• 한국식품영양학회지
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• 제21권4호
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• pp.562-571
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• 2008

The principal objective of this study was to assess dietitian's awareness and performance with regard to food suppliers' selection guidelines and purchase guidelines for the receipt of safe food materials. A questionnaire was administered to 203 dietitians working at an elementary school in Gyeonggi North province, and 190 responses were ultimately returned. Excluding responses with incomplete answers and significant missing data, 161 responses(79.3%) were ultimately utilized for data analysis. We determined that meat/poulty and seafood were purchased mainly by manufacturer's branch(59.8% and 78.3%), and processed food and kimchi were generally purchased by producer's cooperatives(47.7% and 44.9%). 78.3% of the contracts were made via informal purchasing and the frequency of contracts was less than 3 times per year(53.4%). Market studies were conducted individually(54.7%), and by group(47.2%). Dietitian and parents volunteered(50.3%) or dietitians, and school and foodservice staffs(45.3%) participated - together in receiving and inspection. School contracted with $4{\sim}5$(39.1%) and $6{\sim}8$ food suppliers(29.8%). Dietitians(42.3%) or school councils(40.2%) evaluated food suppliers once per semester(60.2%). The majority of dietitians(96.3%) conducted sanitary education for food suppliers once per semester (68.3%). All 13 guidelines which were usually used to evaluate food suppliers were thought to be important(more than 4) based on a 5 scale(1: never important, 5: very important). Among them, 'sanitary storage status of food products(4.85)', 'have a chill car(4.83)' and 'proper control of refrigerator, freezer and storage room(4.81)' were the most crucial guidelines. As dietitians evaluated food supplier's-observances of 13 guidelines, 'have a chill car(4.89)', 'hold medical examination of employees(4.89)' and 'hold liability insurance for handling product(4.80)' were fulfilled relatively well. The guidelines for conducting education for their employees(4.45) and keeping their establishment and equipment sanitary(4.79) were important, but were not observed well(3.39 and 3.37). Additionally, the difference between the importance and the observance score of the 'HACCP certificate' were fairly significant(4.44 and 3.54). Dietitians tended to report that purchasing management related to the removal of foodborne illness factors(4.71), return confirmation(4.50) and purchase specification(4.32) were important. The difference between importance and performance was highest in the process of changing food suppliers when the contracts were violated more than three times. Dietitian's age, education work experience and employment type had no observable effects on how important they considered purchase management to be, but their work experience significantly affected performance in terms of the removal of foodborne illness factors(p<0.05). As supplier management is the most critical factor, it is clearly desirable to educate suppliers at specialized training centers and to supervise suppliers in accordance with the established sanitary guidelines.

• Journal of Preventive Medicine and Public Health
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• 제7권1호
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• pp.163-173
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• 1974

A study on the health care of Ewha Womans University staff, faculty and families was conducted during the period from March 1973 to August 1974 using designed questionaire. A total of 196 persons who were randomly sampled as 27.3% of the total staff and faculty 789 were studied. The response rates were 96.0%. The results and findings obtained from the study are summerized as follow. 1. The sex ratio of the members the faculty and the staff shows 83.2% and the singles are 37.2% of the total. Their mean family size being 4.6 persons per capita, each family has mean number of 2.3 childeren. 2. The median monthly income of a member of faculty amounts \114,000 and that of a staff \43,077. It amounts \79,333 when the median monthly income of both the members of the faculty and the staff are taken. Consequently, it amounts \91,727\ per family (Assumed mean). 3. 71.4% of the total hold the house of their own. A spouses of 59.4% of them are working for the additional income of the family. 4. Their health condition is rated fair, i. e. 92.3% of them enjoy good health. Out of total members faculty and the staff, 20.6% are cared by family physician. 36.2% of them feel that they are burdened by heavy medical expense. 5. 76.7% of them have affirmatively responded that they would purchase medical insurance policy when they were offered. It reaches 84.0% of the total who consider buying the policy for their dependents. 74.0% of them desire to purchase the policy for their spouse's parents. 6. The monthly prevalence rate reaches 17.0% and the hospital admission rate 4.7%.12.3% of them affirmatively responded that they had chronic diseas. The number of sick call per capita counts 0.2 per month and the hospital admission rate 0.05. 7. To examine the nature of their disease, the respiratory disease is rated to be the top and the gastro-intestinal disease comes to the next. As far as chronic disease is concerned, the gastro-intestinal disease is predominent. 8. As to their treatment, 65.4% of them get the physician's treatment and 17.0% treatment of drug purchasing and 7.7% prefer Chinesedrug. 6.6% of them gets no medical treatment at all. 9. The treatment ratio, including drug purchasing and other means, reaches 93.4%. 60.7% of them affirmatively responded that they did not or could not get physician's treatment at least once even though they thought they had to. It is disclosed that 25.4% of them are caused by economical reason. 10. Average medical expense per case amounts \7,116 and monthly medical expense per capita \1,345. Consequently, average monthly medical expense per family amounts \6,185. 11. The medical expense of a family is rated 7.7% of total earnings of the same period.

• 대한치과의사협회지
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• 제53권4호
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• pp.266-274
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• 2015

The price for health service are decided by very complicated process because many of factors are related with them. The RBRVS(resource-based relative value scale) were used to calculate the Korean health service fees including dental fees. This study aimed to compare dental fees of Korea with other countries, such as Japan, Germany, and the US for evaluating the adequacy. Dental fees were categorized as oral evaluation and imaging, dental treatment including restorative, periodontal, and surgical work, and preventive treatment and compared by each country. The official documents about dental fees were collected from Korea, Japan, Germany, and the US. Each fee was presented as their own currency at first. Then they were converted into Korean won (KRW) by applying the market exchange rates at a specific point of time. Finally the fees were adjusted by purchasing power parities (PPPs) which equalize the different currencies. In general, the level of Korean fees were markedly low compared to those of Japan, Germany, and the US. German fees were similar or higher than that of Japan, and the US. The Korean fees were lower than three other countries 1.2~4.1 times for oral evaluation and 2.2~7.3 times lower for panoramic radiography. The endodontic fees of Japan, Germany, and the US were higher 1.8~15.3 times and 4.0~35.9 times for the deciduous teeth extraction compared to the Korean. In Japan the prophylaxis was 3.2 times more priced than the Korean fee. Exceptionally, the fees for re-evaluation, amalgam filling, and scaling were lower priced in Japan than other countries. This study has limitations on the items in definition and contents of dental practices units which were not exactly comparable and differently determined by countries. However, this study is meaningful because it surveyed the price levels to compare four different countries and then applied PPPs adjustment. This finding can be used to develop the dental RBRVs of Korean national health insurance and will contribute to improving the payment systems of health care.

• 대한예방한의학회지
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• 제3권2호
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• pp.1-23
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• 1999

The purpose of this paper is to survey the current status of service utilization in oriental medicine, to identify the determinants of consumers' decision in the service utilization, and then suggest policy implications for promoting the consumers' utilization. A multiple regression model was adopted to analyze the factors that influence consumer's decision in purchasing the oriental medical services. Data used in this research relied on National Survey Data conducted by Korea Institute of Health and Social Affairs, and sampling survey. The results could be summarized as follows.: 1. the number of visits to oriental medical institutions has shown an overall increase during the last decade since the inception of health insurance for oriental medical services. It still, however, revealed a relatively iow figure to western medical services. 2. the main factors, after controlling demographic variables, that determine consumers' selection between oriental medical services and western medical services are considered to be price, belief in effectiveness of services, waiting time for service. Implications for policy recommendation include 1. to reduce a barrier to service utilization by discounting dramatically the price of herb medicine, which is believed to be crucial in expanding market share, 2. to encourage consumer's belief in clinical effectiveness through a specialization in competitive services compared with wertern medicine, 3. to keep the affirmative image among consumers alive through an active participation of oriental medical doctors in community activities, 4 to change the health care system in favor of oriental medicine in the long run.

• 보건행정학회지
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• 제15권2호
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• pp.16-36
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• 2005

Due to the existence of asymmetry of information between doctor and patient, it has been believed that doctor might affect patient's decision making process of purchasing medical care. Based on this notion, doctor's reimbursement method has been suggested as an effective policy device of improving efficiency of patient's medical care use by way of its affecting doctor's practice pattern. By using the Community Tracking Study (CTS) household and physician data set, which includes not only various information on patient's medical care use, but doctor's practice arrangements and sources of practice revenue, this paper investigates the effect of community doctor's characteristics of reimbursement method on community patient's medical care use under the control of patient's socio-demographic characteristics and community doctor's practice type. In the process of estimating econometric model, the endogeneity problem of individual health insurance purchase was corrected by using 2818. And due to the existence of sample selection problem, Heckman's two-step estimation method was used for strengthen the robustness of estimation which was adversely affected by sample selection problem The empirical results show that as the average value of community doctor's portion of practice revenue determined by prospective method out of total revenue increases, the community patient's total out-of-pocket medical cost decreases. This results suggest, as doctor's practice revenues are mainly determined by prospective method, such as capitation, doctors would be more conscious about practice cost, which might affect doctor's practice pattern and by which his/her patient's use of medical care would decrease.

• 한국병원경영학회지
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• 제6권2호
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• pp.173-201
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• 2001

This study purports to examine the current management and information technology related strategy of Korean hospitals and suggest the effective management strategy in the 21st century when is digital era. Specifically the study tries to analyze the changing trends of strategic orientation and investigate the general management and information technology strategy of Korean hospitals. Self-administered Questionnaires were distributed to 721 hospitals nationwide and finally 98 Questionnaires were analyzed for the study. The results of the study are as follows : 1) Half of the respondent hospitals reported that they have an analyzer orientation in 2000, whereas 19.4% were prospectors, reactors 16.4%, and defenders 14.3%. However, the respondent hospitals intended to have a prospector orientation in the future (2002), while 29.6% planned on being analyzers, 17.3% reactors, and 3.1% defenders. 2) Hospital services for improving patient satisfaction were the most common. strategy for the respondent hospitals, followed by cost containment, organizational restructuring, employee education, purchasing system change, specialization of clinical services, quality improvement of medical care, strengthening the networking with the stakeholders, public relations and marketing strategy, diversification, and installing the information system. However, the strategies of annual salary system, retrenchment of unprofitable services, merit payment based on performance were still not popular for the respondent hospitals. 3) As for the strategies related with information technology, most hospitals have not implemented actively, except for the establishment of home-pages, order communication systems, and insurance claims through electronic data interchange system. 4) There were significant differences in the level of strategy implementation in terms of the ownership, bed size, financial performance, and the top managers I knowledge of information technology. The larger bed size, the higher financial performance, the better knowledge of information technology the top managers have, the more strategies the respondent hospitals implemented. The managerial and political implications for Korean hospitals in digital era were also discussed.

• 대한치과기공학회지
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• 제16권1호
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• pp.78-104
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• 1994

Under the fee for service schedule of Korean health insurance system, rational fee for dental laboratory products based on the cost is required to be formulated. The purpose of this study was to find actual cost of dental laboratory products in case of a University Hospital. Materials of this study were used as follows : 1. Balance sheet at Dec. 31, 1992 and profit and loss report of the year 1992 of the sample hospital 2. Performance report of dental laboratory department. 3. Purchasing and other accounting bills of dental laboratory materials. The following methods were used. 1. Actual cost finding of dental laboratory department was performed. 2. Work sampling methods were used for measuring standard working time by the process of working. 3. To porcelain fused to metal crown(non-precious), Relative value of the cost of dental laboratory products was calculated as 1.00. 4. Fee and cost of those products were compared on the basis of Relative values. The results of the study can be summarized as follow : 1. Overall, it took longs time than other items. to product denture-related items. 2. When several teeth are made in a time, average production time is much sorter than when one tooth is made in a time. 3. The relative price cost of Dicor cast crown and denture related items are higher than the criterion items. 4. The material cost occupies average 11% out of the total price cost, proportion of personnel expenses is average as 60.0%. 5. Some of the components consisting of the price cost are not reflected adequately in setting the level of the reimbursement price. 6. Relative values of dental laboratory products price cost are varied in the range from 0.05 to 2.83, overall, the reimbursement price of dental products appears not to reflect adequately the price cost. On the basis of this study results, the following ideas would be suggested : 1. Fee Schedule of dental laboratory products should be renovated in order to reflect their costs. 2. Dental laboratory product manufacturers should be enlarged for the economy of scale which may be useful for cost- containment. 3. Dental laboratory producters themselves are required to be standardiqed according to the categories of skill.

• 대한방사선치료학회지
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• 제19권1호
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• pp.19-26
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• 2007

목 적: Ir-192 고선량율 근접치료(HDR Brachytherapy)선원에 대한 다양한 측정절차의 효율을 서로 비교할 것이며, 측정 장비의 추가 구입 없이 대안으로 새롭게 만든 PMMA (polymethylmethacrylateplastics: $C_5H_8O_2$) plate phantom에 대한임상에서의 적합성과 유용성을 알아 보았다. 대상 및 방법: 세 가지 형태(Well type chamber, Source calibration jig, PMMA plate phantom)의 측정 시스템을 이용하여 측정값을 비교하였다. Source calibration jig와 PMMA plate phantom을 사용 했을 때에는 Farmer type chamber를 이용하여 측정하였으며, 각각 5회씩 측정하여 제조업체의 측정치와 비교하였다. 또한 새로운 선원을 교환 할 때마다 제조업체로부터 선원과 함께 제공되는 제조업체의 측정치를 본 연구의 측정치와 비교하여 방사능의 정확도를 평가 하였다. 결 과: Well type chamber, Source calibration jig, PMMA plate phantom를 사용한 Ir-192 선원의 측정결과 제조업체 측정치와의 상대오차에 대한 RMS (Root Mean Square)값은 Well type chamber에서 0.6%, Source calibration jig에서 1.57%, PMMA plate phantom에서는 2.1%를 나타내었다. 또한 평균 오차에 대한 편차는 Well type chamber에서 $-0.2{\pm}0.5%$, Source calibration jig에서 $0.97{\pm}1.23%$, PMMA plate phantom에서는 $-0.89{\pm}1.87%$를 나타내었다. 결 론: 본 연구를 통해 실험한 세 가지 형태(Well type chamber, Source calibration jig, PMMA plate phantom)의 측정 시스템의 결과에서 나타난 것처럼, Well type chamber를 이용한 측정결과가 가장 우수하게 나타났다. 또한 측정 장비를 구입하지 않고 대안으로 새롭게 만든 PMMA plate phantom의 결과 권고안 ${\pm}5%$를 초과하지 않으므로 임상에서 유용하게 사용 할 수 있을 것이라 생각되어진다.

• 한국유통학회지:유통연구
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• 제15권5호
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• pp.237-255
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• 2010

국내 약사법에서는 약 판매를 약국에 한정하고 있다. 이로 인해 심야나 공휴일에 약 구입이 어려워 소비자 선택폭이 제한되어 소비자 불편이 가중되고 있다. 또한 급속한 고령화의 진전은 노인의료비를 급격히 증가시켜 국가 의료보험 재정을 악화시키는 요인으로 작용하고 있다. 한편 미국, 일본 등 선진국들은 자가치료(self-medication)를 지원하는 관점에서 안전성과 유효성이 검증된 일반의약품에 대해서는 편의점이나 슈퍼마켓 등 일반 소매점에서의 판매를 허용하고 있다. 특히, 세계적으로 안전추구 경향이 강한 일본은 급증하는 의료비를 억제하기 위해 일반의약품의 판매채널을 다양화하였고, 그 결과 경제, 사회분야에 다음과 같은 다양한 규제완화 효과를 얻게 되었다. 첫째, 일반의약품의 유통채널이 약국에서 일반 소매점포로까지 확대되면서 잠재수요가 유발되어 관련시장이 확대되었다. 둘째, 판매채널 간 경쟁이 촉진되면서 의약품 가격이 하락했다. 셋째, 의약품 판매채널 증가로 소비자의 선택폭이 확대되었고 소비자 이용 편리성이 증대되었다. 넷째, 판매채널 다원화로 경쟁 환경이 조성되면서 기업의 경쟁력 제고 노력을 가속화시켰다. 다섯째, 자가치료 환경조성을 통해 의료비 재정건전성 제고 기반을 마련했다. 국내 65세 이상 인구는 2000년에 7%를 넘어섰고 2018년에는 14%를 웃돌 것으로 보여 국민의료비 증가는 가속화될 전망이다. 우리도 의료선진국과 같이 고령화시대를 대비하는 차원에서 일반의약품의 판매처를 다양화하여 자가치료 환경을 조성함으로써 개인의료비 지출을 줄이고, 국가의료보험 재정건전성을 제고하며, 나아가 소비자 후생을 증진시켜나가야 할 것이다.

• Journal of Preventive Medicine and Public Health
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• 제29권4호
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• pp.801-814
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• 1996

연구배경 : 약물복용에 관한 엄격한 규제가 없는 국내 의료현실상, 각종 건강에 관련된 약물이 범람하고 있어 약물 오 남용에 따른 심각한 약물부작용의 발생 가능성이 클 것으로 추정된다. 이에 건강한 성인 남성에서 영양제, 한약을 포함한 자가약물복용에 따라 간 기능 장애를 유발하는지를 코호트 내 환자-대조군 연구로 알아보았다. 방법 : ' 서울코호트' 대상자 중 (1)1990년도 정기 건강검진의 혈청결과상 HBsAg이 음성이면서 AST, ALT 모두 40 IU/L 이하인 대상자 (2) 1990년도 입원진료청구 전산자료상 간질환을 포함한 각종 질병으로 수진받은 적이 없는 자 (3)설문서 응답내용상 1991년 한해 동안 각종 질병이 발생되어 해당 약물을 복용한 적이 없는 자 (4)1992년도 정기 건강검진상 종합소견이 정상이면서 혈청검사상 HBsAg 음성인 자로 국한하여 본 연구를 위한 새로운 코호트를 구축하였다. 2년간의 추적조사 결과 1992년도 검사치상 AST/ALT 모두 40 IU/L 이상이면서 1990년도 AST/ALT에 비하여 100%이상 상승한 경우를 '간효소치 상승군(case group)'으로 정하였고, 반대로 1992년도 검사치상 AST/ALT 모두 40 IU/L 미만이면서 1990년도 ALT/ALT 에 비하여 상승 정도가 100% 미만인 경우를 '대조군(control group)'으로 하여, 약물복용과의 관련성을 카이자승법과 로지스틱 회귀법으로 알아보았다. 결과 : '간기능치 상승군(n=30)'은 대조군(n=2,625)' 에 비하여 44세 이하가 많았고, 경제수준이 높았으며 보다 비만하였으나 교육수준, 직업, 가족력, 수술력, 방사선 촬영력, 침구이용력, 흡연 및 음주습관에서 차이가 없었다. 약물복용에 있어서는 간장제와 한약복용은 차이가 없었으나, 스쿠알렌, 알로에 등의 건강보조식품 복용력은 '간기능치 상승군'에서 유의하게 많았다. 단변수 분석에서 유의성을 보인 변수들을 보정하여 보았을 때도 건강보조식품 복용력은 여전히 통계적 유의성을 잃지 않았다. 결론 : 본 연구결과는 건강인이라 하더라도 '건강보조식품'의 임의 복용은 간기능 장애를 유발할 가능성이 있다고 보아진다. 따라서 현재 '건강보조식품'의 사용이 급증하는 추세 속에서 치료제가 아닌 보조식품으로써의 '건강보조식품'이라 하더라도 장기간 임의 복용에 따라 어떤 부작용이 얼마나 발생할 것인지에 대한 연구가 향후 이루어져야 할 것으로 판단된다.