• Journal of Preventive Medicine and Public Health
• /
• 제55권1호
• /
• pp.49-59
• /
• 2022

Objectives: Access to maternal and neonatal care services (MNCS) is an important goal of health policy in developing countries. In this study, we proposed a 3-level hierarchical location-allocation model to maximize the coverage of MNCS providers in Iran. Methods: First, the necessary criteria for designing an MNCS network were explored. Birth data, including gestational age and birth weight, were collected from the data bank of the Iranian Maternal and Neonatal Network national registry based on 3 service levels (I, II, and III). Vehicular travel times between the points of demand and MNCS providers were considered. Alternative MNCS were mapped in some cities to reduce access difficulties. Results: It was found that 130, 121, and 86 MNCS providers were needed to respond to level I, II, and III demands, respectively, in 373 cities. Service level III was not available in 39 cities within the determined travel time, which led to an increased average travel time of 173 minutes to the nearest MNCS provider. Conclusions: This study revealed inequalities in the distribution of MNCS providers. Management of the distribution of MNCS providers can be used to enhance spatial access to health services and reduce the risk of neonatal mortality and morbidity. This method may provide a sustainable healthcare solution at the policy and decision-making level for regional, or even universal, healthcare networks.

• 간호행정학회지
• /
• 제17권2호
• /
• pp.180-188
• /
• 2011

Purpose: This study was done to evaluate the operating status of community-based home health center for revitalization of the centers. Method: In this study performance data including organization plan and service utilization plan were evaluated according process theory. Target of evaluation was the community-based home health care center. Results: The vulnerable part of the organization was the information system and financial resources. The home health center introduced PDA (Personal Digital Assistants) in 2005, however home health care nurses did not make full use of it. This service received full support from Seoul city and local government and there were no other sources of income. The vulnerable part of service utilization was service expansion and standardization due to vulnerability of organizational aspects. Conclusions: The home health care center provides high quality services to underprivileged people. In the future, these services should be provided with equity for continuous health care for this population.

• 치위생과학회지
• /
• 제14권2호
• /
• pp.207-213
• /
• 2014

본 연구는 국민건강영양조사 5기(2010~2012년) 원시자료를 이용하여 사회경제적 수준에 따른 주관적 구강건강 상태의 차이와 관련성을 분석하기 위하여 실시되었다. 주관적 구강건강 수준을 '좋다'와 '나쁘다'로 분류하여 사회경제적 수준이 건강불평등에 미치는 요인을 분해하여 다음과 같은 결과를 얻었다. 주관적 구강건강 상태는 남자에 비해 여자가 구강건강을 좋지 않다고 인식하는 것으로 나타났으며, 연령 증가 시 본인의 구강건강을 나쁘게 인식하는 것으로 분석되었다. 또한 교육수준이 낮을수록, 가구소득이 낮을수록 주관적 구강건강상태를 나쁘다고 자가 평가하는 경향을 보였다. 로지스틱회귀분석을 활용하여 주관적 구강건강 상태에 대한 영향 요인을 분석한 결과 사회계층에 따른 건강상의 차이는 남자에 비해서 여자에서 자신의 구강건강수준을 더 건강하게 인지할 확률이 높아지고 있으며 교육수준이 높을수록 건강하게 인지할 가능성이 높았다. 소득수준에 따른 주관적 건강수준에 대한 인식의 격차는 소득증가에 따라 더 심화되는 것으로 나타났다. 이상의 연구결과를 살펴보면 구강건강에 사회계층별 불평등은 존재하는 것으로 나타났다. 전체 국민의 구강건강을 증진하는 사업은 물론 사회 양극화에 따른 사회계층별 구강건강의 격차를 해소하기 위해 상대적으로 격차가 큰 취약계층에 적절한 정책적 지원이 고려되어야 할 것으로 사료된다.

• 한국콘텐츠학회논문지
• /
• 제17권11호
• /
• pp.435-445
• /
• 2017

본 연구는 단순 의료이용의 차이를 확인하거나 제한적인 의료필요와 의료이용지표를 활용하여 의료이용의 형평성을 연구한 선행연구의 한계를 극복하기 위하여 수행되었다. 구체적으로 의료필요지표로 활동제한여부, 만성질환이환여부와 수, 주관적 건강상태를 활용하였고 의료이용지표로 외래와 입원, 응급이용횟수와 진료비를 활용하였다. 아울러 의료필요를 고려한 의료이용의 형평성을 분석하기 위하여 집중지수와 집중곡선, Le Grand계수를 활용하였다. 주요 분석결과, 첫째 단순한 의료이용 집중정도로 볼 때 저소득층의 의료이용량이 고소득층에 비해서 많은 것이다. 특히, 저소득층 입원이용이 외래나 응급이용에 비해서 크게 많았다. 둘째, 저소득층에게 의료필요가 집중된 것으로 나타났다. 즉, 저소득층의 건강상태가 좋지 않은 것이다. 셋째, 의료필요를 고려한 의료이용의 형평성을 확인하기 위하여 Le Grand계수를 산출하였다. 의료필요를 고려하더라도 고소득층의 의료이용량이 많았다. 즉, 단순한 양적인 의료이용은 저소득층의 이용이 많았지만, 의료필요를 고려한 의료이용횟수는 고소득층이 많은 것이다. 또한, 전체진료비는 활동제한여부와 만성질환수를 고려했을 때는 고소득층의 의료이용이 많았으며 주관적 건강상태와 만성질환이환여부를 고려하였을 때는 저소득층의 의료이용이 많았다. 따라서 대체로 저소득층이 건강상태에 비해 의료이용을 충분히 하지 못하는 것을 알 수 있었다. 한편, 저소득층의 주관적 건강상태와 만성질환이환여부 관련 의료필요에 비해 의료비지출이 많았는데 이는 저소득층이 스스로의 건강상태와 만성질환이환에 대한 인식을 소극적으로 함으로써 의료필요가 과소평가된 것이 원인으로 사료된다.

• 농촌의학ㆍ지역보건
• /
• 제36권2호
• /
• pp.130-142
• /
• 2011

저자들은 건강증진 사업에서 지역사회 역량강화를 위한 참여 학습을 적용하고 과정을 평가하였다. 먼저 참여 학습의 적용 가능성(feasibility)을 시험하기 위한 파일럿 프로그램을 수행하였다. 지역사회역량강화 시범사업의 건강위원, 지역사회 역량강화 사업을 위한 코디네이터 양성 교육 참가자, 그리고 건강교육진행자에 의한 건강교육 프로그램 참가자를 대상으로 3-4주에 걸친 참여 학습을 진행하고 교육 후 설문조사를 실시하였다. 그 결과 '참여 학습 프로그램이 유익했는지', '재미있었는지', '진행방식이 적절했는지', '진행자의 진행이 적절했는지', '다른 사람에게 참여를 권하겠는지'의 질문에 대하여 80% 이상이 '그렇다' 또는 '매우 그렇다'의 긍정적인 답변을 하였다. 이를 토대로 지역사회 역량강화를 통한 건강증진사업인 경상남도의 건강플러스 행복플러스 사업의 건강위원 역량강화교육에 본격적으로 참여학습 방법을 적용하였다. 첫 단계인 주제의 선정(듣기)은 지역건강토론회로 대신하였다. 두 번째 단계인 문제 제기(대화)에서는 우선순위 선정과 건강문제 해결을 위해 전략과 세부사업을 의논하였다. 그 결과 자신들이 선정한 우선순위 영역에서 지역사회에서 건강생활이 실천되지 않는 이유를 고려하여 향후 건강위원회가 무슨 일을 해야할지 다양한 전략을 잘 도출하였다. 세 번째 단계인 행동-성찰-행동은 현재 진행 중이다. 결론적으로 저자들은 지역사회 역량강화를 통한 건강증진 사업의 여러 대상에 참여 학습을 성공적으로 적용할 수 있었다.

• 보건행정학회지
• /
• 제29권3호
• /
• pp.342-356
• /
• 2019

Background: The objectives of the study are to find out the effect of the implementing reform in three Central Asian countries, identify its impact on health status and health care delivery systems. This study address to identify strong and weak points of the health systems and provide a recommendation for further health care organization. Methods: A comparative analysis was conducted to evaluate the effects of implemented policy on health care system efficiency and equity. Secondary data were collected on selected health indicators using information from the World Health Organization Global Health Expenditure Database, European Health Information Platform, and World Bank Open Data. Results: In terms of population status, countries achieved relatively good results. Infant mortality and under-5 mortality rate decreased in all countries; also, life expectancy increased, and it was more than 70 years. Regulations of the health systems are still highly centralized, and the Ministry of Health is the main organ responsible for national health policy developing and implementation. Among the three countries, only Kyrgyzstan was successful in introducing a national health system. Distribution of health expenditure between public expenditure and out-of-pocket payments was decreased, and out-of-pocket payments were less the 50% of total health expenditure in all countries, in 2014. Conclusion: After independent, all three countries implemented a certain number of the policy reform, mostly it was directed to move away from the old the Soviet system. Subsequent reform should be focused on evidence-based decision making and strengthening of primary health care in terms of new public health concepts.

• 보건행정학회지
• /
• 제28권3호
• /
• pp.226-232
• /
• 2018

The objectives of this study were to evaluate the current state of governance structure and management of the health system to achieve the goals of the health system in South Korea, and to propose reform plan. This study drew implications from the governance of United Kingdom, Germany, and Netherlands, based on the principle of health system proposed by World Health Organization. The presidency and the health ministry should make macroscopic decision-making. The government has to decentralize the enforcement by municipality to operate public health and national health insurance (NHI), and to distribute the centralized NHI fund by municipality. The front line health centers and community centers should provide integrated health and social services. The government has to establish diversified regulatory bodies to enhance both the patient-centered care and the efficiency and equity of health care, and to provide mechanisms for ensuring autonomy of providers. The governance of the health system should be composed of the centralization of macro decision-making, the decentralization of implementation by municipality, the integration of health and social services on the front line, and the well-balanced regulation and autonomy on both consumers and suppliers.

• 보건행정학회지
• /
• 제15권3호
• /
• pp.17-39
• /
• 2005

Social solidarity, equity in financing, and efficiency in administration have been core issues in the development of Korean health insurance reformation since 1988. This study is to investigate the trend of administrative cost in Korean National Health Insurance from various aspects. For the analysis of administrative cost, the expenditures of each insurance society and the National Health Insurance Corporation are divided into 4 items of (1) insurance benefit, (2) administrative cost, (3) an agency provision accounts, (4) other expenses, and then they are reorganized. The analyses based on 5 types of the health insurance administrative cost showed that efficiency in administration has been improved generally. We, however, should consider qualitative aspects such as customer's satisfaction with health insurance administration, prompt service, control of unjust expenditure (unjust claims), and provision of medical service including health consultation in assessing efficiency of administration. And, in order to connect the administrative costs of health insurance with efficiency, we need to give a fundamentally new definition, which can contain elaborateness of expenditure in details including the structure and evaluation method of administrative costs. It may be necessary to develop new indicators or analyzing methods hereafter.

• 한국치위생학회지
• /
• 제24권1호
• /
• pp.17-26
• /
• 2024

Objectives: This study aimed to analyze the relationship between the socioeconomic status and oral health of adults. Methods: Data from the 7th Korea National Health and Nutrition Examination Survey (2016-2018) were analyzed, and 13,199 adults aged 19 years or older were selected as study subjects. Various oral health indicators were used to analyze the effect of socioeconomic status on oral health. Disparities in oral health according to socioeconomic status were analyzed using the complex sample chi-squared test and multiple logistic regression analysis. Results: A statistically significant difference was observed between income level, medical aid, and all oral health indicators, which indicated that the lower the income level, the lower the oral health level (p<0.001). Furthermore, all oral health indicators displayed statistically significant differences, with the exception of the prevalence of dental caries and education level. The lower the education level, the lower the oral health level (p<0.001). Therefore, the oral health level of adults presented significant differences according to different socioeconomic status indicators. Conclusions: To prevent oral health inequalities, the government and local governments need to intervene not only in the field of health care but also in the social determinants. Additionally, concerted efforts should be made to eliminate oral health disparities by improving policies and systems.

• 한국학교보건학회지
• /
• 제36권3호
• /
• pp.71-81
• /
• 2023

Purpose: This study aimed to investigate the trends in domestic research related to health literacy in children and adolescents. Methods: Six journal articles and four dissertations or theses related to health literacy in children and adolescents were analyzed according to the following criteria: study aim, research design, study population and sample size, sampling method, health literacy variables, and characteristics of health literacy measurement instruments. Result: The majority of studies focused on general children and adolescents. Correlational studies were most prevalent, while no experimental study was identified at all. The variable most frequently explored in relation to health literacy was health promoting behaviors. Functional health literacy instruments, assessing numeracy and reading comprehension, were most commonly used to evaluate child and adolescent health literacy. Conclusion: Considering the emphasis on health literacy improvement in order to achieve health equity across the entire life cycle, there is a need for both quantitative and qualitative growth in domestic health literacy studies for children and adolescents. School-based interventions are essential for enhancing health literacy. Furthermore, it is also necessary to develop an instrument to measure health literacy of children and adolescents that can be utilized and monitored at the national level.