• 제목/요약/키워드: health insurance standards

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치면열구전색 급여화에 따른 치면열구전색 수혜 비교 연구: 국민건강영양조사 제5기~7기 자료를 활용하여 (Comparison of study affecting the use of dental sealant in consequence of its inclusion in the National Health Insurance coverage: Using data from the 5th-7th National Health and Nutrition Examination Survey(KNHANES))

  • 김미정;임차영;손주리
    • 한국산학기술학회논문지
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    • 제21권12호
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    • pp.798-806
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    • 2020
  • 치면열구전색법은 건전한 구치부의 교합면의 좁고 깊은 소와나 열구를 전색 하여 교합면에 발생되는 치아우식증을 예방하기 위한 술식이다. 치면열구전색의 급여화 기준 확대 및 국가구강보건사업 결정에 필요한 기초자료를 제공하고자 본 연구를 시행하였다. 본 연구는 국민영양조사 원시자료 제 5기, 6기, 7기 자료를 토대로 만 6~18세 이하 소아청소년을 총 4,366명을 대상으로 치면열구전색 수혜량과 수혜률을 조사하였다. 2012년 치면열구전색 수혜률에서는 나이, 동. 읍면, 월 평균 가구소득에서 차이가 있었고. 일반적 특성이 수혜에 미치는 요인에서는 2014년 월평균 가구소득 2017년 나이, 월평균 가구소득에서 수혜률 차이가 나타났다(P<0.05). 연도별 일반적 특성이 수혜에 미치는 요인에서 2012년에서 동. 읍면, 월 평균 가구소득 2014년은 월 평균 가구소득, 2017년은 나이와 월 평균 가구소득이 영향을 미치는 요인으로 나타났다(P<0.05). 치아우식증에 효과적인 치면열구전색의 수혜량과 수혜률 증가를 위해서는 지속적인 사업의 홍보와, 본인부담금 감소 및 대상 치아 및 연령 확대, 소외지역 및 취약계층에 대한 지원 확대 방안에 대해서 다각적으로 논의해야 할 것으로 요구되어진다.

연령관련황반변성 환자에서 항혈관내피성장인자의 치료 방법과 재정 영향 분석 (Final Impact of Anti-Vascular Endothelial Growth Factor Treatment in Age-related Macular Degeneration)

  • 양장미;신상진;서재경;조송희;최하진;강민주;지동현
    • 대한안과학회지
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    • 제59권11호
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    • pp.1039-1048
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    • 2018
  • 목적: 연령관련황반변성 환자에 대해 항혈관내피성장인자의 가능한 치료 방법에 따라 건강보험 재정에 미치는 영향을 분석하였다. 대상과 방법: 여러 치료 방법에 따른 건강보험 재정의 변화를 향후 5년(2018-2022년) 동안 추정하였다. 새로운 급여기준 이외 바이오시밀러 등장, 허가초과 비급여약제 사용 등을 고려한 시나리오에 대해서도 재정 영향을 분석하였다. 국민건강보험공단 청구자료 및 의료기관 자료를 기준으로 각 시나리오별로 향후 5년 동안 예상 진료환자 수, 치료 횟수를 추정하였으며, 재정부담을 추계하였다. 결과: 연령관련황반변성에서 현행의 사용형태로 기존 급여기준(평생 14회)이 유지되는 경우(시나리오 1) 2018년 기준 향후 5년간 보험소요재정은 약 4,403억 원으로 추정되었다. 2017년 12월에 변경된 급여기준하에서 5년간 보험소요재정은 약 5,601억 원으로 추정되었다. 2020년 이후 바이오시밀러 급여(시나리오 3), 현재 허가초과 비급여약제인 베바시주맙(시나리오 4)을 급여전환하는 경우에 각각 5,210억 원, 4,197억 원으로 예상되었다. 결론: 본 평생 14회라는 급여기준 삭제로 인해 건강보험 재정이 크게 증가할 것이 예상되었으나 실제 0.1 이하 그리고 반흔화/위축성 병변일 경우 급여 중단 등의 새로운 기준으로 중간폭으로 증가하는 것으로 나타났다. 또한 고령화로 인한 연령관련황반변성 유병환자의 증가를 고려할 때 바이오시밀러 및 베바시주맙 도입 등의 정책적 대안도 고려할 수 있다.

보건의료정보관리 실습교육을 위한 실습모델 연구 (A Study on the Practice Model for Practical Education for Health and Medical Information Management)

  • 최준영
    • 보건의료생명과학 논문지
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    • 제8권2호
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    • pp.83-93
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    • 2020
  • 본 연구에서는 보건의료정보관리사 양성을 위한 대학에서 EMR 교육시스템을 활용하여 교육할 수 있는 실습모델을 연구하였다. 현재 보건의료정보관리사의 직무역량 강화를 위해 도입된 보건의료정보관리교육 평가·인증 기준에 보건의료정보관리를 위한 실습과정이 제시되어 있지 않다. 이에 따라서 보건의료 정보관리교육 평가·인증 편람에서 교육환경으로 제시한 실습프로그램을 EMR 교육시스템에서 실습할 수 있도록 프로그램을 구성였다. 또한 프로그램별로 보건의료정보관리 현장실습지침서에 따라 수행할 수 있는 실습모델을 연구하였다. 보건의료정보관리 교육용 EMR시스템을 이용하여 마스터데이터관리, 환자 등록, 의사처방, 진료비 수납, 건강보험청구관리, 서식관리, 퇴원등록, 암등록, 미비기록관리, 보건의료데이터관리, 보건의료통계, 정보보호/보안관리에 대한 실습을 수행할 수 있도록 실습모델을 연구하였다. 대학에서 체계적이고 표준화된 보건의료정보관리 실습과정을 수행하여 보건의료정보관리 교육의 질적 수준을 높임으로써 보건의료정보관리 전문가로써 역할을 수행할 수 있을 것이다. 이에 따라서 보건의료정보관리사의 실습교육을 통하여 의료데이터 분석을 기반으로 의료서비스를 개발하고 관리하는 보건의료 정보관리 전문가를 양성할 수 있도록 해야 할 것이다.

의존형 유료노인시설 거주의 지속성과 관련 요인 -미국 사례의 고찰을 중심으로- (Influential Factors of Continuous Residence in Profit Assistant Living Elderly Facilities -Focused on Literature Review of the Cases of the United States-)

  • 이인수
    • 한국주거학회논문집
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    • 제11권1호
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    • pp.57-68
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    • 2000
  • This study has been performed to review critical issues affecting continuous residence in profit(self-paid) assistant living facilities for the elderly in the United States. There are three factors influencing continuous residence of frail elderly in the facilities as long as they want without involuntary discharge : Financial ability, behavioral aspects, and facility management situation. Regarding financial ability, income, purchase of insurance policy, cashable assets, willingfulness to pay, and health status were found to be crucial determinants of continuous residence. Overall, 40-50% of those aged 65+ are financially able to stay in the assistant facilities as long as they want, without involuntary discharge. As for behavioral aspects, extroversions, congeniality, culture & life style, conscientiousness, preference for person, and physiological habits were found to be crucial determinants of continuous residence. As for the management situation, it is essential that facilities reach nature level of self-governing rights of the older residents and good local images, and conflicts among the residents and managing parties be resolved on the agreeable standards of inspectors. finally in this study, it is proposed that in Korea, national pension authority offer a liability package for assistant residence, for the case of individual bankruptcy.

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일본의 노인건강관리체계 검토를 통한 한국 지역사회노인 예방 건강관리 방안모색 연구 (Development of a Community-based Preventive Health Care Model for the Elderly in Korea through the Evaluation of a Japanese Counterpart)

  • 이인숙
    • Perspectives in Nursing Science
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    • 제7권1호
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    • pp.10-22
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    • 2010
  • Purpose: Through a thorough examination of the CCSC (Community Comprehensive Support Center) system in Japan, this study suggests a scheme to provide community-based preventive health care services for the elderly in Korea. Methods: The study inquired into the applicability of the Japanese model by reviewing the data related to the CCSC project, aided by both in-depth interviews with staff in the field and consultations with specialists. Results: Rearrangement of the Visiting Health Management Project system is needed to manage the collective or individual visiting care management for frailty prevention of the elderly in communities. The delegated service system for preventive care in the community, including direct management by one of the public health centers, also needs to be reviewed and the application of stricter standards for the selection of the agency or corporation to run the delegated service is necessary. Long-Term Care Insurance, along with national and local grants, is to be considered as a financial resource for the community-based preventive health care model for the elderly. By making active use of education rooms at district offices, senior citizen centers in neighborhoods for the elderly with easy access can be created. The project needs to raise active supports from communities, develop programs which can be absorbed into particular local cultures, and promote the understanding of the preventive project in local communities. The preventive program should focus on first solving the problems of depression, seclusion, and lack of mobility of the elderly. Second, the program should instruct physical self-management for exercise-nutrition-dental maintenance, and third, the program should strengthen the cognitive abilities of the elderly. In addition, it is necessary to systematize and implement counter-plans of the family and community to protect the elderly who has mental and cognitive problems. Finally, by establishing a network of public health welfare resources based upon research on a community level, assessment and planning for the health of the elderly should be one with their family, and comprehensive consultation and recommendations should be provided to the family. Conclusion: Taking into consideration the experience Japan has had with respect to a similar project, it is appropriate to develop and implement a service system which would combine the Visiting Health Management Project system which has already been established and a preventive health care model for the elderly on a community level.

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우리 나라의 사회경제적 사망률 불평등: 1998년도 국민건강영양조사 자료의 사망추적 결과 (Socioeconomic Mortality Inequality in Korea: Mortality Follow-up of the 1998 National Health and Nutrition Examination Survey (NHANES) Data)

  • 김혜련;강영호
    • Journal of Preventive Medicine and Public Health
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    • 제39권2호
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    • pp.115-122
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    • 2006
  • Objectives : This study was conducted to examine the relationships of the several socioeconomic position indicators with the mortality risk in a representative longitudinal study of South Korea. Methods : The 1998 National Health and Nutrition Examination Survey was conducted on a cross-sectional probability sample of South Korean households, and it contained unique 13-digit personal identification numbers that were linked to the data on mortality from the National Statistical Office of Korea. Of 5,607 males and females, 264 died between 1999 and 2003. Cox's regression was used to estimate the relative risks (RR) and their 95% confidence intervals (CI) of mortality. Results: Socioeconomic differences in mortality were observed after adjustments were made for gender and age. Compared with those people having college or higher education, those people without any formal education had a greater mortality risk (RR=2.21, 95% CI=1.12-4.40). The mortality risk among manual workers was significantly greater than that for the non-manual workers (RR=2.73, 95% CI=1.47-5.06). A non-standard employment status was also associated with an increase in mortality: temporary or daily workers had a greater mortality risk than did the full-time workers (RR=3.01, 95% CI=1.50-6.03). The mortality risk for the low occupational class was 3.06 times greater than that of the high and middle occupational classes (95% CI=1.75-5.36). In addition, graded mortality differences according to equivalized monthly household income were found. A reduction of monthly household income by 500 thousand Korean Won (about 400 US dollars) was related with a 20% excess risk of mortality. Self-reported poor living standards were also associated with an increased risk of mortality. Those without health insurance had a 3.63 times greater risk of mortality than the insured (95% CI=1.61-8.19). Conclusions: This study showed the socioeconomic differentials in mortality in a national longitudinal study of South Korea. The existence of socioeconomic mortality inequalities requires increased social discussion on social policies in Korean society. Furthermore, the mechanisms for the socioeconomic inequalities of mortality need to be explored in future studies.

대기오염에 의한 폐암 및 만성폐색성호흡기질환 -개인 흡연력을 보정한 만성건강영향평가- (Lung cancer, chronic obstructive pulmonary disease and air pollution)

  • 성주헌;조수헌;강대희;유근영
    • Journal of Preventive Medicine and Public Health
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    • 제30권3호
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    • pp.585-598
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    • 1997
  • Background : Although there are growing concerns about the adverse health effect of air pollution, not much evidence on health effect of current air pollution level had been accumulated yet in Korea. This study was designed to evaluate the chronic health effect of ai. pollution using Korean Medical Insurance Corporation (KMIC) data and air quality data. Medical insurance data in Korea have some drawback in accuracy, but they do have some strength especially in their national coverage, in having unified ID system and individual information which enables various data linkage and chronic health effect study. Method : This study utilized the data of Korean Environmental Surveillance System Study (Surveillance Study), which consist of asthma, acute bronchitis, chronic obstructive pulmonary diseases (COPD), cardiovascular diseases (congestive heart failure and ischemic heart disease), all cancers, accidents and congenital anomaly, i. e., mainly potential environmental diseases. We reconstructed a nested case-control study wit5h Surveillance Study data and air pollution data in Korea. Among 1,037,210 insured who completed? questionnaire and physical examination in 1992, disease free (for chronic respiratory disease and cancer) persons, between the age of 35-64 with smoking status information were selected to reconstruct cohort of 564,991 persons. The cohort was followed-up to 1995 (1992-5) and the subjects who had the diseases in Surveillance Study were selected. Finally, the patients, with address information and available air pollution data, left to be 'final subjects' Cases were defined to all lung cancer cases (424) and COPD admission cases (89), while control groups are determined to all other patients than two case groups among 'final subjects'. That is, cases are putative chronic environmental diseases, while controls are mainly acute environmental diseases. for exposure, Air quality data in 73 monitoring sites between 1991 - 1993 were analyzed to surrogate air pollution exposure level of located areas (58 areas). Five major air pollutants data, TSP, $O_3,\;SO_2$, CO, NOx was available and the area means were applied to the residents of the local area. 3-year arithmetic mean value, the counts of days violating both long-term and shot-term standards during the period were used as indices of exposure. Multiple logistic regression model was applied. All analyses were performed adjusting for current and past smoking history, age, gender. Results : Plain arithmetic means of pollutants level did not succeed in revealing any relation to the risk of lung cancer or COPD, while the cumulative counts of non-at-tainment days did. All pollutants indices failed to show significant positive findings with COPD excess. Lung cancer risks were significantly and consistently associated with the increase of $O_3$ and CO exceedance counts (to corrected error level -0.017) and less strongly and consistently with $SO_2$ and TSP. $SO_2$ and TSP showed weaker and less consistent relationship. $O_3$ and CO were estimated to increase the risks of lung cancer by 2.04 and 1.46 respectively, the maximal probable risks, derived from comparing more polluted area (95%) with cleaner area (5%). Conclusions : Although not decisive due to potential misclassication of exposure, these results wert drawn by relatively conservative interpretation, and could be used as an evidence of chronic health effect especially for lung cancer. $O_3$ might be a candidate for promoter of lung cancer, while CO should be considered as surrogated measure of motor vehicle emissions. The control selection in this study could have been less appropriate for COPD, and further evaluation with another setting might be necessary.

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한국의 호스피스완화의료정책 (Hospice & Palliative Care Policy in Korea)

  • 김창곤
    • Journal of Hospice and Palliative Care
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    • 제20권1호
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    • pp.8-17
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    • 2017
  • 종합적인 보건시스템을 지원하기 위한 완화의료정책의 개발과 강화가 세계적으로 강조되고 있다. 우리나라에서는 암정복 10개년 계획과 국가암관리종합계획의 기틀 하에 암정책의 일환으로, 호스피스완화의료정책이 시행되어왔고, 2003년 암관리법(Cancer Control Act)을 제정하여 법적 근거를 마련하였으며, 최근 호스피스 완화 의료 및 임종과정에 있는 환자의 연명의료결정에 관한 법을 제정하여 시행할 예정이다. 호스피스완화의료정책의 대상은 최근 관련법의 제정에 따라, 말기암환자에서 암(Cancer), 후천성면역결핍증(Acquired immune deficiency syndrome, AIDS), 만성 폐쇄성 호흡기질환(Chronic Obstructive Pulmonary Disease, COPD), 만성간경화(Chronic Liver Disease/Live Cirrhosis) 등으로 확대되었고, 급여체계는 2015년에 모든 의료기관에 일당 정액수가와 행위별 수가의 복합지불방식으로 완화의료 건강보험제도가 시행되었다. 전달체계관련 건강보험제도는 입원형과 자문형, 그리고 가정형으로 구분되고, 완화의료전문기관의 지정 평가 지원제도가 운영되고 있으며, 재원체계는 건강보험기금과 국가지원금으로 조달되고 있다. 호스피스 완화의료 관련법의 시행에 앞서, 정책대상의 사회적 합의가 요구되며, 낮은 급여체계의 현실화, 민관협력을 통한 호스피스완화의료 표준설정과 전문요원양성, 질 관리 및 평가체계정립, 그리고 장기요양보험과 호스피스기금 등을 활용한 안정적인 재정체계를 마련해야 할 것이다.

한국형 호스피스 케어 개발을 위한 기초 조사 연구 (The National Hospice Care Service Development in Korea)

  • 이소우;이은옥;안효섭;허대석;김달숙;김현숙;이혜자
    • 대한간호
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    • 제36권3호
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    • pp.49-69
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    • 1997
  • The urgent needs to establish hospice care systems in Korea arise from the following reasons: 0) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e. g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accomodate other medical insurance beneficiaries; (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life; (6) medical and nursing care of AIDS patient in terminal stage; (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage. grouped in hospice and non-hospice care patients. reveal what they want visiting nursing care to help their pain control. psychological. social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains. the non-hospice care patients. in addition to their desire for pain control. demanded more psychological. social and spiritual helps as well. The results of this research could be utilized to 0) define the standard of hospice care. (2) provide the guidance for hospice medical care costs. (3) establish the database of hospice care systems. (4) develop softwares. (5) build communication network through Medinet. and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy. nursing care. and social welfare programs.

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한의 입원환자분류체계의 적정성 평가 (Assessment of Validity of Inpatient Classification System in Korean Medicine (KDRG-KM))

  • 김동수;류지선;이병욱;임병묵
    • 대한한의학회지
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    • 제37권3호
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    • pp.112-122
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    • 2016
  • Objectives: This study aimed to assess the validity of 'Korean Diagnosis Related Groups-Korean Medicine (KDRG-KM)' which was developed by Health Insurance Review & Assessment Service (HIRA) in 2013 Methods: Among inpatient EDI claim data issued by hospitals and clinics in 2012, the data which included Korean medicine procedures were selected and analyzed. We selected control targets in the Korean medicine hospitals which had longer Episodes-Costliness index (ECI) and Lengthiness index (LI) than average of total Korean medicine hospitals, and compared the results of selection between the major diagnosis-based patient classification system and the KDRG-KM system. Finally, the explanation power (R2) and coefficient of variation (CV) of the KDRG-KM system using practice expenses were calculated. Results: The numbers of control target in Korean medicine hospitals changed from 36 to 32 when patient grouping adjustment method was changed from major diagnosis to KDRG-KM. For expenses of all outpatient claim data on Korean medicine, explanation power of KDRG-KM system was 66.48% after excluding outliers. CVs of expenses of patient groups in Korean medicine hospitals were gathered from under 70% to under 90%, and those in long-term care hospitals mostly belonged under 70%. Conclusions: The validity of KDRG-KM system was assured in terms of explanation power. By adapting KDRG-KM system, fairness of control targets selection for costliness management in Korean medicine hospitals can be enhanced.