• The Korean Society of Law and Medicine
• /
• v.11 no.1
• /
• pp.145-158
• /
• 2010

현재의 의료 영역은 고도로 전문화되어 있고 더불어 의료의 분업화도 활발히 이뤄지고 있다. 의료의 분업화 과정에는 특히 서로 상이한 전문을 가진 의사들 간의 신뢰와 불신의 문제가 제기되는데 이러한 분업적 의료는 일반적으로 수직적 분업과 수평적 분업으로 구분할 수 있다. 수평적 분업의료에서는 원칙적으로 다른 의사의 주의깊은 행위에 대한 신뢰가 허용된다. 물론 그렇다고 하여 의사에게 검사 내지 재검사의 의무가 없는 것은 아니고 이를 필요로 하는 상황에서는 반드시 재검사가 이뤄져야 한다. 신뢰는 현행법의 과책원칙을 나타내는 '행위에 대한 자유'의 표현이며 의사에게 부주의한 행위가 있는 경우에는 신뢰가 인정될 여지가 없기 때문이다. 결국 재검사를 하여야 할 사정이 존재하지 않는 때에는 다른 영역으로부터의 보고를 원칙적으로 신뢰할 수 있다. 이처럼 본 연구에서는 지속적으로 전문화 및 분업화가 이뤄지고 있는 의료영역에서의 신뢰와 불신에 대한 개관을 통해 이를 재검토하고자 하였다.

• Proceedings of the Korea Information Processing Society Conference
• /
• 2010.11a
• /
• pp.966-968
• /
• 2010

최근 정보통신기술의 발전과 세계화의 진전으로 IT제조업의 생산 효율화를 통한 비용절감의 방안으로 각 생산공정의 국제분업이 이루어지게 되었다. 국제분업을 통해 국가는 비교우위의 생산요소에 집적을 통해 효율화를 이루게 된다. 하지만 이러한 국제분업을 통해 기술의 양극화 현상이 나타나게 되고 국제분업구조에서 기술중진국의 비교우위부문의 확보가 새로운 과제로 부상되었다. 따라서 기술중 진국이 장기적으로 국제분업구조에서 기술부문의 비교우위확보를 위해 민간부문과 공공부문에서 동시에 이루어져야한다.

• KDI Journal of Economic Policy
• /
• v.18 no.2
• /
• pp.63-116
• /
• 1996

우리나라 제조업(製造業)의 수직적(垂直的) 구조(構造)는 선진공업국에 비하여 소(小) 영세기업(零細企業)의 비중이 월등히 높은 피라미드형의 형태를 보이며 80년대말 이후 소기업군의 확대는 더욱 두드러지고 있다. 이처럼 소기업의 비중이 높아진 것은 제조업체들이 가격경쟁력(價格競爭力)을 높이기 위하여 생산비용이 높게 드는 자체생산(自體生産)을 가능한 한 줄이고 임금(賃金)이 낮은 중소기업으로 생산공정을 이양해 왔기 때문이다. 소기업 비중이 높은 분업구조는 가격경쟁력이 중시되어 생산을 분업화해야 하는 경제체제에서는 높은 효율성(效率性)을 발휘한다고 평가할 수 있다. 90년대에 이르러 중소기업이 저가(低價)의 생산요소(生産要素)를 조달받기 어려운 경제여건이 조성되면서 중소기업의 경영불안이 높아지는 등 가격경쟁력을 유지하기 위한 생산분업체제(生産分業體制)는 한계(限界)에 도달한 것으로 보인다. 따라서 대기업과 중소기업간 분업도 기술(技術) 중심의 분업관계(分業關係)로 전환되어야 할 단계에 이르렀다고 볼 수 있다. 그러나 종전과 같이 소기업(小企業)에 의존하는 분업구조(分業構造)로는 기술분업(技術分業)이 정착되기 어렵다. 왜냐하면 연구개발, 전문인력의 고용 등 기술개발과 관련된 기업활동에는 생산량에 관계없이 고정비용(固定費用)이 들어서 기술개발 비용과 위험을 분산시키려면 기업의 생산규모가 상당히 커져야 하기 때문이다. 이는 소기업 중심의 분업구조가 중견기업(中堅企業)중심의 구조로 개편(改編)되어야 함을 의미한다. 중견기업이 육성되려면 첫째, 대기업과 직거래하는 중소업체(中小業體)의 수(數)가 축소되어야 한다. 거래업체수의 과다는 기업규모를 영세하게 만드는 가장 직접적 요인이기 때문이다. 그러나 거래업체의 정리과정에서 기존업체들이 중소기업 보호여론을 등에 업고 반발할 수 있고, 대기업이 교섭력을 강화하기 위한 수단으로 악용할 수 있으므로 객관적이고 투명한 정리기준의 제시가 전제되어야 한다. 둘째, 대기업의 중소기업에 대한 대폭적 자본참여(資本參與)가 허용되어야 한다. 대기업의 자본참여는 중소기업 지배를 강화할 것으로 우려되어 현재는 극히 부분적으로 허용하고 있으나, 개방경제하에서는 대기업과 국내 중소기업간의 협력관계를 유지시키는 효과적 수단으로 작용하게 될 것이다. 셋째, 은행 등 금융자본(金融資本)의 중견기업에 대한 투자(投資) 활성화(活性化)가 필요하다. 금융자율화로 금융기관의 수익성이 강조되는 상태에서 금융자본이 거래업체의 주주(株主)로서 참여하면 경영정보를 손쉽게 파악할 수 있어 우량업체의 신속한 육성이 가능해질 수 있다.

• KDI Journal of Economic Policy
• /
• v.11 no.1
• /
• pp.71-94
• /
• 1989

본고(本稿)에서는 대기업(大企業)과 중소기업(中小企業)간의 합리적(合理的) 생산분업체제(生産分業體制)를 논의(論議)하기 위한 참고자료(參考資料)로서 후진적(後進的) 상황(狀況)에서 출발하여 효율적(效率的) 분업체제(分業體制)를 형성하게 된 일본하청제(日本下請制)의 전개과정(展開過程)과 하청론(下請論)의 주요논점(主要論點)을 개괄적(槪括的)으로 정리(整理)하였다. 하청제(下請制)의 전개과정(展開過程)에는 일본(日本)에 특수(特殊)한 경제적(經濟的) 사회적(社會的) 문화적(文化的) 요인(要因)들이 작용하였지만, 산업기형발전(産業技衡發展)과 시장규모확대(市場規模擴大)에 의한 분업(分業)의 확대(擴大) 심화(深化), 분업체제(分業體制)의 재편과정(再編過程)에 일관(一貫)된 경제적(經濟的) 합리성(合理性)과 경쟁원리(競爭原理)의 관철(貫徹), 분업집단전체(分業集團全體)로서 고생산성(高生産性)과 환경적응성(環境適應性)을 실현하는 기업간(企業間) 연결조직(連結組織)의 특성(特性) 등은 일본적(日本的) 조건(條件)과 무관한 경제논리(經濟論理)로 설명될 수 있다.

• The Science & Technology
• /
• v.32 no.8 s.363
• /
• pp.22-23
• /
• 1999

의약분업이 의사회와 약사회의 협의로 2000년 7월부터 실시하게 되었다. 이번 합의안에는 '대체조제'를 전면 허용하고 있는데 여기서 문제되는 것은 '약효의 동등성'이다. 최초로 개발해 시판하는 오리지널 제품이 아닌 카피 제품들의 약효를 믿을 수 있는가. 이번 의약분업 실현을 계기로 이미 시판되고 있는 모든 카피 제품들을 재검정하여 약효가 떨어지는 제품은 과감히 정리하여 '약이 국민 건강을 지키는 진정한 약'으로 새롭게 탄생해야 하겠다.

• Information and Communications Magazine
• /
• v.27 no.7
• /
• pp.36-41
• /
• 2010

본 논문에서는 개미 군집의 행동 생태를 모델로 하여 군집 시스템의 적응적 분업화, 전문화 특성을 살펴보고, 사물 통신 네트워크 분야로의 응용 가능성을 소개하고자 한다. 내 외적인 환경 변화에 대비하여 개미 군집이 어떻게 효율적인 관리와 전체 시스템의 운영 유지를 할 수 있는지는 시스템 관점의 분석 모델이 요구된다. 한 가능한 모델은 반응역(response threshold)과 일의 자극(task associated stimuli)의 관계로 적응적 반응함수를 사용하는 것이다. 본 논문에서는 적응적인 반응함수가 전체 군집의 효율성과 분업화 과정을 촉발시키는 형태로 발전하는 예제를 보여줄 것이다. 이러한 시스템 분석은 사물 통신 네트워크 분야 연구에 적용될 수 있고, 멀티 에이젼트 시스템에서 효율적인 정보 전송 및 유지, 노드 부하의 균등화, 통신 가능한 스웜 로봇의 업무 분업화 등 다양한 분야로 응용 가능성이 있음을 제안한다.

• Journal of Preventive Medicine and Public Health
• /
• v.26 no.1 s.41
• /
• pp.1-19
• /
• 1993

Mail questionnaire was administrated to 370 practising physicians and 388 pharmacists in Taegu city selected by systematic sampling to examine utilization states and opinion of pharmacy under medical care insurance programme and the attitude to the functional division between physicians and pharmacists from April to May 1992. Regarding the opinion on the outcome of drug-store under medical insurance, 71.2 percent of practicing physician answered faliure but 13.4 percent of practicing pharmacists answered failure in contrast. Fifty percent of practicing physician asserted introducing functional division between physician and pharmacist while 66.9 percent of practicing pharmacist answered drug-store under medical insurance itself is sucessful programme. Average daily numbers of preparation of medicine was 32.2 case. Percentage of utilization of drug-store under medical issurance to average daily cases of preparing of medicine was 20 percent, percentage of utilization with physician's prescription was 0.7 percent. And 58.7 percent of practicing physician experienced outside the institute prescription. Regarding the opinion on the pros and cons of enforcing functional division between physician and pharmacist, 59.2 percent of practicing physician prefered pros and 17.7 percent cons, but 38 percent of practicing pharmacist prefered pros and 45.5 percent cons. And pharmacist knew better the content of functional division between physician and pharmacist than physician. As a reason for pros of enforcing functional division between physician and pharmacist, practicing physician emphasized to prevent misuse or abuse of medicine but practicing pharmacist emphasized to display physician and pharmacist's professional ability. And as an opinion on implementation style of functional division between physician and pharmacist in pros respondents, practicing physician favored mandatory enforcement (52.3%), while practicing pharmacist favored partial incomplete functional division (81.7%). As the method of prescription if functional division between physician and pharmacist will be enforced, both practicing physician and pharmacist prefered generic name (44.0%, 89%) mostly, but physician prefered brand name (35.3%) secondly. Regarding the reason for not implementing functional division between physician and pharmacist up to date, both physician and pharmacist answered problem of business right between physician and pharmacist, followed by lack of recognition, and interest of people and lack of the govermental willness. Regarding the opinion on prior decision of condition for enforcing functional division between physician and pharmacist, practicing physician and pharmacist named uneven distribution of medical facilities and drug-store between rural and urban, inequality of physician and pharmacist manpower and the problem of manpower demand and supply mostly, and practicing physician pointed out establishing attitude of acceptance on the part of pharmacist and practicing pharmacist favored establishing attitude of acceptance on the part of physician, which was different attitudes between physician and pharmacist. Following conclusion was reached ; 1. Current drug-store under medical insurance program yield insufficient outcome, so we should consider program conversion from drug-store under medical insurance program to functional division between physician and pharmacist. 2. There were problem of business right and conflicts between physician and pharmacist at enforcing functional division between physician and pharmacist, so the goverment should search for formulating plan to resolve the problem and have neutral willness for the protection of the national health.

• The Korean Society of Law and Medicine
• /
• v.16 no.1
• /
• pp.125-151
• /
• 2015

South Korea's medical system has dual systems-that is, Oriental and Western Medicine. Both are different from method for diagnosis or treatment of diseases and Scientific principle. Of the characteristics of Oriental medical practice in comparison with Western medical practice, notably, it is difficult to acknowledge specific constitutions, Oriental medical doctors' discretion is broad, and Oriental medical practice has a low invasiveness. Thus, it is difficult to acknowledge human specific constitutions when grounded on Oriental medical principles, thereby making it difficult for Oriental medical doctors to argue such specific constitutions as a means of defending against their medical negligence. And, it is difficult to prove Oriental medical doctors' negligence because Oriental medical doctors' scope of discretion is broad. Collaboration of Oriental medicine and western medicine can diagnose and treat the patient's diseases from a different viewpoint, making both medicines complementary. Oriental medicine and western medicine are independent of each other, equal, thus making them divided horizontally. Horizontal medical service division involves the principle of trust, but the principle of trust does not always apply to Oriental medicine and western medicine, because if patients shift from one area of medicine to another, the scientific principle, diagnostic method and treatment method of that medical area should be different. Application of the principle of trust to both of them needs to be analyzed according to types of medical institutions where transfers occur, and to the scope of work division between them.

• Journal of agricultural medicine and community health
• /
• v.27 no.2
• /
• pp.75-86
• /
• 2002

This study was conducted to investigate the changes in patients and medical services before and after the Separation of Prescription and Dispensing in Health Center. For the purpose of this study, prescription data of 5,890 prescribed patients in March 2000(before the Separation of Prescription and Dispensing) and 3,496 prescribed patients in March 2001(after the Separation) in 4 Health Centers located in Gyeongsangbuk-do and Gyeongsangnam-do were collected. For investigation of the change of character of prescribed patients and the disease, sex, age, chief diagnosis, the hind of medical insurance, days of visit, days of prescription were investigated by using National Health Insurance claim data. And for investigation of change of prescription, prescribed drugs per each claim, the use rate of antibiotics, injection, and high-price antiphlogistic drug were investigated for acute respiratory disease and musculoskeletal disease. The major results were as follows: For the changes of prescribed patients of each disease, patients with acute respiratory disease were decreased by 49.7% after the Separation of Prescription and Dispensing than before the Separation of Prescription and Dispensing and patients with hypertension(18.1%), patients with musculoskeletal disease(70.5%), patients with diabetes(8.5%), patients with digestive organ disease(71.2%), patients with chronic respiratory disease(76.4%) were decreased. But patients with urethritis were increased by 66.7%. The mean Health Center visited days of prescribed patients decreased significantly after the Separation of Prescription and Dispensing than before in both male and female(p<0.01) and in health insurance patients(p<0.01). For the each of the disease, hypertension, diabetes, musculoskeletal disease decreased. The mean prescribed days increased after the Separation of Prescription and Dispensing than before(p<0.01). According to the kine of disease, the mean prescribed days increased after the Separation of Prescription and Dispensing than before in all the diseases except the urethritis(p<0.01). For acute respiratory diseases, number of prescribed drugs per each claim decreased significantly after the Separation of Prescription and Dispensing(4.7 drugs) than before(4.9 drugs) and the prescription rate of injection decreased significantly from 63.8% to 7.70%, and the prescription rate of antibiotics decreased significantly from 337% to 19.1%(p<0.01). For musculoskeletal diseases before and after Separation of Prescription and Dispensing, number of prescribed drugs per each claim decreased significantly from 3.7 to 3.2 and the prescription rate of injection decreased significantly from 64.9% to 1.7%, and the prescription rate of high-price antiphlogistic drugs increased significantly from 29.1% to 397%(p<0.01). In consideration of above findings, the mean visited days decreased and on the contrary, the mean prescribed days per each prescription increased after Separation of Prescription and Dispensing than before in health centers. For the prescription pattern of physicians, number of prescribed drugs and the prescription rates of injection and antibiotics per each claim decreased, but the prescription rate of high-price antiphlogistic drugs increased after Separation of Prescription and Dispensing.

• Journal of agricultural medicine and community health
• /
• v.26 no.1
• /
• pp.19-35
• /
• 2001

This study was conducted to investigate the internal changes and the countermeasure for performance improvement by Separation of Prescribing and Dispensing Practice (SPDP) in Health Center. Data were collected from two sources: Performance report before and after SPDP of 25 Health Centers in Kyongsangbuk-do and 6 Health Centers in Daegu-City and self-administerd questionnaire survey of 221 officials at health center. The results of this study were summarized as follows: Twenty-four health centers(77.4%) of 31 health centers took convenience measures for medical treatment of citizens and convenience measures were getting map of pharmacy, improvement of health center interior, introduction of order communication system in order. After the SPDP in health centers, 19.4% of health centers increased doctors and 25.8% decreased pharmacists. 58.1% of health centers showed that number of medical treatments were decreased. 96.4%, 80.6% 80.6% 96.7% of health centers showed that number of prescriptions, total medical treatment expenses, amounts paid by the insureds and the expenses to purchase drugs, respectively, were decreased. More than fifty percent(54.2%) of health centers responded that the relative importance of health works increased compared to medical treatments after the SPDP, and number of patients decreased compared to those in before the SPDP. And there was a drastic reduction in number of prescriptions, total medical treatment expenses, amounts paid by insureds, the expenses to purchase drugs after the SPDP. Above fifty percent(57.6%) of officers at health center responded that the function of medical treatment should be reduced after the SPDP. Fields requested improvement in health centers were 'development of heath works contents'(62.4%), 'rearrangement of health center personnel'(51.6%), 'priority setting for health works'(48.4%), 'restructuring the organization'(36.2%), 'quality impro­vement for medical services'(32.1%), 'replaning the budgets'(23.1%) in order. And to better the image of health centers, health center officers replied that 'health information management'(60.7%), 'public relations for health center'(15.8%), 'kindness of health center officers'(15.3%) were necessary in order. Health center officers suggested that 'vaccination program', 'health promotion', 'maternal and children health', 'communicable disease management', 'community health planning' were relatively important works, in order, performed by health center after SPDP. In the future, medical services in health centers should be cut down with a momentum of the SPDP so that health centers might reestablish their functions and roles as public health organizations, but quality of medical services must be improved. Also health centers should pay attention to residents for improving health through 'vaccination program', 'health promotion', 'mother-children health', 'acute and chronic communicable disease management', 'community health planning', 'oral health', 'chronic degenerative disease management', etc. And there should be a differentiation of relative importance between health promotion services and medical treatment services by character of areas(metropolitan, city, county).