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보건행정학회지 update

Health Policy and Mangemnet

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수록정보
30권3호(2020) |수록논문 수 : 16
간행물 제목
31권3호(2021년 09월) 수록논문
최근 권호 논문
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KCI등재

1위드코로나 시대, 어떻게 준비할 것인가?

저자 : 이선희 ( Sun-hee Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 3호 발행 연도 : 2021 페이지 : pp. 241-243 (3 pages)

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With the increase in vaccinations worldwide, the world is facing the era of coexisting with coronavirus disease 2019 (COVID-19). The government announced that it will change its focus of public health emergency response system, gradually toward daily recovery from November. Hence, this article reviews an overview of policy tasks to prepare for the era of coexistence with COVID-19. The three key policies that should be considered are as follow: (1) vaccination should be administered promptly to improve the immunity of the target population; (2) the government should advance the medical capability for critically ill patients and reorganize the patient delivery system; and (3) epidemiological surveillance system should be reformed in a direction to raise the social capacity.

KCI등재

2코로나19 감염병 대응모델의 국제표준화 요건

저자 : 안선주 ( Sun-ju Ahn )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 3호 발행 연도 : 2021 페이지 : pp. 244-254 (11 pages)

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The management of emerging infectious diseases cannot help but completely depend on non-pharmaceutical interventions in the early stages of the outbreak. Consequently, South Korea has developed and implemented the 3T (test-trace-treat) models, non-pharmaceutical infection prevention and control (IPC) measures, in response to the coronavirus disease 2019 (COVID-19) pandemic. The IPC measures have gained global attention, rendering them to be essential in the development of a shareable, reusable, and applicable protocol for future pandemics. This study was conducted to identify the requirements necessary for standardizing the IPC measures. Three new work items of the 18 3T models were proposed to ISO/TC 304 (International Organization for Standardization/Technical Committee 304; healthcare organization management). Requirements for each IPC measure, identified by participating members (P-members) countries during the ISO ballots, were analyzed in this study. The three new work items were approved by the P-members countries after a 3-month ballot. There was a consensus that the three IPC measure models should be International Standards (IS). Other comments include (1) the models should include not only COVID-19 but also any respiratory pandemic; and (2) keep donning of level D protection at screening sites as an optional protocol, in consideration for the lack of personal protective equipment. Standardization is a systematic process of developing internationally agreed-upon wisdom and knowledge that consider and respect the diversity and universality of each country. It is expected that such standardized applicable IPC measure models contribute to global efforts to rapidly respond to a public health emergency of international concern during its early stages.

KCI등재

3일반건강검진의 이상지질혈증 검진주기 변경에 대한 문제점 고찰

저자 : 이준희 ( June-hee Lee ) , 이경재 ( Kyung-jae Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 3호 발행 연도 : 2021 페이지 : pp. 255-260 (6 pages)

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Background: Korea National Health Checkup Programs are aimed at the prevention and early detection of cardiovascular disease in adults. To establish a countermeasure for this tendency, The current Korea National Health Checkup Programs have been providing Health Risk Appraisal (HRA) since 2009, thereby focusing on individual lifestyle correction. However, from 2018, the dyslipidemia screening exam cycle has been changed from 2 to 4 years.
Methods: In this study, we try to investigate whether policy decisions are valid based on domestic reports that have influenced policy decisions. First, considering the epidemiology of the domestic cardiovascular disease, dyslipidemia, and metabolic syndrome, the change of the 4-year cycle is appropriate or not. Second, whether the research method that applies came to make policy decisions appropriate or not. Third, our study also investigates whether the direction of policy decision was suitable for the second comprehensive national examination plan.
Results: The data that are used in the previous study were that of 10 years ago and there also was a problem in selecting the data, especially the use of one of the research methods to calculate the signal to noise ratio that was aimed at improving health had some problems. This is a research method that does not match with the aim itself.
Conclusion: Changing the screening cycle for dyslipidemia does not match the recent trend of general screening to effectively prevent cardiovascular disease in improving individual lifestyles in the national health checkup plan. Studying the relationship with metabolic syndrome, which can be an intermediate stage of cardiovascular disease, could be a policy direction that is more suitable for the national health examination comprehensive plan.

KCI등재

4MRI 외부병원 판독 수가 인상의 효과 분석: 뇌 관련 자기공명영상을 중심으로

저자 : 김록영 ( Logyoung Kim ) , 사공진 ( Jin Sakong ) , 조민호 ( Minho Jo ) , 위세아 ( Seah Wee ) , 이진용 ( Jinyong Lee ) , 김용규 ( Yongkyu Kim )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 3호 발행 연도 : 2021 페이지 : pp. 261-271 (11 pages)

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Background: In 2018, the government increased the fee for the magnetic resonance imaging (MRI) image deciphering services of the external hospital to discourage the redundant MRI scan and to induce appropriate use of the MRI services. It is important to evaluate the effect of the policy to provide the basis for establishing other MRI-related policies.
Methods: The healthcare data of the patients who had brain MRI scans were organized by episode and analyzed using the panel study in order to find out the effect of the MRI-related policy on the substitution effect and the medical expenses.
Results: As a result of the increase in the fee of deciphering the MRI image, there has been an uplift in deciphering the MRI scan of the external hospital. It implies that more hospitals chose to use the MRI scan taken by other clinics or hospitals, rather than the MRI scan taken at their own facilities.
Conclusion: The research results imply that a policy that facilitates the exchange of the medical image data between the hospitals is needed in order to establish an efficient management system of the healthcare resources. Such improvement is expected to reduce the social cost and contribute to the stability in the finance of national health insurance.

KCI등재

5국가별 건강보험체계에 따른 국가건강검진제도 비교 연구

저자 : 이예지 ( Yeji Lee ) , 김은영 ( Eunyoung Kim ) , 이동현 ( Donghyun Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 3호 발행 연도 : 2021 페이지 : pp. 272-279 (8 pages)

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Background: Korea's health screening program has been faced the need for changes as the population and diseases structure are changing. In addition to Korea, many countries operate state-led health check-up programs to improve the health level of the people, and the operating methods of the program appear in various forms according to each country's health insurance system. This study examines other state-led health screening programs and proposes a direction for the development of Korea's health screening program.
Methods: The study was conducted using the literature review method, and the “country” was set as a unit for the case analysis. The operating method of the health screening programs and the financial resources were compared according to the health insurance system. Five countries were selected as Korea, the United States, the United Kingdom, Japan, and Taiwan.
Results: The analyzed countries mainly operate the health screening program as a management method for chronic diseases, but there were differences in the operating method, financing, and targeted subjects and examination items. In most countries, a risk assessment was performed prior to the examination (screening), and the subjects who needed the examination were first selected, and a follow-up management service was provided in accordance with the risk each individual exposed.
Conclusion: Rather than applying the same screening method to populations with different risk levels, a health screening program will be constructed in consideration of the individual's health level and exposure risk, and the healthcare delivery system will be reorganized so that screening and treatment services can be linked.

KCI등재

6공공기관의 공공성 이행 검토: 의료분쟁조정중재원 사례를 중심으로

저자 : 양화인 ( Fain Yang )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 3호 발행 연도 : 2021 페이지 : pp. 280-291 (12 pages)

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Background: Based on the fact that the Korea Medical Dispute Mediation and Arbitration Agency is a public institution established by social demands for medical disputes, this study reviews the publicness of public organization and discusses its policy implications.
Methods: Through Moore's strategic triangle, which consists of legitimacy and support, public value and operational capacity, the process of creating public value is examined. For the analysis, case studies were conducted using related literature data from 2012, when the agency was established, to the present.
Results: As a result of the analysis, first, the related law examined in the operational capability has been revised dozens of times, but the revised law has its own contradictions and limitations. The human resource system is also being improved, but there is a problem with the fairness and reliability of the arbitration process, especially due to the limitations of the appraiser system. Second, in terms of legitimacy and support, a regional gap occurred despite efforts to improve accessibility through the expansion of the organization. And the arbitration agency failed to reconcile conflicts caused by stakeholders' perception of each other as a trade-off relationship. Third, the public value result shows that, despite many explicit (statistical) achievements, citizens' use of the past dispute resolution means (litigation) has not decreased. Likewise, the perception of value makers (citizens) is important for creating public value as an invisible result, but it has not yet been formally investigated, so the performance can not be recognized.
Conclusion: While the organization's efforts for continuous change and improvement are encouraging, it is not perceived as a better means of resolving disputes and improving quality of services. Therefore, it is necessary to reconsider the institutional design centered on value creators.

KCI등재

7우리나라 고혈압 환자의 투약 순응도 연구

저자 : 홍재석 ( Jae-seok Hong )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 3호 발행 연도 : 2021 페이지 : pp. 292-300 (9 pages)

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Background: Medication adherence in hypertension is the most important to control blood pressure and prevent major complications. The purpose of this study was to identify factors affecting medication adherence and to examine the relationship between medication adherence and blood pressure control in Korea.
Methods: This study used data from the 7th Korea national health and nutrition examination survey (2016-2018) of the Korea Disease Control and Prevention Agency. We selected 4,063 hypertensive patients from the data. And we choose socio-demographic, health behavior, healthcare utilization, and severity characteristics as hypertensive patient characteristics.
Results: Of the patients with hypertension, 92.3% had shown adherence to medication as of 2016-2018 and shows variation according to the characteristic of patients. The cases with male, under 50 years old, urban area, single household, unmet medical services, less than 5 years of hypertension duration, no comorbidities (diabetes mellitus, myocardial infarction) showed significantly low medication adherence. After adjusting for confounders, adherent patients tended to have lower current systolic blood pressure (β=-10.846, p<0.001) and diastolic blood pressure (β=-5.018, p<0.001) than nonadherent patients. And, adherent patients increased the control odds of blood pressure compared with nonadherent patients (odds ratio, 3.02; 95% confidence interval, 2.21-4.12).
Conclusion: This study confirmed that adherence to antihypertensive drugs was effective in controlling blood pressure. In order to more actively manage hypertensive patients at the national level, it is necessary to make an effort to improve the medication compliance of nonadherent groups, such as early-diagnosis patients, young patients under 50 years of age, and patients living alone.

KCI등재

8지역 소멸위험지수와 지역의 만성질환 의료이용의 관계

저자 : 이현지 ( Hyun-ji Lee ) , 오재환 ( Jae-hwan Oh ) , 김재현 ( Jae-hyun Kim ) , 이광수 ( Kwang-soo Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 3호 발행 연도 : 2021 페이지 : pp. 301-311 (11 pages)

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Background: This study purposed to analyze the relationship between the local extinction index and medical service uses of chronic diseases. The local extinction index is an indicator of the demographic structure and population aging of the region.
Methods: The 2014-2018 statistics of National Health Insurance Corporation and Korean Statistical Information Service data were used for the analysis. First, descriptive statistics were used to analyze the general status of research variables. Second, a panel analysis was performed to analyze the relationship between the local extinction index and medical service uses of chronic diseases (hypertension, diabetes mellitus, periodontal disease, arthritis, mental health, epidemic disease, liver disease). Medical service uses were measured by the number of visits/inpatient days and medical charges of seven chronic diseases.
Results: Panel analysis results showed that higher local extinction risks (meaning lower local extinction index) had a positive relationship with the number of visits/inpatient days and medical charges of chronic diseases. But the relationships were varied when the seven chronic diseases were analyzed separately.
Conclusion: This study showed a significant relationship between the local demographic structure and medical service uses of chronic disease. Analyzing the local demographic structure will be an essential prerequisite step for implementing appropriate regional health care policies.

KCI등재

9A Comparative Analysis of Healthcare-Associated Infection Policy in South Korea and Its Implications in Coronavirus Disease 2019

저자 : Yoolwon Jeong , Kinam Kim

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 3호 발행 연도 : 2021 페이지 : pp. 312-327 (16 pages)

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Background: Infection prevention and control (IPC) to manage healthcare-associated infection (HCAI) has emerged as one of the most significant public health issues in Korea. The purpose of this study is to draw implications in IPC policies by analyzing the context, process, and major actors in policy development and comparatively analyzing IPC policy contents of Korea with three other countries. Additionally, IPC policies were analyzed in the context of coronavirus disease 2019 (COVID-19) to provide implications for future pandemics and HCAI events.
Methods: This study incorporates a qualitative approach based on document and content analysis, applying codes and thematic categorization. IPC policy contents are comparatively analyzed by adopting the concept model, developed by the World Health Organization, which consists of core components of IPC structure at the national and facility level.
Results: National IPC policies were developed within a complex social and political context, through the involvement of various stakeholders. IPC policies in Korea place a high emphasis on establishing IPC programs and built environments in healthcare facilities, whereas there were potentials for improvement in policies involving patients and promoting a safety culture. IPC policies, which currently focus on general hospitals and certain functions of hospitals, should further be expanded to target all healthcare facilities and functions, to ensure more efficient and sustainable IPC responses in the current and future disease outbreaks.
Conclusion: IPC is a complex policy arena and lessons learned from the analysis of existing policies in the context of COVID-19 should provide valuable strategic implications for future policies.

KCI등재

10우리나라 성인 당뇨병 환자의 미충족의료 관련 요인

저자 : 장혜영 ( Hye Young Jang ) , 한미아 ( Mi Ah Han ) , 박종 ( Jong Park )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 3호 발행 연도 : 2021 페이지 : pp. 328-334 (7 pages)

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Background: This study was conducted to investigate factors related to unmet medical needs of medical care in adult diabetes patients and to suggest factors related to unmet medical in Korea.
Methods: This study used data from the Korea National Health and Nutrition Examination Survey (KNHNES) 2014-2017. The subjects of the study were conducted on patients with unmet medical needs experience among the patients and analyzed using the IBM SPSS ver. 25.0 program (IBM Corp., Armonk, NY, USA).
Results: Overall, 10.9% of patients had unmet medical needs. Being female, less educated, and lower medical aid were related to unmet medical needs. And subjects with poor subjective health and higher stress level were more likely to report unmet medical needs.
Conclusion: Although comprehensive health insurance coverage, 10.9% of people with diabetes experienced unmet healthcare needs. The results of this study suggest that socioeconomic factors such as low education and medical aid were associated with unmet medical needs.

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KCI등재

1보건부 설립

저자 : 박은철 ( Eun-cheol Park )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 30권 3호 발행 연도 : 2020 페이지 : pp. 265-269 (5 pages)

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Korea has failed to respond to the Middle East respiratory syndrome of 2015 and the early phase of coronavirus disease 2019 (COVID-19) of 2020. This is due to the structural problems of the Ministry of Health and Welfare that has been more increased manpower and budgets of the welfare part relative to those of the health part, and the ministers were appointed welfare experts, not health experts. In 21 (56.8%) of the Organization for Economic Cooperation and Development countries, the Ministry of Health operates independently, and these countries have been relatively well coping with COVID-19. The importance of the Korean health sector is increasing even further. Korea faces on the emerging infectious diseases, chronic infectious diseases such as tuberculosis that has been being a huge burden, and rapidly increasing non-communicable diseases, suicide and mental disorders, and some diseases due to fine dust and climate change. In addition, the rapid advancement of the aging society, the entry of an era of ultra-low fertility and low-economic growth, and the unification of the Korean peninsula are calling for a health policy reform. Therefore, the Ministry of Health should be established and systematically responsible for health policy, disease policy, medical policy, and medical security policy. Ministry of Health will be the control tower for K-Disease Control, K-Bio, and K-Health.

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24차 산업혁명 시대의 대한민국 의료기술 전주기 관리현황 및 단계별 개혁과제

저자 : 김아림 ( Arim Kim ) , 김은정 ( Eun-jung Kim ) , 윤석준 ( Seok-jun Yoon )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 30권 3호 발행 연도 : 2020 페이지 : pp. 270-276 (7 pages)

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Entering the fourth industrial revolution era, health technology is rapidly developing and the people's needs for medical services are gradually increasing. Establishing a life cycle management of health technology has emerged as a new policy agenda to cope with these changes. However, the management of health technology have been conducted without continuity and with several problems pointed out. Therefore, we suggest the reform agendas by stages to establish system for a life cycle management of health technology in the fourth industrial revolution era as follows. In the stage of development, it is important not only to provide research funding, but also consulting by professional about whole cycle of health technologies. In the phase of market entry, there are needs for enhance the system that would expand the early adoption for innovative technology and increase its effectiveness. After the spread of health technology to clinical settings, a reassessment and post management system should be established that have an institutional framework with strong price adjustment and exit mechanism. Furthermore, we hope that discussions will be brisk in macro perspective on the balancing of development in healthcare industry, health of people and national health insurance finance.

KCI등재

3공유진찰제: 만성질환 관리를 위한 혁신적 의료서비스 전달방식

저자 : 이현주 ( Hyunju Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 30권 3호 발행 연도 : 2020 페이지 : pp. 277-285 (9 pages)

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Chronic diseases as well as a growing population of older adults are currently the leading cause of ill health and economic burden worldwide. Managing those diseases in one-on-one medical consultations poses substantial challenges due to limited time and resources in the current health care system. Various approaches have been taken to manage these conditions, most with limited success. Shared medical appointments (SMAs) are an innovative care delivery option to make the testing of alternative care modalities a prime concern. SMAs are individual medical consultations carried out in a group of patients with similar diseases by providing education, medication management, and disease monitoring. SMAs, since their initial conceptualization in 1998, have gained much popularity and adopted as one of the standard processes in many countries. Accumulated evidence-based studies show outcomes for increasing access to care, behavioral change facilitated through self-management education, maintained/better outcomes, physician productivity, and enhanced resource management. This review summarizes current evidence regarding the existing status of SMAs abroad. An extensive literature search was conducted on major electronic databases including PubMed and Google Scholar. This study suggests to explore and exploit the SMAs which have unique potential as a healthcare delivery innovation in Korea.

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4다중흐름모형을 적용한 서울형 유급병가 정책 도입과정에 관한 연구

저자 : 정현우 ( Hyun Woo Jung ) , 박소현 ( So Hyeon Park ) , 손민성 ( Minsung Sohn ) , 정혜주 ( Haejoo Chung )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 30권 3호 발행 연도 : 2020 페이지 : pp. 286-300 (15 pages)

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In 2019, the Seoul metropolitan government established its own 'Seoul-type paid sick leave project'. Although the central government had to introduce such a system, which is also called sickness benefits, it was not implemented. In order to understand the process by which the Seoul government has implemented such a policy, this study used Kingdon's multiple streams framework. As a result, in the problem stream, it was found that the economic burden of sickness has been considered only in terms of medical expenses in the past of Korea. Then Songpa's three women and Middle East respiratory syndrome incidents raised awareness of the necessity of the sickness benefit system in 2014 and 2015. In the political stream, several social affairs such as national health insurance huge surpluses and the 2017 presidential election opened policy window. At that time, Seoul Mayor actively promoted sickness benefits as a policy entrepreneur. In the policy stream, the sickness benefit system has gained new attention through political events. To summary, these three streams flowed separately and then they assembled around huge political affairs. As a result, it was confirmed that Kingdon's model is the most effective theory than any other models in analyzing the health care policy decision process in Korea.

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5체제통합국 건강지표 비교를 통한 통일 후 보건의료에 대한 시사점

저자 : 주영준 ( Yeong Jun Ju ) , 허성은 ( Sung-eun Huh ) , 이주은 ( Joo Eun Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 30권 3호 발행 연도 : 2020 페이지 : pp. 301-310 (10 pages)

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Background: In this study, we aimed to investigate the recent trends for health care indicators including maternal mortality ratio, infant mortality rate, under-five mortality rate, life expectancy, years of life lost, and healthcare resources in South Korea, North Korea, Germany, Russian Federation, Mongolia, Vietnam, China, Czech Republic, Poland, and Hungary.
Methods: We used data from five sources: World Health Organization, Federal Institute for Population Research, World Bank, Organization for Economic Cooperation and Development health statistics, and national statistics.
Results: In the early 1990s, health indicators continued to improve in countries that switched to the health insurance system, but the gap widened in North Korea as health indicators worsened.
Conclusion: The establishment of a sustainable health care system after unification of the Korean peninsula requires substantial changes in the health care system and efforts to improve the health of North Koreans.

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6국내 2018년 의약품 소비량 및 판매액 통계 산출 및 국제 비교

저자 : 김지혜 ( Jihye Kim ) , 이다희 ( Dahee Lee ) , 김수연 ( Sooyon Kim ) , 김동숙 ( Dong-sook Kim )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 30권 3호 발행 연도 : 2020 페이지 : pp. 311-325 (15 pages)

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Background: Health statistics of pharmaceutical use and expenditure are essential to make and implement evidence-based pharmaceutical policy. This study aims to demonstrate the methods and results of pharmaceutical consumption and sales in 2018 according to the sources and methods given by the Organization for Economic Cooperation and Development (OECD).
Methods: The medication list contains 39,346 medicines both reimbursed and non-reimbursed by the National Health Insurance in 2018. We used the therapeutic categories based on Anatomic Therapeutic Chemical Classification of World Health Organization. This study analyzed National Health Insurance claims data and supply data generated from wholesalers to health care facilities. The indicators are defined daily dose (DDD), per 1,000 inhabitants per day and US$ per capita.
Results: In South Korea, the number of medications to which DDD were assigned was 18,055 and it was 45.9% of the total number of medications on the list. The consumption in anti-infective for systemic use (J) and musculo-skeletal system (M) was higher than the mean consumption among the OECD countries. The pharmaceutical sales per person in Korea was also higher than the mean sales per person across the OECD countries. Conclusion: We sought to explain the methods to produce pharmaceutical consumption and sales statistics which we had submitted annually to OECD. Considering the characteristics of pharmaceutical statistics, a direct comparison should be approached with caution. Since the growth in pharmaceutical spending has greatly increased over the past decade, we need to monitor pharmaceutical consumption and expenditure consistently.

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7상복부초음파검사 급여확대에 따른 의료이용의 변화: 이중차이 혼합효과모형 추정방법을 이용하여

저자 : 손예나 ( Yena Son ) , 이용재 ( Yongjae Lee ) , 남정모 ( Chung-mo Nam ) , 김규리 ( Gyu Ri Kim ) , 정우진 ( Woojin Chung )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 30권 3호 발행 연도 : 2020 페이지 : pp. 326-334 (9 pages)

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

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8장애인 건강검진 접근성 저해요인과 개선방안 도출에 대한 질적 연구

저자 : 홍혜수 ( Hye-su Hong ) , 임명준 ( Myung Joon Lim ) , 김외숙 ( Oi-sook Kim ) , 최은숙 ( Eun-sook Choi ) , 김정환 ( Jung Hwan Kim )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 30권 3호 발행 연도 : 2020 페이지 : pp. 343-352 (10 pages)

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Background: The purpose of this study was to identify factors inhibiting access of people with disability to health check-ups as well as identify pertinent solutions for improvement.
Methods: Twenty-three people with disability older than the age of 19 who took respective health check-ups within the last 3 years were selected as participants. For the data collection, the 1:1 intensive interview was used. The data were analyzed by the grounded theory by Corbin and Strauss.
Results: The results comprised nine categories, 23 subcategories, and 179 concepts. The central phenomenon was 'failure to obtain check-ups.' Causal conditions were observed as a 'lack of communication method,' 'physical difficulties,' and 'staff unfamiliar with people with disability,' Interventional conditions comprised 'physical accessibility,' 'staffs' competency,' and 'assistant manpower.' The active strategy was included 'to investigate the professional medical institution,' 'to find the medical institution of convenient traffic accessibility,' 'to overcome communication difficulties through equipment,' and 'to overcome linguistic barriers through sufficient communication.' Whereas, 'utilization of ancillary equipment,' 'the education of staffs on people with disability,' 'universal design manual,' and 'customized check-ups' were included in the passive strategy. Such processes arose in the contextual conditions of 'lack of expectations for daily lives' and 'lack of government support.' As a consequence, the subjects participated experienced the 'disadvantages,' 'discrimination,' and 'reduced reliability of the health check-ups.'
Conclusion: The subjects who participated in this study emphasized 'staffs familiar with people with disability' and 'systems customized for people with disability' are mandatory to secure complete health check-ups for people with disability.

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9장애가 비만 단계별 유병률에 미치는 영향: 장애중증도, 장애유형을 고려하여

저자 : 정재연 ( Jeong Jae Yeon ) , 구준혁 ( Koo Jun Hyuk ) , 신의철 ( Shin Eui Chul ) , 이해종 ( Lee Hae Jong )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 30권 3호 발행 연도 : 2020 페이지 : pp. 345-354 (10 pages)

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Background: This study purposed to examine the difference in the prevalence of obesity at each stage among people with and without disabilities considering the severity and type of disability.
Methods: The study targeted a total of 1,315,967 people, including 68,418 disabled and 1,247,549 non-disabled, who completed the national health screenings. Logistic analysis and average marginal effect analysis were conducted in three stages (pre-obesity, obesity, severe obesity). Those analyses were conducted considering the severity and type of disabilities.
Results: People with disabilities were more likely to be at all stages of obesity than non-disabled people. In severely disabled people, the probability of obesity was higher than non-disabled people at all stages of obesity, but mildly disabled people had a higher only in the severe obesity stage, no difference in obesity stage, and a low in the pre-obesity stage. In physical and mental disabilities, the probability of obesity was higher than non-disabled people at all stages of obesity, but external physical function and internal organs disabled had a lower in the obesity and pre-obesity stage, and no difference in severe obesity stage.
Conclusion: This study found that people with disabilities had a higher relationship with obesity than people without disabilities. In addition, severity and types of disabilities have different effects on the stage of obesity. Therefore, it is necessary to care about the health inequality and health of disabled people considering their severity and types of disabilities.

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10다수준분석을 활용한 개인특성 및 지역환경에 따른 우울증 관련 영향요인 분석

저자 : 문석준 ( Seok-jun Moon ) , 이가람 ( Ga Ram Lee ) , 남은우 ( Eun-woo Nam )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 30권 3호 발행 연도 : 2020 페이지 : pp. 355-365 (11 pages)

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Background: This study is aimed to verify individual and regional-level factors affecting the depression of Koreans and to develop social programs for improving the depressive status.
Methods: This study used individual-level variables from the Korean Community Health Survey (2018) and used the e-regional index of the Korean Statistical Information Service as the regional-level variable. A multi-level logistic regression was executed to identify individual and regional-level variables that were expected to affect the extent of depressive symptoms and to draw the receiver operating characteristic curve to compare the volume of impact between variables from both levels.
Results: The results of the multi-level logistic regression analysis in regards to individual-level factors showed that older age, female gender, a lower income level, a lower education level, not having a spouse, the practice of walking, the consumption of breakfast higher levels of stress, and having high blood pressure or diabetes were associated with a greater increase in depressive symptoms. In terms of regional factors, areas with fewer cultural facilities and fewer car registration had higher levels of depressive symptoms. The comparison of area under the curve showed that individual factors had a greater influence than regional factors.
Conclusion: This study showed that while both, individual and regional-level factors affect depression, the influence of the latter was relatively weaker as compared to the first. In this sense, it is necessary to develop programs focused on the individual, such as social prescribing at the local or community-level, rather than the city and nation-level approach that are currently prevalent.

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