• 제목/요약/키워드: Public Health Care Institution

검색결과 106건 처리시간 0.026초

고혈압 환자의 투약순응도와 영향 요인 분석 (Analysis of the medication compliance of hypertensives and its influential factors)

  • 손경애;김윤신;홍민희;정미애
    • 한국산학기술학회논문지
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    • 제11권5호
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    • pp.1897-1904
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    • 2010
  • 본 연구는 행정자료인 건강보험 및 의료급여비용 청구자료를 이용하였으며, 일개지역(2개도, 남 북)에 개설되어있는 전체 의료기관을 대상으로 진료일 기준 '08.7월~'08.12월(184일)동안 외래 방문이 1회 이상인 30세 이상의 수진자 432,915명을 대상으로 하였다. 투약순응도와 영향 요인을 분석한 결과 아래와 같다. 연구대상자의 투약순응도 평균은 61.5%로 나타났으며, 이는 분석대상기간 6개월(184일)동안 약 113일 정도 처방 받았음을 의미하며, 투약순응군 비율은 13.0%에 불과하였다. 고혈압상병(주 부상병)으로 외래를 방문한 평균 횟수는 4.3일, 방문한 기관수는 평균 1.1곳이었고, 한곳의 의료기관만을 이용한 환자가 전체의 94.9%로 나타났다. 당뇨병을 동반상병으로 가지고 있는 환자가 11.6%로 가장 많았고 고혈압 환자의 23.3%가 동반상병을 가지고 있었다. 투약순응도는 남성, 건강보험 가입자, 종합전문을 주이용기관으로 이용하는 환자, 동반상병을 가지고 있는 환자에서 높게 나타났으며, 65-74세까지 투약 순응도가 증가하다가 그 후 감소하는 경향을 보였다. 투약순응도에 영향을 미치는 요인으로는 남성, 55-64세, 건강보험 가입자가, 종합전문, 종합병원, 보건기관을 주 이용기관으로 방문하는 환자와 심장질환, 당뇨병을 동반상병으로 가지고 있는 환자에서 투약순응도가 높았다. 이상의 연구결과 투약 순응도가 낮은 환자에 대한 다양한 요인분석이 필요하며, 투약 순응도를 높이기 위한 고혈압관리사업의 정책적 검토 및 대안이 필요할 것이다. 또한 고혈압 환자의 경우 당뇨 등 동반상병 비율이 높아 저염식, 금연 등 올바른 생활습관 관리를 위한 체계적 보건교육과 홍보 프로그램을 개발할 필요성이 요구된다.

고관절 부분 치환술 시술정보 공개에 따른 재입원율, 입원일수 및 진료비의 변화 (The Change in Readmission Rate, Length of Stay and Hospital Charge after Performance Reporting of Hip Hemiarthroplasty)

  • 장원모;은상준;사공필용;이채은;오무경;오주환;김윤
    • Journal of Preventive Medicine and Public Health
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    • 제43권6호
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    • pp.523-534
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    • 2010
  • Objectives: We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. Methods: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume (over 16 operations in a year) and low volume institutions, after performance reporting (December 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. Results: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p = 0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25 - 0.95) and 10% (${\beta}$=-0.102, p<0.01) and cost was not changed (${\beta}$=-0.01, p=0.27). The high volume institutions were more decreased than low volume in length of stay. Conclusions: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginally shifted from low volume institutions to high volume institutions.

중학교 체질검사 실태에 관한 연구 (A study on physical examination of middle school students)

  • 박성희
    • 한국학교보건학회지
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    • 제14권1호
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    • pp.131-143
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    • 2001
  • The primary aim of this dissertation is to contribute to the improvement of methods in physical examination by providing quality information for the current school system and advice for improving status. Present status, controversial points and possible remedies in physical examination were analyzed on a frequency and percentage basis. An $x^2$-test was used to verify the statistics between the results from the examination and each variable. In case of multiple categories of variables, an $x^2$ cs was adopted. Chronological data as well as both total and sampling physical examination data verified the statistics using an $x^2$-test. This thesis is based both on the data from middle school health care specialists in Gyunggi Province and on the analysis of physical examinations reported from local schools to the municipal education agency from 1997 to 1999. The results of the study are as follows: First, according to the survey, only 29.0% of the total schools had their school doctors examine all the students while most of the educational institutions failed to implement the whole process of physical examination on the list. It also turned out that the more students the schools have, the lower the rate of implementation of physical examination by school doctors(p=0.014). Second, the average time a school doctor spends for checkup turned out to be approximately 1.7 minutes per student This means that the quality of the physical examination is not guaranteed in the process. Third, 47.7% of those surveryed say that a dental examination was performed, each taking 21.24 seconds on average. In addition, it shows that some 31.5% wanted to have a task force team for dental checkups at the local health center. Given the fact that dental caries among students is progressively on the rise, the dental health centers that are now set up in some elementary schools should be expanded to cover the whole educational institution in order to raise awareness of the importance of dental care. Fourth, 48.5% of those surveyed say that a comprehensive physical examination should be adopted to promote the health of high schoolers. Since it takes a lot of public funds to implement a comprehensive method, it is essential to make sure that in-depth studies should be based on the frequency and methods of physical examination. Fifth, regarding such diseases among 3rd year middle school students in 1999, statistics shows that there was a slight difference in the prevalence rate of color blindness, and allergic diseases for male students ; and color blindness, hearing disturbance and allergic disease for female students. For those items, however, it is too little to say that there is a significant difference and accordingly it is assumed to be a problem of the measuring process. Sixth, the result of analysis on the sample physical examination and the total physical examination of the year 1999 shows as follows: For male students in the 3rd year of middle school, a slight difference appeared to those students in 11 items including eye problems and eye disease, otitis media, tonsillar hypertrophy, spinal shape, respiratory urinary allergic disease and other abnormal diseases(p<0.05). Particularly, the prevalence rate between students with and without disease was shown to be two times more in the following: eye problems, otitis media, tonsill hypertrophy, allergic diseases, etc. For female students in the 3rd year, prevalence rate showed little difference in 14 items(p<0.05). For items including eye problem, otitis media, tonsill hypertrophy, allergic disease, etc. it was shown that the rate was two times more between students with and without diseases. Physical examinations under the current school system are not producing any fundamental results for the health of the students. Methods and results are not trustworthy. Accordingly, a drastic overhaul of the current practices is needed in frequency, methods and items on the list in order to promote the health of the students. Cost-benefit studies as well as political considerations to ensure the development of efficient methods for physical examination are urgently needed at this moment.

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의료서비스의 결합판매와 경쟁제한성의 판단 - Cascade Health 사건을 중심으로 - (Bundled Discounting of Healthcare Services and Restraint of Competition)

  • 정재훈
    • 의료법학
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    • 제20권3호
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    • pp.175-209
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    • 2019
  • 시장지배적 사업자의 결합판매는 경쟁법 적용에 있어 어려운 문제 중 하나이다. 결합판매는 통상 할인을 수반하는데, 소비자 입장에서는 더 낮은 가격에 더 많은 상품을 구매할 수 있는 혜택을 보게 된다. 공급자도 별개로 판매할 경우에 소요되는 판매비용보다 더 낮은 비용으로 판매할 수 있게 된다. 이와 같이 소비자 입장에서는 가격인하의 혜택을, 공급자 입장에서는 판매비용 인하의 혜택을 보는 효율적인 측면이 있다. 대상판결은 결합판매 자체는 경쟁촉진적일 수도 있고, 경쟁제한적일 수도 있으며, 시장지배적 사업자가 아니더라도 거래관행상 광범위하게 이루어지고 있으므로 중립적이고 객관적으로 경쟁제한성 평가를 할 필요가 있음을 전제로 하고 있다. 대상판결은 동등 효율 경쟁자를 배제할 위험이 있는지를 심사해야 한다는 입장을 취함으로써 제1심이 선례로 고려한 LePage 판결을 따르지 않고 비용 기반 분석(cost based approach)이 필요하다고 봄으로써, 결합판매에서 비용기반 분석의 대표적인 판결로 평가받고 있다. 이 판결의 가장 돋보이는 점은 결합판매에서 경쟁제한성 평가의 방법론에 있어, 할인귀속 기준을 채택하여 결합판매에 따른 할인분을 전체 상품이 아니라 경합하는 상품에 적용한 후, 비용보다 가격이 낮은지를 심리해야 한다는 점을 지적한 점이다. 동등효율 경쟁자의 배제 문제는 결국 행위자 자신이 스스로 위반여부를 판단할 수 있어야 하므로, 이때 문제되는 비용은 경쟁자의 비용이 아니라 행위자의 비용임을 명시하였다. 결합판매를 통한 할인은 소비자가 별개로 구입할 수 있는 선택권을 침해받지 않으면서도 저가에 상품을 구입할 수 있는 긍정적인 효과가 있다. 따라서 결합판매를 경쟁법 차원에서 규제할 수 있는 근거로는, 가격할인에도 불구하고 동등효율 경쟁자를 배제한다는 점이 합리적인 사유가 될 것이다. 그 점에서 대상판결이 제시한 동등효율 경쟁자의 배제 위험 문제를 가격비용 테스트와 할인귀속기준을 통하여 적용한 점은 설득력이 있다. 반면, 결합판매의 기본적인 구조는 끼워팔기의 강제성 요건과 유사한 측면이 있다는 지적도 경청할 필요가 있다. 한국은 공적 건강보험 체계가 당연지정 요양기관 제도와 결합하면서 의료서비스에 대한 가격 경쟁은 요양급여에서는 불허되며 비급여 부분을 중심으로 존재한다. 이러한 비급여 부분을 중심으로 의료가 발달한 분야에서도 가격에 관한 의료공급자들의 시장지배적 지위의 남용이 가능하다. 진료비에 대한 가격결정과 공적 건강보험 제도와 민간의료보험의 관계를 검토해보면, 의료공급자 중 시장지배적 사업자의 결합판매를 통한 경쟁사업자의 배제는 비급여 부분에 대하여 국민건강보험공단이 아닌 민간보험회사와 관계에서 결합판매를 통한 할인계약을 통하여 가능할 것이다.

인터넷 영양전산 프로그램의 현황과 요구도에 대한 조사연구 (A Study on the Current Situation and Needs for the Internet Program of the Nutrition Computing)

  • 홍순명;황혜진
    • 대한영양사협회학술지
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    • 제8권1호
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    • pp.9-18
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    • 2002
  • This study was reviewed databases and outcomes of national/international off-line and on-line(Internet) nutrition softwares to identify the present conditions of nutrition softwares, and investigated user's needs and determine which component should be included in nutrition software. The most frequently used databases for the national programs were the food composition table provided from the National Rural Living Science Institution in Rural Development Administration and the food composition table and the nutrient contents of foods provided from the Korean Nutrition Society. For international programs, the food composition table from the USDA was commonly used. The analysed outcomes included the degree of obesity, nutrient analysis and nutrient intake compared with RDA, food intake from each by food group, food habits and the frequency of food consumption. As to the result of needs assessment for the Internet nutrition softwares, it was suggested that the needs of the Internet nutrition softwares were high because most of the respondents replied that 3-point('it is needed') or 4-point('it is necessary') on 4-points likert scale. As to the databases, the needs of 'food composition analysis' and 'the suggestion of the Korean RDA' were high. For the basic information for foods, the respondents replied that 'the classification of foods', 'foods codes', 'the amount of ingredients' and 'nutrient analysis' should be included. The needs of 'nutrient analysis of meal', 'diet therapy' and 'meal plan by caloric requirements' were high. As for utilizing the Internet meal planning programs, the respondents replied that 'it should be easy to use' most and demand for 'data saving and the saved data should be usable later' and 'meal planning education tools' were high. In conclusion, the Internet nutrition software that satisfies various needs of users should be developed for policy making that promote public health, nutritional care and self-supporting of foods.

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IMF와 경기침체 전후 음독자살 환자에 대한 분석 -1997년부터 2004년까지 일개 대학병원 응급센터 연구조사를 중심으로- (Trends Analysis of Suicidal Poisoning in Korea- Comparison before and after the IMF Crisis and the Economic Recession)

  • 이원재;박규남;최승필;이미진
    • 대한임상독성학회지
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    • 제3권1호
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    • pp.33-39
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    • 2005
  • Purpose: Nowadays the Korean society is in the center of time of the social change. Because of dissociation of traditional family, IMF (International Monetary Fund) crisis and economic recession, the mortality rate of suicidal attempts are increasing annually. The majority of suicidal attempts were by poisoning considering the characteristics of korean society. Therefore we studied to find out the characteristics of suicidal poisoning before and after social economic stress, and to suggest the direction for the proper management. Methods: We reviewed medical records of 547 patients of suicide by poisoning who visited the emergency medical centers of St. Mary's hospitals from 1997 to 2004. For the annual trends analysis, we analyzed the demographic and toxicologic data of these patients compared with before and after IMF crisis (1998) and the economic recession ($2003\~2004$). Results: At the time of IMF and the economic recession, the number of suicidal poisoning increased, especially in fifth decade. The refusal rate of toxicological emergency treatment increased. Also the mortality rate and the admission rate to ICU (Intensive Care Unit) increased during the same period. In the result of the comparison analysis, clinical severity and mortality of social problem group were higher. However they couldn't be treated appropriately because of financial problem and the family indifference. Conclusion: At the economic recession period, the severity of suicidal poisoned patients was high. But the refusal rate of toxicologic treatment also increased, so the patients had lost the chance for proper toxicologic treatment. Therefore they would be supported by medical institution and public health.

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노인 입원환자에 대한 항궤양약물 처방양상 분석 (Drug Utilization Review of Antiulcerative Agents in Korean Elderly Inpatients)

  • 이원식;이승미;구혜원;박병주
    • Journal of Preventive Medicine and Public Health
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    • 제35권1호
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    • pp.41-48
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    • 2002
  • Objectives : To review the drug prescription pattern of antiulcerative agents for elderly inpatients, Methods : The study population comprised inpatients of community hospitals who were members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, beneficiaries of the Korea Medical Insurance Corporation (KMIC) and residing in Busan city in 1993. The drug prescription information was collected from the claims data of hospitals where the cohort members received medical care between January 1993 and December 1594. The information included personal identification, age, gender, diagnosis, drug dosage, date of hospital admission and name of medical institutions where the study subjects received drug prescriptions. The data analysis produced outcomes in terms of distribution of antiulcerative agents by class and by medical institution and trend of relative prescription, Analysis was also performed in terms of combined prescriptions of antiulceratives and drugs that could induce risk from drug interaction with antiulceratives. Results : The number of patients prescribed antiulcerative agents was 1,059 (64,9%) male and 1,724 (65.5%) female among the total inpatients. An antacid and composite agent was the most frequently prescribed antiulcerative agent (70.8%), followed by $H_2$ antagonist (16.0%), Among the potential drugs that could induce risk from drug interaction with the antiulcerative agents, diazepam was the most frequently prescribed. The proportion of diazepam co-prescription was 22.5% of the total cimetidine prescriptions and 14.5% of the fetal omeprazole prescriptions. Conclusions : Antiulcerative drugs were frequently prescribed in the elderly inpatients. The adverse drug reaction could possibly be due to drug interaction. The study results could be used as fundamental data for further drug utilization review of antiulceratiye agents.

Timing of Esophagectomy after Neoadjuvant Chemoradiation Therapy Affects the Incidence of Anastomotic Leaks

  • Roh, Simon;Iannettoni, Mark D.;Keech, John;Arshava, Evgeny V.;Swatek, Anthony;Zimmerman, Miriam B.;Weigel, Ronald J.;Parekh, Kalpaj R.
    • Journal of Chest Surgery
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    • 제52권1호
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    • pp.1-8
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    • 2019
  • Background: Neoadjuvant chemoradiation therapy (nCRT) has become the standard of care for esophageal cancer patients prior to esophagectomy. However, the optimal timing for surgery after completion of nCRT remains unclear. Methods: A retrospective review was performed of patients who underwent esophagectomy with cervical anastomosis for esophageal cancer at a single institution between January 2000 and June 2015. Patients were categorized into 3 cohorts: those who did not receive nCRT prior to esophagectomy (no nCRT), those who underwent esophagectomy within 35 days after nCRT (${\leq}35d$), and those who underwent esophagectomy more than 35 days after nCRT (>35d). Results: A total of 366 esophagectomies were performed during the study period, and 348 patients met the inclusion criteria. Anastomotic leaks occurred in 11.8% of all patients included in the study (41 of 348). Within each cohort, anastomotic leaks were detected in 14.7% of patients (17 of 116) in the no nCRT cohort, 7.3% (13 of 177) in the ${\leq}35d$ cohort, and 20.0% (11 of 55) in the >35d cohort (p=0.020). Significant differences in the occurrence of anastomotic leaks were observed between the no nCRT and ${\leq}35d$ cohorts (p=0.044), and between the ${\leq}35d$ and >35d cohorts (p=0.007). Conclusion: Esophagectomy with cervical anastomosis within 35 days of nCRT resulted in a lower percentage of anastomotic leaks.

빅데이터를 이용한 치면열구전색 급여화 이후의 소아청소년 치면열구전색 환자에 대한 분석 (Analysis of the Characteristics of Children and Adolescent Patients Received Sealant after National Health Insurance Coverage using Big Data)

  • 이한길;손동현;나채현;김지훈
    • 대한소아치과학회지
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    • 제48권2호
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    • pp.129-139
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    • 2021
  • 이 연구의 목적은 치면열구전색의 급여화 이후 치면열구전색 처치를 받은 소아청소년 환자들의 성별, 나이, 보험종류, 지역, 의료기관 등의 특성을 알아보는 것이다. 건강보험심사평가원의 환자표본자료를 이용하였으며 2010년부터 2017년까지 총 8,454,636명의 환자의 정보를 얻을 수 있었고 이중 치면열구전색 처치가 포함된 환자는 114,680명이었다. 여자에서 남자보다 치면열구전색 처치를 받은 비율이 더 높았고, 5 - 9세 집단이 다른 연령에 비하여 가장 많은 치면열구전색 환자 및 진료 비율을 보였다. 보험의 경우 건강보험을 가진 경우가 의료급여에 해당하는 환자에 비해 치면열구전색 진료를 받은 비율이 높았고 진료기관은 치과의원, 치과병원, 보건소 순으로 나타났다. 지역별 비교에서는 경기도가 가장 많은 치면열구전색 환자를 보였으나, 환자 비율의 경우 전북이 가장 높게 나타났다.

종합병원 이용형태에 관한 분석 - 지방소재 종합병원 입원환자 중심 - (Analysis on the utilization Pattern of a General Hospital - With Cases of General Hospital Inpatients in the Provincial Area -)

  • 정용모;전선경;이용철
    • 보건의료산업학회지
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    • 제3권1호
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    • pp.14-24
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    • 2009
  • This study aims at deriving any useful information necessary to strengthen the competitiveness for growth through empirical analyses on general hospital located in a province in order to countermeasure the opening and competition of medical markets. The characteristics of user were identified on the basis of disease groups under KCD in the research method. In addition, the analysis on the expenses of diagnosis and treatment was divided into the treatment progress and degree of hospital resource utilization And the regression was carried out to identify the impacts of characteristics of inpatient users on the degree of hospital resource utilization. As a result of major research, the inpatient users of the general hospital located in the provincial area in consideration of inpatient users were formed around the inpatient disease groups representative for Korea(diseases of the respiratory system, injury and poisoning & certain other consequences of external causes). And it was understood that most of residents within a distance of 40 minute by the public transportation were using. And mostly were under the age of 9 or over 60, and the provision of medical features such as the degree of consultation and operational functions were inadequate. When we classify inpatient treatment cost for each resource application as the medical cost being the center of patient care function, the equipment and human resource application sector are constituted over half. Accordingly, the following suggestions are made as plans to strengthen the competitiveness for the growth of general hospitals located in the provincial areas on the basis of analytical results. First, it is necessary to have the characterization matching to the age and disease groups with a high frequency. Second, it is necessary to increase the degree of hospital resource utilization according to the characterization. Third, it is necessary to concentrate on public relations. The above suggestion, as a method for securing image improvement and competitive power as a general hospital, and through expansion of social function that a regional general hospital needs to secure not only as an individual institution but also as a general hospital, it can be seen that a general improvement of image as a regional general hospital is possible.

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