• 보건행정학회지
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• 제34권2호
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• pp.120-128
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• 2024

2024년 2월부터 현재까지 의과대학 입학정원 확대를 두고 논란이 계속되고 있다. 이런 논란은 현재와 미래의 시점의 문제가 혼합되어 논란을 더 가중하고 있다. 현시점에서 의사의 인력부족 여부에 대한 논란은 다양하다. 동일한 근거가 의사 부족 또는 부족하지 않은 근거로 제시되기도 한다. 부족하다는 근거로 제시하는 것에 대해서도 이견이 많으며 그 반대의 근거도 이견이 많다. 현시점에서 의사 부족 여부를 둘러싼 이런 논란은 합의될 가능성이 그리 크지 않다. 10년 후에는 노인인구의 급격한 증가로 인해 의사가 더 필요하게 될 것이므로 의과대학 입학인원을 늘려야 할 것이다. 그러나 그 숫자는 의학교육의 질이 저하되지 않을 수준이어야 한다. 이를 위해 의학교육의 질이 높은 의과대학에 더 많은 입학인원을 배정해야 하며, 그 대안으로 대규모 의과대학은 입학인원을 20%-30% 늘리고, 소규모 의과대학은 입학인원을 40%-50% 늘리면 전체 증가인원은 760-1,066명이 되는 것이다. 2,000명 증원이 강행된다면 의학교육의 질을 면밀히 평가해 그 결과를 의과대학 정원 조정에 반영해야 할 것이다. 20년 후에는 의과대학 입학정원을 줄여야 한다. 이는 의사공급이 1차함수로 증가할 것인데 반해 의사수요(의료수요)가 꼭지점이 있는 2차함수로 변화하고 있기 때문이다. 현재의 인원을 유지하더라도 2048년부터는 의사가 과잉되기 때문에 의과대학 입학인원을 줄여야 하며, 규모는 현재보다 1,000명이 적은 2,000명 정도로 축소해야 할 것이다. 정원 축소 시 모든 의과대학에 일률적으로 축소한다면 소규모 의과대학이 많아지기에 M&A (mergers and acquisitions) 전략을 적용해야 할 것이며, 그 대상은 40개의 의과대학과 12개의 한의과대학이어야 할 것이다. 우리나라의 경우 의사수요 추정에 가장 큰 영향을 미치는 요인은 인구 변화이다. 합계출산율의 급격한 감소로 인해 향후 인구 전망은 불확실성이 상당 수준 있으며, 최근 의료이용률의 급격한 증가가 반영된 수급추계는 재검토되어야 한다. 의사 수급추계의 불확실성으로 인해 의사 수급추계는 최소한 5년 단위로 지속적으로 실시되어야 하며, 이를 위해 보건의료인력검토위원회를 설치 운영해야 한다.

• 대한한방내과학회지
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• 제39권4호
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• pp.662-675
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• 2018

Objective: The aim of this study was to establish the developmental history of hospice palliative care (HPC) with Korean medicine (KM). Methods: We compared the developmental history of HPC in Korea with that of Britain, the United States, Taiwan, Japan, and China. The articles in English or Korean published until Feb. 2017 were searched using 'Hospice' or 'Palliative care' with the name of each nation in the PubMed, MEDLINE, ScienceDirect, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases for foreign articles and OASIS (Oriental Medicine Advanced Searching Integrated System) for domestic articles. Books and gray literature were searched on the same databases and websites of the Ministry of Health and Welfare and related organizations in each country. Results: Modern palliative care began with the hospice movement led by Dr. Cicely Saunders. HPC in Korea started earlier than in other countries but it took considerable time for social consensus, so Korean policies have only been published recently. In this process, KM was excluded from HPC. For this reason, western medicine in Korea does not fully accept the spirit of HPC, the government does not take an aggressive stance with KM, and the institutes of KM do not have any interest in HPC. The World Health Organization recommends the establishment of policies and programs connected with a country's own health care system. In 2015, the Korean government made the third comprehensive plan for the development of KM. It included critical pathway guidelines about cancer-related fatigue and anorexia. More effort is required to set up HPC than other care types because Korea has two medical systems. Conclusions: Each nation has been trying to improve systems of HPC. We need to overcome the problems and bring out the best by making our own model of HPC with KM.

• Journal of Preventive Medicine and Public Health
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• 제31권3호
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• pp.516-539
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• 1998

The objective of this study is to identify the difference in attitude toward medical care between patients who visited a university hospital or an oriental medical hospital of oriental medical college, and physicians who engaged in the same hospitals. The subjects of this study were 397 cases who agreed to respond the prepared questionnaire, including 288 patients(146 university hospital utilizers and 142 utilzers for an oriental medical hospital) and 109 physicians(76 physicians and 33 oriental medical doctors). The attitude toward medical care was measured by the structured questionnaire developed for this study, which had high validity and reliability according to factor analysis, item discriminant validity, and Cronbach's $\alpha$ coefficients. On the criteria of mean value of care and cure score, the attitude toward medical care was classified into 4 groups encompassing a group with dependent attitude on medical care, a group with skeptical attitude toward it, a group with cure-oriented attitude, and a group with care-preferred attitude. The results of chi-square test, discriminant analysis, and logistic regression analysis were as follows; patients who visited a univisity hospital, patients who visited an oriental hospital, physicians, and oriental medical doctors included in the group with dependent attitude, the group with cure-oriented attitude, the group with skeptical attitude, and the group with care-preferred attitude, retrospectively. Among the subdomains of care and cure domains, which classified in reference to the result of factor analysis on pilot study, those that patients ranked more importantly than physicians were 'the importance of medical equipment for diagnosis and treatment', 'authority of physician, 'aggressiveness of treatment', 'information giving', 'personal interest' in the case of western medicine. In the case of oriental medicine, those were 'the importance of equipment for diagnosis and treatment', 'aggressiveness of treatment', 'amenities and accessibility', 'coordination of medical staff'. Both physicans and patients put the subdomain, 'physicians' medical knowledge and skillfulness' on the highest rank. The differences in ranking the important attributes of medical care between patients and physicians were apparent in the area of an 'importance of medical equipment for diagnosis and treatment' and so on. It meant that patient had over-expectation on medical care and suggested that the policy on demanad side such as the developement and dissemination of an evidence-based recommendation protocol for health care consumers might be important in Korea. In addition, regarding the attitude of physicians, during the medical education and training it may be neccessary to emphasize the aspect of 'care' of medical care rather than 'cure'. In planning on heath care delivery system, it should be considered that there is a difference in the attitude toward medical care between western medicine and oriental medicine as well as between health care providers and consumers. We expect that more valid measurement tool be developed in this area, which may be major limitation of this study and that this kind of research be expanded into the non-academic settings.

• Journal of Yeungnam Medical Science
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• 제3권1호
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• pp.87-94
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• 1986

1983년 5월부터 1986년 11월까지 3년 6개월 동안 본 영남 의료원에서 입원 치료를 받았던 농흉 환자 48예를 대상으로 임상적 고찰을 실시한 바 다음과 같은 결과를 얻었다. 1. 호발 연령군은 15세 이하와 36세에서 65세 사이의 연령층이었고, 16세 이상의 성인에서는 남녀 비율이 6.4:1로서 남자가 월등히 많았다. 2. 농흉의 유발인자는 음주나 사고로 인한 의식장애가 36.4%로 가장 많았으며 이중 94.1%가 남자였다. 3. 농흉의 원인은 폐렴이 64.6%로 가장 많았으며 그외에 폐농양이 6.3%, 횡격막하 질환이 6.3%, 수술후 합병증이 6.3%였다. 4. 증상은 발열, 기침, 흉통, 호흡곤란, 객담, 체중감소, 식욕부진, 도한의 순서로 있었다. 5. 늑막액의 세균 배양율은 50%였으며 원인균은 그람음성 간균(33.3%), 포도상구균(25%), 연쇄상구균 (25%) 등의 순서였다. 6. 치료 방법으로는 항생제의 사용 및 원인 치료와 함께 삽관배농술(77.1%), 늑막천자(6.3%), 폐박피술(6.3%) 등이 응용되었고, 전체 사망율은 8.3%였다.

• 사상체질의학회지
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• 제23권1호
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• pp.115-124
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• 2011

1. Objectives : This study aimed to provide practical insights on the development of traditional Korean medical tourism and maximize the satisfaction of foreign patients. The main objectives of this study were also to evaluate Sasang Constitutional Medicine(S.C.M.) diagnosis cost from foreigners' perspectives. 2. Methods : For this study, the data were collected from tourists to Korea between January 3, 2010 to February 20, 2010. The sample used in this study was mainly composed of Japanese, Chines and US/Canada, because they are the major national visitor origin group to Korea. The primary data were collected by questionnaire survey using a standardized instrument with a convenience sampling procedure, and efforts of the interviews involved an on-site, self-administrated questionnaire to those sitting or visiting tourist attractions. The total size of the sample was 276 of which 275 showed no missing value against the factors needed for final analysis and were for analysis as an effective sample. SPSS 13.0 for window was used to analyze the collected data on which descriptive statistics and the Limited Dependent(LIMDEP) 8.0 program was used in estimating the willingness-to-pay(WTP) for traditional Korean medical tourism through the Contingent Valuation Method(CVM). A dichotomous choice question form of a CVM was applied to estimating the value. 3. Results and Conclusion: 1. There was significant statistical relationship between attributes when considering medical tourism destination and socio-demographic profiles such as age group, nationality, educational level and occupation. 2. In the level of recognition on Korean medicine, north Americans showed low level of recognition compared to other nationalities. In addition, in terms of age group, 20's and 30's showed low level of recognition on Korean medicine, 3. In relation to the level of interest on Korean medicine, Japanese respondents had higher interesting level on Korean medicine. Also singles had higher level of interest. 4. Regarding preferred Korean medical treatment program, there found significant statistical relationship between Korean medical treatment program and socio-demographic characteristics. 5. The estimating result of the logit model showed that the variables affecting the WTP for Sasang Constitutional medicine diagnosis were offered price and potential ability of medical tourism destination. 6. In relation to WTP for Sasang Constitutional medicine diagnosis, Japanese respondents showed a WTP of USD 62.69 and Chinese respondents showed USD 57.09. On the other hands, respondents from north America and other countries showed a WTP of USD 65.50. In conclusion, from this study, the results found that the opportunities in tradition Korean medical tourism are immense and the possible rewards are numerous. It is time to continue to promote 'Sasang Constitutional medicine' and make the Korean medical tourism programs considering on nationalities, age group, gender and WTP.

• 동의생리병리학회지
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• 제21권6호
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• pp.1590-1596
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• 2007

Complementary and alternative medicine (CAM) has gained in popularity among cancer patients in recent years. The use of CAM in cancer patients is common with about one third of patients using some form of CAM in Western countries. The purpose of this study was to analyze the use of CAM and determine what factors affect to use CAM among cancer patients to provide CAM therapy information and assist therapy selection among various CAM therapies to cancer patients. The design of the study was descriptive cross-sectional, and data were collected using a 16-item questionnaire. This study was conducted in subjects with confirmed diagnosis of stomach, colon, liver, or pancreas cancer, in both out-patients clinics and inpatients setting in a tertiary hospital in Seoul Korea. As a result, among the participants, past or current CAM use was reported by 75%, which shows a statistically significant difference in income groups(P<0.05), but no difference in age and religion groups. The most common therapies use by cancer patients included traditional Korean medicine (32.1%), folk remedies (26.6%), exercise (14%), dietary supplements (11.6%), physical therapy (9.9%), diet therapy (5%), and meditation (4%). 77.8% of patients show satisfaction and 64.4% shows perceived effectiveness of CAM. Male patients with higher income, and previous treatment were more likely to use CAM. The main benefits from CAM reported by cancer patients were psychological improvement and symptom improvement. Of the cancer patients used CAM, 30.9% were dissatisfied, 25.8% did not have benefits from the use, and 7.6% experience side effects. Cancer patients who prefer CAM (more than 3 kinds) used it to cure cancer, on the contrary, the one who do not prefer CAM used to improve symptoms and psychological stability. The main sources of information about CAM were family and friends(54.4%), and media(24.5%), doctor and nurse(18.3%), and religion group(2.6%). Findings suggest that due to the relatively high use of CAM among cancer patients in Korea, this topic should be taken into account in the development of a holistic approach to cancer patients and efficient cancer patients management system and proactive and consistent management of CAM is necessary in the health care system in Korea.

• 대한한방종양학회지
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• 제9권1호
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• pp.39-46
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• 2003

Objectives : The former study of Oriental Medicine on cancer has been mostly focused on lab studies with herbal medicine. Among this atmosphere, the aim of this study is to investigate the suitability of Oriental Medicine institutions to participate in cancer registry programme in R.O.K by investigating the type of treatments used for cancer patients in Oriental Medicine institutes. Methods : To investigate the actual conditions of cancer patients who visited Oriental Medicine institutes, a survey was done based on clinical charts of 258 patients of cancer. Results : The order for the percentage of the original tumor organ of the patients, the number of patients who recognized the outbreak on the year of the first visit was the biggest, and the number gradually decreased while the years passed. For the type of treatment, herbal medicine was the most for 92.6%, acupuncture 52.6%, moxibustion 16.7%, cupping 14.7%. It can be seen that multiple treatment was preferred to single treatment. Among the periods for herbal medication, 10 days was the most for 34.1%, 29.8% for within 50 days and 10.5% for within 100 days. The percentage of patients who took treatment of western medicine at the same time and those who took treatment of Oriental medicine only was 47.4% and 43.8% respectively. By surveying categories such as the symptoms, diagnosis of syndrome, principle of treatment from the chart by a free description, there was 841 names of symptoms, 207 diagnoses of syndromes and 206 principles of treatment. But no relation or connection between these could be found statistically. At there were even occasions which the doctor didn't record the cancer itself, precise investigatio for the actual condition of cancer patients in Oriental Medicine institutions appeared to be very difficult. Conclusions : It seems impossible to enroll cancer patients of Oriental Medicine institutions to the cancer registry programme in R.O.K as far as the patients are recorded only under the paradigm of Oriental Medicine. However, if the Oriental Medicine doctors keep a consistency in classifying categories such as cause of death, syndrome diagnosis, principle of treatment and prescriptions, and limit the choices, for each category, a pilot study for cancer registry programme in R.O.K. in Oriental Medicine could be carried out.

• 동의생리병리학회지
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• 제20권3호
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• pp.527-534
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• 2006

This is a pilot study to survey the general demand of senior-assistive necessities before a standardization system for senior-assistive necessities is developed as well as to describe health professionals' opinions about the demand and quality of Oriental medical aids and necessities for daily living for the elderly. This is a descriptive survey in which 29 health professionals are questioned, using structured questionnaires based on ISO 9999. The questionnaires were developed by 7 expert conduction standardization system of senior-assistive products in Korea. The data is analyzed by descriptive statistics. The result is as follows : First, with regard to the demand for all of the items in Oriental medical aids for the elderly, the demand of cupping glasses is the highest, followed by instrument used to apply heat treatment, massage equipment, thermo-therapeutic mattress, and heat or ice packs. With regard to the demand for all of the items for the necessities for daily living for the elderly, chairs are the highest, followed by rolling chairs, beds for health, and heigh adjustable beds. Second, with regard to quality of Oriental medical aids, ${\ulcorner}$aids for hair care${\lrcorner}$ are the best, whereas ${\ulcorner}$aids for boiling Oriental medicine${\lrcorner}$ are the worst. In quality of the necessities for daily living, ${\ulcorner}$chairs${\lrcorner}$ are the best, whereas ${\ulcorner}$beds${\lrcorner}$ are the worst. Above all, this result shows that with ${\ulcorner}$aids for heat or cold treatment${\lrcorner}$, there is relatively high demand and low quaily of Oriental medical aids, and with ${\ulcorner}$Beds${\lrcorner}$, there is relatively high demand and low quality. Therefore, aids for heat or cold treatment and beds in th necessities for daily living are required to be developed for standardization of senior-assistive necessities.

• 혜화의학회지
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• 제19권1호
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• pp.143-151
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• 2010

The purpose of this study is to survey the current status of the oriental medical service satisfaction and needs that the people who utilizing the medical services and suggest the primary factors of consumption and satisfaction in the oriental medical services the city of Asan. We analyze the use and satisfaction of the customers for the oriental medical services with using the questionnaires to the citizens of Asan. The method of this study is that the participants of the survey was 556 people of Asan City. The survey was conducted from August 15th, 2009 to September 15th, 2009(during 30 days) with disease index that specially developed as oriental medicine. The results of this study are as follows: 556 people were responded the survey. 471(84.7%) of respondents were who have ever been treated with oriental medical service and 85(15.3%) of respondents were who have never been treated with oriental medical service. 25(4.7%) of respondents were who doesn't believe the treat of oriental medicine. 76(13.6%) of respondents prefered the oriental medical service. 413(50.1%) of respondents prefered the acupuncture and moxa treatment and 280(33.9%) prefered the herbs. 227(39.6%) of respondents were treated for musculoskeletal disorders The conclusions from this study are as follows: Firstly, it was found that the people who prefer to use oriental medical services usually have one or more of these following diseases: musculoskeletal disorders, paralysis, unclear diseases or injuries. Secondly, the main factor of customers' satisfaction with oriental medical services lies in the age of the user. The more aged, the more high in customers' satisfaction with oriental medical services was found through the survey. The results of this study can be used to develop marketing strategies for oriental medical institutions in the city of Asan.

• 수면정신생리
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• 제25권2호
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• pp.82-91
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• 2018

목 적 : 본 연구는 전 수면 주기 동안 수면단계에 따른 전체 뇌 영역과 수면 관련 뇌 영역들의 뇌기능 연결망의 변화를 살펴보기 위해 동기화된 뇌파(EEG)-자기기능공명영상(fMRI)를 전 수면 주기 동안 측정하고 신호처리 기법을 사용함으로 수면 단계에 따른 뇌 연결망의 탐구가 가능함을 살펴 보기 위해 수행되었다. 방 법 : 정상 성인 피험자 5인을 대상으로 6~7시간의 수면동안 MRI 기계 안에서 안전도, 심전도, 근전도와 EEG-fMRI를 측정하였고 EEG에 발생한 MRI 자장 변화 잡음과 심박관련 잡음을 제거하였다. fMRI에서는 피험자의 움직임에 의해 발생하는 영상 왜곡을 보정하는 부분볼륨활용기법을 제안하여 사용하였다. 잡음이 제거된 수면중 fMRI에 독립성분분석기법을 적용하여 뇌 전체를 68 영역으로 구획하여 수면 연구에 적합한 뇌 구획 지도를 만들고 이를 바탕으로 각 구획들간의 연결성을 계산하였다. 수면관련 뇌심부 영역을 선택하여 연결망 분석을 수행하였다. 결 과 : 뇌파를 비롯한 수면 생리적 신호들은 잡음 제거의 방법을 이용하게 되면 수면단계설정에 문제가 없으며 수면 단계별 뇌 연결망 연구가 가능함을 보여 주었다. 뇌연결망 분석에서 수면 관련 뇌심부 연결망은 렘과 비렘수면에 따라 다른 특성이 나타나는데 비렘수면에서 전반적으로 높은 연결성을 보였다. 대뇌를 포함한 전체 뇌 연결망의 경우 각성에 비해서 수면 중에 뇌 연결성이 떨어지는 양상을 보였다(Kolmogorov-Smirnov 검정 ; p < 0.05, Bonferroni corrected). 결 론 : 본 연구를 통해서 장시간 수면 EEG-fMRI 측정과 수면단계설정이 가능하고 신호처리 기법을 통해서 보정하게 되면 뇌기능 연결망을 이용한 전체 수면 뇌 연구가 가능함을 시사한다.