• Journal of Preventive Medicine and Public Health
• /
• 제28권2호
• /
• pp.325-333
• /
• 1995

Laparoscopic cholecystectomy was introduced into Korea in 1990 and has been rapidly replacing open cholecystectomy when the indications were met. In this study a medical utilization and technology was assessed on the selected hospitalized patients with cholelithiasis who underwent open or laparoscopic cholecystectomy from April 1, 1991 to March 31, 1994. The results are as follows. Despite the low reimbursement rate by the health insurance, the number of laparoscopic cases have been steadily increased. The post-operative days before health insurance coverage were significantly shortened from 8.4 days to 4.6 days. The preoperative days before health insurance coverage were significantly shorted from 8.4 days to 4.0 days. The total length-of-stays in the hospital were also significantly shortened from 15.2 days to 10.7 and 9.8 days in laparoscopic cholecystectomy. The laparoscopic cholecystectomy showed low expenses in all aspects expect the average hospital charges per day. For the hospital to have cost containment, it is more effective if length-of-stay is shorter because of high daily inpatient hospital charge. The laparoscopic cholecystectomy also showed shortened anesthesia time and operation time compared with open cholecystectomy that were statistically significant. The mean anesthesia and operation time for open cholecystectomy were 113.2 and 90.2 minutes but those of laparoscopic cholecystectomy were 105.7 and 68.6 minutes. According to this study the laparoscopic cholecystectomy has reduced the medical expenditure and we recommend this procedure over open cholecystectomy. The further discussion on the different morbidity rate between two types of procedure is essential in providing quality medical care, and to educate specialist.

• 가정과삶의질연구
• /
• 제27권1호
• /
• pp.61-71
• /
• 2009

The purpose of this study was to resolve the issues of inferior housing environment and the population decrease in rural community by improving the environment and attracting urban inhabitants. A simulation on the costs and the local programs was operated from a point of view that Pension Insurance House with Long-term Lease and a plan for the program in connection with local resources should be accompanied to attract urban inhabitants. The study was carried out through mainly documents analysis and specialists' opinions. The simulation results are as follows. Firstly, the pre-existing rural housing development projects have only emphasized the hardware, while underestimated the post-management with operating programs. The software should be underlined when Pension Insurance House is developed. Secondly, as a result of the simulation on construction expenditure and the operating and maintenance cost for 30 years, about 82.3 million Wons are necessary residential expenses for 15 years per unit. Thirdly, in case of MUJU County, it has made the most of its pre-existing institutions. It's medical institutions provide medical care system with health education, facilities related leisure and culture offer recreational programs and the local community center and its program of each town helps new habitants adopt to the rural life. Additionally, the employment project of a local welfare center allow people living in a rural community to continue their careers with their talents and interests through local class programs for a life worth living. Lastly, guide for getting information of rural life, local community gathering and preliminary education should be carried out to reduce expectant tenants' incompatibility and assist them settle down early. The community program expansion is also required at the local government level.

• 한국산학기술학회논문지
• /
• 제13권1호
• /
• pp.236-246
• /
• 2012

지역 환자의 역외유출 현상이 갈수록 심화되고 있다. 특히 중증질환을 가진 암 환자는 거리와 상관없이 양질의 의료서비스를 받기 위해 수도권 의료기관을 많이 찾는다. 하지만 이러한 환자의 역외유출은 진료 연속성 저하와 함께 불필요한 물적, 인적 이동을 야기 시킨다. 이에 본 연구는 부산지역 암환자들이 부산과 수도권에서 진료를 받는 경우에 환자의 만족도에 영향을 미치는 요인을 체계적으로 비교, 분석하여 지역 병원의 이용도를 제고시킬 수 있는 방안을 마련하고자 수행하였다. 부산지역 암환자를 대상으로 부산 의료기관에서 수술을 받은 암환자 223명과 수도권에서 수술을 받은 암환자 187명을 대상으로 2011년 3월 21~3월 30일까지 설문조사를 실시하였다. 자료 분석은 SPSS및 SAS 프로그램을 이용하여 접근성, 의료진 만족도, 이용편의성이 의료서비스 전반적 만족도 요인으로 나누어 접근하였다. 연구 결과, 이용편의성과 의료진 만족도는 수도권 의료기관 이용자가 높은 것으로 나타났으나, 접근성과 의료서비스의 전반적 만족도는 부산지역 의료기관을 이용한 암환자가 높았다. 이에 부산지역 의료기관은 의료진의 질적 향상을 위한 우수 의료진 유치 및 양성, 환자 중심의 의료 시설 제공을 위한 노력이 필요하다. 본 연구를 토하여 향후 환자의 수도권 집중현상 완화를 위한 정책개발 시 유용한 기초자료로 활용할 수 있을 것으로 기대된다.

• 정보관리연구
• /
• 제40권4호
• /
• pp.93-108
• /
• 2009

중국정부는 중의약의 발전을 도모하고자, 1988년에 중국중의약관리국을 개설하여 매년마다 전국중의약통계적편(全國中醫葯統計摘編)을 대내외에 공개하고 있다. 이것은 중국의 중의약 인프라에 대한 체계적인 관리를 통해 중의약을 향후 세계시장에서 선점하고자 하는 의도로 판단된다. 전국중의약통계적편(全國中醫葯統計摘編)의 통계는 초기에는 구성도 체계화되지 못하였으나, 해를 거듭할수록 통계의 구성 내용이 다양화되었으며, 체계화 및 표준화되고 있음을 알 수 있다. 뿐만 아니라, 중의자원, 중의 의료기구 운영 및 서비스, 중의교육, 중의약과학연구 및 사업비에 대한 투자를 증가시켜 동양의약의 주도권을 잡기 위한 노력을 엿볼 수 있다. 이에 본 논문에서는 중국중의약관리국에서 매년 발표하는 전국중의약통계적편(全國中醫葯統計摘編)에 대한 구성 체계, 구축현황, 통계작성 제도에 대한 구성분석과 연도별 중의자원, 중의의료기구 운영 및 서비스, 중의교육, 중의약과학연구 및 사업비에 대한 변동 추이에 대한 내용분석으로 나누어 중국의 중의약 발전을 위해 어떤 노력을 하고 있는지 알아보고자 하였다.

• 보건행정학회지
• /
• 제33권3호
• /
• pp.243-252
• /
• 2023

This paper aims to introduce Korea's total current health expenditure (CHE) and National Health Accounts of the year 2021 and their 2022 preliminary figures constructed on the basis of the System of Health Accounts 2011. As CHE includes expenditures for prevention, tracking, and treatment of coronavirus disease 2019 (COVID-19) and compensation for losses to medical institutions from 2020, the details are also introduced. Korea's total CHE in 2021 is 193.3 trillion won, which is 9.3% of gross domestic product (GDP). The preliminary figure in 2022, 209.0 trillion won, exceeded the 200 trillion won line for the first time, and its "ratio to GDP" of 9.7% is expected to exceed the average of Organisation for Economic Co-Operation and Development member countries for the first time. Korea's health expenditures, which were well controlled until the end of the 20th century, have increased at an alarming rate since the beginning of the 21st century, threatening the sustainability of national health insurance. The increase in health expenditure after 2020 is partly due to a temporary increase in response to COVID-19. However, when considering the structure of Korea's health insurance price hike, where the ratchet effect of increased medical expenses works particularly strongly, it is unlikely that the accelerating growth trend that has lasted for more than 20 years will stop easily. More aggressive policies to control medical expenses are required in the national health insurance which not only constitutes the main financing sources of the Korean health system but also has the most powerful policy means in effect for changes in the health care provision.

• 대한간호학회지
• /
• 제28권1호
• /
• pp.117-131
• /
• 1998

The purpose of this study was to develop a critical pathway for case management for patients who have received Coronary Artery Bypass Graft (CABG) because of Ischemic Heart Disease(IHD) which is a factor of rising medical expenses. For this study. a conceptual framework was developed through a review of the literature including six critical pathways which are currently being used in USA. In order to identify the overall service contents required by these patients and to draw up a preliminary critical pathway, 30 cases of medical records of patients who had CABG because of IHD between January, 1995 to June. 1996 at the Cardiovascular Center of Yonsei Medical Center in Seoul were analyzed. An expert validity test was done for the preliminary critical pathway and clinical validity test was also done using seven IHD patients with CABG between November 11 and 23, 1996. After these processes. the final critical pathway was developed. The results of this study are summarized as follows : 1. The vertical axis of the critical pathway includes the following eight items : tests, nutrition, medications, consultations, activity, assessments, treatments, education discharge planning and the horizontal axis includes the time from the start of hospitalization to discharge. 2. Analysis of the 30 medical records indicated that the average length of stay was 20.2days with the average length of stay from hospitalization day to operation day being 6.2 days, and the average length of stay from operation day to discharge day was 13. 9 days. Analysis of the service contents showed that the horizontal axis of the preliminary critical pathway was set from hospitalization to the 14th post operation day and the vertical axis was set to include eight items, the contents which ought to have occurred, according to the time frames of the horizontal axis. 3. As a result of the experts validity, it was found that among the total of 571 items. there was over 83% agreement for 482 items, less than 83% for 89 items, which were then deleted and a revision of the critical pathway was done. 4. A clinical validity test was done using seven IHD patients with CABG. During the process, three patients were deleted because they were out of the criteria the investigator set. Finally, four patients were used. The result of study indicated that only one patient was discharged on the tenth post operation day, which was one day later than the expected day. Three patients were discharged later than the expected day from three days to nine days. All the cases progressed on schedule until the operation day and the first post operation day, but from the second post operation days, there were differences between the critical pathway and the actual practice. The differences came from tests, assessments, and treatments. 5. On the basis of the results of the clinical validity test. the following revisions in the final critical pathway were made : the transfer from ICU to step down ward would be the second post operation day, and the transfer to a general ward, the fifth post operation day, for patients who complained of lack of sleep from the fifth post operation day to discharge, a sleeping pill would be prescribed, skin observations would be performed routinely from immediately after the operation until the third post operation day, and would continue if there was a sign of skin injury on the fourth post operation day, and assessment of chest pain would be done from the third post operation day, and the “stairs climbing” item, expected to be done on the ninth post operation day would be deleted. In conclusion, this critical pathway is partially applicable to the care of patients with CABG but there are some parts needed to be further investigated.

• 한국임상수의학회지
• /
• 제30권1호
• /
• pp.80-85
• /
• 2013

Twenty one cows in Goyang and Paju cities were referred due to displacement of the abomasum and foreign body in the rumen. Omentopexy and rumenotomy through a right flank celiotomy were performed for treatment of abomasal displacement and the foreign body removal in the rumen. The right paralumbar fossa is clipped and prepared surgically. Local anesthesia is instituted by performing inverted L block. The abdomen was entered through 25 to 30 cm vertical incision in the right paralumbar fossa starting 4 to 5 cm ventral to the transverse processes of the lumbar vertebrae. A 14-gauge needle with rubber tubing attached is inserted to relieve the gaseous pressure and to facilitate further exploration and manipulation. The rumen was gently pulled out of the abdominal cavity and incision was made at the omentum. Rumenotomy was done and retrieved the foreign body. After the rumen was rinsed with sterile saline, the rumen wall was closed by a Lembert suture technique. The omentum was closed by a simple continuous suture. Right flank omentopexy was performed for the surgical correction of abomasal displacement. Recovery results among 21 cows included 9 excellent, 5 good, 2 fair and 5 bad. It was considered that operation of abomasal displacement and foreign body removal in the rumen through right flank celiotomy was a good surgical technique to reduce expenses, surgical pain, and surgery time.

• 한국추진공학회지
• /
• 제14권3호
• /
• pp.16-22
• /
• 2010

가스터빈 엔진의 성능은 구성품 성능 특성에 큰 영향을 받는다. 일반적으로 구성품 성능 특성은 여러 조건에서의 많은 실험을 통해서만 얻을 수 있어 많은 시간과 비용이 소모되므로 엔진 제작자는 엔진 구매자에게 고비용의 구성품 성능 특성맵의 제공을 하지 않는다. 따라서 일반적으로 유사한 성능맵을 스케일링하여 사용하는데, 이 방법은 탈설계점에서 큰 오차를 보이는데 특히 성층권 이상의 고도에서 운용되는 가스터빈 성능은 더욱 차이를 보인다. 이에 본 연구는 PT6A-67A 터보프롭 엔진을 대상으로 하여 제공된 성능 데이터로부터 구성품 성능맵을 역생성 하는 방법을 제안하였으며, C++를 이용한 대상 엔진 모델링 결과와 제공된 엔진 성능덱 결과를 비교하여 타당성을 검증하였다.

• 한국IT서비스학회지
• /
• 제15권1호
• /
• pp.227-243
• /
• 2016

In order to maximize profitability by optimizing the entire supply chain process, enterprises have made efforts to apply IT technologies such as POS, MES, and TMS. In addition, academic societies have also made efforts to verify the effects of IT technology introduction through various researches. However, until now, there is almost no research that analyzes the relationship between the IoT, a new IT technology, and the SCM. To study the effect of IoT technology on SCM, this study conducted professional Delphi surveys for three times. Through this method, this study analyzed changes that will be caused by the IoT technology, the priority area in IoT introduction, and the expected difficulty in IoT introduction on SCM. As a result of the Delphi surveys and analyses, it was expected that when IoT technology is introduced, the level of SCM's IT use and partnership will increase. However, the effect of the increased performance of the supply chain, which includes inventory management and quality control, will become weaker. The reason is that the development of operation and management skills, as well as the improvement of IT technology, are also important elements for the performance improvement of the supply chain. As for the priority area in IoT introduction, it was expected that the effect will be greater when IoT is introduced in customer service, transportation, and delivery areas. As difficulties in IoT technology introduction, such as the shortage of IoT platform development personnel, standardization, integration with the existing system, securing professional manpower, expenses, data management, and operation, were derived, it has thus become necessary for us to exert greater efforts in order to come up with solutions.

• 한국조경학회지
• /
• 제26권4호
• /
• pp.36-58
• /
• 1999

We designed the model picture of Tourism Botanical Garden, as a kind of theme park, in which we could enjoy flowers all the year round and the glorious tints of its autumn foliage. It would be very important to decide what kinds of trees should be planted and where to plant them. We selected the appropriate flowers and trees according to their value of appreciation and flowering time and the grand view around there and the weather conditions of the central region. We selected perennial plants as native plants, according to their color, flowering time and for the convenience of maintenance. And we selected some kinds of culture plants to show the seasonal change and diversity, according to their color and flowering time. We adopted the roof-tile pattern of Pakjae Kingdom to design the basic model of the garden, and the area was divided into eight sections. Six of them were divided again into four small planting areas from the outside respectively, according to the kinds of trees; pine-tree area, native flowering plant area, flowering tree area and flowering shrub area. The last two sections are by a lake, so they could make a beautiful landscape of waterfront. For the effective and economic operation of the garden, some kinds of flower trees and shrubs, which are little damaged by blight and are needless to prune, were selected. And perennial plants were also selected, because we don't have to change them into other plants, so we could cut down the expenses. As for the culture plants, they could be easily replaced with other culture plants in the flowering time, to show seasonal change and the harmony with the scenery around the garden.