• 보건행정학회지
• /
• 제26권1호
• /
• pp.63-70
• /
• 2016

Background: Selective health benefit was introduced for decreasing economic burden of patients. Medical devices with economic uncertainty have been covered as selective health benefit by National Health Insurance since December 2013. We aimed to analyze impact of selective health benefit to medical expenditure and provider behavior focused on electrosurgery (ultrasonic shears, electrothermal bipolar vessel sealers) for gastric cancer patients covered since December 2014. Methods: We used the National Health Insurance claims data of 2,698 patients underwent gastric cancer surgery between August 2014 and March 2015. Medical cost and patient sharing per inpatient day were analyzed to verify that covering electrosurgery increased medical expenditure and changed provider behavior from open surgery to endoscopic or laparoscopic surgery. Additionally, we analyzed the claim rate of medical device or goods relating gastric endoscopic and laparoscopic surgery. Results: Medical cost and patient sharing per inpatient day were increased after covering electosurgery as selective health benefit (39,724/1,421 won). However, there were no medical expenditure increases after adjusting claim of electosurgery and patient sharing was decreased 1,057 won especially. The coverage of selective health benefit did not increase the claim rate of medical device or goods related endoscopic or laparoscopic surgery, either. Conclusion: Covering electosurgery decreased patient economic burden and did not change of provider behavior. Expanding selective health benefit is needed to decrease economic burden of severe patients. Further study should evaluate the long term effect with accumulated data.

• 한국병원경영학회지
• /
• 제22권4호
• /
• pp.61-73
• /
• 2017

In the Health Insurance System of South Korea, patients must pay high out-of-pocket expenditures for the medical service by uninsured medical benefits. So, the government implemented a policy to relieve the burdens of patients by lowering the uninsured selective-medical treatment costs in August, 2014. This study investigate the policy effects of selective-medical treatment(SMT) on the medical service's usage and cost with severe lung cancer patients. The patients are selected in one university hospital(with 1,000 beds), between one year before and after policy implementation. The study find that the usages of outpatient(visit number) and inpatient (length of stay) are not changed by statistically significant. It means that there are no effect in medical service behavior between before and after the policy. In medical expenses, outpatients decreased in their out-of-pocket payments by policy, but total medical expenses and insured medical benefits is not changed, because of the increased another medical insurance fees. For inpatient, although the SMT costs are statistically significant decrease, the total out-of-pocket payments and insured medical expenses are not changed statistically significant. Those findings show that the political decision making about SMT made lowing the selective-medical expenses, but total insured cost and patient's out-of pocket money were not changed by the new increased medical insurance fees. It means that the policy about SMT gave no particular benefit for patients. So, it need another benefit plans to lower the medical expenses of severe lung cancer patients with a high medical service usage and much total medical expense.

• Journal of Digestive Cancer Research
• /
• 제11권2호
• /
• pp.104-107
• /
• 2023

The Ministry of Health and Welfare of Korea has implemented various social security programs to ensure a basic standard of living and raise overall quality of life for all citizens. The Korean social security system provides social insurance, public assistance, and social welfare services. To achieve adequate drug benefits, the Drug Management Department of Health Insurance Review and Assessment Service (HIRA) implement drug management duties including drug listing, upper price limit setting, scope of benefits, and post-factum management. When a manufacturer or an importer wants to apply for National Health Insurance (NHI) coverage of the drug that has obtained safety and efficacy approval, the pharmaceutical benefit assessment committee of HIRA evaluates the drug's clinical efficacy and cost-effectiveness to determine whether or not to include the drug into the benefit package. The benefit standards for a listed drug (ingredient) are set either for the whole permitted range or a part of range with conditions. To increase the coverage rate for new drugs, the listed drugs are regularly reviewed for their value. The status of listed drugs can be adjusted or eliminated from the benefit package if the clinical efficacy turns out to be insignificant. Therefore, through these pharmaceutical management procedures, high-quality drugs are provided at reasonable prices, which save healthcare expenditure by price determination and selective coverage in consideration of economic evaluation.

• Journal of Yeungnam Medical Science
• /
• 제16권2호
• /
• pp.155-168
• /
• 1999

Osteoporosis is one of the most important public health problems facing the aging population. Drug therapy for osteoporosis can be divided operationally into two main categories: drugs that inhibit bone resorption, and thus reduce bone turnover, and those that stimulate bone formation, exerting an anabolic effect. Antiresorptive agents such as estrogens, calcitonin, and bisphosphonates are most effective in the prevention of osteoporosis. Formation-stimulating agents such as sodium fluoride or monofluorophosphate, parathyroid hormone fragments, and anabolic steroids are of potential value in the treatment of established osteoporosis, where bone mass is already low and benefit from antiresorptive drugs is likely to be small Recently, raloxifene, a selective estrogen receptor modulator, has become available in various countries for clinical use in the treatment of involutional osteoporsis. This paper will review the use of these drugs in postmenopausal woman.

• 한국콘텐츠학회논문지
• /
• 제17권9호
• /
• pp.39-49
• /
• 2017

본 연구는 질적 연구를 통하여 의료급여환자들의 의료이용 경험을 이해함으로써 의료급여환자와 건강보험환자 간 의료이용량의 통계적 차이현상의 원인과 과정을 파악하기 위해 수행되었다. 주요 분석결과는 다음과 같다. 첫째, 의료급여환자의 과잉의료는 대체로 존재하지 않으며, 복합적 질병을 가지고 있어서 발생하는 것이다. 그러나 물리치료와 한방 침에 있어서 일부 과잉이용이 발생하고 있는 것으로 판단된다. 둘째, 의료급여환자들은 의료비를 마련하기 위하여 생계급여에서 일부를 활용하거나 주변 가족이나 이웃의 도움을 받고 있었다. 그러나 과도한 의료비 부담으로 비급여 의료서비스와 대형병원 의료이용은 실제 의료필요만큼 이용하지 못하고 있었다. 또한 일부 환자는 아파도 우선 참고 견디고 있었다. 한편, 일부 의료기관에서는 의료급여환자에 대한 차별적 진료행위를 여전히 하고 있었다. 셋째, 공무원과 의료기관 모두는 의료급여환자에게 의료비 지원정책에 대한 미흡한 정보 제공 등 충분한 도움을 주지 못하고 있었다. 넷째, 정부가 수행하고 있는 의료급여정책인 선택병의원제도, 의료급여사례관리제도, 진료연장승인제도 모두는 불필요한 의료이용을 감소시키는데 기여하고 있는 것으로 판단된다. 그러나 의료급여환자들에게 필요한 의료이용을 제한하는 문제를 초래할 수 있어 이에 대한 대책마련이 요구되었다. 이상의 연구결과를 살펴보면 건강보험환자와 의료급여환자의 의료이용량의 차이를 통계적으로 검증한 선행연구와는 달리 의료급여환자들은 의도적인 과잉이용을 하지 않고 있으며, 오히려 필요한 의료서비스 이용에 제한을 받는다고 생각하고 있었으므로, 이에 대한 대책마련이 요구된다.

• Imaging Science in Dentistry
• /
• 제43권3호
• /
• pp.179-184
• /
• 2013

Purpose: X-ray exposure should be clinically justified and each exposure should be expected to give patients benefits. Since dental radiographic examination is one of the most frequent radiological procedures, radiation hazard becomes an important public health concern. The purpose of this study was to investigate the attitude of Korean dentists about radiation safety and use of criteria for selecting the frequency and type of radiographic examinations. Materials and Methods: The study included 267 Korean dentists. Five questions related to radiation safety were asked of each of them. These questions were about factors associated with radiation protection of patients and operators including the use of radiographic selection criteria for intraoral radiographic procedures. Results: The frequency of prescription of routine radiographic examination (an example is a panoramic radiograph for screening process for occult disease) was 34.1%, while that of selective radiography was 64.0%. Dentists' discussion of radiation risk and benefit with patients was infrequent. More than half of the operators held the image receptor by themselves during intraoral radiographic examinations. Lead apron/thyroid collars for patient protection were used by fewer than 22% of dental offices. Rectangular collimation was utilized by fewer than 15% of dental offices. Conclusion: The majority of Korean dentists in the study did not practice radiation protection procedures which would be required to minimize exposure to unnecessary radiation for patients and dental professionals. Mandatory continuing professional education in radiation safety and development of Korean radiographic selection criteria is recommended.

• 대한한방부인과학회지
• /
• 제19권2호
• /
• pp.240-260
• /
• 2006

Purpose : The objective of this study is to serve guidelines for the investigation and management of uterine myomas with KM therapies. Methods : English-language articles from PubMed and Korean-language articles from the database of the journal of oriental gynecology were reviewed from 2000 to 2005, using the key words 'uterine myoma', 'uterine leiomyoma', 'fibroid', 'uterine artery embolization', 'endometrial ablation', 'myomectomy', and jagungguenjong(子宮筋腫)'. Results and Limits : The areas of clinical practices considered in formulating this guideline are assessment, KM therapies, medical treatments, myolysis, selective artery occlusion, endometrial ablation and surgical therapies including myomectomy and hysterectomy. Implementation of this guideline would optimize the decision-making process of women with uterine myomas and further investigation or therapy of their KM doctors. But we don't have abundant evidences of clinical trials of uterine myoma treated with KM therapy, though we treat or manage that with every-day clinical practices. Moreover cultural gaps between Korea and other western countries make many differences in the attitude to surgical therapies, especially hysterectomy. So it is very difficult to compare W therapies with other therapies. Moreover it is much difficult to estimate cost-effectiveness and benefit of those therapies in QOL. Conclusions : The majority of uterine myoma is asymptomatic and will not require any intervention or further investigation. But unmarried women who wish to marry and get pregnant want to find safe therapy for their asymptomatic uterine myomas. In that case, most of the patients prefer non-surgical therapy to surgical therapy. So KM herbal medicinal therapy is a good alternative method for those patients. For the symptomatic myomas, hysterectomy offers a definitive solution. However, it is not the best solution for women who wish to preserve their uterus. So KM therapy is a good alternative for them. But the predicted benefits of alternative therapies including KM therapy must be carefully weighed against the Possible risks of these therapies. To improve the quality of life of both women with asymptomatic and symptomatic myomas, selecting and treating patients should be done carefully. Moreover, the effect of KM therapy has to evaluated, comparing the possible situation without treatment and the benefit of constant treatment as a health-care system.

• 벤처혁신연구
• /
• 제4권2호
• /
• pp.97-108
• /
• 2021

근로계약은 형식상으로는 노동력상품과 임금의 교환관계로서 나타나지만, 단순한 물물교환의 차원을 초월하는 것이기 때문에 경제학적으로 노동력상품과 화폐의 교환관계로서 '매매'로서 파악하는 것도 가능하고 '임대차'로 파악할 수도 있다. 상품교환관계를 법적인 측면에서 보면, 노동력과 임금의 교환관계를 합법적으로 지지하고 그것에 구속력을 부여하여 강제화하는 법적인 장치가 계약이다. 이러한 근로계약은 임금을 수령하고, 임금의 수령의 반대급부로 일정한 시간을 사용자의 지휘·감독하에 두는 관계를 가져오게 하였다. 근로시간은 자신의 노동력을 사용자의 처분권하에 둔 종속시간이기 때문에 장시간의 근로는 근로자의 건강과 안전을 위해할 수 있고, 더 나아가 인간으로서 누려야 할 가치를 침해하는 행위가 될 수 있음으로 그 규제가 필요하다고 할 것이다. 근로시간의 단축은 인간의 생체적 한계를 설정하고, 확대 재생산을 할 수 있도록 생산적 측면에서 근로자의 문화에 대한 향유와 인간으로서 삶의 질을 확보하는 사회적인 측면에서 단축이 필요하지만, 사용자의 기업 경영상의 노동력 확보와 생산 활동 및 자본주의 국가에서 추구하는 것과 비교하여 이 둘의 양립을 할 수 있어야 한다. 근로시간은 개인에게서의 시간과 사회전체에서의 시간으로 볼 수 있고, 개인적인 차원에서 장시간 근로는 개인에게서의 시간은 줄어들게 되어 개인적 차원에서는 바람직하지 않지만, 사회전체적인 차원에서 생산 활동에 투입시간의 증대로 인한 생산물의 증가는 사회발전에 도움이 될 수 있다. 근로시간은 이러한 개인적 차원과 사회적 차원에서의 균형을 찾아간다는 측면에서 근로시간을 고찰하는 것이 필요하다. 근로시간의 규제방법이 근로시간의 시작과 근로시간의 종료에 대한 것으로 근로시간의 총량을 규제하는 것이었다면, 근로시간의 유연화, 탄력화는 근로시간의 총량을 1주 최대 52시간의 범위 내에서 범위를 한정하면서 기업의 새로운 업무의 출현에 따라 근로시간을 탄력적으로 배분하고 편성하는 것이 가능하도록 하는 근로시간의 질적인 규제방식이다. 이에 따라 근로시간은 단축하되 기업의 상황에 따른 유연근로시간제를 확대하여 시행하는 것이 필요하다. 이를 위하여 현재 6개월로 제한되어 있는 탄력적 근로시간제의 운용의 폭의 유연화와 사용자와 근로자간의 합의에 의한 선택적 근로시간제의 실 근로시간에 대한 처리, 정보통신 기술의 발전과 4차 산업혁명에 기반한 새로운 근로형태에 출현에 따른 재량근로시간의 대상 업무를 확대하는 것이 필요하다.