• 한국환경보건학회지
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• 제36권3호
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• pp.182-190
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• 2010

We examined the association of particulate matter with an aerodynamic diameter < $10\;{\mu}m$ ($PM_{10}$) with asthma-related hospitalization, stratified by socioeconomic status (SES), among children less than 15 years of age in Seoul, Korea, between 2003 and 2005. In addition, we estimated the reduction in the number of asthma-related hospitalizations that would result from implementing the World Health Organization (WHO) guideline. SES was defined based on data concerning health insurance premium grades, and grouped into two levels: lower-income group and control group. The lower-income group was classified as having an accumulated income which did not exceed the 50th percentile of the median income. Time-series analysis was performed to evaluate the association between $PM_{10}$ and asthma-related hospitalization. The Environmental Benefits Mapping and Analysis Program was used to analyze the impact on children's health. Based upon an increase of $10\;{\mu}g/m^3$ of $PM_{10}$, the asthma-related hospitalization risk for the lower-income group was increased by 1.78% (95% confidence intervals (CI) = 0.79-2.78%), while the risk for the control group was increased by 0.83% (95% CI = 0.34-1.32%). Attaining the WHO guideline, relative to the concentration in 2007, would result in a reduction in asthma-related hospitalizations of 18 cases per 100,000 of the children population in the lower-income group, and 7 cases in the control group. The health benefits of improved air quality for children in the lower-income group were thus 2.5 times greater than for children in the control group. Our results show that the lower-income group is disproportionately burdened with asthma-related hospitalization arising from air pollution. Therefore, biologically- and socioeconomically-disadvantaged populations should be considered in public health interventions in order to protect the children's health.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권4호
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• pp.334-347
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• 2006

The aim of this study is to evaluate the reasonableness of the medical fee on oral and maxillofacial surgery field according to surgeon's opinions and actual conditions. The medical fee has significant influence on hospital income, the supply and distribution of medical manpower, quality and facilities of medical services. Questionnaire survey was sent to 86 oral and maxillofacial surgeons who worked more than 3 years in general hospital. Among them, 25 doctors replied the 109 answers survey and the average of treatment time and physician work relative value on each category was calculated. And the health insurance cost (that has been applied since 2003) was compared with the questionnaire results. And finally we investigated items that health insurance system did not include in oral and maxillofacial field but actually performed in oral and maxillofacial surgery clinic. The result was that the medical fee did not properly reflect physician work relative value of actual treatments. In case of complicated extraction, work relative value needed 3.5 times enhancement of present value. For simple impacted tooth extraction 1.8 times, for impacted tooth extraction including odontomy 1.7 times, and for fully impacted tooth more than 2/3 of it located into the alveolar bone, 1.8 times enhancement needed. In respect of the present physician work relative value, hemimandibulectomy with neck lymph node dissection for the malignancy is appropriated as 3.3 times of open reduction and internal fixation for the mandibular fracture, but the questionnaire result showed 25 times discrepancy. In conclusion, this research shows the need for intervention that health insurance included items and legal relative medical value must act in union with treatment in clinic to reduce the imbalance between them.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권5호
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• pp.414-421
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• 2004

This is a reprospective study on the care of odontogenic infections in admission patients with geriatric diseases. The study was based on a series of 480 patients at Dong San Medical Center, Wonju Christian Hospital and Il San Health Insurance Hospital, From Jan. 1, 2000, to Dec. 31, 2002. The Obtained results were as follows: 1. The systemic malignant tumor was the most frequent cause of the geriatric diseases with odontogenic infectious diseases, and refractory lung disease, systemic heart disease, type II diabetes mellitus, cerebrovascular disease, bone & joint disease, senile psychologic disease were next in order of frequency. 2. Male prediction(57.5%) was existed in the odontogenic infectious patients with geriatric diseases. But, there were female prediction in senile psychologic disease, systemic heart disease and cerebrovascular disease. 3. The most common age group of the odontogenic infectious patient with geriatric disease was the sixty decade(47.9%), followed by the seventy & eighty decade in order. 4. In the contents of chief complaints on the odontogenic infectious patients with geriatric disease, peak incidence was occurred as toothache(52.7%), followed by extraction wish, tooth mobility, oral bleeding, oral ulcer, fracture of restoration, gingival swelling in order. 5. In the diagnosis group of odontogenic infectious diseases, periodontitis, pulpitis & periapical abscess were more common. 6. In the treatment group of odontogenic infectious diseases, the most frequent incidence(34.2%) was showed in primary endodontic treatment (pulp extirpation, occlusal reduction and canal opening drainage) and followed by scaling, incision & drainage, only drugs, pulp capping, restoration in order.

• 대한지역사회영양학회지
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• 제17권3호
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• pp.341-352
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• 2012

It is well established that excessive sodium intake is related to a higher incidence of chronic diseases such as hypertension, stroke, coronary heart disease, cardiovascular disease and gastric cancer. Although the upper limit of the current sodium intake guideline by WHO is set at 2,000 mg/day for adults, sodium intake of Koreans is well over 4,700 mg/capita/day implying an urgent need to develop and implement sodium intake reduction policy at the national level. This study investigated the cost-effectiveness of the sodium intake reduction policy, for the first time, in Korea. Analyses were performed using most recent and representative data on national health insurance statistics, healthcare utilization, employment information, disease morbidity/mortality, etc. The socioeconomic benefits of the policy, resulting from reduced morbidity of those relevant diseases, included lower medical expenditures, transportation costs, caregiver cost for inpatients and income losses. The socioeconomic benefits from diminished mortality included reductions in earning losses and welfare losses caused by early deaths. It is estimated that the amount of total benefits of reducing sodium intake from 4.7 g to 3.0 g is 12.6 trillion Korean Won; and the size of its cost is 149 billion Won. Assuming that the effect of sodium intake reduction would become gradually evident over a 5-year period, the implied rate of average return to the sodium reduction policy is 7,790% for the following 25 years, suggesting a very high cost-effectiveness. Accordingly, development and implementation of a mid-to-long term plan for a consistent sodium intake reduction policy is extremely beneficial and well warranted.

• 보건행정학회지
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• 제23권1호
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• pp.44-51
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• 2013

Background: This study designed to evaluate the homogeneity of Korean diagnosis related group (KDRG) version 3.4 classification system. Methods: The total 5,921,873 claims data submitted to the Health Insurance Review and Assessment Service during 2010 were used. Both coefficient of variation (CV) and reduction in variance of cost were measured for evaluation. This analysis was divided into before and after trimming outliers at the level of adjacent DRG (ADRG), aged ADRG (AADRG) split by age, and DRG split by complication and comorbidity. Results: At the each three level of ADRG, AADRG, and DRG, there were 38.9%, 38.7%, and 30.0% of which had a CV > 100% in the untrimmed data and there were 1.4%, 1.4%, and 1.9% in the trimmed one. Before trimming outliers, ADRGs explained 52.5% of the variability in resource use, AADRGs did 53.1% and DRGs did 57.1%. The additional explanatory power by age and comorbidity and complication (CC) split were 0.6%p and 4.6%p for each, which were statistically significant. After trimming outliers, ADRGs explained 75.2% of the variability in resource use, AADRGs did 75.6%, and DRGs did 77.1%. The additional explanatory power were 0.4%p and 2.0%p for each, which were statistically significant too. Conclusion: The results demonstrated that KDRG showed high homogeneity within groups and performance after trimming outliers. But there were DRGs CV > 100% after age or CC split and the most contributing factor to high performance of KDRG was the ADRG rather than age or CC split. Therefore, it is recommended that the efforts for improving clinical homogeneity of KDRG such as review of the hierarchical structure of classification systems and classification variables.

• 보건행정학회지
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• 제33권1호
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• pp.3-18
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• 2023

Background: A chronic disease management program including patient education, recall and remind service, and reduction of out-of-pocket payment was implemented in Korea through a chronic care model. This study aimed to assess the effect of a community-based intervention program for improving medication adherence of patients with diabetes mellitus in rural areas of Korea. Methods: We applied a non-equivalent control group design using Korean National Health Insurance Big Data. Hongcheon County has been continuously adopting this program since 2012 as an intervention region. Hoengseong County did not adopt such program. It was used as a control region. Subjects were a cohort of patients with diabetes mellitus aged more than 65 years but less than 85 years among residents for 11 years from 2010 to 2020. After 1:1 matching, there were 368 subjects in the intervention region and 368 in the control region. Indirect indicators were analyzed using the difference-in-difference regression according to Andersen's medical use model. Results: The increasing percent point of diabetic patients who continuously received insurance benefits for more than 240 days from 2010 to 2014 and from 2010 to 2020 were 2.6%p and 2.7%p in the intervention region and 3.0%p and 3.9%p in the control region, respectively. The number of dispensations per prescription of diabetic patient in the intervention region increased by approximately 4.61% by month compared to that in the control region. Conclusion: The intervention program encouraged older people with diabetes mellitus to receive continuous care for overcoming the rule of halves in the community. More research is needed to determine whether further improvement in the continuity of comprehensive care can prevent the progression of cardiovascular diseases.

• 한국병원경영학회지
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• 제9권1호
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• pp.46-65
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• 2004

The study was designed to investigate what effect of working time reduction which will be gradually expanded to corporate size from June, 2004 could give to medical industries, and to provide basic information for hospitals and government to prepare the policy. 276 hospitals were surveyed about medical service income and manpower realities during the first half of 2003, using a structured survey tool. Response rate was 8% and 20 hospitals were finally analyzed. The effect of working time reduction in hospital management was different to the size of hospitals and the alternative. Income to existing service income was decreased by $2.2{\sim}4.6%$ in tertiary hospitals, by $3.2{\sim}5.7%$ in general hospitals with more than 300 beds, and by $3.7{\sim}6.0%$ in general hospitals with less than 300 beds. In preparation against such decrease in income, government is required to raise insurance payment, to calculate added service charge for day-off on Saturday forenoon, to retain emergency care payment, to expand emergency care facilities, to secure duty doctors, and to support middle and small sized hospitals. Hospitals are required to give self improving efforts such as fortifying of weekday care, development of weekend care program, strengthening of care capacity and function of emergency care center, and making manpower operation efficient.

• 디지털융복합연구
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• 제10권1호
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• pp.407-412
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• 2012

본 연구는 행정전담인력의 유무에 따라 의원급 의료기관 경영에 미치는 요인을 파악하고자 2009년 1월1일부터 3월31일까지 건강보험심사평가원에 신규 개설을 신고한 전국의 의원급 의료기관 295개를 조사대상으로 선정하였다. 의료기관에 행정인력이 있을 때와 없을 때에 따른 횟수 별 조정건수에 따라서는 모든 항목에서 행정인력이 있을 때가 없을 때보다 많았으며, 1회를 제외하고 통계적으로 유의하게 나타났다(p<0.01). 연구결과 행정인력이 있고 없음은 삭감에 중요한 영향을 미치는 것으로 나타나, 의료기관에 병원행정 전문가 배치가 매우 중요할 것으로 사료된다.

• Journal of Preventive Medicine and Public Health
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• 제47권3호
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• pp.129-135
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• 2014

Tobacco use is the most important preventable risk factor for premature death. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), the first international public health treaty, came into force in 2005. This paper reviews the present status of tobacco control policies in Korea according to the WHO FCTC recommendations. In Korea, cigarette use is high among adult males (48.2% in 2010), and cigarette prices are the lowest among the Organization for Economic Cooperation and Development countries with no tax increases since 2004. Smoke-free policies have shown incremental progress since 1995, but smoking is still permitted in many indoor public places. More than 30% of non-smoking adults and adolescents are exposed to second-hand smoke. Public education on the harmful effects of tobacco is currently insufficient and the current policies have not been adequately evaluated. There is no comprehensive ban on tobacco advertising, promotion, or sponsorship in Korea. Cigarette packages have text health warnings on only 30% of the main packaging area, and misleading terms such as "mild" and "light" are permitted. There are nationwide smoking cessation clinics and a Quitline service, but cessation services are not covered by public insurance schemes and there are no national treatment guidelines. The sale of tobacco to minors is prohibited by law, but is poorly enforced. The socioeconomic inequality of smoking prevalence has widened, although the government considers inequality reduction to be a national goal. The tobacco control policies in Korea have faltered recently and priority should be given to the development of comprehensive tobacco control policies.

• 한국산학기술학회논문지
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• 제14권9호
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• pp.4437-4446
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• 2013

본 연구의 목적은 택시운전자를 위한 심뇌혈관질환 예방 프로그램을 개발하고 생리적 변수(혈압, 혈당, 혈청 지질), 신체적 변수(체지방율, 근지구력, 심폐지구력, 균형)에 미치는 효과를 검증하고자 시도하였다. 본 연구는 프로그램 개발과 효과 평가의 2단계로 진행하였다. 1단계는 택시 운전자를 위한 심뇌혈관질환 예방 프로그램을 개발하기 위해 2011년 3월 2일부터 4월 30일까지 택시 운전자 321명을 대상으로 건강상태 및 생활습관, 건강관리 요구도를 설문조사하였으며 이를 근거로 프로그램을 개발하였다. 2단계는 개발된 프로그램의 효과를 검증하기 위해 2011년 6월 1일부터 10월 5일까지 택시 운전자 51명에게 12주 동안 운동 1주 3회, 질병교육 4회, 영양 상담 2회 실시하였다. 연구결과는 프로그램 전보다 후에 혈압, 혈당, 혈청지질은 통계적으로 유의하게 감소하지 않았으나 체지방율은 유의하게 감소하였으며(t=3.108, p=.003), 근지구력(t=-7.621, p<.001), 심폐지구력(t=-3.388, p=.001), 균형(t=-4.133, p<.001)은 통계적으로 유의하게 증가한 것으로 나타났다. 이와 같은 결과를 근거로 운동, 질환교육, 영양상담으로 구성된 프로그램을 고혈압, 당뇨, 비만 등 심뇌혈관질환 선행질환 유병율이 높은 택시 운전자를 위한 심뇌혈관질환 예방프로그램으로 제안하고자 한다.