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한국보건행정학회> 보건행정학회지> 다수준분석을 활용한 개인특성 및 지역환경에 따른 우울증 관련 영향요인 분석

KCI등재

다수준분석을 활용한 개인특성 및 지역환경에 따른 우울증 관련 영향요인 분석

Related Factors of Depression according to Individual Attributes and Regional Environment: Using Multi-Level Analysis

문석준 ( Seok-jun Moon ) , 이가람 ( Ga Ram Lee ) , 남은우 ( Eun-woo Nam )
  • : 한국보건행정학회
  • : 보건행정학회지 30권3호
  • : 연속간행물
  • : 2020년 09월
  • : 355-365(11pages)
보건행정학회지

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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.

UCI(KEPA)

I410-ECN-0102-2021-500-001353150

간행물정보

  • : 의약학분야  > 예방의학및보건학
  • : KCI등재
  • :
  • : 계간
  • : 1225-4266
  • : 2289-0149
  • : 학술지
  • : 연속간행물
  • : 1991-2021
  • : 948


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1연구윤리 환경 변화와 연구윤리 정책동향

저자 : 이선희 ( Sun-hee Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 2호 발행 연도 : 2021 페이지 : pp. 145-147 (3 pages)

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The ethical environment in academic research is rapidly changing at a global level. Further, social expectations and public interest toward research ethics are also escalating in Korea. Understanding and applying ethical issues in academic research has become increasingly important. To conform to such changes in the ethical environment, the official journal of the Korean Academy of Health Policy and Management has been consistently establishing and modifying rules and principles regarding research ethics. For instance, we amended the submission guidelines to further address the policies for gendered innovations. For this editorial of the current issue, we would like to organize and share several ethical concerns, which recently gained considerable attention. We hope this review provides scholars with practical guidelines to comprehend and incorporate critical ethical issues into academic research.

KCI등재

2합리적 기술 활용이 연구개발에 미치는 영향: 의료기기 개발 사례를 중심으로

저자 : 민혜숙 ( Hye Sook Min ) , 박지은 ( Ji Eun Park ) , 김창엽 ( Chang-yup Kim )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 2호 발행 연도 : 2021 페이지 : pp. 148-157 (10 pages)

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Background: Based on that the key function of health technology is improving the quality of healthcare services, our study purports to explore the process of medical device development in detail and to discuss its policy implications.
Methods: A total of 12 in-depth interviews were conducted with four groups of industry, hospital, academia, and civil society. All of the interviewees except those from civil society were involved in the new medical device development between 2009 and 2018. We performed a text network analysis and content analysis of the interview data.
Results: The frequency and the degree centrality rankings suggested a close association between the utilization issue and the technology development. Similarly, the results of the content analysis showed that the appropriate intervention in the utilization of technology has a direct impact on the progress of development. Under the continuous industrial effort to boost profits by developing new technology, service providers and citizens should be knowledgeable of and make good use of the new technology for the provision of better services.
Conclusion: As the development itself would not guarantee the improvement of service quality and better health outcomes, health technology policies should take a more comprehensive view to serve the unmet needs and even to facilitate the technology development.

KCI등재

3우리나라 성인의 고감도 C-반응성 단백과 대사증후군의 관련성: 성별 분석

저자 : 신은영 ( Eunyoung Shin ) , 이용재 ( Yongjae Lee ) , 김태현 ( Taehyun Kim ) , 정금지 ( Keum Ji Jung ) , 정우진 ( Woojin Chung )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 2호 발행 연도 : 2021 페이지 : pp. 158-172 (15 pages)

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Background: Metabolic syndrome has been known as a risk of cardiovascular disease. Meanwhile, high sensitivity C-reactive protein (hs-CRP) is used as a predictor of cardiovascular disease. In this paper, we aimed to investigate the association between hs-CRP and metabolic syndrome.
Method: A total of 7,633 were chosen as the study population from the 7th Korea National Health and Nutrition Examination Survey dataset (2016-2017). Our dependent variable was whether an individual had metabolic syndrome or not, and the independent variable of interest was hs-CRP which was categorized into three groups. The chi-square tests and hierarchical logistic regression analyses reflecting survey characteristics were conducted. All analyses were stratified by gender.
Results: According to the adjusted model with all covariates, compared to individuals having the low risk of hs-CRP, those having its average risk were more likely to have metabolic syndrome in men (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.12-1.76) and women (OR, 1.69; 95% CI, 1.33-2.16). Individuals having the high risk was not significantly different in men; however, they were more likely to have metabolic syndrome in women (OR, 2.03; 95% CI, 1.28-3.23).
Conclusion: In an upcoming aging society, it is important to reduce the risk of metabolic syndrome to improve population health. This study suggests that hs-CRP may be used as a marker of the risk of metabolic syndrome in a gender-specific way, thereby contributing to enhancing awareness of the risk of metabolic syndrome among the general public.

KCI등재

4장기입원 의료급여 환자의 재원일수에 미치는 영향요인: 요양병원 입원유형 중심으로

저자 : 윤은지 ( Eun Ji Yun ) , 이요셉 ( Yo Seb Lee ) , 홍미영 ( Mi Yeong Hong ) , 박미숙 ( Mi Sook Park )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 2호 발행 연도 : 2021 페이지 : pp. 173-179 (7 pages)

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Background: In Korea, the length of stay and medical expenses incurred by medical aid patients are increasing at a rate faster than the national health insurance. Therefore, there is a need to create a management strategy for each type of hospitalization to manage the length of stay of medical aid patients.
Methods: The study used data from the 2019 National Health Insurance Claims. We analyzed the factors that affect the length of stay for 186,576 medical aid patients who were hospitalized for more than 31 days, with a focus on the type of hospitalization in long-term care hospitals.
Results: The study found a significant correlation between gender, age, medical aid type, chronic disease ratio, long-term care hospital patient classification, and hospitalization type variables as factors that affect the length of hospital stay. The analysis of the differences in the length of stay for each type of hospitalization showed that the average length of stay is 291.4 days for type 1, 192.9 days for type 2, and 157.0 days for type 3, and that the difference is significant (p<0.0001). When type 3 was 0, type 1 significantly increased by 99.4 days, and type 2 by 36.6 days (p<0.0001).
Conclusion: A model that can comprehensively view factors, such as provider factors and institutional factors, needs to be designed. In addition, to reduce long stays for medical aid patients, a mechanism to establish an early discharge plan should be prepared and concerns about underutilization should be simultaneously addressed.

KCI등재

5Diagnosis-Related Group 지불제도가 위험도 보정 제왕절개 분만율에 미치는 영향

저자 : 곽진미 ( Jin-mi Kwak ) , 이광수 ( Kwang-soo Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 2호 발행 연도 : 2021 페이지 : pp. 180-187 (8 pages)

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Background: This study analyzed the effect of applying the diagnosis-related group (DRG)-based payment system, which was implemented in July 2012 for hospitals and clinics nationwide, on the cesarean section rate.
Methods: The subjects of the study were divided into new groups that participated in the payment system after July 2012 and maintenance groups that participated in the payment system before July 2012. As an analysis method, a difference-in-difference analysis, which is a quasi-experimental design, was used. The risk-adjusted cesarean section rate was used as a dependent variable.
Results: Seven risk factors (malpresentation of fetus, eclampsia, multiple pregnancies, problems in the placenta, previous Cesarean section, cephalopelvic disproportion, problems in amniotic fluid) were included in the final risk-adjustment model, and found to have a statistically significant relationship with the cesarean section rate. Results showed that the risk-adjusted cesarean section rate increased significantly in new groups after the application of the DRG-based payment system.
Conclusion: Study results provided policy implications for the reorganization of the DRG-based system should that reflects the demands of obstetricians, such as organizing a consultative body with obstetricians and establishing a reasonable fee.

KCI등재

6소멸위험지역과 치료 가능 사망률 간의 관계

저자 : 설진주 ( Jin-ju Seol ) , 조형경 ( Hyung-kyung Cho ) , 이현지 ( Hyun-ji Lee ) , 이광수 ( Kwang-soo Lee )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 2호 발행 연도 : 2021 페이지 : pp. 188-196 (9 pages)

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Background: This study purposed to analyze the relationship between extinction risk regions and amenable mortality.
Methods: This was a cross-sectional study based on the statistics of 2018 which was extracted from the 228 administrative districts in Korea. Cause of death statistics on each region in 2018 was used to produce the age-adjusted amenable mortality. Regional characteristics were measured by demographic factors, health behavior factors, socioeconomic factors, and medical resources factors. Multiple linear regression model was applied to test their relationship.
Results: Results showed that extinction risk regions, crude divorce rates, national cancer screening rates, and independent rate of finance were significantly related to the amenable mortality.
Conclusion: The study demonstrated differences in health status by the extinction risks of regions. This study suggests that the use of customized community care program can provide integrated services such as housing, health care or the use of information and communications technology which can make early diagnosis.

KCI등재

7거주지역에 따른 물리적 접근성으로 인한 미충족 의료경험

저자 : 김지은 ( Ji Eun Kim ) , 함명일 ( Myung-il Hahm )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 2호 발행 연도 : 2021 페이지 : pp. 197-206 (10 pages)

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Background: The purpose of this study was to identify factors affecting unmet healthcare needs due to physical accessibility by residential area by utilizing the Korea Community Health Survey (KCHS).
Methods: Andersen's medical service behavioral model was applied to analyze the enabling factors, predisposing factors, and needs factors of unmet healthcare needs focusing on residential areas. This study used data from the KCHS (2017-2019, n=440,792). We used multivariate survey logistic regression analysis in order to identify affecting factors. Sub-group analysis was conducted in order to evaluate the effects of residential areas.
Results: Some participants (2,621, 0.59%) had experienced unmet healthcare needs due to physical accessibility and 2,047 subjects (78.1%) of them lived in rural areas. Multivariate survey logistic regressions revealed that experience of unmet healthcare needs due to physical accessibility increased when people lived in rural areas (odds ratio [OR], 3.95; 95% confidence interval, 3.46-4.51).
Conclusion: This study showed that despite the development of transportation and efforts to alleviate medical inequality, residents in rural areas may still have higher experience of unmet healthcare needs due to physical accessibility compared to the metropolitan city regardless of any other sub-group differences (OR range, 1.90-6.31). This study suggested that government and policymakers should identify the causes of the experience of unmet healthcare needs due to physical accessibility and should develop policies to alleviate those healthcare disparities.

KCI등재

8외래 환자경험에 영향을 주는 요인

저자 : 김경훈 ( Kyoung-hoon Kim )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 2호 발행 연도 : 2021 페이지 : pp. 207-216 (10 pages)

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Background: Good patient experience is positively associated with adherence to treatment recommendations, better clinical effectiveness, and health outcomes. This study aims to find out the key factors affecting positive patient experience to improve the quality of care using nationally representative survey data.
Methods: The data was collected from the 6th National Health Nutrition Survey in 2015. Four patient experience items were investigated for patients with visiting outpatient care over the past year. Positive patient experience was defined as a case of responding always or usually yes. The t-test, chi-square test, and multiple logistic regression were performed to determine the key factors affecting the outpatient experience.
Results: More than 80% of the respondents reported their care experience as positive excluding doctor spending enough time during the consultation. Male, poor health status, and single/divorced, and the longer time interval between outpatient care visit and survey were found to be significantly correlated with negative care experiences in the multiple logistic regression. Patients who received outpatient care at the oriental medicine clinic had a positive experience compared to those received outpatient care at the general hospital. However, patient factors including age, income, job, and insurance type had no significant association with patient experience.
Conclusion: Health care providers should prioritize patients who report negative patient experiences and implement management decisions to improve the patient experience.

KCI등재

92018년 한국 보건의료의 상대적 위치와 추이: 경제협력개발기구 국가와 비교

저자 : 윤흰뫼 ( Hin Moi Youn ) , 이현지 ( Hyeon Ji Lee ) , 박은철 ( Eun-cheol Park )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 2호 발행 연도 : 2021 페이지 : pp. 217-224 (8 pages)

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The objective of this study is to investigate the healthcare status of South Korea and other member countries of the Organization for Economic Cooperation and Development (OECD) using OECD health statistics 2020. We employed the position value for relative comparison index to measure the healthcare status in five following components: demand, supply, accessibility, quality, and cost. The Mann-Kendall test was used to analyze for increasing or decreasing trend of the position value for relative comparison values from 2000 to the recent year. Results showed that Korea was positioned above than the OECD median values in most of components, but lower than the median values in certain indices including healthcare employment, primary care, and mental health care. This study sheds some light on healthcare issues to be improved and the policy-makes can take into account for prior setting process.

KCI등재

102019 미충족의료율과 추이

저자 : 장빛나 ( Bich Na Jang ) , 주재홍 ( Jae Hong Joo ) , 김휘준 ( Hwi Jun Kim ) , 박은철 ( Eun-cheol Park ) , 장성인 ( Sung In Jang )

발행기관 : 한국보건행정학회 간행물 : 보건행정학회지 31권 2호 발행 연도 : 2021 페이지 : pp. 225-231 (7 pages)

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Unmet healthcare is an important indicator to measure accessibility of healthcare services. To examine the latest status of unmet healthcare needs in South Korea, the four different data which is composed of nationally representative sample of South Korean population were used; the Korea Health and Nutrition Examination Survey (KNAHANES, 2007-2019), the Community Health Survey (CHS, 2008-2019), the Korea Health Panel Survey (KHP, 2011-2017), and the Korean Welfare Panel Study (KOWEPS, 2006-2019). The proportion of individuals reporting unmet healthcare needs were 5.8% (KNHANES), 5.3% (CHS), and 11.6% (KHP). Annual percentage change (APC) which identifies trend for the follow-up period was -9.5%, -8.0%, and -6.5%, respectively. The proportion of individuals reporting unmet healthcare needs due to cost were 1.1% (KNAHANES), 0.7% (CHS), 2.4% (KHP), and 0.4% (KOWEPS). The APC was -10.5%, -14.2%, -12.2%, and -19.6%, respectively. Compared to last year, the rate of unmet healthcare needs has declined in general. However, the low-income and the elderly population were reporting the highest rate of unmet health care needs, and the disparity between lowest and highest groups were remained. These results suggest that adequate benefit coverage is needed for low-income and elderly population.

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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.

KCI등재

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.

KCI등재

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.

KCI등재

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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