• Ocean and Polar Research
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• v.37 no.4
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• pp.341-356
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• 2015

A nation has a sovereign right to develop and use its natural resources according to its policies with regard to development and the relevant environment. A nation also has an obligation not to harm other countries or damage environments of neighboring countries as consequences of such actions of developments or use of natural resources. However, international precedents induce a nation to take additional actions not to cause more damages from the specific acts causing environmental damages beyond national borders, when such acts have economic and social importance. That is to say that there is a tendency to resolve such issues in a way to promote the balance between the mutual interests by allowing such actions to continue. A solution to China's Three Gorges Dam dilemma based on a soft law approach is more credible than relying on a good faith approach of national responsibilities and international legal proceedings since the construction and operation of the dam falls within the category of exercising national sovereign rights. If a large scale construction project such as the Three Gorges Dam or operation of a nuclear power plant causes or may cause environmental damage beyond the border of a nation engaged in such an undertaking, countries affected by this undertaking should jointly monitor the environmental effects in a spirit of cooperation rather than trying to stop the construction and should seek cooperative solutions of mutual understanding to establish measures to prevent further damages. If China's Three Gorges Dam construction and operation cause or contain the possibility of causing serious damages to marine environment, China cannot set aside its national responsibility to meet international obligations if China is aware of or knows about the damage that has occurred or may occur but fail to prevent, minimize, reverse or eliminate additional chances of such damages, or fails to put in place measures in order to prevent the recurrence of such damages. However, Korea must be able to prove a causal relationship between the relevant actions and resulting damages if it is to raise objections to the construction or request certain damage-prevention actions against crucial adverse effects on the marine environment out of respect for China's right to develop resources and acts of use thereof. Therefore, it is essential to cumulate continuous monitoring and evaluations information pertaining to marine environmental changes and impacts or responses of affected waters as well as acquisition of scientific baseline data with observed changes in such baseline. As China has adopted a somewhat nonchalant attitude toward taking adequate actions to protect against marine pollution risks or adverse effects caused by the construction and operation of China's Three Gorges Dam, there is a need to persuade China to adopt a more active stance and become involved in the monitoring and co-investigation of the Yellow Sea in order to protect the marine environment. Moreover, there is a need to build a regular environmental monitoring system that includes the evaluation of environmental effects beyond borders. The Espoo Convention can serve as a mechanism to ease potential conflicts of national interest in the Northeast Asian waters where political and historical sensitivities are acute. Especially, the recent diplomatic policy advanced by Korea and China can be implemented as an important example of gentle cooperation as the policy tool of choice is based on regional cooperation or cooperation between different regions.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.565-574
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• 1993

Background: Pulmonary hamartomas are benign tumors that occur in the parenchyma or in the bronchi. They present as a solitary pulmonary nodule(SPN) or as a cause of bronchial obstruction. The incidence, once minimal, is increasing in Korea. To get clinical spectrum about the tumor, we analyzed all the reported cases in Korea since 1964. Methods: We reviewed the clinical, radiological and pathological findings of 13 patients of intrapulmonary or endobronchial hamartomas in Severance Hospital and of 38 reported cases in Korea published in literatures from 1964 to 1992 retrospectively. Results: Including 17 endobronchial hamartomas, 54 cases were studied. There were 25 men and 29 women, with a mean age of 47.2 years; 45.3 years in endobronchial type and 51.3 years in parenchymal type. Pulmonary symptoms were present in 8 patients (22%) of intrapulmonary type and in all patients of endobronchial type: cough (65%), dyspnea (53%), sputum (35%), fever (29%) in order. On chest X-rays, atelectasis was seen in 10 patients (59%) in endobronchial type; but SPN was noted in 36 patients (97%) of intrapulmonary type. Calcification was present in 7 intapulmonary hamartomas (23%); but is in 2 endobronchial hamartomas (12%). The diagnostic yield was 6 out of 14(43%) in endobronchial ones; 4 out of 7(57%) in intrapulmonary ones. Fifty patients underwent operations as follows: lobectomy (28), enucleation (8), resection (8), bilobectomy (4), pneumonectomy (2). The hamartomas were 1.2 times more common in the right lung; mean transverse diameter at the time of operation was 2.3 cm in endobronchial type, 3.8 cm in intrapulmonary ones. Chondroid components were present in 11(65%) of 17 endobronehial ones but in 30(91%) of 33 intrapulmonary hamartomas. No malignant changes were seen perioperative period and up to early 1993. Conclusion: The younger age in endobronchial hamartomas, the preponderance of the female sex and the more incidence in the right lung, and the diagnostic choice of lobectomies were different from the studies of the Western countries.

• 한국사회정책
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• v.25 no.3
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• pp.37-71
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• 2018

Since 2016, public and political interest on basic income has been increased beyond academic interest. The recent debate on basic income has expanded on issues regarding to the concrete implementation of basic income moving further than the debate on conception of the basic income in the abstract level. This study examines major critiques of basic income which was raised from social policy area and makes a counter-argument on these critiques. Major points summarized as follows. First, the problem of jobs and social insurance exclusion is not serious enough to call for basic income. Second, existing social security systems will be crowded out by excessive financial burden if basic income is introduced. Third, policies to cultivate citizens' capacities to cope with a technological change should be given priority over basic income. This study disputes these critiques by counter arguing four points. First, it is necessary to reconstruct welfare state based on basic income, given the labor market changes, such as long-term trend of employment change, newly emerging employment of platform companies, and inconsistency of platform labor and social insurance. Second, hypothesis of crowding-out effect on social security system is just a criticism that can be applied to the basic income initiative of the right-wing. Also, it is unable to find a logical basis or evidence of this hypothesis from the historical process of welfare state development or previous studies. Third, it is necessary to discuss how to reconfigure existing social security system and basic income which are complementary to each other and also have consistency with labor market as a configuration, not as a matter of choosing between basic income and social security system. Fourth, de-laborization does not mean a refusal to labor but a free choice, and the basic principle of social security is not needs but right. In conclusion, in order to develop more productive debate on basic income, it requires more sophisticated discussion and criticism from the point of view of the distributive justice; the debate on the sustainability of social insurance-centered welfare states; and debates on the political realization of basic income.

• Clinical and Experimental Pediatrics
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• v.52 no.8
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• pp.910-916
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• 2009

Purpose : The arterial switch operation (ASO) has become the preferred procedure for the surgical management of transposition of the great arteries (TGA). We conducted a retrospective evaluation of our experience in 30 patients seen from January 2003 to July 2008, in order to determine outcomes and related risk factors after the arterial switch operation. Methods : Patients charts, surgical reports, and echocardiograms were retrospectively reviewed. And they were analyzed in 2 different groups: complex (n=16) versus simple TGAs (n=14). Complex TGAs are TGAs with VSD or the Taussig-Bing anomaly with or without aortic arch anomalies. Simple TGAs are defined as TGAs with intact ventricular septum having no such anomalies. Median follow-up time was 44 months (3-63 months). Results : Hospital mortality was 0%. However, follow-up echocardiographies revealed potential complications, including stenosis of the branch pulmonary arteries, neo-aortic and/or neo-pulmonary valvar regurgitation, and right or left ventricular outflow tract obstructions. Great arterial relationship (side-by-side), association of aortic arch anomalies, and the existence of the Taussig- Bing anomaly were assessed as significant risk factors of neo-aortic and/or neo-pulmonary valvar regurgitation in this series. On the other hand, right or left ventricular outflow tract obstructions were more frequently found in patients demonstrating VSD, side-by-side positioned great arteries, or associated coronary anomalies. Conclusion : The ASO is the procedure of choice in the treatment of TGA. However, special attention and follow-ups are needed to detect residual problems like the stenosis of the branch pulmonary arteries, neo-aortic and/or neo-pulmonary valvar regurgitation, as well as ventricular outflow tract obstructions.

• Journal of the Korean Geographical Society
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• v.38 no.2
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• pp.312-323
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• 2003

This writer absolutely agrees with the government that regional disequilibrium is severe enough to consider moving the administrative capital. Pursuing this course solely to establish a balanced development, however, is not a convincing enough reason. The capital city is directly related to not only the social and economic situation but, much more importantly, to the domestic political situation as well. In the mid-1970s, the proposal by the Third Republic to move the capital city temporarily was based completely on security reasons. At e time, the then opposition leader Kim, Dae-jung said that establishing a safe distance from the demilitarized zone(DMZ) reflected a typically military decision. His view was that retaining the capital city close to the DMZ would show more consideration for the will of the people to defend their own country. In fact, independent Pakistan moved its capital city from Karachi to Islamabad, situated dose to Kashmir the subject of hot territorial dispute with India. It is regrettable that no consideration has been given to the urgent political situation in the Korean peninsula, which is presently enveloped in a dense nuclear fog. As a person requires health to pursue his/her dream, a country must have security to implement a balanced territorial development. According to current urban theories, the fate of a country depends on its major cities. A negligently guarded capital city runs the risk of becoming hostage and bringing ruin to the whole country. In this vein, North Koreas undoubted main target of attack in the armed communist reunification of Korea is Seoul. For the preservation of our state, therefore, it is only right that Seoul must be shielded to prevent becoming hostage to North Korea. The location of the US Armed Forces to the north of the capital city is based on the judgment that defense of Seoul is of absolute importance. At the same time, regardless of their different standpoints, South and North Korea agree that division of the Korean people into two separate countries is abnormal. Reunification, which so far has defied all predictions, may be realized earlier than anyone expects. The day of reunification seems to be the best day for the relocation of the capital city. Building a proper capital city would take at least twenty years, and a capital city cannot be dragged from one place to another. On the day of a free and democratic reunification, a national agreement will be reached naturally to find a nationally symbolic city as in Brazil or Australia. Even if security does not pose a problem, the governments way of thinking would not greatly contribute to the balanced development of the country. The Chungcheon region, which is earmarked as the new location of the capital city, has been the greatest beneficiary of its proximity to the capital region. Not being a disadvantaged region, locating the capital city there would not help alleviate regional disparity. If it is absolutely necessary to find a candidate region at present, considering security, balanced regional development and post-reunification scenario of the future, Cheolwon area located in the middle of the Korean peninsula may be a plausible choice. Even if the transfer of capital is delayed in consideration of the present political conflict between the South and the North Koreas, there is a definite shortcut to realizing a balanced regional development. It can be found not in the geographical dispersal of the central government, but in the decentralization of power to the provinces. If the government has surplus money to build a new symbolic capital city, it is only right that it should improve, for instance, the quality of drinking water which now everyone eschews, and to help the regional subway authority whose chronic deficit state resoled in a recent disastrous accident. And it is proper to time the transfer of capital city to coincide with that of the reunification of Korea whenever Providence intends.

• Radiation Oncology Journal
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• v.22 no.3
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• pp.165-176
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• 2004

Purpose: Firstly, to analyze facto in terms of radiation treatment that might potentially cause subfrontal relapse in two patients who had been treated by craniospinal irradiation (CSI) for medulloblastoma, Secondly, to explore an effective salvage treatment for these relapses. Materials and Methods: Two patients who had high-risk disease (T3bMl, T3bM3) were treated with combined chemoradiotherapy CT-simulation based radiation-treatment planning (RTP) was peformed. One patient who experienced relapse at 16 months after CSI was treated with salvage surgery followed by a 30.6 Gy IMRT (intensity modulated radiotherapy). The other patient whose tumor relapsed at 12 months after CSI was treated by surgery alone for the recurrence. To investigate factors that might potentially cause subfrontal relapse, we evaluated thoroughly the charts and treatment planning process including portal films, and tried to find out a method to give help for placing blocks appropriately between subfrotal-cribrifrom plate region and both eyes. To salvage subfrontal relapse in a patient, re-irradiation was planned after subtotal tumor removal. We have decided to treat this patient with IMRT because of the proximity of critical normal tissues and large burden of re-irradiation. With seven beam directions, the prescribed mean dose to PTV was 30.6 Gy (1.8 Gy fraction) and the doses to the optic nerves and eyes were limited to 25 Gy and 10 Gy, respectively. Results: Review of radiotherapy Portals clearly indicated that the subfrontal-cribriform plate region was excluded from the therapy beam by eye blocks in both cases, resulting in cold spot within the target volume, When the whole brain was rendered in 3-D after organ drawing in each slice, it was easier to judge appropriateness of the blocks in port film. IMRT planning showed excellent dose distributions (Mean doses to PTV, right and left optic nerves, right and left eyes: 31.1 Gy, 14.7 Gy, 13.9 Gy, 6.9 Gy, and 5.5 Gy, respectively. Maximum dose to PTV: 36 Gy). The patient who received IMRT is still alive with no evidence of recurrence and any neurologic complications for 1 year. Conclusion: To prevent recurrence of medulloblastoma in subfrontal-cribriform plate region, we need to pay close attention to the placement of eye blocks during the treatment. Once subfrontal recurrence has happened, IMRT may be a good choice for re-irradiation as a salvage treatment to maximize the differences of dose distributions between the normal tissues and target volume.

• MISULJARYO - National Museum of Korea Art Journal
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• v.97
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• pp.87-104
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• 2020

Myogilsang on Diamond Mountain, signed and dated (2000) by Seon-u Yeong (1946-2009), is the first work by a North Korean artist to enter the collection of the National Museum of Korea (fig. 1a). The donor acquired the painting directly from the artist in Pyeongyang in 2006. In consequence, there are no issues with the painting's authenticity.This painting is the largest among all existing Korean paintings, whether contemporary or from the Joseon Dynasty, to depict this iconography (see chart 1. A Chronological List of Korean Myogilsang Paintings.) It is ink and color on paper, measures 130.2 × 56.2 centimeters, and is in a hanging scroll format. Since this essay is intended as a brief introduction of the painting and not in-depth research into it, I will simply examine the following four areas: 1. Seon-u Yeong's background; 2. The location and the traditional appellation of the rock-cut image known as Myogilsang; 3. The iconography of the image; and 4) A comparative analysis of Seon-u Yeong's painting in light of other paintings on the same theme. Finally, I will present two more of his works to broaden the understanding of Seon-u Yeong as a painter. 1. Seon-u Yeong: According to the donor, who met Seon-u at his workshop in the Cheollima Jejakso (Flying Horse Workshop) three years before the artist's death, he was an individual of few words but displayed a firm commitment to art. His preference for subjects such as Korean landscapes rather than motifs of socialist realism such as revolutionary leaders is demonstrated by the fact that, relative to his North Korean contemporaries, he seems to have produced more paintings of the former. In recent years, Seon-u Yeong has been well publicized in Korea through three special exhibitions (2012 through 2019). He graduated from Pyeongyang College of Fine Arts in 1969 and joined the Central Fine Arts Production Workshop focusing on oil painting. In 1973 he entered the Joseon Painting Production Workshop and began creating traditional Korean paintings in ink and color. His paintings are characterized by intense colors and fine details. The fact that his mother was an accomplished embroidery specialist may have influenced on Seon-u's choice to use intense colors in his paintings. By 1992, he had become a painter representing the Democratic People's Republic of Korea with several titles such as Artist of Merit, People's Artist, and more. About 60 of his paintings have been designated as National Treasures of the DPRK. 2. The Myogilsang rock-cut image is located in the Manpok-dong Valley in the inner Geumgangsan Mountain area. It is a high-relief image about 15 meters tall cut into a niche under 40 meters of a rock cliff. It is the largest of all the rock-cut images of the Goryeo period. This image is often known as "Mahayeon Myogilsang," Mahayeon (Mahayana) being the name of a small temple deep in the Manpokdong Valley (See fig. 3a & 3b). On the right side of the image, there is an intaglio inscription of three Chinese characters by the famous scholar-official and calligrapher Yun Sa-guk (1728-1709) reading "妙吉祥"myogilsang (fig. 4a, 4b). 3. The iconography: "Myogilsang" is another name for the Bhodhisattva Mañjuśrī. The Chinese pronunciation of Myogilsang is "miaojixiang," which is similar in pronunciation to Mañjuśrī. Therefore, we can suggest a 妙吉祥 ↔ Mañjuśrī formula for the translation and transliteration of the term. Even though the image was given a traditional name, the mudra presented by the two hands in the image calls for a closer examination. They show the making of a circle by joining the thumb with the ring finger (fig. 6). If the left land pointed downward, this mudra would conventionally be considered "lower class: lower life," one of the nine mudras of the Amitabha. However, in this image the left hand is placed across its abdomen at an almost 90-degree angle to the right hand (fig. 6). This can be interpreted as a combination of the "fear not" and the "preaching" mudras (see note 10, D. Saunders). I was also advised by the noted Buddhist art specialist Professor Kim Jeong-heui (of Won'gwang University) to presume that this is the "preaching" mudra. Therefore, I have tentatively concluded that this Myogilsang is an image of the Shakyamuni offering the preaching mudra. There is no such combination of hand gestures in any other Goryeo-period images. The closest I could identify is the Beopjusa Rock-cut Buddha (fig. 7) from around the same time. 4. Comparative analysis: As seen in , except for the two contemporary paintings, all others on this chart are in ink or ink and light color. Also, none of them included the fact that the image is under a 40-meter cliff. In addition, the Joseon-period paintings all depicted the rock-cut image as if it were a human figure, using soft brushstrokes and rounded forms. None of these paintings accurately rendered the mudra from the image as did Seon-u. Only his painting depicts the natural setting of the image under the cliff along with a realistic rendering of the image. However, by painting the tall cliff in dark green and by eliminating elements on either side of the rock-cut image, the artist was able to create an almost surreal atmosphere surrounding the image. Herein lies the uniqueness of Seon-u Yeong's version. The left side of Seon-u's 2007 work Mount Geumgang (fig. 8) lives up to his reputation as a painter who depicts forms (rocks in this case) in minute detail, but in the right half of the composition it also shows his skill at presenting a sense of space. In contrast, Wave (fig. 9), a work completed one year before his death, displays his faithfulness to the traditions of ink painting. Even based on only three paintings by Seon-u Yeong, it seems possible to assess his versatility in both traditional ink and color mediums.

• The Korean Journal of Air & Space Law and Policy
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• v.2
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• pp.31-67
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• 1990

One of the first issues which arose in the evolution of air law was the determination of the vertical limits of airspace over private property. In 1959 the UN in its Ad Hoc Committee on the Peaceful Uses of Outer Space, started to give attention to the question of the meaning of the term "outer space". Discussions in the United Nations regarding the delimitation issue were often divided between those in favour of a functional approach ("functionalists"), and those seeking the delineation of a boundary ("spatialists"). The functionalists, backed initially by both major space powers, which viewed any boundary as possibly restricting their access to space(Whether for peaceful or military purposes), won the first rounds, starting with the 1959 Report of the Ad Hoc Committee on the Peaceful Uses of Outer Space which did not consider that the topic called for priority consideration. In 1966, however, the spatialists, were able to place the issue on the agenda of the Outer Sapce Committee pursuant to Resolution 2222 (xxx1). However, the spatialists were not able to present a common position since there existed a variety of propositions for delineation of a boundary. Over the years, the funtionalists have seemed to be losing ground. As the element of location is a decisive factor for the choice of the legal regime to be applied, a purely functional approach to the regulation of activities in the space above the Earth does not offer a solution. It is therefore to be welcomed that there is clear evidence of a growing recognition of the defect inherent to such an approach and that a spatial approach to the problem is gaining support both by a growing number of States as well as by publicists. The search for a solution of the problem of demarcating the two different legal regimes governing the space above the Earth has undoubtedly been facilitated, and a number of countries, among them Argentina, Belgium, France, Italy and Mexico have already advocated the acceptance of the lower boundary of outer space at a height of 100km. The adoption of the principle of sovereignty at that height does not mean that States would not be allowed to take protective measures against space activities above that height which constitute a threat to their security. A parallel can be drawn with the defence of the State's security on the high seas. Measures taken by States in their own protection on the high seas outside the territorial waters-provided that they are proportionate to the danger-are not considered to infringe the principle of international law. The most important issue in this context relates to the problem of a right of passage for space craft through foreign air space in order to reach outer space. In the reports to former ILA Conferences an explanation was given of the reasons why no customary rule of freedom of passage for aircraft through foreign territorial air space could as yet be said to exist. It was suggested, however, that though the essential elements for the creation of a rule of customary international law allowing such passage were still lacking, developments apperaed to point to a steady growth of a feeling of necessity for such a rule. A definite treaty solution of the demarcation problem would require further study which should be carried out by the UN Outer Space Committee in close co-operation with other interested international organizations, including ICAO. If a limit between air space and outer space were established, air space would automatically come under the regime of the Chicago Convention alone. The use of the word "recognize" in Art. I of chicago convention is an acknowledgement of sovereignty over airspace existing as a general principle of law, the binding force of which exists independently of the Convention. Further it is important to note that the Aricle recognizes this sovereignty, as existing for every state, holding it immaterial whether the state is or is not a contracting state. The functional criteria having been created by reference to either the nature of activity or the nature of the space object, the next hurdle would be to provide methods of verification. With regard to the question of international verification the establishment of an International Satelite Monitoring Agency is required. The path towards the successful delimitation of outer space from territorial space is doubtless narrow and stony but the establishment of a precise legal framework, consonant with the basic principles of international law, for the future activities of states in outer space will, it is still believed, remove a source of potentially dangerous conflicts between states, and furthermore afford some safeguard of the rights and interests of non-space powers which otherwise are likely to be eroded by incipient customs based on at present almost complete freedom of action of the space powers.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.5
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• pp.404-416
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• 2001

Purpose : Traditionally, the treatement of choice has been a bone grafting procedure to increase the length of bone in case of actual length discrepancy. But, bone grafting procedure has many disadvantages, for example, graft resorption, donor site morbidity, and so on. So, many trials have been performed to avert the use of autogenous bone graft via introducing new materials or methods. And, one of those trials has been realized by the development of a technique inducing bone lengthening by osteotomy (or corticotomy) and slow gradual distraction of the osteotomized segments. This new technique of bone lengthening dates back to the early 20th century. But, the majority of information concerning the biology of new bone formation during bone lengthening and technical details of the procedure were produced by extensive clinical and experimental studies performed by Ilizarov, a Russian surgeon. According to Ilizarov, with adequate blood supply, preservation of periosteum, rigid fixation of the osteotomized segments, and proper rate and rhythm of distraction, intramembranous bone rapidly develops within the distraction gap in the limb lengthening procedure. In the limb lengthening, many orthopedic surgeons try to observe the biologic and clinical principles recommended by Ilizarov. In the oral and maxillofacial region, however, not a few studies must be performed to apply this surgical technique in the clinical cases. Besides, the mechanism of bone formation in the distraction gap is not clear, yet. The purpose of this experiment was to scrutinize serially the histological changes in the elongated bone affected by osteodistraction of the mandibular body in an adult canine model. In addition, it was performed to confirm the presence of specific region(s) which was important in the bone formation in the gap through the observation of the expression pattern of osteocalcin and osteonectin with the immunohistochemical examination. Materials and Methods : The experimental and control specimens were obtained from seven adult male mongrel dogs weighing over 20kg. The distractors were custom-made linear extraoral devices and bicortical fixation screws were 2.3mm in diameter, 50mm in total length, 15mm in screw length. The distractors were devised to produce a linear gap of 0.75mm between two bony segments every $360^{\circ}$ turn of the rotation rod of the device. The mandibular body of the right side of each animal was corticotomized perpendicular to the occlusal plane and then two bony segments were separated completely by careful manipulation of the segments with bone forceps. The left side of each animal was left intact. This side was served as control. At sixth day after osteotomy and fixation of the segments were performed, distraction of the segments was commenced with a rate of 1.1mm/day and a rhythm of two/day for ensuing 7 days. The animals were euthanized at the 16th. 29th, and 44th day after the osteotomy. The bony specimens were decalcified, embedded in paraffin, sectioned $5{\mu}m$ thick and stained with H&E. The prepared specimens were examined under the light microscope. And, immunohistochemical examinations using anti-osteocalcin antibody (OC1, Biodesign, USA) and anti-osteonectin antibody (Haematologic Technologies Inc., Essex, VT) to locate the expressions of osteocalcin and osteonectin, respectively, were performed. Results : 1. New bone was observed already at the 16th. day after osteotomy. This suggests that new bone formation in osteodistraction was commenced at an early stage of the regenerative process. But, radiologically and microscopically, bony union was not completed in the distraction gap at the 44th. day after osteotomy. Therefore, rigid fixation must be maintained between the bony fragments till the complete bony union is confirmed clinically rather than one month or so after the completion of distraction.

• Korea Journal of Hospital Management
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• v.12 no.1
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• pp.1-30
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• 2007

The study carried out a survey with employees of hospitals located in Daejeon, Chungnam, and Chungbuk from Sep. 12 to Sep. 30, 2005 in order to derive primary elements that affect the improvement of hospital's competitiveness. The study investigated and analyzed the employees' recognition on the change of competitive environment caused by the change of medical environment. The study also analyzed the elements that affect the hospital's competitiveness and the competitive strategies of the hospitals. The conclusion of this study can be summarized as follows. 1. Summary 1) Most of the employees responded that there is a rival in the competitive environment and the competitive is intense. Especially when the employees are married, live in urban areas, have an education level of university graduate or are managers, they tend to think the competitive is very intense. Also, they said that the competitive is based upon the quality of medical service. They mentioned the element that has the biggest effect on the competitiveness is the element of medical consumer and they recognized that the medical services in university and general hospitals have more competitiveness than the one-department hospitals. 2) It was investigated that the medical technique service has the most effect on the hospital's competitiveness. Also, the external service of medical techniques also has a large effect on the hospital's competitiveness. 3) When they were asked for the factors that affect the patients' decision on selecting a hospital, most of them responded "capability and technique of the medical staffs." Also, they said that "sufficient explanation from doctors" and "special center and clinic" are the factors that have big effects on the patients' decision. 4) In the SWOT analysis, most of them responded that the strength is the hospital's characteristics and the weakness is insufficient and obsolete equipment. They said the opportunity is the demands for professional medical service and the risk is the intense competitive among the hospitals. 5) In the SWOT strategy, they emphasized the strategy that uses the opportunity and the strength and the strategy that uses the opportunity while overcoming the weakness. 6) As for the basic competition strategy, most of them thought of the strategy of professionalizing the medical service most importantly. Next, they focused on the strategy of distinct service and the strategy of lower prime cost. 2. Conclusion 1) Because service competition between hospitals is happening seriously, need competitiveness security through right awareness transfer and satisfaction upgrade about medical consumer. 2) For medical technique service upgrade that equip Hospital's competitiveness but affects most, must solidify the countermeasure because professionalizing the medical service and newest medical technique induction should be achieved first, and compose task force for the external service of medical techniques improvement. 3) To improve SWOT of hospital, opportunity and the strength strategy choice that rescue hospital's characteristics heightening professionalizing the medical service level is fancied. 4) As for the basic competition strategy, will have to try in phase triangular position of hospital which is trusted medical level upgrade and excellent manpower security and finance independence through upgrade. The study was only done with hospitals in Daejeon, Chungnam and Chungbuk. Also, it is a study from the side of suppliers of medical service so there are limitations. However, the significance of the study is to present the basic data for improvement of hospital's competitiveness by examining the importance of medical techniques and external service of medical techniques that are the main effects on the improvement of hospital's competitiveness.