• 의료법학
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• 제21권1호
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• pp.33-67
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• 2020

사무장병원은 경제력을 지니고 있으나 의료기관을 개설·운영할 수 없는 비의료인이 의료업계에 첫발을 내딛는 의료인이 경제적으로 자립하기 어려운 상황에서 의료기관 개설 초기에 소요되는 막대한 자본을 감당할 수 없다는 점을 악용하여, 의료인과 공모하여 외형상 요건을 구비한 의료기관을 난립시켜 의료인이 중심이 되어야 하는 의료시장질서를 교란시키고 있다. 또한 사무장병원은 정부로부터 요양급여나 보조금 등 다양한 혜택을 부정하게 수급하여 감으로써 국민건강보험의 막대한 재정 누수를 가져오고 있어 사회적으로 큰 문제를 야기하고 있다. 사무장병원의 개설상의 불법성은 그 개설에 관한 약정을 민사상 무효화하고 의료법상 개설에 관여하는 자 전체에 대하여 형사벌을 가함과 동시에 의료인에게 행정처분을 부과할 정도로 높다. 또한 사무장병원이 개설상의 위법을 인지하고 있음에도 불구하고 이를 묵비한 채 국민건강보험공단에 대하여 요양급여비용을 청구하여 수급하는 행위에 대하여, 국민건강보험법과 의료급여법상의 환수에 더하여 형법상 사기죄, 나아가 이득액에 따라 특정경제범죄 가중처벌등에 관한 법률위반(사기)죄의 처벌, 그리고 민사상 불법행위책임까지 적용하고 있다. 본고에서는 사무장병원에 대한 현행법상 법적 규제와 현재까지의 판례의 태도를 살펴봄으로써, 사무장병원에 대한 규제가 어떻게 이루어지고 있는지 그 현황을 고찰하고, 향후 입법 방향의 토대를 제시하고자 한다.

• 의료법학
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• 제15권2호
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• pp.345-366
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• 2014

Because the health care or medical sector has such characteristics as publicity, professionality, and exclusivity, it cannot be left to the free market system. As a consequence, the state has restricted the establishment of medical institutions in order to protect the life and health of people. Also, the medical law has regulated to permit the establishment of medical institutions by only medical personnel and a few corporate bodies and to ban the establishment of medical institutions under disguised ownership as well as double opening of medical institutions by medical personnel. Nevertheless, there are still many cases that non-medical personnel have dominantly established medical institutions under disguised ownership of other medical personnel or nonprofit corporation. Because they are willing to recover their investment costs as soon as possible, these illegally established medical institutions are likely to make patients undergo unnecessary tests or to perform the excessive treatments and, as a result, are likely to cause infringement on the health and lives of the people. In addition, even if the misconduct is uncovered, the rate at which the costs already paid is very low and, as a result, the damages are straightly connected to the people's loss. On the other hand, there are also increasing number of cases that medical personnel or nonprofit corporations are establishing medical institutions against the medical law regulations. The examples of this illegality are also the double opening of medical institutions and the establishment of medical institutions under disguised ownership by medical personnel or nonprofit corporations. And the damages in these cases may not differ from those in the above cases. In this study, regarding medical law regulations restricting opening a medical institution, I will review the intent of those regulations, the type of violations and criminal punishments, and the possibility of recovery from unlawful profit by the National Health Insurance Act. And then, I would like to find a way for rational improvement of each.

• Journal of Preventive Medicine and Public Health
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• 제54권2호
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• pp.86-95
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• 2021

Objectives: This study investigated associations between perceptions of coronavirus disease 2019 (COVID-19) and the prevalence of posttraumatic stress disorder (PTSD) in workers at hospitals designated to treat COVID-19, as well as the difference in the magnitude of these associations by occupational type and previous Middle East respiratory syndrome coronavirus (MERS-CoV) experience. Methods: The participants were workers at hospitals designated to treat COVID-19 who completed a questionnaire about their perceptions related to COVID-19, work experience during the previous MERS-CoV outbreak, and symptoms of PTSD ascertained by the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders. Participants' characteristics were compared using the chi-square test. Multivariable logistic regression was performed to evaluate the associations between perceptions and the prevalence of PTSD, stratified by occupational type and previous MERS-CoV experience. Results: Non-medical personnel showed stronger associations with PTSD than medical personnel according to general fear (odds ratio [OR], 6.67; 95% confidence interval [CI], 1.92 to 23.20), shortages of supplies (OR, 1.29; 95% CI, 1.07 to 1.56), and issue-specific fear (OR, 1.29; 95% CI, 1.05 to 1.59). Those with prior MERS-CoV quarantine experience were more prone to PTSD than those without such experience in terms of general fear (OR, 1.70; 95% CI, 1.22 to 2.37), shortages of supplies (OR, 1.24; 95% CI, 1.10 to 1.40), and issue-specific fear (OR, 1.21; 95% CI, 1.06 to 1.38). Conclusions: During the COVID-19 pandemic, non-medical personnel tended to have higher odds of being categorized as having PTSD. Workers with prior MERS-CoV experience were more susceptible than those without such experience. These findings suggest the need for timely interventions to manage human resources for a sustainable quarantine system.

• 의료법학
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• 제17권2호
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• pp.281-313
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• 2016

우리 헌법은, 국가로 하여금 국민의 건강을 보호할 의무를 지우고 있고, 그 구체화된 규범인 의료법은 의료기관 개설 등에 관한 사항을 상세히 규정하고 있는데, 그 내용 중 하나가 의료인의 의료기관 복수개설 운영 금지 제도이다. 이에 대하여, 종래의 판례는 '다른 의사 명의로 추가 개설하는 의료기관에서 직접 의료행위 등을 하지 않는다면 여러 개의 의료기관을 개설 운영할 수 있다'고 해석함으로써, 사실상 복수의 의료기관을 개설 운영할 수 있었다. 하지만 일부 의료인들이 다른 의사의 면허로 의료기관을 여러 장소에 개설하고 이익을 극대화하기 위하여, 환자유인행위를 하거나 과잉진료 및 위임치료를 하는 등의 불법의료행위를 조장할 뿐만 아니라 국민의 건강권 등을 침해하는 현실적 문제가 발생하게 되었다. 이에 입법자는 의료법의 개정을 통해 의료인은 어떠한 명목으로도 둘 이상의 의료기관을 개설하거나 운영할 수 없도록 의료기관 개설제도를 정비하게 된 것이다. 이에 따라 개정 의료법 하에서 1인의 의료인이 더 이상 복수의 의료기관을 개설 내지 운영할 수 없게 되자, 일부 의료인들은 새로이 개정된 규정 하에서는 네트워크병원의 장점을 살릴 수 없다며, 개정 의료법의 규정이 위헌이라고 주장하고 있다. 그러나 사무소의 복수개설을 금지하는 규정은 의료인에게만 특별한 제한을 두고 있는 것이 아니며, 변호사, 약사 등 수많은 다른 전문자격사들에 대해서도 하나의 사무소만을 개설하도록 규정하고 있으며, 이는 자신이 직접 그 본연의 업무를 수행하기 위하여 필요한 장소적 범위 내에서만 사무소를 책임지고 개설 운영토록 하기 위함이다. 또한 동 규정이 위헌적 소지가 있어 폐지된다면, 어렵사리 의료법인 또는 비영리법인을 설립하여 여러 개의 의료기관을 개설 운영하는 절차를 따를 이유도 없게 된다. 나아가 무엇보다 중요한 것은 의료인의 복수 의료기관 개설을 허용할 경우 사실상 영리병원을 허용하는 결과를 초래하게 된다는 점을 유념해야 한다. 요컨대 공공의료가 차지하는 비율이 절대적으로 적은 우리나라의 보건 의료 현실에서 일부 소수의 자본력 있는 의료인이 수많은 의료기관들을 독점하여 소유하고 사실상 영리병원으로 운영한다면, 이는 의료서비스의 질 저하를 초래하고, 궁극적으로 국민의 건강권 내지 생명권을 침해할 수 있다는 점을 깊이 고려해야 한다.

• 임상간호연구
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• 제17권3호
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• pp.363-374
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• 2011

Purpose: The purpose of this study was to identify the types and causes of non-value-added (NVA) activities in nursing practice, and to determine the frequency of each NVA type and causes of NVA in clinical area. Methods: This study was conducted using Delphi technique. First, in order to identify NVA and their causes, 24 nurses with 7 years or more of clinical experience were recruited from medical/surgical units in six general hospitals in Korea. Then the NVA types and causes were tested using a larger sample of 130 nurses with more than 3 years of clinical experience at two general hospitals in Korea. Results: NVA was categorized into 6 different types, which are repeating, duplicating, waiting, reverse-proxy working, reworking, and searching. The most prevalent NVAs were repeating and duplicating works. Reworking and searching were less frequent types than others. The causes of NVA were classified into personnel-related, supporting departments, records, regulations, information, materials or instruments, and others. Among them, personnel-related and supporting departments were reported with the highest scores. Conclusion: NVA leads to waste cost and time. These results demonstrated the situations and causes of NVA occurred in nursing practice. Further studies on the typology and moderation of NVA activities are warranted to improve the efficiency and quality of nursing care in day-to-day practice.

• 호스피스학술지
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• 제1권1호
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• pp.46-69
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• 2001

Hospice Care is the best way to care for terminally ill patients and their family members. However most of them can not receive the appropriate hospice service because the Korean health delivery system is mainly be focussed on acutly ill patients. This study was carried out to clarify the situation of hospice in Korea and to develop a hospice care delivery system model which is appropriate in the Korean context. The theoretical framework of this study that hospice care delivery system is composed of hospice resources with personnel, facilities, etc., government and non-government hospice organization, hospice finances, hospice management and hospice delivery, was taken from the Health Delivery System of WHO(1984). Data was obtained through data analysis of litreature, interview, questionairs, visiting and Delphi Technique, from October 1998 to April 1999 involving 56 hospices, 1 hospice research center, 3 non-government hospice organizations, 20 experts who have had hospice experience for more than 3 years(mean is 9 years and 5 months) and officials or members of 3 non-government hospice organizations. There are 61 hospices in Korea. Even though hospice personnel have tried to study and to provide qualified hospice serices, there is nor any formal hospice linkage or network in Korea. This is the result of this survey made to clarify the situation of Korean hospice. Results of the study by Delphi Technique were as follows: 1.Hospice Resources: Key hospice personnel were found to be hospice coordinator, doctor, nurse, clergy, social worker, volunteers. Necessary qualifications for all personnel was that they conditions were resulted as have good health, receive hospice education and have communication skills. Education for hospice personnel is divided into (i)basic training and (ii)special education, e.g. palliative medicine course for hospice specialist or palliative care course in master degree for hospice nurse specialist. Hospice facilities could be developed by adding a living room, a space for family members, a prayer room, a church, an interview room, a kitchen, a dining room, a bath facility, a hall for music, art or work therapy, volunteers' room, garden, etc. to hospital facilities. 2.Hospice Organization: Whilst there are three non-government hospice organizations active at present, in the near future an hospice officer in the Health&Welfare Ministry plus a government Hospice body are necessary. However a non-government council to further integrate hospice development is also strongly recommended. 3.Hospice Finances: A New insurance standards, I.e. the charge for hospice care services, public information and tax reduction for donations were found suggested as methods to rise the hospice budget. 4.Hospice Management: Two divisions of hospice management/care were considered to be necessary in future. The role of the hospice officer in the Health & Welfare Ministry would be quality control of hospice teams and facilities involved/associated with hospice insurance standards. New non-government integrating councils role supporting the development of hospice care, not insurance covered. 5.Hospice delivery: Linkage&networking between hospice facilities and first, second, third level medical institutions are needed in order to provide varied and continous hospice care. Hospice Acts need to be established within the limits of medical law with regards to standards for professional staff members, educational programs, etc. The results of this study could be utilizes towards the development to two hospice care delivery system models, A and B. Model A is based on the hospital, especially the hospice unit, because in this setting is more easily available the new medical insurance for hospice care. Therefore a hospice team is organized in the hospital and may operate in the hospice unit and in the home hospice care service. After Model A is set up and operating, Model B will be the next stage, in which medical insurance cover will be extended to home hospice care service. This model(B) is also based on the hospital, but the focus of the hospital hospice unit will be moved to home hospice care which is connected by local physicians, national public health centers, community parties as like churches or volunteer groups. Model B will contribute to the care of terminally ill patients and their family members and also assist hospital administrators in cost-effectiveness.

• 동아시아식생활학회지
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• 제14권3호
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• pp.302-308
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• 2004

This study was conducted to compare the acquiring and using patterns of information about food and nutrition between medical professional group (MP) and non-medical professionals group (NP). Questionnaire survey were done by total 310 subjects, 149 doctors/nurses (MP) working in Dankook University Hospital and 161 general laborers (NP) in Cheonan area. Personal characteristics, interests in food and nutrition information, and application of information about food and nutrition were asked in questionnaire. Age of MP and NP ranged from 20 to 50. In education level, 59.8% of MP and 46.6% of NP had college degree. The source of information favored the most was the internet website, 53.0% in MP and 51.6% in NP. The most interested information subjects in MP were ‘the diet therapy related to diseases’, and ‘cooking recipes’ in NP. The information was applied to their real life in 55.7% of MP and 58.4% of NP. The percentiles who would like to take part in the education about food and nutrition through internet system were 44.3% of MP and 34.8% of NP. From the results of this study, we concluded that many of MP and NP wanted and needed the education on food and nutrition through internet system. For being the better and more efficient source for the information about food and nutrition, internet websites should provide accurate informations and easier method to find the needed information to the users.

• 대한간호
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• 제29권2호
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• pp.48-65
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• 1990

The government has adopted a policy to introduce Home Health Care Program, and has established a three stage plan to implement it. The three stage plan is : First, to amend Article 54 (Nurses for Different Types of Services) of the Regulations for Implementing the Law of Medical Services; Second, to tryout the new system through pilot projects established in public hospitals and clinics; and third, to implement at all hospitals and equivalent medical institutions. In accordance with the plan, the Regulation has been amend and it was promulgated on January 9,1990, thus establishing a legal ground for implementing the policy. Subsequently, however, the Medical Association raised its objection to the policy, causing a delay in moving into the second stage of the plan. Under these circumstances, a study was conducted by collecting and evaluating the opinions of physicians, nurses, non-medical personnel and patients on the need and expected result from the home health care for the purpose of help facilitating the implementation of the new system. As a result of this study, it was revealed that: 1. Except the physicians, absolute majority of all other three groups - nurses, non-medical personnel and patients -gave positive answers to all 11 items related to the need for establishing a program for Home Health Care. Among the physicians, the opinions on the need for the new services were different depending on their field of specialty, and those who have been treating long term patients were more positive in supporting the new system. 2. The respondents in all four groups held very positive view for the effectiveness and the expected result of the program. The composite total of scores for all of 17 items, however, re-veals that the physicians were least positive for the- effectiveness of the new system. The people in all four groups held high expectation on the system on the ground that: it will help continued medical care after the discharge from hospitals; that it will alleviate physical and economic burden of patient's family; that it will offer nursing services at home for the patients who are suffering from chronic disease, for those early discharge from hospital, or those who are without family members to look after the patients at home. 3. Opinions were different between patients( who will receive services) and nurses (who will provide services) on the types of services home visiting nurses should offer. The patients wanted "education on how to take care patients at home", "making arrangement to be admitted into hospital when need arises", "IV injection", "checking blood pressure", and "administering medications." On the other hand, nurses believed that they can offer all 16 types of services except "Controlling pain of patients", 4. For the question of "what types of patients are suitable for Home Health Care Program; " the physicians, the nurses and non-medical personnel all gave high score on the cases of "patients of chronic disease", "patients of old age", "terminal cases", and the "patients who require long-term stay in hospital". 5. On the question of who should control Home Health Care Program, only physicians proposed that it should be done through hospitals, while remaining three groups recommended that it should be done through public institutions such as public health center. 6. On the question of home health care fee, the respondents in all four groups believed that the most desireable way is to charge a fixed amount of visiting fee plus treatment service fee and cost of material. 7. In the case when the Home Health Care Program is to be operated through hospitals, it is recommended that a new section be created in the out-patient department for an exclusive handling of the services, instead of assigning it to an existing section. 8. For the qualification of the nurses for-home visiting, the majority of respondents recommended that they should be "registered nurses who have had clinical experiences and who have attended training courses for home health care". 9. On the question of if the program should be implemented; 74.0% of physicians, 87.5% of non-medical personnel, and 93.0% of nurses surveyed expressed positive support. 10. Among the respondents, 74.5% of -physicians, 81.3% of non-medical personnel and 90.9% of nurses said that they would refer patients' to home health care. 11. To the question addressed to patients if they would take advantage of home health care; 82.7% said they would if the fee is applicable to the Health Insurance, and 86.9% said they would follow advises of physicians in case they were decided for early discharge from hospitals. 12. While 93.5% of nurses surveyed had heard about the Home Health Care Program, only 38.6% of physicians surveyed, 50.9% of non-medical personnel, and 35.7% of patients surveyed had heard about the program. In view of above findings, the following measures are deemed prerequisite for an effective implementation of Home Health Care Program. 1. The fee for home health care to be included in the public health insurance. 2. Clearly define the types and scope of services to be offered in the Home Health Care Program. 3. Develop special programs for training nurses who will be assigned to the Home Health Care Program. 4. Train those nurses by consigning them at hospitals and educational institutions. 5. Government conducts publicity campaign toward the public and the hospitals so that the hospitals support the program and patients take advantage of them. 6. Systematic and effective publicity and educational programs for home heath care must be developed and exercises for the people of medical professions in hospitals as well as patients and their families. 7. Establish and operate pilot projects for home health care, to evaluate and refine their programs.

• 대한한의학회지
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• 제41권1호
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• pp.1-10
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• 2020

Objectives: This study investigated the financial performance of Korean Medicine hospitals in Korea in order to understand the current status of hospital management and improve its efficiency. Methods: Financial statements of 24 medical corporations, 19 juridical foundations and 18 school hospitals from 2016 to 2018 were obtained from the secondary data published by the Health Insurance Review and Assessment Service, the National Tax Service and the Korea Advancing Schools Foundation. Financial performance was measured on 6 dimensions: liquidity, profitability, activity, growth, cost and productivity (investment efficiency) by analyzing 8 financial indicators: Liability to Total Assets, Net Profit to Patient Service Revenues, Total Assets Turnover, Growth Rate of Patient Service Revenues, Operating Expenses to Patient Service Revenues, Value Added to Patient Service Revenues, Value Added to Total Assets, and Value Added to Personnel Expenses. Results: Korean Medicine hospitals showed lower Liability to Total Assets, Liquidity and Value Added to Total Assets than Western Medicine hospitals did. They also showed higher Value Added to Patient Service Revenues and Value Added to Personnel Expenses than Western Medicine hospitals did. They also showed higher Value Added to Patient Service Revenues and Value Added to Personnel Expenses than those of Western Medicine hospitals do. The net profit decreased significantly (-50.8%) in 2018 whereas Patient Service Revenues increased (6.9%) for the same period due to Operating Expenses increase and Non-Operating loss. Conclusions: These findings suggest that the Korean Medicine hospital sector in Korea needs to improve liquidity and financial structure and to enhance profitability by reducing Personnel Expenses and generating Non-operating revenues in order to improve its investment efficiency and competitiveness.

• 한국병원경영학회지
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• 제19권2호
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• pp.1-11
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• 2014

The purpose of this study is to investigate awareness on medical insurance on the caregivers cost for hospital administrative staff and to provide the basic data for realization of legislation. The subjects were caregivers living in Busan, the survey was conducted from February 18 to March 9, 2013, 283 except for 17 copies of non-response and error response among a total of 300 questionnaires were analyzed. As a result, To improve the quality of care services, there were 51.8% of refresher training needs in refresher training items, 72.7% in favor of premiums increases in health insurance details, as for health insurance coverage subjects, patients' income were 32.0%, copayment for caregivers cost was 20.0%, which was 42.3%. Refresher training item, premiums increases, health insurance applied subjects, variables for copayment for care fee were related to medical insurance on the caregivers cost. On legislation on the medical insurance, systematic and standardized criteria should be provided to provide standardized curriculum for caregivers, to relieve patients and guardians of economic burden for caregivers cost and offer the stability of the cost.