• 제목/요약/키워드: Medical Policy

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의료법에서의 의료기관 이중개설 금지조항의 필요성에 대한 치과 사례연구 (The necessity of ban on opening and operating the multiple medical institutions in medical law in Dental case)

  • 주진한;이가영;정구찬;이재용;민경호
    • 대한치과의사협회지
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    • 제57권9호
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    • pp.514-522
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    • 2019
  • In accordance with Article 33(8) of the Korean Medical Law, it is stated that a medical person cannot open or operate a medical institution by borrowing the name of another medical person. However, the publicity of medical care is threatened by the recent illegal network dental clinics. The purpose of this study is to investigate the actual condition of illegal network dentistry and to analyze the cases and to find out the reason why the prohibition of double opening & operating of medical institution. As a result, the illegal network dental clinics treated less health care insurance treatment such as dental caries and periodontal treatment than general dental hospitals. In contrast, the rate of implementation of illegal network dentistry was high in endodontics treatment and extraction, which could lead to uninsured treatments such as crowns and implants. As a result of Supreme Court precedent analysis, it is concluded that illegal act is not only the opening of a medical institution by borrowing the name of other medical personnel, but also the duplicated operation which has the authority to make decision about management matters of medical institutions. The results of the patient's case survey also showed that excessive dental treatment due to such as dental staff incentive system. In conclusion, the illegal network dental clinics not only threatens the oral health of the public, but also causes leakage of health insurance premiums. In other words, the ban on opening and operating the multiple medical institution should be strictly applied as a strong protection device for protecting the patient in dental case.

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연구를 위한 건강보험 청구자료 요구 및 이용 요인분석 (Assessment of Needs and Accessibility Towards Health Insurance Claims Data)

  • 이정아;오주환;문상준;임준태;이진석;이진용;김윤
    • 보건행정학회지
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    • 제21권1호
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    • pp.77-92
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    • 2011
  • Objectives : This study examined the health policy researchers' needs and their accessibility towards health insurance claim datasets according to their academic capacity. Methods : An online questionnaire to capture relevant proxy variables for academic needs, accessibility, and research capacity was constructed based on previous studies. The survey was delivered to active health policy researchers through three major scholarly associations in South Korea. Seven-hundred and one scholars responded while the survey as open for 12 days (starting on December 20th, 2010). Descriptive statistics and logistic regression analysis were carried out. Results : Regardless of the definition for operational needs, the prevalent needs of survey respondents were not met with the current provision of claim data. Greater research capacity was shown to be correlated with increased demand for claim data along with a positive correlation between attempts to obtain claim datasets and research capacity. A greater research capacity, however, was not necessarily correlated with better accessibility to the claim data. Conclusions : The substantial unmet need for claim data among the healthcare policy research community calls for establishing proactive institutions which could systematically prepare and make available public datasets and provide call-in services to facilitate proper handling of data.

의과대학생 국가시험 거부 사태에 대한 고찰: 신호게임 이론을 중심으로 (A Study on the Refusal of National Examination for Medical Students: Focusing on the Signaling Game Theory)

  • 현승효;김다영;이민규
    • 보건행정학회지
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    • 제31권4호
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    • pp.479-490
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    • 2021
  • Background: Conflict in the medical world in 2020 led to the rejection of the national examination for doctors. This study explained the process until the end of the national test refusal situation triggered in 2020 through the signaling game theory. The government has succeeded in requiring medical students to take the national exam. Methods: To explain the rejection of the national examination, we first compose and show an example of two small non-signaling games where medical students know which type the government is of, then combine them to play a signaling game. Results: The behavior of the government and medical students was examined through the signaling game model. In the context of the coronavirus disease 2019 (COVID-19) pandemic, the government makes an ultimatum, whatever the type. And the medical students accept it. They judged that the government could not be expected to abolish the policy. If COVID-19 had not occurred, medical students would have been able to continue the confrontation. Conclusion: The government instilled in the other party the perception that the government would not bend its policies because it was the surly type and would not be afraid of a strong confrontation. Through the image created in this way, the government was forced to accept the ultimatum by medical students. Academically, this study is to deal with the policy-making process through the signaling game theory. In the area of health care policy, this study suggests that various situations such as the type of government or the spread of COVID-19 can become important in addition to the rationality of the policy itself.

요양병원 의료비 및 의료서비스 정책 (Nursing Hospital Medical Expenses and Medical Service Policy)

  • 김호영;김동일
    • 디지털정책학회지
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    • 1권1호
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    • pp.21-26
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    • 2022
  • 본 연구에서는 요양병원이 입원비 지출 발생에 기여도가 큰점을 주목하여, 요양병원의 입원정책을 살펴보고, 불필요한 입원비발생을 유발한 점이 있다면, 해외사례를 참조하여 개선방안을 제안하고자 한다. 본 연구는 건강보험공단과 건강보험심사평가원에서 발행한 건강보험통계연보, 건강보험 주요통계를 주로 활용하여 연구를 진행하였다. 이를 바탕으로 요양병원이 입원비 발생에 가장 큰 기여를 한다는 것을 추론하였다. 본 연구 결과 요양병원의 입원규정이 명문화 되지 않았다는 문제점을 발견하였고, 명문화 되지않은 입원 기준이 불필요한 입원비 발생해 기여 할수 있다는 점을 발견하였고, 이를 극복하기 위한 개선방안을 우리보다 먼저 고령화를 경험한 미국의 사례에서 제안해보았다. 본연구를 시작으로 요양병원에서의 불필요한 입원비 지출을 줄인 보다 많은 외국의 사례들을 찾아야 할 것이다.

건강보험정책심의위원회의 이익집단 간 대립이 물리치료 수가에 미치는 영향 (Conflict of Interest Groups on the Health Insurance Policy Deliberation Committee Affect the Medical Insurance Cost of Physical Therapy)

  • 김유신;윤범철
    • The Journal of Korean Physical Therapy
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    • 제25권2호
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    • pp.43-48
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    • 2013
  • Purpose: The aim of this study was to demonstrate that non-participation of physical therapists on the political decision-making committee results in invasion of their interests. Methods: To demonstrate the effects, we analyzed the change of medical insurance score decided by the Health Insurance Policy Deliberation Committee between 2001 and 2012 years, focusing on medical examination as the interest of the participation group and physical therapy cost as interest of the non-participation group. Results: Total medical insurance cost increased by 23.72%, on average. Medical examination cost increased by 23.90% and 37.66% in medical examination for new and established patients, respectively. However, physical therapy cost was reduced by 5.01%. The medical examination cost for physical therapy without medical checkup increased by 2.62%. Conclusion: This study shows that the physical therapy cost, related on the interest of the non-participative group in the Health Insurance Policy Deliberation Committee, rather decreased while the total medical insurance cost increased.These findings demonstrate the invasion of the non-participative group on the Health Insurance Policy Deliberation Committee. Thus, aggressive participation in political decision-making committee is necessary in order to protect and increase rights and interests of Korean physical therapists.

공적연금유형에 따른 은퇴자들의 보건의료비지출 결정요인 (Influence Factors on Health and Medical of Retirees Expense to Public Pension Recipients)

  • 최령;황병덕
    • 보건행정학회지
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    • 제25권2호
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    • pp.80-89
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    • 2015
  • Background: This study aims to identify the monthly average medical expenses of public pension recipients, and analyze the determinants of total health and medical expenses and Western and Oriental medicine expenses, medical service expenses, and medical supplies expenses. Methods: This study used the fifth year data of 2013 out of the raw data of the Korean Retirement and Income Study collected by the National Pension Research Institute. This study conducted t-test, analysis of variance, and linear regression to verify publicly the relevance between pension recipients' general characteristics and health and medical expenses status using IBM SPSS ver. 21.0 for data analysis. Results: It was analyzed that there is a difference in the spending of expenditure and health care costs according to public pension recipients. Medical expenses of the national pensioners was higher compared to the special corporate pensioners. The national pensioner is related expenditure size, education level, family members living together, residential areas, status of spouse, number of chronic illness, and status of limitation in daily life with psychological health status. Conclusion: Therefore, fairness does not occur fire to the medical use between the special corporate pensioners and national pensioners, aggressive of government such as health policy and financial support for the retiree pension policy that reflects the reality intervention would be required.

119구급대원이 경험한 폭력대응에 대한 문제점과 정책대안의 주관적 인식유형 (Type of subjective recognition on the problem and policy alternatives to violence response experienced by emergency medical technicians)

  • 이가연;최은숙
    • 한국응급구조학회지
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    • 제26권1호
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    • pp.37-56
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    • 2022
  • Purpose: This study aimed to identify and present suitable recognition types of policy alternative for before and after response, according to the recognition types of problems in response to violence. Methods: This study investigated 36 EMT's of 17 cities and provinces nationwide. The study was approved by the Kongju National University Institute Review Board (KNU_IRB_2021-17). Data were collected from May 1, 2021 to August 30, 2021 and analyzed by Q factor analysis using the PC-QUNAL program. Results: Recognition types of the problem in 119 EMT's response to violence were described as "I type; lack of professional manpower," "II type; inadequate policy on violence," and "III type; lack of awareness on the emergency field." Recognition types of policy alternative on response to violence by 119 EMT's were described as "Itype; training and public relations oriented," "II type; work environment improvement," "III type; violence handling specialization demand," and "IV type; recovery support seeker." Conclusion: This study provides the foundation required to develop and implement the policies regarding the response to violence; therefore, contributing to EMT's provision.

의료공급체계 구조의 개혁방향에 대한 조직이론적 시각 (An Organization Theory Perspective on the Structural Reform of the Health Care Delivery System)

  • 한달선
    • 보건행정학회지
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    • 제28권3호
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    • pp.197-201
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    • 2018
  • There is a general consensus that many health care problems are attributable to the structural defects of the health care delivery system in Korea. The basic policy aimed to address these problems is to reform the delivery system so as that it incorporates two core principles: (1) stratification of medical care institutions into primary, secondary, and tertiary care providers according to the capability to perform specialized and complex services; (2) patients seeking care starting from the primary care provider and, if necessary, to be referred to the other provider step by step. This policy has been consistently pursued for about 30 years, but the achievement is far from success. Thus it is believed that the feasibility of the policy should be questioned. Starting from this question, based upon the observation of the current structure of the delivery system and its expected changes, the reform policy was discussed focusing on the assessment of its feasibility from both practical and theoretical viewpoints. The discussion leads to cast doubt on the policy for its possibility of making planned changes and producing expected desirable effects. Therefore it is advisable to investigate a wide range of alternative strategies and models for improving health care delivery.

Evaluating the Performance of the Emergency Medical Services Index

  • Eun, Sang Jun;Lee, Jin-Seok;Kim, Yoon;Jung, Koo Young;Park, Sue Kyung;Lee, Jin Yong
    • 보건행정학회지
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    • 제23권2호
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    • pp.176-187
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    • 2013
  • Background: In 2006 Emergency Medical Services Index (EMSI), which summarizes the performance of regional emergency medical services system, was developed. This study assesses the performance of the EMSI to help determine whether EMSI can be used as evaluation tool. Methods: To build a composite score of the EMSI from predefined 24 indicators, 3 normalized values were calculated for each indicator, the normalized values of each indicator were weighted using 4 weighting methods, and the weighted values were aggregated into the final composite score using 2 aggregation schemes. The performance of EMSI was evaluated using 3 criteria: discrimination, construct validity, and sensitivity. Discrimination was the proportion of regions that did not include the overall median rank in the 5th to 95th percentiles rank interval, which was calculated from Monte Carlo simulation. Construct validity was a correlation among the alternative EMSIs. Sensitivity of EMSIs was evaluated by total shift of quartile membership and changes of 5th to 95th percentile intervals. Results: The total discrimination performance of the EMSI was 50.0%. Correlation coefficients between EMSIs using standardized values and those using rescaled values ranged from 0.621 to 0.997. Variation of the quartile membership of regions ranged from 0.0% to 75.0%. The total change in the 5th to 95th percentile intervals ranged from -19 to +17 places. Conclusion: The results suggested that the EMSI could be used as a tool for evaluating quality of regional EMS system and for identifying the areas for quality improvement.

보건의료분야에서 4차산업혁명, 어떻게 대처할 것인가? (How to Integrate the Fourth Industrial Revolution in the Healthcare Industry?)

  • 이선희
    • 보건행정학회지
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    • 제33권1호
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    • pp.1-2
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    • 2023
  • As the industrial paradigm shift, often condensed as the "4th Industrial Revolution," gains momentum, there is a growing need to actively introduce digital healthcare into the medical field. The new administration announced its commitment to become a global leader in the biohealth and digital healthcare sector. To fulfill this pledge, preemptive policy leadership and attention from the government are required. The recent issue of legislating non-face-to-face medical care suggests that introducing digital healthcare goes beyond simply adopting new technologies. Incorporating digital healthcare involves changing the existing healthcare delivery process and coordinating the roles of stakeholders. To successfully change the structure of the medical industry, a mid- to long-term roadmap should be meticulously organized and promoted. Policy efforts are needed to resolve conflicts and lead to compromises through continuous communication with interest groups.