=0.0435). Further, morbidity rate for control group was 2.05% higher than that of case group (p=0.0002). These results indicate that persons who received the follow-up management service better maintained their health significantly than persons who did not. Conclusion: The present study shows that the appropriate follow-up management services need to be provided for maximaizing potential effect of periodic health screening by NHI.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제35권1호
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• pp.31-34
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• 2009

Purpose: This study compared the frequency of postoperative infections in patients for a closed mandibular fracture with that without the postoperative antibiotic prophylaxis. Patients and Methods: 48 patients without any specific medical history were divided into two groups depending on whether or not antibiotics had been applied after the surgery. The 24 patients in group 1 received only a second-generation cephalosporin ($Cefotetan^{(R)}$) intravenously from admission to immediate after the surgery. Likewise, 24 patients in group 2 received 1.0g of $Cefotetan^{(R)}$ twice daily longer than the third day after surgery. The mean (SD) duration of antibiotics administration after surgery was 6.9 (${\pm}3.56$). The patients were evaluated after surgery for any postoperative infections according to the criteria: purulent drainage from a wound, spontaneous wound dehiscence accompanied by swelling, pain, and fever around the wound. Results: Postoperative infections were encountered in 2 out of 24 patients in group 1, who received antibiotic medication until shortly after surgery, and in 3 out of the 24 patients in group 2, in whom the medication was continued even after the surgery. There was no sig nificant difference in the incidence of postoperative infections between the two groups. Conclusion: From this study, postoperative use of antibiotics seems to be unnecessary with view of the little significance of the factors that could affect the wound infection.

• Journal of Korean Neurosurgical Society
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• 제46권4호
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• pp.285-291
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• 2009

Objective : This study examined the change of range of motion (ROM) at the segments within the dynamic posterior stabilization, segments above and below the system, the clinical course and analyzed the factors influencing them. Methods : This study included a consecutive 27 patients who underwent one-level to three-level dynamic stabilization with Bioflex system at our institute. All of these patients with degenerative disc disease underwent decompressive laminectomy with/without discectomy and dynamic stabilization with Bioflex system at the laminectomy level without fusion. Visual analogue scale (VAS) scores for back and leg pain, whole lumbar lordosis (from L1 to S1), ROMs from preoperative, immediate postoperative, 1.5, 3, 6, 12 months at whole lumbar (from L1 to S1), each instrumented levels, and one segment above and below this instrumentation were evaluated. Results : VAS scores for leg and back pain decreased significantly throughout the whole study period. Whole lumbar lordosis remained within preoperative range, ROM of whole lumbar and instrumented levels showed a significant decrease. ROM of one level upper and lower to the instrumentation increased, but statistically invalid. There were also 5 cases of complications related with the fixation system. Conclusion : Bioflex posterior dynamic stabilization system supports operation-induced unstable, destroyed segments and assists in physiological motion and stabilization at the instrumented level, decrease back and leg pain, maintain preoperative lumbar lordotic angle and reduce ROM of whole lumbar and instrumented segments. Prevention of adjacent segment degeneration and complication rates are something to be reconsidered through longer follow up period.

• 대한두경부종양학회지
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• 제24권2호
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• pp.169-173
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• 2008

Purpose：This is a retrospective study to evaluate the results of concurrent chemoradiotherapy in nasopharyngeal carcinoma. Material and Methods：From Mar 2000 to June 2005, 18 patients with nasopharyngeal carcinoma completed planned concurrent chemoradiotherapy. Stages were I in 1 patients, II in 2 patients, III in 7 patients and IV in 8 patients. Pathologic type was squamous cell carcinoma(WHO type 1) in 2 patients, non-keratinizing type(WHO type 2) in 8 patients and undifferetiated carcinoma(WHO type 3) in 8 patients. The follow up period ranged from 30 months to 95 months with a median of 56 months. Follow up was possible in all patients. Results：Response to concurrent chemoradiation therapy was a complete response in all patients. Patterns of failure were as follows：local recurrence in only one patient(5.6%) and distant metastases in three patients with N3 diseases(16.7%). The overall 5 year survival rates were 88.5%, the 5 year disease free survival rate was 77% and these were very good results. There were no significant differences in the local control and survival rates between the clinical stages and pathologic types. Conclusion：The outcome of the nasopharyngeal carcinoma treated with concurrent chemoradiotherapy was very good, even though most of the patients(15/18=83.3%) were in stage III and IV diseases. We concluded that concurrrent chemoradiotherapy in nasopharyngeal carcinoma showed the good local control and survival rates without significant complications. In the patients with N3 disease, we have to consider the more effective and strong chemotherapeutic regimens to prevent distant metastases.

• 대한치과교정학회지
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• 제32권5호
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• pp.355-360
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• 2002

교정치료 후 연조직의 변화가 나타난다. 특히, 하안면부위에 많은 변화를 일으키게 되며, 대표적으로 입술은 치아 이동량의 $60\~70\%$정도 이동한다고 알려져 있다. 하지만, 이동량은 개인마다 그 양상이 다양하다. 본 연구는 환자의 입술두께에 따라 연조직 이동 양상에 차이가 있는지 여부를 조사하는데 그 목적이 있다. 발치를 동반한 교정치료를 받은 성인환자를 대상으로 basic upper lip thickness에 따라 환자를 분류한 결과, 두께가 얇은 군(group 1)에서 치료 후 연조직 변화에 영향을 미치는 요인으로는 mentolabial angle와 하순의 변화간에 음의 상관관계를 보였다. 두께가 평균인 군(group 2)에서 상순의 변화에 영향을 미치는 요소로는 상악전치의 변화, 하악전치의 변화, 하순의 변화, nasolabial angle의 변화로 나타났으며, 하순의 변화에 영향을 미치는 요소로는 상순의 변화, 상악전치의 변화, 하악전치의 변화로 나타났다. 두께가 두꺼운 군(group 3)에서 는 상순, 하순의 변화는 전치위치의 변화나 연조직 변화와는 관련 없음으로 관찰되었다.

• 보건행정학회지
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• 제23권1호
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• pp.35-43
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• 2013

Background: Diagnosis procedure combination (DPC) has recently been introduced in Korea as a demonstration project and it has aimed the improvement of accuracy in bundled payment instead of Diagnosis related group (DRG). The purpose of this study is to investigate that the model of end-stage liver disease (MELD) score as the severity classification of liver diseases is adequate for improving reimbursement of DPC. Methods: The subjects of this study were 329 patients of liver disease (Korean DRG ver. 3.2 H603) who had discharged from National Health Insurance Corporation Ilsan Hospital which is target hospital of DPC demonstration project, between January 1, 2007 and July 31, 2010. We tested the cost differences by severity classifications which were DRG severity classification and clinical severity classification-MELD score. We used a multiple regression model to find the impacts of severity on total medical cost controlling for demographic factor and characteristics of medical services. The within group homogeneity of cost were measured by calculating the coefficient of variation and extremal quotient. Results: This study investigates the relationship between medical costs and other variables especially severity classifications of liver disease. Length of stay has strong effect on medical costs and other characteristics of patients or episode also effect on medical costs. MELD score for severity classification explained the variation of costs more than DRG severity classification. Conclusion: The accuracy of DRG based payment might be improved by using various clinical data collected by clinical situations but it should have objectivity with considering availability. Adequate compensation for severity should be considered mainly in DRG based payment. Disease specific severity classification would be an alternative like MELD score for liver diseases.

• 한국노년학
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• 제32권2호
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• pp.467-485
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• 2012

노인장기요양보험 재가서비스의 질 향상을 목적으로 2010년도에 처음 도입된 재가장기요양기관평가제도는 재가서비스 질의 수준을 한 단계 끌어올렸다는 평가를 받고 있지만, 한편으로는 지속적인 제도개선의 필요성이 제기되었다. 재가장기요양기관평가제도의 발전을 위해서는 평가대상자인 재가장기요양기관들의 의견을 수렴하여 제도 개선에 반영함으로써 평가에 대한 피평가기관의 수용성을 높이는 것이 중요하다. 이에 본 연구는 '2010년 재가장기요양기관 평가'에 참여한 피평가기관 중 재가서비스 이용자의 86.7%를 차지하고 있는 방문요양기관의 평가책임자들을 대상으로 평가단계와 평가체계 전반에 대한 인식과 태도를 조사하였다. 조사는 국민건강보험공단 대용량 웹팩스 서버와 전자메일을 이용하여 진행되었으며, 3,487개 방문요양기관 중 473개소가 최종 설문을 완료하였다. 연구결과에 의하면, 평가등급에 따라 장기요양기관평가에 대한 인식과 태도에 차이가 있는 것으로 나타났다. 즉, 평가등급이 높은 기관일수록 평가준비기간이 길었고, 평가에 대한 이해도가 높았으며, 평가항목들이 장기요양서비스의 질을 적절히 평가한다고 생각하고 있었고, 평가결과 통보서의 내용이 기관의 질 개선 활동에 유용하다고 생각하고 있었다. 이러한 연구결과는 피평가기관의 재가장기요양기관평가 제도에 대한 인식과 의견을 제시함으로써 향후 재가장기요양기관평가제도에 대한 개선안을 마련하는데 유용하게 활용될 것으로 기대한다.

• 대한치과의사협회지
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• 제48권1호
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• pp.6-11
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• 2010

Amid the rapid transitions in both local and international markets, the Korean dental industry is facing more challenges than at any time in its history. This paper tried to address some of the key issues faced by the industry as well as the policy issues and I direction of implementation that the Korean Dental Association (KDA) is expected to tackle. First, the direction of reforming the country's health insurance system was examined with emphasis on the expected changes in and improvement of the fee-for-service reimbursement system (FFSRS) and medical reimbursement system (MRS). With FFSRS, the most urgent issue would be ameliorating the current lop-sided, unreasonable reimbursement system that prevents suppliers from voicing their opinions. To help achieve that goal, the limited authority and responsibility of the president of National Health Insurance Corporation (NHIC) as one of the contract-making parties must be clarified. In addition, the functions of NHIC's Health Insurance Finance Committee must be restricted; at the same time, the panel organization of the Health Insurance Policy Review Committee needs to be reformed to embrace greater democracy. As with MRS, the government is considering a block budget bill to help promote efficiency in employing and managing the health insurance fund. Policymakers must understand that the implementation of such proposal could exacerbate an already dire situation. Improving MRS requires meeting the following preconditions: (a) the structurally vicious cycle of small charge-small salary needs to be resolved, and a certain percentage of fee raise must be guaranteed on a yearly basis to help adjust the fee system to a more realistic level; (b) the supply-and-demand balance in producing health care professionals must be improved including the prevention of oversupply of doctors, nurses, etc., and; (c) institutional strategies must be provided to enhance the quality of medical care and ensure academic advancement in health care disciplines.

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 2005년도 제57차 추계 학술대회 연제집
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• pp.329-329
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• 2005