• Journal of Preventive Medicine and Public Health
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• 제11권1호
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• pp.123-127
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• 1978

The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the hospital with the lowest average DTOC ($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variance to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of interhospital cost variation: 59.1 percent for TOTC and 44.3 percent for DTOC. Thsee results demonstrate that the casemix index is the most importand determinant of interhospital cost variation Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.

• 농촌의학ㆍ지역보건
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• 제27권1호
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• pp.143-153
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• 2002

경상북도 일개면 지역에 거주하는 65세 이상 재가노인 355명을 대상으로 방문보건의료 요구도를 알아봄으로써 향후 보건기관의 효율적이고 효과적인 방문보건의료서비스 제공방안의 기초자료를 제시하고자 하였다. 주관적 건강상태는 64.5%가 허약하다고 하였고, 저ADL과 저IADL이 각각 14.1%, 14.9%였다. 의료인의 도움을 받아야할 건강문제가 있다고 응답한 노인이 73.5%이었는데, 성, 연령, 결혼상태, 의료보장상태, 직업유무, 경제적 상태, 치료여건, 주관적 건강상태, 일상생활수행정도, 수단적 일상생활수행정도에 따라 차이가 있었다(p<0.05). 의료인의 도움을 받아야 할 건강문제가 있다고 느끼는 노인의 주관적인 방문보건의료 요구도는 19.5%였다. 방문보건의료 요구도는 75세 이상인 경우(p<0.05), 직업이 없는 경우(p<0.01) 유의하게 높았고, 가족이 화목하지 않을수록, 주관적 건강상태가 허약한 경우, 저 IADL인 경우 유의하게 높았다(p<0.01). 방문보건의료를 받기를 원하는 경우 이유는 돌봐줄 사람이 없어서가 64.7%로 가장 높았고, 거리가 너무 멀어서(지역적 문제)가 23.5%로 그 다음이었다. 제일원하는 방문보건의료서비스는 투약이 82.3%로 가장 높았다. 방문보건의료를 원하지 않는 경우 이유는 거동이 가능하므로 60.0%, 의사와 직접 만나기를 원하므로 25.7%의 순이었다. 방문보건의료 요구여부를 종속변수로 한 다중 로지스틱 회귀분석 결과, 가족이 화목하지 않을수록, 주관적 건강상태가 허약할수록 방문요구도가 높았다(p<0.05).

• 항공우주정책ㆍ법학회지
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• 제33권2호
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• pp.291-314
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• 2018

최근 3년간 우리나라의 저비용항공사는 총 6개사(소형항공운송업 항공사 포함 8개사)로서 국내시장 점유 뿐 아니라 일본, 중국, 동남아 및 미국령까지 그 영역을 확대하고 있다. 현재에도 약 3개 항공사가 저비용항공사로 출범하고자 항공운송사업증명을 신청한 상태로서 이 확장세는 지속될 전망이다. 이러한 국내 및 외국의 저비용항공사의 공격적인 항공사 운영 실태에 대응하며 경쟁력을 제고하고자 각 저비용항공사는 객실서비스 증진에 많은 전략을 강구하고 있다. 따라서 객실승무원의 업무량이 확장세에 비례하여 증가되어 안전업무 수행 능력과 직결되는 피로를 가중시키고 있다. 우리나라는 승객 좌석 50석 당 최소 1인의 객실승무원이 탑승하도록 항공안전법 시행규칙에 규정하고 있으며, 이를 기반으로 모든 저비용항공사에는 최소 객실승무원만 탑승하고 있다. 때로는 객실승무원의 주 업무인 비상 시 비상탈출에 필요한 비상구(창문형 비상구 제외)에 착석이 불가능하게 되어 비상 시 승객의 혼란을 야기할 수밖에 없는 상황에 처해 있다. 또한 최소 객실승무원 중 1인이 부상 등으로 업무수행 불능상태가 되면 비상탈출 업무를 수행하는데 큰 장애요소로 작용하게 되고, 정상상황에서도 최소 객실승무원의 성원을 이룰 수 없으므로 위규가 되어, 모든 승객이 다른 가용한 항공사 비행편으로 이동할 수밖에 없는 불편을 초래하게 된다. 국제민간항공협약 부속서 6에는 최소 객실승무원의 수를 정할 때 안전하고 신속한 비상탈출을 위하여 승객좌석 수 또는 탑승 승객 수만을 기반으로 정하도록 국제표준으로 규정하고 있다. 객실안전의 강화 및 승객의 편의를 위하여 객실승무원의 다양한 업무특성(서비스, 안전, 보안, 응급처치)에서 발생할 수 있는 피로 및 비상구 착석(창문형 비상구 제외)을 최소 객실승무원 수 산정에 고려할 필요가 있다. 정부의 항공사 관리.감독 차원에서도 저비용항공사 객실승무원의 업무량에 기인한 피로, 비상구 착석불가 상황 등을 검토하여 최소 객실승무원 수 규정에 반영함으로써 승객과 승무원의 객실안전을 강화할 필요가 있다고 사료된다.

• 한국응급구조학회지
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• 제6권1호
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• pp.153-168
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• 2002

Since 1992, conventional fire fighting businesses have been converted into a metropolitan autonomous fire fighting system to be ready for a variety of disasters. However, the corresponding investment has been overlapped due to the non-integration of businesses to prevent any potential disasters, and a series of collaborative systems have been not functioning so well. In the meantime, our fire fighting sector has been trying to set up its own clean and faithful position by abolishing any inconvenient system or outsourcing private sectors, and expanded its work scope from conventional fire fighting even to rescue and emergency works. While focusing on handling disaster, the fire fighting sector has been widely trusted and reliable throughtout our nation. Moreover, our fire fighting sector has secured nation wide mobile organizations, technical personnel by field, special equipments and independent communication network. In addition, the fire fighting sector has knowledges, expertise and capabilities required for managing disasters, while in charge of almost every disaster management works including fire, explosion, collapse, disaster and flood. It becomes an organization for comprehensive disaster management under an absolute national trust, which is based on the system for prevention, preparation and countermeasure against a variety of disasters. Thus, our fire fighting sector must make many efforts and try to modernize conventional education and training. The ways to facilitate rescue and emergency works may include the nurture of technical fire fighting personnel along with modernized equipments, the reinforcement of rescue and emergency education, the facilitation of operating civil defense corps, the facilitation of operating volunteer fire fighting corps, the better arrangement of 119 briefing room for public healthcare in provincial offices, the sterilization of rescue instruments and equipments the better repair education for emergency rescue member, the establishment of regional emergency assistant system and the expansion of fire fighting personnel and equipments. In terms of reinforcing the functions and services of rescue 119 and emergency corps, we must review the following considerations: Building up security system along with operational expansion, building up a system for emergency medical treatment, building up a comprehensive information management system for rescue and emergency, constructing a provincial safety museum and so forth. For the ways to better the works of rescue 119 we can review the following considerations : Improving the education for fire fighting training corps under Jeju Provincial Fire and Disaster Management Department, providing rescue members with more opportunities for clinical practices, enhancing the morale of rescue members, installing a comprehensive briefing room for emergency rescue members, building up medical networks along with reasonable policies for information service, operating the consulting system for rescue 119 and so on. If these requirements are met, it is expected that the fire fighting departments in Jeju province can cope with every accident and disaster a little more rapidly and quickly in compliance with local needs, so that they can keep their own position as a public fire fighting organization which may be trusted by the public.

• 한국응급구조학회지
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• 제6권1호
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• pp.141-152
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• 2002

The purpose of this study is to provide the basic materials for searching the way of improvement to heighten the emergency medical welfare level by one step further. To achieve this purpose, the subjects of this study were selected 452 college students in Gwangju, using a random sampling method. The statistical analysis methods utilized for analyzing the collected data are frequency analysis, $x^2$ test. The conclusions obtained from these analyses are as following ; 1. In question about necessary optimum number of persons for rescue first aid activity, health and non-health major college students responded by 39.2%, 45.3% respectively that rescue team 15 people, first aid team 3 people is most suitable. But there was no significant difference in major department(p<0.05). 2. In question about security of the public health doctor and the emergency medical technician, all health and non-health major college students are recognizing necessity urgently, but there was no significant difference in major department(p<0.05). 3. In question about 119 rescue first aid team member applying for an examination qualification grant to the department of EMT's graduate, all health and non-health major college students were highest by 52.9%, 52.4% respectively in "necessity" item. But there was no significant difference in major department(p<0.05). 4. Because rescue first aid equipment level appears higher than 41.7% in non-health major college student's case by 54.2% in health major college student's case, health major college students are recognizing that equipment level should be supplemented more but there was no significant difference in major department(p<0.05). 5. In question about equipment supplement, all health and non-health major college students appeared highest by 64.8%, 69.3% in accident type different special equipment. But there was no significant difference in major department(p<0.05). 6. In question about rescue ambulance car size, we could know being thinking that health and non-health major college student each 61.2%, 56.5% is small and narrow that large size of the rescue ambulance amount need. But there was no significant difference in major department(p<0.05). 7. In question about patient's state is worsened, because rescue first aid equipment is inferior, health major college student responded sometimes 55.1%, many 29.5%. very many by 11.5%, while non-health major college student responded 65.8%, 23.1%, 4.0% respectively. There was significant difference in major department(p<0.05). 8. In question about emergency patient must utilize for 119 rescue ambulance car, all health and non-health major college students appeared highest by 38.8%, 41.3% in "not so" item. In question about rescue first aid team's first-aid treatment ability improves more, all health and non-health major college students appeared highest by 58.1% and 58.7% respectively in "improve" item. In question about "119 rescue ambulance car must go more rapidly than now", all health and non-health major college students are recognizing that should be quicker by 58.1%, 60.9% respectively. When called to 119 all health and non-health major college students responded highest by 55.5%, 53.3% respectively that we must receive first-aid treatment direction from a doctor. In question about "119 rescue ambulance car must be made the pay system", all health and non-health major college students responded 74%, 80% respectively in "not so" item. There was significant difference in major department(p<0.05). In conclusions, In oder to provide superior rescue first aid service to people, a public health doctor should be placed in the situation room inside the fire station so that the doctor could instruct the proper emergency treatment suitable for each situation to the rescue first aid team. Also, national education about a first-aid treatment that do to all people is necessarily necessary in emergency delivery system and this should be spread extensively through school education and broadcasting medium and education should be gone side by side, and see that will can save emergency patients' life which is more when these education consists continuously fixed period for public institution of policeman, fire officer etc. specially. And for reinforcement of patient transfer system, public organization must procure special ambulance car so that emergency patient receive first aid treatment while transfer.

• 한국재난정보학회 논문집
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• 제11권4호
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• pp.622-633
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• 2015

최근 들어 외국인 강력범죄에 대한 언론보도로 인해 외국인범죄자에 대한 혐오증과 시민들의 범죄두려움이 증가하고 경찰의 치안대책과 외국인 출입국관리 정책이 불신을 받고 있다. 세계화 흐름과 국내 노동인구 시장의 구조변화로 앞으로 외국인 근로자 유입이 늘어날 것은 명약관화한 상태이다. 따라서 이 논문은 우리나라 체류외국인의 현황과 범죄 실태를 수원시 중심으로 살펴보고 외국인 범죄에 대한 경찰의 치안대책에 대한 제언을 목표로 한다. 아울러 출입국외국인정책본부와 수원시 등 유관기관의 치안대책을 살펴보고 외국인 범죄예방을 위한 대책을 단기와 장기로 구분하여 제시하였다. 우선 우리나라 경찰이 진행 중인 외국인 범죄치안 대책을 살펴보았으며 수원시의 단속과 계획도 살펴보았다. 이를 통해 부족한 단속 및 수사 인력의 문제점을 지적하고 유관기관과 함께 개선방향을 살펴보았다. 앞으로 더욱 늘어날 외국인에 대한 우리사회의 올바를 대처는 적극적 변화하고 받아들여야 하는 데 현재의 소극적 출입국 관리제도와 경찰의 대처는 분명 변화가 있어야 할 것이다. 경찰의 단계에서 노력뿐만 아니라 우리사회에서 외국인 노동자와 이주민들의 비중이 커지는 만큼 국가적인 차원에서 적극적인 대처와 계획이 마련되어야 할것이다. 관련기관을 비롯한 시민들의 의식개혁과 더불어 경찰의 장 단기적인 치안대책 개선과 계획을 통해 효율적으로 외국인범죄에 대처해야 한다.

• 한국경제지리학회지
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• 제22권3호
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• pp.258-273
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• 2019

2018년 정부의 산업위기대응특별지역 지원책은 문화 관광 관련 지원책들을 포함하고 있다. 여기에는 정부가 문화 관광산업을 제조업의 대안으로 인식하고 있다는 의미가 내포되어 있다. 스페인 빌바오는 구겐하임 미술관을 유치하여 문화 관광산업을 중심으로 지역발전을 추진하였고, 빌바오의 성공 사례는 "빌바오 효과" 또는 "구겐하임 효과"라는 용어를 탄생시켰다. 이 연구의 목적은 스페인 빌바오의 지역발전 재생과정에서 나타나는 장소적 특수성과 지역발전 재생 전략을 구조적 맥락에서 분석해 우리나라 산업위기지역의 대응책에 대한 시사점을 모색하는 데 있다. 연구 결과는 다음과 같다. 첫째, 빌바오는 유럽 내 초국가적 무역 네트워크의 중요 결절지라는 지리적 이점을 바탕으로 바스크 지방정부에게 정치적, 재정적 자율권을 보장하였다. 바스크 지방정부는 자율성을 적극적으로 활용해 지역발전 재생사업을 수행할 수 있었다. 둘째, 빌바오는 지역발전 재생 프로젝트를 수행하는 과정에서 민관협력체계를 원활하게 가동해 오랜 시간 동안 꾸준한 실천력을 확보할 수 있었다. 셋째, 빌바오의 지역발전 재생사업은 대형프로젝트와 장소마케팅의 효과로 주목 받았지만, 그 이면에는 문화 관광산업이 창출하는 일자리의 불안과 서비스업 내의 양극화 문제가 도사리고 있다. 빌바오가 추진한 탈산업화는 문화 관광산업과 더불어 지식기반서비스와 금융서비스 등 서비스산업이 다양하게 특화되었기 때문에 성과를 얻을 수 있었다.

• 유통과학연구
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• 제11권6호
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• pp.31-40
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• 2013

Purpose - The Northeast Asian Logistic Hub strategy was established to create a national competitive advantage in northeast Asia. Countries in this region are competing fiercely to become the central base distribution port as the volume of container shipping continues to increase due to the northeast Asian (especially Chinese) economic growth. The primary method by which shippers are improving their customer service and distribution is enhancing profits by minimizing call ports on the key route through strategic affiliations and the use of large vessels. Each nation is planning large-scale investments in the construction of sea ports that can accommodate large vessels. This paper proposes ways by which the logistical strategies of domestic corporations can keep pace with changes in government policy concerning the Northeast Asian Business Hub policy. It examines the logistics system in the Northeast Asian region, analyzes the government's Northeast Asian Business Hub policy, and suggests logistical strategies for domestic corporations through an analysis based on a questionnaire designed to grasp domestic firms' needs and goals. Research design, data and methodology - The purpose of this study is to determine how shipping companies establish partnerships with third-party logistics providers and draws out the implications of the results. The survey methods used were personal interviews and questionnaires distributed to a sample population through e-mail, fax, mail, and telephone. A total of 600 questionnaires were distributed, of which 165 were returned. Among these, ten were excluded due to insufficient content; ultimately, 155 were used for the sample. The statistical data collection process was analyzed through data coating and a statistical package program. Results - This study argues that greater flexibility in policies, administration, and systems will be needed to significantly improve established business practices. In this dissertation, we primarily identify that in order to become a center of northeast Asian logistics, Korea must adopt a new paradigm and abandon the existing systems that are based on the economic and social systems that have stemmed from bureaucracy, inflexibility, chauvinism, and equalitarianism. Flexible policies, administration, and systems will be necessary to improve business practices. Domestic corporations must establish a strategic logistics hub and related network while simultaneously pursuing value-added logistics businesses by increasing their manpower and building a logistics information system. This will strengthen their competitive edge and lead to system improvements. Conclusions - Domestic corporations must adopt a new paradigm and use more reasonable business laws, systems, and policies that are based on market-driven flexibility and transparency. Moreover, social norms and regulations should be established to help ensure political and social security. Korea must also develop a culture of tolerance for foreign companies. Finally, the paradigm defining the policy governing the development of the capital city and its satellite cities in this context must be changed.

• 한국융합학회논문지
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• 제5권4호
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• pp.113-119
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• 2014

소방공무원은 근무 중 예고 없이 출동해야 하기 때문에 식사속도가 빠를 것으로 추정된다. 본 연구의 목적은 소방공무원의 식사속도가 건강에 어떤 영향을 주는지 알기 위해 수행되었다. 이를 검증하기 위하여 소방공무원과 다른 직종 종사자에 대한 식사속도를 측정하였다. 식사에 소요되는 평균시간 측정결과, 소방공무원이 8분 29.00초로 가장 짧았으며, 해양경찰공무원 8분 33.17초, 군인 10분 44.77초, 일반직공무원 12분 49.33초, 대학생 14분 15.00초, 일반회사원 16분 51.00초 순으로 측정되었다. 빠른 식습관은 체중증가 및 대사증후군에 영향을 준다는 것을 선행연구에서 확인할 수 있었으며, 미국 소방관을 대상으로 한 설문조사에서는 8년간 7.7파운드의 체중증가가 있었다고 발표되었다. 소방공무원의 식사시간을 늦추기 위해서 각 소방학교의 교육과정 중에 건강에 유익한 식습관에 대한 교육을 실시할 것을 제안한다.

• Journal of Preventive Medicine and Public Health
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• 제26권4호
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• pp.599-613
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• 1993

농촌지역의 모성을 대상으로 산전관리서비스 이용양상과 그 결정요인을 규명하기 위하여 서부 경남 3개군(합천군, 사천군, 진양군)에서 1990년 7월 1일부터 1991년 6월 30일 사이에 분만한 모성 1,489명중 65.5%인 976명을 훈련된 면보건요원들이 1992년 1월 3일에서 1992년 2월 15일사이에 면담조사하였다. 의료서비스 이용의 관련요인을 포괄적으로 포함하는 Anderson의 의료이용 행태모형을 기본분석모형으로 하고 종속변수는 산전진찰의 회수, 그것을 설명하는 독립변수로는 의료요구요인, 개인의 속성요인, 가능성요인 그리고 기타요인의 변수들을 설정하였다. 조사대상자들의 산전진찰 수진율은 97.3%로 높은 편이었으나 10회 이상의 수진율은 20.6%로 전문가에 의해 추천되는 정상임신시 $10{\sim}12$회의 산전진찰회수에는 미흡하였다. 산전진찰의 저이용(미수진 또는 4회 이하의 수진)은 모성의 낮은 교육수준, 출생아의 출생순위가 두번째 이상, 의료보호 대상자, 의원이 없는 지역, 임신중 진단된 질병이 없을 때 그리고 모성의 직업이 농업인 경우 등과 관련이 있었다. 그러나 거주지 군의 변수(즉 지역내 모자보건센터 유무)는 유의한 관련성이 없었다. 산전진찰의 저이용은 인구학적 변수라 할 수 있는 출생아의 출생순위, 의료요구요인인 임신중 진단된 질병의 유무와도 높은 관련성이 있기는 하나, 더 많은 부분이 어머니의 교육수준, 어머니의 직업이라는 사회구조적 요인과 의료보장의 종류, 지역내 의원의 유무라는 가능성요인과 관련이 있어 균점을 이루지 못하고 있다. 또 변경성이란 견지에서 보면 변경성이 높은 가능성요인에 의해서 상당부분 설명되고 있어 보건정책적으로 해결 가능성이 있는 것을 시사한다. 예를 들면 의료보호 대상자와 의원이 없는 지역 산모들의 산전진찰 서비스의 접근성을 높히는 방안을 마련하는 것을 고려할 수 있다.