• 사회복지연구
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• 제41권2호
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• pp.35-65
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• 2010

본 연구는 최근에 이루어진 '건강보험 보장성 확대' 정책의 효과를 개인의 의료이용 및 건강수준을 중심으로 평가하였다. 2005년부터 시행된 건강보험 보장성 확대 정책은 암 등의 중증질환자에 대한 본인부담 경감, 입원환자 식대의 급여전환, 비급여항목의 급여전환, 본인부담상한제 시행 등을 주요 내용으로 한다. 이러한 정책 변화에 대해 만성질환을 보유하고 있어 의료욕구가 일반적으로 높은 제도의 주요 수혜집단에 비해 급성질환 등으로 의료서비스를 이용한 집단의 입원이용이 상대적으로 증가한 것과 제도의 직접적인 수혜집단인 중증질환자 집단의 입원이용이 상당 정도 증가한 것을 확인하였다. 또한 이러한 건강보험제도의 변화가 입원이용에서 혜택을 누린 중증질환자의 단기간의 건강평가지표인 2주간 이환경험 면에서 긍정적인 개선을 이끌어내고 있음을 확인하였다. 본 연구는 건강보험제도가 의료이용 및 건강수준에 인과적인 효과를 나타내고 있음을 확인하였고, 이후 건강보험 보장성 확대의 정책설계에 대한 정책적 함의를 제공한다.

• 보건행정학회지
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• 제24권3호
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• pp.205-218
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• 2014

Background: Most studies on the national health insurance benefit expansion policy have focused on policy tools or decision-making process. Hence there was not enough understanding on how policies are actually implemented within the specific policy context in Korea which has a national mandatory health insurance system with a dominant proportion of private providers. The main objectives of this study is to understand the implementation process of the benefit coverage expansion policy. Unlike other implementation studies, we tried to examine both the process of implementation and decision making and how they interact with each other. Methods: Interviews were conducted with the ex-members of the Health Insurance Policy Review Committee. Medical doctors who implement the policy at the 'street-level' were also interviewed. To figure out major variables and the degree of their influences, the data were analyzed with Winter's Policy Implementation Model which integrates the decision making and implementation phases. Results: As predicted by the Winter model, problems in the decision making phase, such as conflicts among the members of committee, lack of applicable causal theories application of highly symbolic activities, and limited attention of citizen to the issue are key variables that cause the 'implementation failure.' In the implementation phase, hospitals' own financial interests and practitioners' dependence on the hospitals' guidance were barriers to meeting the policy goals of providing a better coverage for patients. Patients, the target group, tend to prefer physicians who prescribe more treatment and medicine. To note, 'fixers' who can link and fill the gap between the decision-makers and implementers were not present. Conclusion: For achieving the policy goal of providing a better and more coverage to patients, the critical roles of medical providers as street-level implementers should be noted. Also decision making process of benefit package expansion policy should incorporate its influence on the implementation phase.

• 보건행정학회지
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• 제30권3호
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• pp.326-334
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• 2020

Background: Korea has gradually expanded the coverage of medical care services in its national health insurance system. On April 1, 2018, it implemented a policy that expanded the coverage for an ultrasonography in the upper abdomen. In this study, we aimed to investigate the effect of the policy on the utilization of the ultrasonography in the upper abdomen in tertiary care hospitals. Methods: Using the dataset of the Health Insurance Review and Assessment Service, we explored changes in the utilization of the ultrasonography in the upper abdomen in tertiary care hospitals from July 1, 2017 to November 30, 2018 through the difference-in-difference (DID) mixed-effects-model method. Facility factor, equipment factor and personnel factors, type of hospital, the total amount of medical care expenses, and geographic region were considered as control variables. Results: On average, the utilization of the ultrasonography in the upper abdomen increased by 228% after the coverage expansion policy. However, the results of DID mixed-effects-model method analysis showed that the utilization increased by 73%. As for the number of beds, the utilization was higher with a group of 844-930, 931-1,217, and 1,218 or greater compared with a group of 843 or fewer, while the utilization of the number of ultrasonic devices was lower with a group of 45-49 compared with a group of 44 or fewer. The utilization decreased with the number of interns and the number of nurse assistants. Besides, relative to Seoul, the utilization was lower in the other metro-cities and provinces. Conclusion: The coverage expansion policy in the national health insurance system increased service utilization among people. Future research needs to investigate the degree to which such coverage expansion policy reduces the unmet medical care needs among the deprived in Korea.

• 보건행정학회지
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• 제33권3호
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• pp.325-337
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• 2023

Background: While there are many studies estimating the effects of private health insurance on various types of health care utilization, few have examined how such effects change in conjunction with important policy reforms in national health insurance (NHI). This study examined how the effect of private health insurance (supplemental and fixed cash benefit) on high-cost outpatient imaging test utilization changed following the expansion of magnetic resonance imaging (MRI) coverage in 2018, which is a key example of the NHI benefit expansion policy in recent years. Methods: Data from the 2017 and 2019 Korea Health Panel Survey, which contained information about healthcare utilization before and after the expansion of MRI coverage in 2018, were used. The incremental effect of private health insurance on high-cost outpatient imaging test utilization for each period were quantified and compared, with special attention given to the type of private health insurance. Results: While people with supplemental private health insurance were more likely to use high-cost outpatient imaging tests than those without, both before and after the expansion of MRI coverage, the incremental effect increased from 1.6% points in 2017 to 2.5% points in 2019. Conclusion: Benefit expansion in NHI does not necessarily reduce disparities in the use of health care between private health insurance subscribers and non-subscribers. The results of our study also suggest that the path through which private health insurance affects healthcare utilization may not be limited to the price mechanism alone but can be more complex.

• 한국정보통신학회논문지
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• 제22권1호
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• pp.183-189
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• 2018

본 논문은 제한된 백홀 용량으로 발생하는 소형셀 네트워크에서의 트래픽 병목현상을 완화하기 위한 분산 파일저장 기술과 커버리지 확장 기술을 제안하였다. 제안 기법은 한정된 메모리 용량으로 백홀 망의 부하를 최소화하기 위해 파일의 인기도와 기지국의 메모리 용량에 따라 기지국의 커버리지와 파일 저장방법을 결정한다. 즉, 메모리 공간이 작거나 이용자들로부터 요청되는 파일이 다양할 경우 개별 기지국에 저장된 파일로 이용자를 서비스할 수 있는 확률이 낮아지므로 커버리지를 확장하고 기지국 사이 저장 파일의 중복을 줄여 커버리지 중첩지역에 있는 이용자가 다수의 기지국에 저장된 다양한 파일로 서비스 받을 수 있게 한다. 시뮬레이션을 통한 기존 배타적인 커버리지를 갖는 소형셀 네트워크에서의 파일저장 기법과의 전송용량 비교를 통해 제안 기법이 메모리 공간이 작거나 이용자들로 부터 요청되는 파일이 다양한 상황에서 높은 성능 이득을 가짐을 보였다.

• 대한영상의학회지
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• 제81권5호
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• pp.1069-1082
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• 2020

복부 영상 영역에서는 새로운 건강보험 보장성 강화 대책으로 인하여 2018년 4월 1일 상복부 초음파, 2019년 2월 1일 하복부 초음파와 2019년 11월 1일 복부 MRI가 순서대로 급여 확대되었다. 많은 환자들이 건강보험 급여 혜택을 보게 되었으며 간경화, 담낭용종, 간선종, 이형성 결절, 췌장 낭종과 자가면역성 췌장염, 담석 등이 건강보험에 포함되었다. 그러나 급여화로 인해 각 검사의 적응증, 추적검사 가능 질환과 적용 횟수 등이 보다 복잡해졌으며 획득하여야 할 표준영상과 판독소견서의 양식이 지정되었으며, 따라서 외래나 병실에서 검사를 처방하고 검사실에서 검사를 시행할 때 주의해야 할 필요가 있다.

• 한국진공학회지
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• 제14권2호
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• pp.59-68
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• 2005

부피가 다른 세 개의 진공용기를 조합하여 정적법 (static expansion method)을 이용한 중진공영역의 국가표준기를 개발하였다. 이 장치를 이용하여 133pa 범위의 용량형 진공게이지 (capacitance diaphragm gauge)를 교정하여 국제표준화기구의 측정불확도 표현지침에 따라 분석하였다. 그 결과 표준압력 0.553Pa에서의 확장불확도 (expanded uncertainty)가 95% 신뢰수준 (confidence level), 포함인자 (coverage factor) k=2에서 $2.628\times10^{-3}Pa$로 우수한 성능을 보였다.

• 한국치위생학회지
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• 제20권5호
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• pp.611-621
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• 2020

Objectives: This study aimed to verify the impact of dental health care insurance coverage policy by analyzing the changes in dental care utilization and expenditures over 5 years from 2012 to 2016, when the dental health insurance coverage expansion policy was implemented. From the national cohort data collected by the Korea Health Panel Survey, a retrospective study was conducted for all household members using dental services. Methods: This study statistically verified the difference in the dependent variables by frequency analysis, chi-square test, t-test, and one-way analysis of variance (SPSS version 22, IBM Co. USA, p<0.05). Results: The annual utilization rate steadily increased from 23.4% to 26.1% between 2012 and 2016. Although there were differences in utilization rates by gender, age, and income level, patients kept using the dental services in 2016 regardless of the type of health insurance. The average annual copayment for patient expenditures (out-of-pocket amount) increased from ￦463,844 to ￦537,401 in 2012 and 2016, respectively. Of the dental care expenditures over 5 years, the ratio of uninsured expenses by the elderly decreased from 38.5% to 25.9%, and the national health insurance service coverage increased from 40.3% to 49.1%. Conclusions: Although this policy did not reduce overall patient expenditures, it has been found that there was a positive effect on the elderly and low-income groups; it increased the utilization and access to dental services.

• 생태와환경
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• 제42권4호
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• pp.502-509
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• 2009

In this study a total of 27 stream sites, at 1 km intervals, were monitored for simple physicochemical water characteristics, land coverage patterns, and stream environment characteristics using the Habitat-riparian Indexing System (HIS), in the Yangsan Stream. The HIS has been tested in previous research, resulting in some identification of advantages in the application to the stream ecosystems data. Even though reliable stream environment characterization was possible using HIS, there was no information about the application of this tool to present continuity of environmental changes in stream systems. Also the necessity was raised to compare the results of HIS application with land coverage information in order to provide useful information in management strategy development. The monitoring results of this study showed that changes of environmental degradation were well represented by HIS. Especially, stream environment degradation due to construction was relatively well reflected in the HIS monitoring results, and the main causality of Yangsan Stream degradation was expansion of the urbanized area. In addition, there were significant relationships between the HIS scores and land coverage information. Therefore, it is necessary to prepare appropriate options in controlling or managing the expansion of the industrialized areas in this stream basin in order to improve the stream environment. For this purpose, ensemble utilization of HIS results, water quality, and geographical information, resulting in integration with remote sensing processes can be possible.

• 한국정보통신학회논문지
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• 제22권1호
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• pp.140-146
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• 2018

최근 실내조명으로 사용하는 LED(Light Emitting Diode)와 무선통신 기술을 융합한 가시광통신이 주목받고 있다. 하지만 가시광 통신은 광 신호를 측정할 수 있는 커버리지 내에서만 통신이 가능하고, 비가시선 영역에서 통신이 단절되는 현상이 발생한다. 본 논문에서는 가시광 통신의 커버리지 확장과 비가시선 영역에서 통신 단절 현상 개선을 위해 VLC(Visible Light Communication) 릴레이 모듈을 제안한다. 제안하는 VLC 릴레이 모듈은 송신기로부터 전달받은 패킷을 VLC 릴레이 모듈 및 수신기로 전송한다. 1개의 VLC 송신기와 3개의 VLC 릴레이 모듈을 설치하여 실험을 진행하였으며, VLC 릴레이 모듈의 증가에 따른 통신 커버리지 확장과 비가시선 영역에서 통신 단절 현상 개선을 확인하였다. 또한, 이중 샘플링 기법을 사용하여 광 신호 측정 성능이 2.4배 향상됨을 확인하였다.