• 보건행정학회지
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• 제32권1호
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• pp.3-13
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• 2022

Health centers provided intensive health care services for local residents according to changes in the times and environment. Public health centers were given various roles such as medical treatment, administration, and service, and the demand for functional reorganization has emerged. We analyzed the literature on the functional restructuring of public health care institutions. In addition, the current status of medical services, which is the main function of institutions, will be analyzed through health insurance statistical data, and detailed contents will be analyzed according to regional types and income levels. As a result of the analysis of medical services at institutions, the total number of patients was 2,238,000, and the number of visits was 11,806 times. Total medical expenses were 169.6 billion won, of which 132 billion won was found to be benefit. When analyzing the number of patients per institution, public health centers had the largest number of 4,326, and the share of benefit was also the highest at public health centers. It should focus on the function of providing local health and medical services related to health promotion and disease prevention in the community. This functional reorganization of public health centers can contribute to forming cooperative relationships with private medical institutions in the local community. For this, first, to establish the role, essential functions for public health centers for preventive health management are established. Secondly, regular manpower expansion and flexible manpower management are required in the human resources sector. Finally, in the organizational sector, it is necessary to establish a step-by-step organizational system according to environmental changes.

• Industrial Engineering and Management Systems
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• 제7권2호
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• pp.171-181
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• 2008

Home care, known also as domiciliary care, is part of the community care service that is a responsibility of the local government authorities in the UK as well as many other countries around the world. The aim is to provide the care and support needed to assist people, particularly older people, people with physical or learning disabilities and people who need assistance due to illness to live as independently as possible in their own homes. It is performed primarily by care workers visiting clients' homes where they provide help with daily activities. This paper is concerned with the dispatching of care workers to clients in an efficient manner. The optimized routine for each care worker determines a schedule to achieve the minimum total cost (in terms of distance traveled) without violating the capacity and time window constraints. A collaborative population-based meta-heuristic called Particle Swarm Optimization (PSO) is applied to solve the problem. A particle is defined as a multi-dimensional point in space which represents the corresponding schedule for care workers and their clients. Each dimension of a particle represents a care activity and the corresponding, allocated care worker. The continuous position value of each dimension determines the care worker to be assigned and also the assignment priority. A heuristic assignment scheme is specially designed to transform the continuous position value to the discrete job schedule. This job schedule represents the potential feasible solution to the problem. The Earliest Start Time Priority with Minimum Distance Assignment (ESTPMDA) technique is developed for generating an initial solution which guides the search direction of the particle. Local improvement procedures (LIP), insertion and swap, are embedded in the PSO algorithm in order to further improve the quality of the solution. The proposed methodology is implemented, tested, and compared with existing solutions for some 'real' problem instances.

• 농촌의학ㆍ지역보건
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• 제19권2호
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• pp.97-106
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• 1994

In order to estimate the utilization pattern of a rural health subcenter, and to identify the recognition for it among the inhabitants in Kogsung district, a questionnaire survey was carried out for objects of 708 population. The results observed were as follows; 1. The annual utilization rate of a rural health subcenter for a basic health service unit was 27.5 per 100 persons, and annual mean visiting times was 1.43 times. 2. The most frequent disease by, annual health subcenter utilization illness was respiratory disease(26.5%), and the next was musculoskeletal disease(23.9%), gastrointestinal disease(15.9%) by order. 3. Favorite reasons for community health subcenter utilization were lower medical cost(23.4%), near distance from living place(20.7%) and lower disease severity(19.5%) by order. But disfavorite reasons for it were non effective treatment(26.2%), insufficient equipment(25.4%) and absence of specialist(17.4%) by order. 4. Insufficient items about community health subcenter utilization were restriction of treatment limit(47.1%), lower reliance(22.4%) and not punctral(21.8%) by order. 5. The results of logistic regression analysis suggested that statistically significant factors in health subcenter utilization were age, educational level and the nearest medical facility class. 6. There was no difference between recognition for a community health subcenter's work and actual utilizing service, and desirable works for it were disease preventing service, disease control of elderly and sanitation control by order. These results suggested that to increase the utilization of rural health subcenter and to promote the accessibility of rural residents to primary health care, there must be considered public relation about health subcenter, expansion of health equipment and recognition about access time.

• 중소기업융합학회논문지
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• 제5권4호
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• pp.17-23
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• 2015

정보통신 기술의 발전으로 인하여 헬스케어 서비스가 대중화되면서 환자의 바이오인포매틱스 저보를 활용한 다양한 서비스가 환자에게 제공되고 있다. 특히, 바이오인포매틱스 정보를 활용한 헬스케어 서비스는 다양한 의료서비스 트랜드로 변화하고 있다. 그러나, 환자의 바이오인포매틱스 정보를 이용한 헬스케어서비스는 질병의 복잡성과 새로운 질병(SARS, AIDS 등)의 등장으로 인하여 의료비용이 증가하고 있고 환자에게 건강 증진 서비스가 원활하게 제공되지 못하고 있다. 본 논문에서는 저비용의 의료 서비스와 빠른 환자의 바이오인포매틱스 정보 접근을 위한 의료 서비스 모델을 제안한다. 제안 모델은 환자의 바이오인포매틱스 정보를 빅 데이터화하여 환자가 언제/어디서나 자신의 질병 관리를 위해 가까운 병원이나 자택에서 의료서비스를 제공받을 수 있도록 한다. 특히, 제안 모델의 의료서비스는 환자의 질병 정보를 손쉽게 분석하여 의료기관에게 전달함으로써 의료기관의 업무 부담을 줄이고 업무 효율성을 향상시키는 특징이 있다.

• 대한가정학회지
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• 제41권6호
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• pp.143-156
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• 2003

The present study was initially designed to figure out the general condition of care giving system for the elderly women who need long term care and the level of their depression according to the conditions of care. And This research is intented to present appropriate policy that could help the establishment of supporting system for the fragile elderly women.1 used the data from <2001 National Study on the Needs for the Long-Term Care Elderly> by Korea Health and Population Institute. The results are as follows: First, Two third of all the respondents had serious problems (2-9 activities limits) in Instrumental Daily Living Ability(DAL). Most respondents reported “low” in satisfaction level related to receiving care, meaning the elderly had negative perception for the care from the family. The elderly expected their children to be as the primary care giver and mostly wanted to live with them in the future. Second, The majority of the long term care elderly women haven't used community service facilities very often and said they are not likely going to use the facilities in the future. Third, The respondents reported high in depression level as to lower satisfaction with their children's support, poorer health condition, more reluctant to use service facilities due to the cost, and fewer friends and neighbors resources around them. Therefore I could say that negative factors for the elderly women's psychological health were having unsatisfactory relationship with intimate people, developing physical illness, being in economic difficulties. That is, receiving less help from close family members, shrinking social network, and experiencing economic hardship would have negative effects on elderly women's psychological health. In the basis of these results, I suggest that in the mean time we shouldn't overlook the importance of the private support when we develop the public elderly support system.

• Asian Pacific Journal of Cancer Prevention
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• 제13권4호
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• pp.1525-1531
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• 2012

Cigarette smoking is one of the most important public health concerns in Korea and worldwide. A number of studies have been conducted to measure the health and economic burden of smoking, but these did not reflect recent changes such as the decrease in smoking rate and the increase in the incidence of cancer. The purpose of this study was to provide up-to-date estimates of the health and economic burden of cancer caused by smoking and to compare the results with those of previous studies. Cancer-related burden was assessed with nationally representative data such as claims data from the National Health Insurance Corporation, and cause of death records from the National Statistical Office and the Korea Health Panel. We determined the smoking-attributable burden by multiplying the smoking-attributable fraction by the total burden. As a result, the burden of major cancers due to smoking was found to be substantial despite a recent sharp decrease in smoking by the Korean population. The total economic cost reaches $2,234.0 million in males and $870.0 million in females. Also, the health burden of cancers due to smoking is 2,038.9 disability adjusted life years (DALYs) per 100,000 individuals in men and 732.2 DALYs per 100,000 individuals in women. Among all cancers, cancers of the trachea, lungs and bronchus are the leading causes of health and economic burden. The huge burden caused by cancers linked to smoking makes it imperative that adequate policies to decrease the prevalence of smoking be developed, particularly considering the recent increase in smoking rate among women.

• 대한간호
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• 제33권2호
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• pp.45-58
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• 1994

This study was conducted for the purpose of identifying the trends of nursing research and to suggest the direction of future research in the graduate levels of the study. The data was collected from 469 abstracts of master's and doctoral rapers from three graduate schools, one in Nursing, another in Education, and the other in Public Health Graduate College. The results of the study are as follows: The number of research was increased from 102 to 286 between the 1970 s and 1980's. The most frequently employed research design was descriptive studies in the master's level, but there was some balance between descriptive and experimental studies along with some qualitative approaches in the doctoral thesis. Patients were the most often studied sample group reaching 42% of the cases, though it Was noted that there was steady shift: toward the non-ratient population. With this shifting of the study sample, the places of the study also have showed some changes moving toward community. The most widely studied area was in clinical practice. Chronic illness, preventive, and health promoting areas of studies also increased in numbers. However, most of them were at the descriptive level of phenomena and only a few were concerned with cost/effective measures of nursing intervention. The number of variables studied repeatedly more than five times was 43. They were not only physical but also psychosocial aspects which imply the efforts to incorporate the whole person in nursing discipline. However, most researches with repeated studies showed little relation to previous studies, and thus little accumulation in knowledge. There was also little evidence of linkage to nursing theory in most studies of master's level. For the doctoral rapers, 17 out of 51 rapers showed specific theories related to the researches. Based on the above findings, the following suggestions were made. Various research design should be employed including case studies, historical studies, as well as qualitative approaches. There should be more effort to establish linkage between theory and research. The areas needing more attention are Korean Nursing History, Ethics in our Culture, Cost/Effective Measures of Nursing Intervention, Concept and Thory Development, and the Strategies for the Implication of the Research Results in clinical practice.

• 한국임상약학회지
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• 제15권2호
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• pp.75-81
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• 2005

Community acquired pneumonia (CAP) remains a prevalent and potentially life threatening illness. American Thoracic Society and Infectious Disease Society America recommend combination therapies with ${\beta}-lactam$ plus a macrolide or a fluoroquinolone monotherapy for the empirical treatment of CAP. The aim of this study was to compare moxifloxacin monotherapy with cephalosporin plus azithromycin combination therapies. From January 2004 to March 2005, 18 patients in the moxifloxacin group(MG) and 21 patients in the cefuroxime or ceftriaxone plus azithromycin group(CAG) with CAP were retrospectively reviewed with regard to clinical, laboratory and microbiological data. Each patient was stratified into mild (risk class I-II), moderate (risk class III) and severe (risk class VI, V) group according to and PSI (Pneumonia Severity Index) score. Each group was compared for microbiological eradication, clinical assessment, the length of hospital stay. As results, Total 39 patients with CAP were reviewed. The appropriateness of admission was 83.3% in MC vs. 76.2% in CAC. The mean length of the hospital day was for 8.31 days vs. 7.39 days, days switching parenteral to oral antibiotics in 5.19 days vs. 5.28 days, clinical improvement in 2.43 days vs. 2.61 days in MG vs. CAC. Radiological improvement required 3.75 days vs 3.63 days in MG vs. CAG and bacteriological eradication rate at discharge was the same in the both groups. Mortality rate was 11.1% (2 of 18) vs 14.3% (3 of 21) in MG vs. CAG (p=0.77). Drug cost of the mean 5 hospital days requiring parenteral antibiotics was the most inexpensive in moxifloxacin group for the 147,045 won, and ceftriaxone 1g-azithromycin group for the 170,285 won, cefuroxime bid-azithromycin group for the 207,800 won, ceftriaxone 2g-azithromycin group far the 220,570 won, cefuroxime tid-azithromycin group for the 251,700 won. There was no significant statistical difference in clinical, bacterial, radiological cure and hospital days, and switch to oral days. In conclusion, that i.v. moxifloxacin monotherapy was as effective as azithromycin plus cefuroxime or ceftriaxone combination therapies fur the treatment of CAP. In drug cost analysis, moxifloxacin is less expensive than CAG.

• 의료법학
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• 제15권1호
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• pp.335-373
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• 2014

한 자료에 의하면 2011년 미국의 의료비 지출 총액은 국내총생산의 약 18 퍼센트에 달하였으며, 그 비율은 다른 대다수 선진국의 두 배에 해당하는 것이었다. 그중 메디케어 비용은 전체 의료비의 21 퍼센트인 5540억 달러 였는데, 환자의 최후 6 개월에 들어간 의료비는 그 5540억 달러의 28 퍼센트 (전체 의료비의 5.9 퍼센트)인 1700억 달러에 달하였다. 이러한 말기의료의 고비용성은 어떤 사유에 기인하며, 그 해소 방안은 무엇인가. 지난 수십 년 간의 의료경제학적 연구는 말기의료가 일반적으로 공급민감성을 지니며 비용대비 효율성이 매우 낮다는 결론에 도달하였다. 의료서비스 공급의 양은 질병의 정도나 환자의 선호도와는 무관하고, 그보다는 의료서비스 공급자원에 민감하게 반응한다는 것이다. 이는 말기의료에서는 의료자원이 과용된다는 것을 의미한다. 한편 "더 많은 의료처치에 더 나은 효용"이라는 일반적인 추론과는 반대로, 많은 의료처치의 결과는 오히려 매우 부정적인 것이었다. 실제 환자들의 선호와 관심사는 격렬한 말기의료가 기도하는 것과는 아주 달랐던 것이다. 이 논문은 먼저 말기의료에서의 공급민감성의 원인을 분석한다. 그 원인으로는 격렬한 치료와 그 효용성에 대한 일반적인 오해, 의사들의 환자에 대한 직업적인 사명의식, 환자 자신의 말기의료 의향결정의 부재, 의사들의 법적 책임에 대한 우려, 의료기관의 경영차원에서의 관리전략 등을 들 수 있다. 다음으로, 논문에서는 말기의료의 공급민감성에서 연유하는 과잉진료에 대한 현실적 해결책을 제시한다. 그 해결책은 두 가지 측면으로 나누어서 들 수 있는데, 하나는 사전의료의향서 제도의 활성화 방안이고, 다른 하나는 의료기관 경영관리전략적 관점에서의 방안이다. 우선 사전의료의향서의 활용도를 제고하기 위해서 다음과 같은 구체적 노력이 필요하다. 즉 의사들의 말기의료에 대한 태도를 바꾸도록 하는 새로운 의료윤리 교육 실시, 의사와 환자 간 말기의료에 대한 소통 기회의 강화, 환자와 말기의료에 대한 대화를 적극적으로 실천하는 의사에 대한 보상제도 도입, 일반 공공에 대한 관련 교육 확대, 온라인 등록시스템과 같은 용이하고도 공식적인 사전의료의향서 등록체제의 구축 확대 등이 필요하다. 경영관리적 측면에서는 대체 전략이 필요하다. 예컨대 불필요한 비용을 절감하고 의료공급자로서의 가치를 재정립하는 등의 새로운 재무전략과 경영교육계획 등이 고려되어야 할 것이다. 효과적으로 말기의료의 경제적 문제점을 해소하고 환자에게 더 나은 의료경험을 제공하기 위해서는 의료 환자 국가 등 모든 부문에서 관행과 오해에서 비롯된 신조가 시급히 수정되어야 하고, 그 기초 위에서 제도와 문화가 개선되어야 하는 것이다.

• 농촌의학ㆍ지역보건
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• 제28권2호
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• pp.107-122
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• 2003

만성질환자들의 보완요법 이용률과 이용양상을 알아보기 위하여 보건소에 등록된 고혈압, 당뇨병, 만성관절염 환자를 대상으로 하여 2001년 1월 3일부터 1개월간 각 질환별로 200명씩 총 600명에게 지난 12개월간의 보완요법이용실태에대하여직접면담조사를실시하였다. 지난 1년 동안 전체 대상자의 47.5%가 보완요법을 이용하였는데, 고혈압 환자는 35.0%, 당뇨병 환자는 44.6%, 관절염 환자는 62.9%가 보완요법을 이용하여 관절염 환자의 이용률이 가장 높았다. 보완요법 이용률은 대상자의 일반적 특성에 따라서 거의 유의한 차이를 보이지 않았다. 보완요법 이용자 중 고혈압 환자는 약초요법(31.0%)과 침요법(29.6%)을 많이 이용하였고, 당뇨병 환자는 식이요법(57.5%)과 약초요법(35.1%)을 그리고, 관절염 환자는 침요법(85.0%)과 약초요법(34.7%)을 많이 이용하였다. 보완요법 이용자중 2종류 이상을 이용한 사람은 36.8%였고, 고혈압 환자가 18.3%, 당뇨병 환자가 24.1%, 관절염 환자가 55.9%로서 관절염 환자가 여러종류의 보완요법을 이용하였다. 가장 많이 이용한 보완요법을 종류별로 보면 침술이 47.0%로 가장 높은 빈도를 보였고, 그 다음이 한약(26.3%), 건강보조기구(21.8%), 민간요법(21.4%), 물리치료(9.5%), 건강보조식품(8.4%), 약초(7.7%), 수지침(3.2%), 단전호흡(1.1%), 기공치료(0.7%)의 순이었다. 보완요법을 이용한 장소로는 한의원이 42.8%로 가장 많았고, 이용한 이유로서는 치료를 위해서가 61.8%, 증상완화가 26.0%로 대부분의 환자들이 치료와 증상완화를 위해서 이용하였으며, 지난 1년간 보완요법 이용에 지출한 비용은 9만원 이하가 40.3%로 가장 많았고, 50만원 이상도 31.2%이었다. 보완요법 이용 후 56.1%가 만족하다고 대답했고, 6.0%는 부작용을 경험했다고 하였다. 보완요법을 이용한 사람들의 74.0%가 계속 이용하겠다고 하였으며, 56.1%는 다른 사람에게 권유할 의향이 있다고 하였다. 정통의료와 비교한 보완요법의 이점으로는 33.5%가 심리적으로 안정감을 준다, 21.2%는 몸을 보호해 준다, 19.2%가 효과가 좋다라고 하였다. 또한 조사대상자 가운데 보완요법에 대한 교육을 희망하는 사람은 34.0%였다. 이상의 연구결과에서 볼 때 만성질환자들의 상당수(47.5%)가 지난 1년간 자신들의 건강문제를 해결하기 위하여 다양한 종류의 보완요법을 이용하였고, 비록 부작용 경험률이 6.0%정도 되지만 보완요법에 대한 만족도가 비교적 높고, 계속적으로 이용할 의사가 높기 때문에 보건기관이나 의료인들의 적극적인 관심이 요구되며, 부작용이 없고 건강증진에 도움이 되는 다양한 보완요법 프로그램 개발에 노력을 기울려야 할 것으로 생각된다. 그리고 보안요법의 효능를 확인하는 노력이 계속되어야 하고, 적절한 가격을 유지할 수 있는 제도적 장치도 필요하다고 생각된다.