• Journal of Hospice and Palliative Care
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• 제22권2호
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• pp.49-66
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• 2019

의료기술 발달 및 경제개발 수준 상승 등으로 호스피스 완화의료(hospice & palliative care) 서비스를 받는 말기 환자들이 점점 늘어나고 있다. 이와 더불어 최근 호스피스 완화의료 분야 임상전문가들은 환자나 가족 대상 호스피스 완화의료 서비스의 질을 향상시킬 목적으로 하는 연구에도 많은 관심을 보이고 있다. 한편 정부의 연구대상자 보호 정책이 강화되면서 IRB(생명윤리심의위원회)에서도 호스피스 완화의료 연구의 연구계획서를 심의할 때 환자의 취약성과 관련된 다양한 윤리적 사안들을 더 엄밀하게 점검하고 있다. 그러나 말기 환자들의 삶의 질 향상 및 유지를 위해서는 질적으로 보장된 호스피스 완화의료 서비스가 제공되어야 한다. 이를 위해서 윤리적으로 안전한 호스피스 완화의료 연구의 시도가 지지되어야 한다. 이에 필자는 호스피스 완화의료 연구의 윤리지침을 종설 논문 형식으로 제안했다. 이는 윤리적으로 안전하고 과학적으로 가치가 있는 연구계획서를 준비해야 하는 연구자 및 그 연구계획서를 심의하는 IRB가 적절하게 참조할 수 있도록 해주기 위함이다.

• Journal of Preventive Medicine and Public Health
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• 제56권3호
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• pp.248-254
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• 2023

Objectives: Measuring the quality of care is paramount to inform policies for healthcare services. Nevertheless, little is known about the quality of primary care and acute care provided in Korea. This study investigated trends in the quality of primary care and acute care. Methods: Case-fatality rates and avoidable hospitalization rates were used as performance indicators to assess the quality of primary care and acute care. Admission data for the period 2008 to 2020 were extracted from the National Health Insurance Claims Database. Case-fatality rates and avoidable hospitalization rates were standardized by age and sex to adjust for patients' characteristics over time, and significant changes in the rates were identified by joinpoint regression. Results: The average annual percent change in age-/sex-standardized case-fatality rates for acute myocardial infarction was -2.3% (95% confidence interval, -4.6 to 0.0). For hemorrhagic and ischemic stroke, the age-/sex-standardized case-fatality rates were 21.8% and 5.9%, respectively in 2020; these rates decreased since 2008 (27.1 and 8.7%, respectively). The average annual percent change in age-/sex-standardized avoidable hospitalization rates ranged from -9.4% to -3.0%, with statistically significant changes between 2008 and 2020. In 2020, the avoidable hospitalization rates decreased considerably compared with the 2019 rate because of the coronavirus disease 2019 pandemic. Conclusions: The avoidable hospitalization rates and case-fatality rates decreased overall during the past decade, but they were relatively high compared with other countries. Strengthening primary care is an essential requirement to improve patient health outcomes in the rapidly aging Korean population.

• 산업진흥연구
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• 제9권1호
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• pp.103-111
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• 2024

본 연구는 여성의 사회진출 확대와 맞벌이 부부의 증가로 인한 아동 돌봄 공백의 문제점이 발생하였고, 자녀의 초등학교 입학 이후의 돌봄 절벽 현상이 여성의 경력 단절을 심화하고 저출산의 원인 중 하나로 밝혀지며 돌봄 문제 해결과 일·가정의 양립을 위한 아동 돌봄서비스가 시작되었다. 코로나19 상황에서 아동의 등교 제한과 보호자가 부재한 상황에서 아동의 안전과 복지에 돌봄서비스의 중요성이 대두되었다. 정부는 정책적 노력을 통해 아동 돌봄 공백을 줄이기 위한 복지서비스를 제공했지만, 돌봄서비스 시행에 있어서 부처별·사업별로 대상자 선정과 전달체계의 불안정으로 인한 돌봄 제도의 효과성과 효율성의 문제점이 발생하였다. 따라서 본 연구에서는 방과 후 돌봄서비스의 사각지대를 해소하고 통합 전달체계의 효율적 운영방안을 마련하기 위해 각 부처에서 시행하는 돌봄서비스를 살펴보고, 아동 돌봄서비스 발전을 위한 방향을 모색해 보고자 한다.

• 보건행정학회지
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• 제16권3호
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• pp.19-36
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• 2006

The purpose of this study was to assess adequately equipped with convenience facilities for the disabled in 160 healthcare institutions in Jongno district, Seoul. Healthcare institutions were equipped an average of 3.7 facilities out of 10. General hospitals had an average of 5.0 facilities, which was higher than an average of 3.6 facilities for private clinics (p<0.05). Of 160 healthcare institutions, only 13 (8.1%) offered easy access to the outpatient setting from the entrance for wheelchair users, highlighting difficult wheelchair access within hospitals. To provide easy access to medical service for the disabled, more accessible designs need to be adopted as part of the effort to improve public facilities for the disabled. Also, universal designs could be applied for newly constructed roads, structures and transportation vehicles to maximize accessibility for the disabled. Increased accessibility for the disabled in the community will eventually increase the use of healthcare institutions.

• 대한치과의사협회지
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• 제57권9호
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• pp.514-522
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• 2019

In accordance with Article 33(8) of the Korean Medical Law, it is stated that a medical person cannot open or operate a medical institution by borrowing the name of another medical person. However, the publicity of medical care is threatened by the recent illegal network dental clinics. The purpose of this study is to investigate the actual condition of illegal network dentistry and to analyze the cases and to find out the reason why the prohibition of double opening & operating of medical institution. As a result, the illegal network dental clinics treated less health care insurance treatment such as dental caries and periodontal treatment than general dental hospitals. In contrast, the rate of implementation of illegal network dentistry was high in endodontics treatment and extraction, which could lead to uninsured treatments such as crowns and implants. As a result of Supreme Court precedent analysis, it is concluded that illegal act is not only the opening of a medical institution by borrowing the name of other medical personnel, but also the duplicated operation which has the authority to make decision about management matters of medical institutions. The results of the patient's case survey also showed that excessive dental treatment due to such as dental staff incentive system. In conclusion, the illegal network dental clinics not only threatens the oral health of the public, but also causes leakage of health insurance premiums. In other words, the ban on opening and operating the multiple medical institution should be strictly applied as a strong protection device for protecting the patient in dental case.

• 보건행정학회지
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• 제31권3호
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• pp.335-343
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• 2021

Background: The purpose of this study was to extract the major areas of interest in health insurance research in Korea, and infer policy agendas related to health insurance by analyzing research keywords. Methods: For this study, 2,590 articles were selected from among 7,459 academic papers related to health insurance published between January 1987 and December 2018, which were looked up using the Research Information Sharing Service (RISS). Keyword extraction and keyword network analysis were performed using the KrKwic, KrTitle, and UCINET software. Results: First, the number of studies in the area of health insurance continued to increase in all government terms, and it was not until after the 2000s that the subjects of health insurance researches were diversified. Second, degree centrality showed that 'medical expenditure' and 'medical utilization' were consistently high-ranking keywords regardless of the government in power. Aging and long-term care insurance-related keywords were ranked higher in the Lee Myung-bak government, Park Geun-hye government, and Moon Jae-in government. Third, betweenness centrality showed the same high ranking in key topics such as medical expenditure and medical utilization, while the ranking of key keywords differed depending on the interests and characteristics of each government policy. Conclusion: We confirm that health insurance as a research topic has been the main theme in Korean health care research fields. Research keywords extracted from articles also corresponded to the main health policies promoted during each government period. Efforts to systematically investigate policy megatrends are needed to plan adaptive future policies.

• 품질경영학회지
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• 제39권3호
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• pp.391-399
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• 2011

Our study was carried out to analyze the variation factors of severity-adjusted length of stay(LOS) in coronary artery bypass graft(CABG). The subjects were 932 CABG inpatients of the Korean National Hospital Discharge In-depth Injury Survey from 2004 through 2008. The data were analyzed using $x^2$ test and the severity-adjusted model was developed using data mining technique. The results of the study were as follows: male(71.1%), older than 61 years of age(61.6%), more than 500 beds(92.8%) and admitting via ambulatory care(70.0%) appeared to have higher rate than otherwise. In-hospital mortality of CABG inpatients was 2.8%. In addition, 46.4% of the patients received their care in other residence. The angina pectoris(45.6%) was found to be the highest in principle diagnosis, followed by chronic ischemic heart disease(36.9%) and acute myocardial infarction(12.0%). We developed severity-adjusted LOS model using the variables such as gender, age and comorbidity. Comparison of adjusted values in predicted LOS revealed that there were significant variations in LOS by location of hospital, bed size, and whether patients received the care in their residences. The variations of LOS can be explained as the indirect indicator for quality variation of medical process. It is suggested that the severity-adjusted LOS model developed in this study should be utilized as a useful method for benchmarking in hospital and it is necessary that national standard clinical practice guideline should be developed.

• 보건의료산업학회지
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• 제5권4호
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• pp.177-192
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• 2011

The arguments exist that private health insurance(PHI) policy holders tend to use the health care services more than non-policy holders due to their little out-of-pocket spending, resulting in the adverse effects on the finances of National Health Insurance. This study aims to increase the objective understanding of the issue and to draw a direction of further research, by reviewing the articles, reports and statistics which examined the effects of purchasing PHI policies on health care utilization. Significant differences in healthcare utilization, except for the very partial increase of utilization in outpatient settings, have been not found. The similar trends of the results have existed in a few previous studies which tried to control the endogeneity of medical use and health insurance with latent variables which affect the decision on medical use and health insurance. However, we can not exclude the potential change of healthcare utilization patterns because the portion of the insured of indemnity PHI is becoming rapidly larger in the market. For further research, we should try to obtain the objective information of subjects' past medical history, health status, health related behavior, and income affecting purchase of PHI and utilization of healthcare services. And the efforts of controlling the endogeneity of medical use and health insurance with latent variables which affect the decision on medical use and health insurance, are very considerable.

• Nutrition Research and Practice
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• 제3권3호
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• pp.171-179
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• 2009

Onto the world-fastest ageing of society, the world-lowest fertility rate prompted a development of various policies and programs for a betterment of the population in Korea. Since the vulnerability of young children of low socio-economic class to malnutrition was clearly shown at the in-depth analysis of the 2001 Korea National Health and Nutrition Examination Survey data, an effort to devise supplemental nutrition care program for pregnant/breastfeeding women, infants and preschool children was initiated. The program was designed to offer nutrition education tailored to fit the needs of the participants and special supplementary foods, using USDA WIC program as a benchmark. Based on the dietary intake of those age groups, target nutrients were selected and their major food sources were searched through nutrient content of foods and dietary pattern analysis. As a result, we developed 6 kinds of food packages using combinations of 11 different food items. The amount of each item in a food package was determined to supplement the intake deficit in target nutrients. Nutrition education in $NutriPlus^+$ aims to improve the nutrition knowledge, attitude, and dietary behaviors of the participants, and is provided through group lessons, individual counseling sessions and home visits. Breastfeeding is promoted with top priority in education for the health of both mother and baby. The eligibility guidelines were set for residency, household income, age, pregnancy/breastfeeding and nutritional risk such as anemia, stunting, underweight, and/or inadequate nutrient intake. Income eligibility was defined as household income less than 200 percent of the Korean poverty guidelines. A pilot study to examine the feasibility of program implementation was run in 3 public health centers in 2005 and expanded to 15 and 20 in the following 2 years. The result of 3-year pilot study will be reported separately along with the ultimate nationwide implementation of the $NutriPlus^+$ in 2008.

• 성인간호학회지
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• 제19권4호
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• pp.556-566
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• 2007

Purpose: This study attempted to analyze problems of informed consent in the clinical setting and appraise ethical aspects inherent in such issues in order to boost awareness of informed consent and its implementation among healthcare professionals. Methods: Study methods included identifying ethical meanings of informed consent in the clinical setting based on the principal ethics, and exploring the process of informed consent utilizing communicative ethics and feminine care ethics Results: The ethical basis of informed consent encompasses not only respect for autonomy but also prohibiting malice, practicing beneficience, and establishing justice. These principles, however, are limited in illustrating the ethical aspects of communicative ethics and care ethics that are entailed in informed consent within clinical settings. The ethical meaning of informed consent involves a communicative and caring process between healthcare professionals, patients, and family built on mutual respect. Conclusion: Healthcare professionals must fully understand the ethical meanings of informed consent and in turn respect and protect the clients' right to know and making decisions. Nurses especially, must take on the role of mediator and advocate throughout the process of obtaining informed consent, and practice ethical caring by facilitating communication grounded in mutual understanding among the physician, patient, and family members.