• 제목/요약/키워드: Total annual cost

검색결과 238건 처리시간 0.035초

노인 코호트의 의료이용 및 입원진료비 변화 추이 -공.교 의료보험 대상자를 대상으로- (Trend of Medical Care Utilization and Medical Expenditure of the Elderly Cohort)

  • 이경수;강복수
    • Journal of Preventive Medicine and Public Health
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    • 제30권2호
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    • pp.437-461
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    • 1997
  • 이 연구는 의료보험관리공단의 공 교 의료보험자료를 이용하여 1989년부터 1993년까지의 5년간의 60세이상의 노인의 의료이용과 진료비의 변화를 연령별, 성별, 의료 보험료 수준별 코호트를 구성하여 상병당으로 분석함으로써 좀 더 정확한 변화의 양상을 파악하고 예측을 하는데 연구의 목적이 있다. 연령별 연도별 입원 수진율은 연도별 입원수진율은 70-74세 군이 89년과 93년에 각각 1,000명당 117.3과 141.1로 가장 높았으며, 매년 증가하는 추세이다. 연령 코호트의 연도별 상병건수는 전체적으로는 5년 동안에 40.5%증가하였다. 성별 코호트의 연도별 상병건수는 남자 상병건수보다 여자가 많이 증가하였으며, 남자와 여자의 연평균 증가율은 각각 9.1%와 10.2%였다. 연령 코호트의 상병당 연도별 입원진료비의 변화는 전체적으로 보았을 때 5년간 총 진료비는 15.4%증가 하였다. 이 중 진료행위료의 증가가 21.5%로 가장 큰 폭으로 증가하였다. 의료 보험료 수준별 코호트의 상병당 입원진료비 변화는 보험료 수준이 낮은 군보다 높은 군에서 진료비가 높았으며, 보험료 수준별 코호트의 연도의 경과에 따라서 각종 진료비가 증가하였다. 재원기간은 0.08% 증가하여 거의 변화가 없었으며, 1991년을 기점으로 감소하는 경향이었다. 10대 다빈도 상병 중에서 가장 흔한 질병은 백내장이었다. 1993년의 10대 다빈도상병 중 1989년에 비하여 비율이 증가한 상병은 백내장, 뇌동맥 폐색이었으며, 감소한 질병은 폐결핵과 본태성 고혈압이었다. 전체 상병에서 10대 상병이 차지하는 비율은 30-35%였으며, 연령군별로는 차이가 없었다. 연령 코호트의 이용의료기관별 평균진료비 및 재원 기간은 전체적으로는 병원급 의료기관에서의 진료비 증가율이 가장 높았으며, 재원기간은 의료기관 종별에 관계없이 감소하였으며, 병원이 4.9% 감소하여 감소폭이 가장 켰다. 총 상병건수에서 고액진료건수가 차지하는 비율은 67.6% 증가하였고, 암환자건수는 8.9% 증가하였으며, 장기입원환자가 차지하는 비율은 오히려 1.2% 감소하였다. 총 진료비 규모는 62.2% 증가하였으며, 고액상병진료비가 차지하는 비율은 5년간 129.9% 증가하였고, 암환자 진료비는 68.5%, 장기입원환자의 진료비는 59.4% 증가하였다. 상병당 입원진료비 및 재원기간을 1989년 수가로 환산하여 변화 추이를 보면, 상병당 총 진료비는 매우 완만한 증가를 보이고, 약제비는 오히려 약간 감소하는 경향이었고, 진료행위료는 지속적으로 상승하는 추세였다. 재원기간은 완만하게 감소하는 양상을 보였다. 연령구간별로 구분하여 분석한 결과 진료비와 재원기간과는 연령에 관계없이 비슷한 상관계수를 보였으나, 의료보험료 수준과 연령구간별 진료비는 상관계수는 매우 작았으며, 연령군별로 큰 차이는 없었다. 시계열 분석 결과 향후 약제비는 매우 완만한 감소 추세를 보일 것이고, 진료행위료와 총 진료비는 지속적으로 증가할 것으로 예측되었으며, 재원기간은 13.0일로 변화가 없을 것으로 예측되었다. 이 연구에서는 진료행위료의 증가가 총 진료비의 상승을 주도하고 있는 것으로 생각된다. 이는 첨단 의료기기나 신기술의 도입에 의한 것으로 의료기관들의 서비스 다각화 전략과도 관련 있는 것으로 생각된다. 또한 의료이용량 즉 입원상병건수의 증가가 진료비 상승에 영향을 많이 미치는 것으로 판단되며 전체 인구 집단의 의료비 상승요인과는 다른 양상을 보일 수 있으므로 노인 인구에 대한 의료비 절감 대책은 다른 연령층과 구별하여 적용할 필요성이 있다고 볼 수 있다. 향후 노인 연령 군별 질병양상의 변화와 서비스량 및 변화에 대한 연구를 개인특성 자료나 의료기관의 특성 등과 연계하여 포괄적인 연구를 수행함으로써 노인입원 특성과 향후 노인의료 이용량과 진료비의 추이를 판단하고 이를 토대로 노인의료문제의 해결을 위한 방안을 마련할 수 있으리라 생각된다.

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톱밥으로부터 생산되는 개질 바이오오일 생산공장의 공정모사 및 경제성 분석 (Process Simulation and Economic Feasibility of Upgraded Biooil Production Plant from Sawdust)

  • 오창호;임영일
    • Korean Chemical Engineering Research
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    • 제56권4호
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    • pp.496-523
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    • 2018
  • 본 연구의 목표는 톱밥의 건조, 급속열분해, 바이오오일 응축, 바이오오일 수첨개질, 전기생산, 폐수처리를 포함하는 2개의 바이오오일 생산공정들에 대한 경제적 타당성을 평가하는 것이다. 첫번째 공정은 수소생산을 위한 steam-methane reforming (SMR)을 포함하는 바이오오일 생산공정이다(Case 1). 두번째 공정은 SMR을 포함하지 않고 수소를 외부로부터 공급받아 수첨개질을 수행하는 바이오오일 생산공정이다(Case 2). 상용공정모사기인 ASPEN Plus를 이용하여 이두 공정에 대한 공정흐름도를 구축하였고, 물질 및 에너지 수지식을 계산하였다. 원료로서 40%의 수분을 포함하는 톱밥 100 t/d, 30% 자기자본비율, 자기자본에 상응하는 자본지출, 수소 구입가 $1,050/ton, 완전건조된 원료대비 수송용 연료 수율 20% (Case 1) 및 25% (Case 2) 로 가정하고, 4단계 경제성 분석기법인 4-level EP를 사용하여 기술경제성 분석을 수행하였다. 총투자비(TCI), 총생산비(TPC), 연간판매금액(ASR), 그리고 개질 바이오오일의 최소판매가격(MFSP)은 Case 1에 대하여 $22.2 million, $3.98 million/yr, $4.64 million/yr, 그리고 $1.56/l 이고, Case 2에 대하여 $16.1 million, $5.20 million/yr, $5.55 million/yr, $1.18/l로 산출되었다. 수소를 직접 생산하는 Case 1과 수소를 외부로 부터 공급받는 Case 2의 투자회수율(ROI)와 투자회수기간(PBP)은 큰 차이를 보여주지 않았고, Case 1과 Case 2의 원료 공급량을 1,500 t/d로 증가할 경우, ROI는 15% 이상으로 향상될 것으로 예상되었다.

일부 농촌지역에서의 보건지소 의료인의 정의적인 태도가 주민의 보건지소 이용에 미치는 영향 (A Study on Desirable Attitudes of Health Subcenter Personnel, Affecting to Utilization of a Rural Health Subcenter for Primary Health Care)

  • 위자형
    • 농촌의학ㆍ지역보건
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    • 제14권1호
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    • pp.30-36
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    • 1989
  • In order to desirable attitudes of health subcenter personnel, affecting to utilization of a rural health subcenter for primary health care, a study carried out, through analyzing the specific survey datas of 228 out of 1151 total house-holders in a rural community, Su-Dong Myun, Yam-yang-ju kun, Kyung-Gi Do in Korea, and the medical re-cords of total out-patients of health subcenter in this district during 1981-1988. The following results were obtained: 1) The annual utilization rate showed decreasing tedency such as 723 per 1,000 inhabitants in 1981, 652 in 1982, 618 in 1985, 54H in 1984 and 341 in 1987, since 1981. 2) The utilization Rate in 1987 was unusually the lowest with 341 per 1,000 inhabitants in decreasing tendency, steadily. 3) In advatage on utilization of health subcenter for primary health care in a rural area, 68.8% of the respondents answered that it was in comprehensive health care with the highest rate and next order in near distance from living place with 16.7% in easy and simple process to utilize with 9.2% and in lower medical cost with 5.3%. 4) The order of desirable image of rural health subcenter personnel for primary health care was of good attitude(57.0%), of good skill(29.0 %) and of wide knowledge(14.0%), 5) The order of desirable image of doctor for primary health care in rural health subcenter was of good skill(.44.3%), of good attitude(36.8%) and of wide knowledge(18.9%), and nurse was of good attitude(76.8%), of good skill(14.0 %) and of wide knowledge(9.2%). 6) The percentage order by good attitudes of rural health subcenter personnel was the highest in responsibility(38.2%), kindness(26.3% ), proprieties(14.9%), sincerity(12.7%) and notion of duty hours(6.6%). 7) The statistical datas in health subcenter was written and kept, without distinction of definition of new and old patients, by month and for suitable method of medical expenses of medical insurance and medicaid by clerical convenience. 8) In future, the organization of health subcenter must be unified, systematized and rationlized for primary health care. Health subcenter must be organized by 3 parts of function(medical care, health service and clerical affair) and then function of health subcenter will be more activated by clerical activities.

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한국, 일본, 글로벌 택배기업의 효율성 및 생산성 비교 분석 (Comparative Analysis on Efficiency and Productivity for Korea, Japan and Global Parcel Delivery Companies)

  • 마진희;안영효
    • 유통과학연구
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    • 제14권3호
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    • pp.73-83
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    • 2016
  • Purpose - The parcel delivery service(courier) industry all over the world has been expanding its market so far, but its growth has been declining in recent years. In this situation, most parcel delivery companies are having trouble with managing themselves because of the pressure from the customer to increase service level and decrease the rate. The purpose of this study is to provide ways to improve competitive advantages of the parcel delivery service industry by evaluating the multi-period operating efficiency of Korea, Japan and global service providers. Research design, data, and methodology - The data for the period of 2011 to 2014 were collected from the annual reports published by parcel delivery companies. In this study, we analyze the marketability (revenue), profitability (operating profits), and management conditions (net profits) of parcel service companies by combining information on human resources (number of employees) and material resources (total assets and equity). Therefore, the number of employees, total assets, and equity are selected as input variables, and revenue, operating profits, and net profits as the output variables. In this study, DEA (Data Envelopment Analysis) is used to measure the comparative efficiency and MPI (Malmquist Productivity Index) is used to analyze the trend of change of the efficiency for a multi-year period. Results - The operational efficiency scores of medium-sized parcel delivery companies in Korea are higher than other larger competitors such as Korean, Japan and Global larger companies. As of 2014, Logen(1.878) was found to be the most efficient parcel delivery enterprise, followed by KGB (1.224), and Kyoungdong(1.002). Otherwise, Hanjin(0.235), CJ(0.262), Hyundai Logistics(0.657), DHL(0.611), UPS(0.766), FedEx(0.498), TNT(0.350), Yamato(0.762) and Sagawa(0.520), larger sized companies, were done inefficiently. The productivity of parcel delivery companies is influenced by endogenous factors as well as exogenous ones such as changes in business environment and technological advances. Conclusions - Korean medium-sized companies have relatively high efficiency scores in operation. That is why they still survive the competitive market in Korea where market restructuring on the industry has been expected to be conducted for many years. The reason why medium-sized couriers had higher efficient scores than larger couriers is that most of couriers spend more operating expenses versus unit price of delivery which is the amount of money that is needed in order to send a package by parcel service. So the delivery unit price must be taken into account by all the expenses associated with the cost of fuel, labor and maintenance expenses for facilities, etc. therefore, the unit price must be increased to strengthen business competitive power. In order for the industry to have more competitive advantage, the companies need to make profits by increasing demand volume and raising the delivery rate to provide high-quality delivery service to customers. And both endogenous and exogenous change must take precedence in order to strengthen their competitiveness.

구제역 관리를 위한 혈청학적 예찰계획 평가 (Evaluation of Serological Surveillance System for Improving Foot-and-Mouth Disease Control)

  • 박선일;신연경
    • 한국임상수의학회지
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    • 제30권4호
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    • pp.258-263
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    • 2013
  • The primary goal of this study was to compute sample sizes required to achieve the each aim of a variety of foot-and-mouth disease (FMD) surveillance programs, using a statistically valid technique that takes the following factors into account: sensitivity (Se) and specificity (Sp) of diagnostic test system, desired minimum detectable prevalence, precision, population size, and desired power of the survey. In addition, sample sizes to detect FMD if the disease is present and also as proof of freedom were computed. The current FMD active surveillance programs consist of clinical, virological, and serological surveillance. For the 2012 serological surveillance, annual sample sizes (n = 265,065) are planned at four separate levels: statistical (n = 60,884) and targeted (n = 115,232) at breeding pig farms and slaughter house, in together with the detection of structural proteins (SP) antibodies against FMD (n = 88,949). Overall, the sample size was not designed taking the specific aims of each surveillance stream into account. The sample sizes for statistical surveillance, assuming stratified two-stage sampling technique, was based to detect at least one FMD-infected case in the general population. The resulting sample size can be used to obtain evidence of freedom from FMD infection, not for detecting animals that have antibodies against FMD virus non-structural proteins (NSP). Additionally, sample sizes for targeted surveillance were not aimed for the population at risk, and also without consideration of statistical point of view. To at least the author's knowledge, sampling plan for targeted, breeding pig farms and slaughter house is not necessary and need to be included in the part of statistical surveillance. Assuming design prevalence of 10% in an infinite population, a total of 29 animals are required to detect at least one positive with probability of 95%, using perfect diagnostic test system (Se = Sp = 100%). A total of 57,211 animals needed to be sampled to give 95% confidence of estimating SP prevalence of 80% at the individual animal-level with a precision of ${\pm}5%$, assuming 800 herds with an average 200 heads per farm, within-farm variance of 0.2, between-farm variance of 0.05, cost ratio of 100:1 of farm against animals. Furthermore, 779,736 animals were required to demonstrate FMD freedom, and the sample size can further be reduced depending on the parameters assumed.

한국 동해 명태 어업의 적정어획노력량 추정 -동해구기선저인망어업과 동해구트롤어업의 경제성분석을 근거로- (Estimation on Optimum Fishing Effort of Walleye Pollock Fishery in the East Coast of Korea : Based on the Economic Analysis between Danish Seine Fishery and Trawl Fishery for Walleye Pollock)

  • 이장욱
    • 수산경영론집
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    • 제22권2호
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    • pp.75-99
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    • 1991
  • A quantitative analysis was carried out to monitor the commercial yield level of walleye pollock Theragra chalcogramma in the east coast of Korea, based on available data on catch and fishing effort, catch per unit of effort including fish prices from 1911 to 1988, using a traditional yield model. The results from the quantitative assessment were based to estimate maximum economic yield (MEY) and optimal fishing effort (E-opt) at MEY. On the other hand, interaction aspects between danish seine fishery and trawl fishery mainly targeting walleye pollock in the east coast of Korea were studied to predict optimal situation in fishing effort level from economic point of view which gives the most benefits to the two fisheries. Total production of walleye pollock in 1911 when its catch record was begun for the first time was about 12, 000 metric tons(M/T), and then the catch trend maintained nearly at the level of 50, 000 M/T per annum, showing a decreasing trend until 1930. The highest production from historical data base on walleye pollock fishery statistics was from the years in 1939 and 1940, about 270, 000 M/T and 26, 000 M/T, respectively. No production of the fish species was recorded during the years from 1943 to 1947, and from 1949 to 1951. From 1952 onwards annual production was only available from the southern part of 38$^{\circ}$N in the east coast. During two decades from 1952 to 1970, the production had sustained about less than 30, 000 M/T every year. Annual production showed an increasing trend from 1971, reaching a maximum level of approximately 162, 000 M/T in 1981. Afterwards, it has deceased sharply year after year and amounted to 180, 000 M/T in 1988. The catch composition of walleye pollock for different fishery segments during 1970~1988 showed that more than 70% of the total catch was from danish seine fishery until 1977 but from 1978 onwards, the catch proportion did not differ from one another, accounting for the nearly same proportion. Catch per unit of effort (CPUE) for both danish seine fishery and trawl fishery maintained a decline tendency after 1977 when the values of CPUE were at level of 800 kg/haul for the former fishery and 1, 300 kg/haul for the latter fishery, respectively. CPUEs of gillnet fishery during 1980~1983 increased to about 3.5 times as high value as in the years, 1970~1979 and during 1987~1988 it decreased again to the level of the years, 1970~1978. The bottom longline fishery's CPUE wa at a very low level (20 kg/basket) through the whole study years, with exception of the value (60 kg/basket) in 1980. Fishing grounds of walleye pollock in the east coast of Korea showed a very limited distribution range. Danish seine fishery concentrated fishing around the coastal areas of Sokcho and Jumunjin during January~February and October~December. Distributions of fishing grounds of trawl fishery were the areas along the coastal regions in the central part of the east coast. Gillnet and bottom longline fisheries fished walleye pollock mainly in the areas of around Sokcho and Jumunjin during January~February and December. Relationship between CPUEs' values from danish seine fishery and trawl fishery was used to standardize fishing effort to apply to surplus production model for estimating maximum sustainable yield (MSY) and optimum fish effort (F-opt) at MSY. The results suggested a MSY of 114, 000 M/T with an estimated F-opt of 173, 000 hauls per year. Based on the estimates of MSY and F-opt, MEY was estimated to be about 94, 000 M/T with a range of 81, 000 to 103, 000 M/T and E-opt 100, 000 hauls per year with a range of 80, 000 to 120, 000 hauls. The estimated values of MEY and E-opt corresponded to 82% of MSY and 58% of F-opt, respectively. An optimal situation in the fishing effort level, which can envisage either simultaneously maximum yield or maximum benefit for both danish seine fishery and trawl fishery, was determined from relationship between revenue and cost of running the fleet : the optimal fishing effort of danish seine fishery was about 52, 000 hauls per year, corresponding to 50 danish seiners and 27, 000 hauls per year which is equal nearly to 36 trawlers, respectively. It was anticipated that the net income from sustainable yield estimated from the respective optimal fishing effort of the two fisheries will be about 3, 800 million won for danish seine fishery and 1, 000 million won for trawl fishery.

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추후관리가 필요한 만성질환 퇴원환자 가정간호 시범사업 운영 연구 (An Operations Study on a Home Health Nursing Demonstration Program for the Patients Discharged with Chronic Residual Health Care Problems)

  • 홍여신;이은옥;이소우;김매자;홍경자;서문자;이영자;박정호;송미순
    • 대한간호학회지
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    • 제20권2호
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    • pp.227-248
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    • 1990
  • The study was conceived in relation to a concern over the growing gap between the needs of chronic patients and the availability of care from the current health care system in Korea. Patients with agonizing chronic pain, discomfort, despair and disability are left with helplessly unprepared families with little help from the acute care oriented health care system after discharge from hospital. There is a great need for the development of an alternative means of quality care that is economically feasible and culturally adaptible to our society. Thus, the study was designed to demonstrate the effectiveness of home heath care as an alternative to bridge the existing gap between the patients' needs and the current practice of health care. The study specifically purports to test the effects of home care on health expenditure, readmission, job retention, compliance to health care regime, general conditions, complications, and self-care knowledge and practices. The study was guided by the operations research method advocated by the Primary Health Care Operations Research Institute(PRICOR) which constitutes 3 stages of research : namely, problem analysis solution development, and solution validation. The first step in the operations research was field preparation to develop the necessary consensus and cooperation. This was done through the formation of a consulting body at the hospital and a steering committee among the researchers. For the stage of problem analysis, the Annual Report of Seoul National University Hospital and the patients records for last 5 years were reviewed and selective patient interviews were conducted to find out the magnitude of chronic health problems and areas of unmect health care needs to finally decide on the kinds of health problems to study. On the basis of problem analysis, the solution development stage was devoted to home care program development asa solution alternative. Assessment tools, teaching guidelines and care protocols were developed and tested for their validity. The final stage was the stage of experimentation and evaluation. Patients with liver diseases, hemiplegic and diabetic conditions were selected as study samples. Discharge evaluation, follow up home care, measurement and evaluation were carried out according to the protocols of care and measurement plan for each patient for the period of 6 months after discharge. The study was carried out for the period from Jan. 1987 to Dec. 1989. The following are the results of the study presented according to the hypotheses set forth for the study ; 1. Total expenditures for the period of study were not reduced for the experimental group, however, since the cost per hospital visit is about 4 times as great as the cost per home visit, the effect of cost saving by home care will become a reality as home care replaces part of the hospital visits. 2. The effect on the rate of readmission and job retention was found to be statistically nonsignificant though the number of readmission was less among the experimental group receiving home care. 3. The effect on compliance to the health care regime was found to be statistically significant at the 5% level for hepatopathic and diabetic patients. 4. Education on diet, rest and excise, and medication through home care had an effect on improved liver function test scores, prevention of complications and self - care knowledge in hepatopathic patients at a statistically significant level. 5. In hemiplegic patient, home care had an effect on increased grasping power at a significant level. However. there was no significant difference between the experimental and control groups in the level of compliane, prevention of complications or in self-care practices. 6. In diabetic patients, there was no difference between the experimental and control groups in scores of laboratory tests, appearance of complications, and self-care knowledge or self -care practices. The above findings indicate that a home care program instituted for such short term as 6 months period could not totally demonstrate its effectiveness at a statistically significant level by quantitative analysis however, what was shown in part in this analysis, and in the continuous consultation sought by those who had been in the experimental group, is that home health care has a great potential in retarding or preventing pathological progress, facilitating rehabilitative and productive life, and improving quality of life by adding comfort, confidence and strength to patients and their families. For the further studies of this kind with chronic patients it is recommended that a sample of newly diagnosed patients be followed up for a longer period of time with more frequent observations to demonstrate a more dear- cut picture of the effectiveness of home care.

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Knowledge, Barriers and Attitudes Towards Breast Cancer Mammography Screening in Jordan

  • Abu-Helalah, Munir Ahmad;Alshraideh, Hussam Ahmad;Al-Serhan, Ala-Aldeen Ahmad;Kawaleet, Mariana;Nesheiwat, Adel Issa
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권9호
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    • pp.3981-3990
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    • 2015
  • Background: Breast cancer is the most common type of cancer in Jordan. Current efforts are focused on annual campaigns aimed at increasing awareness about breast cancer and encouraging women to conduct mammogram screening. In the absence of regular systematic screening for breast cancer in Jordan, there is a need to evaluate current mammography screening uptake and its predictors, assess women's knowledge and attitudes towards breast cancer and screening mammograms and to identify barriers to this preventive service. Materials and Methods: This cross-sectional study was conducted in six governorates in Jordan through face-to-face interviews on a random sample of women aged 40 to 69 years. Results: A total of 507 participants with mean age of $46.8{\pm}7.8$ years were interviewed. There was low participation rate in early detection of breast cancer practices. Breast self-examination, doctor examination and periodic mammography screening were reported by 34.9%, 16.8% and 8.6% of study participants, respectively. Additionally 3.8% underwent breast cancer screening at least once but not periodically, while 87.6% had never undergone mammography screening. Reported reasons for conducting the screening were: perceived benefit (50%); family history of breast cancer (23.1%); perceived severity (21.2%); and advice from friend or family member (5.8%). City residents have shown higher probability of undergoing mammogram than those who live in towns or villages. Results revealed negative perceptions and limited knowledge of study participants on breast cancer and breast cancer screening. The most commonly reported barriers for women who never underwent screening were: fear of results (63.8%); no support from surrounding environment (59.7); cost of the test (53.4%); and religious belief, i.e. Qadaa Wa Qadar (51.1%). Conclusions: In the absence of regular systematic screening for breast cancer in Jordan, the uptake of this preventive service is very low. It is essential for the country of Jordan to work on applying regular systematic mammography screening for breast cancer. Additionally, there is a need for improvement in the current health promotion programmes targeting breast cancer screening. Other areas that could be targeted in future initiatives in this field include access to screening in rural areas and removal of current barriers.

국민건강보험 지역가입자 중 뇌졸중 입원환자의 의료이용 양상 및 지역친화도 추이 (1998-2005) (Trends of Health Care Utilization and Relevance Index of Stroke Inpatients among The Self-Employed Insured and Their Dependents of National Health Insurance (1998-2005))

  • 김지현;조병만;황인경;손민정;윤태호
    • 보건행정학회지
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    • 제18권4호
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    • pp.66-84
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    • 2008
  • Objectives: This study aimed to. offer some fundamental evidences for the stroke management policy by investigating the trends of medical care utilization and regionalization in stroke inpatients. Methods: We used the National Health Insurance claims and registry data for stroke inpatients from 1998 to 2005. Among all stroke inpatient claims data, self-employed insured and their dependents were only included in this study. The classification of stroke was based on ICD-10(I60-I69) and its subtype was divided by hemorrhage(I60-I62) and infarction(I63-I64) type. To evaluate regionalization of medical care utilization, relevance index was calculated by regions. The regions were classified 8 large catchment areas and 163 self authorized areas. Results: The overall medical care utilization rate of stroke inpatient has been increased, especially infarction subtype. Among medical care institutions, the utilization of hospital has been the most rapidly increased. Although considered annual rate of interest, total medical cost of stroke inpatients has been increased, Totally, more than 84% of stroke inpatient were admitted to medical care institutions in their own large catchment area during 1998-2005. The relevance indices in their own large catchment area (self sufficiency rates) were more than 70% in most areas regardless of stroke subtype except Chungbuk catchment area. Self sufficiency rates of stroke inpatients among 163 self authorized areas in 1998 and 2005 were 84.2% and 83.1% in metropolitan, 46.7% and 45.5% in urban, and 19.5% and 22.6% in rural areas, respectively. Conclusion: Stroke management policy for improvement of distribution at the district level, especially in rural areas, may be helpful for reducing regional inequality in stroke.

장기미집행공원 개발에 따른 도시 식생 탄소 흡수량에 미치는 영향 및 경제적 가치 평가 (Impact Assessment of Vegetation Carbon Absorption and Economic Valuation Under Long-term Non-executed Urban Park Development)

  • 성웅기;최재연;유재진;김동우;손승우
    • 한국산학기술학회논문지
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    • 제21권10호
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    • pp.361-371
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    • 2020
  • 2020년 일몰제가 시행되면서 장기미집행공원 개발에 대한 우려가 제기되고 있다. 본 연구의 목적은 장기미집행공원이 개발됨에 따라 소실되는 탄소량과 경제적 가치를 평가하여 장기미집행공원 개발에 따른 영향 최소화 방안 도출에 근거를 제공하고자 한다. 본 연구에서는 FSDAF 시공간 영상융합기법과 CASA-NPP 모형을 활용하여 서울시 내 장기미집행공원의 연평균 NPP를 산정하고, 이를 바탕으로 5개의 개발 시나리오에 따라 소실되는 탄소량과 경제적 손실을 평가하였다. 서울시 내 개발제한구역을 제외한 장기미집행공원의 총 NPP 값은 4,892.18 t C로 나타났으며, 개발 시나리오 1에서는 4,892.18 t C, 개발 시나리오 2에서는 2,548.55 t C, 개발 시나리오 3에서는 238.94 t C, 개발 시나리오 4에서는 848.38 t C, 개발되는 시나리오 5에서는 1,596.00 t C의 탄소가 소실될 것으로 나타났으며, 각각 5개의 개발 시나리오에 따른 탄소의 사회적 비용을 계산하면 약 11억 8천만원, 6억 1천만원, 5천 8백만원, 2억 5백만원, 3억 8천 5백만원이며 개발로 인해 해당금액의 경제적 손실이 발생할 것으로 나타났다. 본 연구의 결과는 5개의 개발 시나리오를 바탕으로 장기미집행공원의 탄소 손실량과 경제적 손실을 평가하였다는데 의의가 있으며, 일몰제 이후 개발가능성이 높은 장기미집행공원 내 산림생태기능에 대한 영향 최소화 방안 마련, 개발 대안의 기초자료로 활용되기를 기대한다.