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A Study Concerning Health Needs in Rural Korea (농촌(農村) 주민(住民)들의 의료필요도(醫療必要度)에 관(關)한 연구(硏究))

  • Lee, Sung-Kwan;Kim, Doo-Hie;Jung, Jong-Hak;Chunge, Keuk-Soo;Park, Sang-Bin;Choy, Chung-Hun;Heng, Sun-Ho;Rah, Jin-Hoon
    • Journal of Preventive Medicine and Public Health
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    • v.7 no.1
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    • pp.29-94
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    • 1974
  • Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.

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A Baseline Survey on Development of Primary Health Care in the Rural Korea -Sanpuk Village, Kumsa-Myun, Yuju- Gun, Kyunggi-Do- (농촌지역의 일차보건사업 개발을 위한 기초조사 연구 - 경기도 여주군 금사면 산북부락을 중심으로 -)

  • Kim, Myung-Ho;Yun, Suk-Woo;Rhee, Hae-Soak
    • Journal of agricultural medicine and community health
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    • v.12 no.1
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    • pp.5-27
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    • 1987
  • It is widely recognized that primary health care in the community is one of the most important and effective health measures in these days. However, it is reality that unsatisfactory health care system, ineffective utilization of health care by the community people in the rural area are hampering better understanding for primary health care. Therefore promoting health for the rural people and increasing understanding about primary health care, the baseline survey in the community focused in examination for safe community water supply was carried out. The survey was conducted through August 25-31, 1986 in order to find out health problems and relevant factors and to define the demographic characteristics of $^*$Sanpuk village, Kumsa-Myun, Yuju-Gun, Kyunggi-Do, Korea. Household survey was carried out for every home by trained interviewers. The major results are found out as follows : 1) 84.2%(400 houses) of total households were surveyed because 15.8%(75 houses) were unable to survey due to either refusal against interview or absence of family. These 400 households were composed of 1,697 residents(male:830, female 867). Educational level of respondents showed 34.1% as elementary school graduated. Religion distribution showed Buddism(23.8%) as the most dominant. 50.7% of respondents married in the area. 2) Most households(91.5%) have lived in their own house in Sanpuk area. Average family size showed 4.3. More than half of residents(64.2%) have used public supplied water tap. Only 1.5% of the households had a flush toliet. The rest of households have still used primitive insanitary latrines. 3) 32.5% of residents have used gas burner for cooking and for heating in the house, and the coal briquet were used for boiler. Lack of convenient public transportation was the chief complaint for their day life. 4) Each household occupied 1,990 pyungs of rice paddy and 1,170 pyungs of ordinary field in average. Beside farming products, mushroom was the highest product. 5) Sixth percent of households in the survey area regularly participated in community meeting one hand and on the other hand 39.5% never participated. Most of respondents closely contacted with their neighbours and they seemed very friendly each other. 6) The prevalence rate of illness and injury during recent 15 days showed 48.3 per 1,000. The prevalence rate of chronic illnesses during the past one year showed 74 per 1,000. Injury and accident lead the higher portion(22.0%) in the former and in the latter pain(arthritis, back-pain) showed 27.0% as the dominant sickness. 87.8% of the ill residents in the former received medical treatment. As the most frequently utilized medical facility, the clinic or hospital were counted. Among the residents suffering from chronic illnesses, 77.3% in Sanpuk area get some kind of medical treatments and they rarely utilized the clinic or hospital. The reason why the patient did not receive any medical care was found out the fact that symptoms of illness was light or mild and economic problems was serious. 7) Average age of marriage showed 21.6 years old in the women and the average duration of marital period was shown for 15.1 years. The married woman in reproductive age in Sanpuk area had experienced pregnancies 4 times in the aver-age including 0.7 time of pregnancy in average were interrupted by induced abortion and 0.3 time by spontaneous abortion respectively. The practicing rate of the family planning of the married woman during reproductive ages showed 70.7% and the tuballigation was found out as the most frequently used contraceptives. 8) Among woman who has children under 2 years old, 70.0% had received the prenatal care for the last pregnancy. However, the average number of prenatal care visitis per woman showed 3.3 times. Fifty-two % of woman who received the postnatal care for the last delivery showed only 37.5%. 9) Immunization rate of the children under 2 years old showed relatively high and looked successful. The breast feeding for these children showed dominantly in the most. Most of the mothers in Sanpuk area had started the supplementary diet during weaning period of their infants of 6th and 7th month after birth. * : Sanpuk area is a demstration area for community development which has been supported by the Community Development Foundation during the part 10 years. The village is relatively closer to urban area such as Seoul, However, it has a similar characteristics shown as a remote village because of geographical location and inconvenient transportation at present.

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A Study on the Mobile Medical Service Program -Based on the Community Diagnosis of a Remote Farm Area- (순회진료사업(巡回診療事業)의 문제점(問題点)과 개선방향(改善方向) (일부(一部) 무의지역에 대(對)한 지역사진단(地域社診斷)을 중심(中心)으로))

  • Park, Hung-Bae;Choi, Dong-Wook
    • Journal of Preventive Medicine and Public Health
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    • v.11 no.1
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    • pp.86-97
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    • 1978
  • The mobile medical service has been operated for many years by a number of medical schools and hospitals as a most convenient means of medical service delivery to the people residing in such area where the geographical and socioeconomic conditions are not good enough to enjoy modern medical care. Despite of official appraisal showing off simply with numbers of outpatients treated and medical persons participated, however, as well recognized, the capability (in respect of budget, equipment and time) of those mobile medical teams is so limitted that it often discourages the recipients as well as medical participants themselves. In the midst of rising need to secure medical service of good quality to all parts of the country, and of developing concept of primary health care system, authors evaluated the effectiveness of and problems associated with mobile medical servies program through the community diagnosis of a village (Opo-myun, Kwangju-gun) to obtain the information which may be halpful for future improvement. 1. Owing to the nationwide Sae-Maul movement powerfully practiced during last several years, living environment of farm villages generally and remarkably improved including houses, water supply and wastes disposal etc. Neverthless, due to limitations in budget time and lack of knowledge (probably the most important), these improvements tend to keep up appearances only and are far from the goal which may being practical benefit in promoting the health of the community. 2. As a result of intensive population policy led by the government since 1962, there has been considerable advances in understanding and the rate of practicing family planning through out the villages and yet, one should see many things, especially education, to be done. Fifty eight per cent of mothers have not received prenatal check and the care for most (72%) delivery was offered by laymen at home. 3. Approximately seven per cent of the population was reported to have chronic illness but since only a few (practically none) of the people has had physical check up by doctors, the actual prevalence of chronic diseases may reach many times of the reported. The same fact was observed also in prevalence of tuberculosis; the patients registered at local health center totaled 31 comprising only 0.51% while the numbers in two neighboring villages (designated as demonstration area of tuberculosis control and mass examination was done recently) were 3.5 and 4.0% respectively. Prevalence rate of all dieseses and injuries expereinced during one month (July, 1977) was 15.8%. Only one tenth of those patients received treatment by physicians and one fifth was not treated at all. The situation was worse as for the chronic patients; 84% of all cases either have never been treated or discontinued therapy, and the main reasons were known to be financial difficulty and ignorance or indifference. 4. Among the patients treated by our mobile clinic, one third was chronic cases and 45% of all patients, by the opinion of doctors attended, were those who may be treated by specially trained nurses or other paramedics (objects of primary care). Besides, 20% of the cases required professional managements of level beyond the mobile team's capability and in this sense one may conclude that the effectiveness (performance) of present mobile medical team is quite limitted. According to above findings, the authors would like to suggest following for mobile medical service and overall medicare program for the people living in remote country side. 1. Establishment of primary health care system secured with effective communication and evacuation (between villages and local medical center) measures. 2. Nationwide enforcement of medical insurance system. 3. Simple outpatient care which now constitutes the main part of the most mobile medical services should largely be yielded up to primary health care unit of the village and the mobile team itself should be assigned on new and more urgent missions such as mass screening health examination of the villagers, health education with modern and effective audiovisual aids, professional training and consultant services for the primary health care organization.

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The Life Cycle of Tour Destination Hot Spring in Korea (한국 온천관광목적지의 수명주기)

  • Cho, Sung-Ho;Lee, Kyung-Ja
    • Journal of the Korean association of regional geographers
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    • v.4 no.2
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    • pp.165-182
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    • 1998
  • When tour site is being used by people for the destination of tour, it has a life, or it will lose its life as a tour site. Therefore this paper aims to, based on Butler's theory, has chosen 46 hot spring spots in Korea which are legally assigned and presently running, and tried to analyze the life cycles, the stage of dispositional characteristics, and visitors' favoritism, and to try to find activating method which is not decline. Out of 46 spots, 29 Places were found on the stage of development, which took high percentage, 4 were on the growing stage, 5 were on the mature stage, 5 were on the stagnation or decline stage and the rest 3 were on the stage of rejuvenation. Geographically, Korean hot springs were located on the plain or mountainous areas mostly, and less of them were on hills and coast lines. In water quality, most of places had simple water while the places with salt and sulfur contained water were marked low rate. The temperatures of hot spring water were variable between $25^{\circ}C{\sim}78^{\circ}C$, but the older hot springs were hotter than new ones. After observing the relationship between disposition characteristics and life cycles, the geographical locations and the matter of approach were found as majour influential factors to the life cycles of them. The type of mountainous areas were observed slow progress in life cycle, due to traffic problem, until the road expansion or pavement work were done. Meanwhile, the suburban ones adjacent to big cities were favored by hot spring tourists due to their easy approach and easy traffic. The new born hot springs with such conditions have shown the fast growth. As studied above, since the hot springs were supposed to be for recuperation and vacational, a hot spring with better recreational and accommodational facilities was more favored by tourists than the one with pretty interior decorations. It was because the tour purpose of people has been switched from single purpose to multi one. Thus, the suggestion for activating a declining hot spring and bringing people in them is to develop new and attractive tour resources, expanding the related area, maintaining good quality of water, developing a complex site for long-term tour, developed traffic routs, hot spring festivals, utilizing adjacent tour resources, preparing public water supply system, and assigning as special tour zone.

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Comparison of Nutrient Balance in a Reclaimed Tidal Upland between Chemical and Compost Fertilization for the Winter Green Barley Cultivation (간척농경지에서 비종에 따른 동계 청보리 재배 포장의 영양물질 수지 비교)

  • Song, In-Hong;Lee, Kyong-Do;Kim, Ji-Hye;Kang, Moon-Seong;Jang, Jeong-Ryeol
    • Korean Journal of Environmental Agriculture
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    • v.31 no.2
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    • pp.137-145
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    • 2012
  • BACKGROUND: Along with the surplus rice production, introduction of upland crop cultivations into newly reclaimed tidal areas has gained public attentions in terms of farming diversification and farmers income increase. However, its impacts on the surroundings have not been well studied yet, especially associated with nutrient balance from reclaimed upland cultivation. The objective of this study was to investigate water and nutrient balance during winter barley cultivation as affected different fertilization methods. METHODS AND RESULTS: TN and TP balance for three different plots treated by livestock compost, chemical fertilizer, and no application were monitored during winter green barley cultivation (2010-2011) at the NICS Kyehwa experimental field in Jeonbuk, Korea. Nutrient content in soil and pore water near soil surface appeared to increase, while sub-soil layer remained similar with no fertilization plot. Livestock compost application appeared to increase organic matter content in surface soil compared to chemical fertilization. Crop yield was the greatest with livestock compost application (10.6 t/ha) followed by chemical fertilization (6.9 t/ha) and no application (1.8 t/ha). The nitrogen uptake rate was also greater with livestock compost (52.4%) than chemical fertilizer (48.1%). Phosphorus uptake rate was much smaller (about 7.0%) compared to nitrogen. Nutrient loss by surface and subsurface runoff seemed to be minimal primarily due to small rainfall amount during the winter season. Most of the remaining nutrients, particularly phosphate seemed to be stored in soil layer. Phosphate accumulation appeared to be more phenomenal in the plot applied by livestock compost with higher phosphorus content. CONCLUSION: This study demonstrated that livestock compost application to tidal upland may increase barley crop production and also improve soil fertility by supplying organic content. However, excessive phosphorus supply with livestock compost seems likely to cause a phosphate accumulation problem, unless the nitrogen-based fertilization practice is adjusted.

A Study on Improvement Plans for Local Safety Assessment in Korea (국내 지역안전도 평가의 개선방안 연구)

  • Kim, Yong-Moon
    • Journal of Korean Society of Disaster and Security
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    • v.14 no.4
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    • pp.69-80
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    • 2021
  • This study tried to suggest improvement measures by discovering problems or matters requiring improvement among the annual regional safety evaluation systems. Briefly introducing the structure and contents of the study, which is the introduction, describes the regional safety evaluation method newly applied by the Ministry of Public Administration and Security in 2020. Utilization plans were also introduced according to the local safety level that was finally evaluated by the local government. In this paper, various views of previous researchers related to regional safety are summarized and described. In addition, problems were drawn in the composition of the index of local safety, the method of calculating the index, and the application of the current index. Next, the problems of specific regional safety evaluation indicators were analyzed and solutions were presented. First, "Number of semi-basement households" is replaced with "Number of households receiving basic livelihood" of 「Social Vulnerability Index」 in the field of disaster risk factors is replaced with "the number of households receiving basic livelihood". In addition, the "Vinyl House Area" is evaluated by replacing "the number of households living in a Vinyl House, the number of container households, and the number of households in Jjok-bang villages" with data. Second, in the management and evaluation of habitual drought disaster areas, local governments with a water supply rate of 95% or higher in Counties, Cities, and Districts are treated as "missing". This is because drought disasters rarely occur in the metropolitan area and local governments that have undergone urbanization. Third, the activities of safety sheriffs, safety monitor volunteers, and disaster safety silver monitoring groups along with the local autonomous prevention foundation are added to the evaluation of the evaluation index of 「Regional Autonomous Prevention Foundation Activation」 in the field of response to disaster prevention measures. However, since the name of the local autonomous disaster prevention organization may be different for each local government, if it is an autonomous disaster prevention organization organized and active for disaster prevention, it would be appropriate to evaluate the results by summing up all of its activities. Fourth, among the Scorecard evaluation items, which is a safe city evaluation tool used by the United Nations Office for Disaster Risk Reduction(UNDRR), the item "preservation of natural buffers to strengthen the protection functions provided by natural ecosystems" is borrowed, which is closely related to natural disasters. The Scorecard evaluation is an assessment index that focuses on improving the disaster resilience of local governments while carrying out the campaign "Creating cities resilient to climate crises and disasters" emphasized by UNDRR. Finally, the names of "regional safety level" and "local safety index" are similar, so the term of local safety level is changed to "natural disaster safety level" or "natural calamity safety level". This is because only the general public can distinguish the local safety level from the local safety index.

A Study on the Evaluation Criteria for Reconstruction Charge Allocation (재건축부담금 배분을 위한 지자체 평가기준 연구)

  • Kim, Joo-Jin;Song, Young-Hyun
    • Land and Housing Review
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    • v.2 no.1
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    • pp.35-46
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    • 2011
  • This paper aims at examining the indices and their weights for the evaluation of local government to allocate reconstruction charge and reviewing the availability of them simulating local governments' evaluation. There has been no specific evaluation criteria existed, while central government has to allocate the reconstruction charge to local governments by the provision 3 of Restitution of Housing Reconstruction Gains Act. The results as follows : According to a survey on evaluation indices weight and AHP analysis, the weight of 'the housing welfare improve effort' is the highest with 25.1% among 5 upper-classification indices. Following this, each weight of 'housing welfare conditions(22.7%)', 'housing SOC establishment(22.5%)', 'the achievement and planning on reconstruction charge use(15.8%)', and 'housing sector achievement such as Bogeumjari(13.9%)' are ranked. Meanwhile, Among 16 lower-classification indices, 'the rate of minimum housing standard households(11.5%)', 'public rental housing supply(8.9%)', 'reconstruction charge use achievement(8.3%)', 'reconstruction charge use planning submit(7.5%)', and 'rate of water and sewage(6.3%)' hold high rank. The analysis results show the weight of 'housing sector achievement such as Bogeumjari' on the existing provisions should be decreased(30%${\rightarrow}$13.9%) as others' weight has to be slightly increased. According to the result of the simulation, Jeonbuk, Gyeongbuk, Jeonnam, Jeju, Gyeonggi received higher scores in the comprehensive evaluation, while Daejeon, Seoul, Incheon, Daegu and Gwangju, where the housing conditions are relatively good, received lower scores. These results of the analysis correspond with the direction of reconstruction charges allocation and indicate that the evaluation criteria used in this simulation is acceptable.