• Journal of Periodontal and Implant Science
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• 제47권5호
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• pp.264-272
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• 2017

Purpose: This study evaluated trends in tooth extraction due to acute and chronic periodontal disease (PD) using data from the National Health Insurance Service-National Sample Cohort for 2002-2013. Methods: A random sample of 1,025,340 individuals was selected as a representative sample of the population, and a database (DB) of diagnostic and prescription codes was followed up for 12 years. We used multivariate logistic regression analysis to assess the incidence of total extraction (TE), extraction due to periodontal disease (EPD), and immediate extraction due to periodontal disease (IEPD) according to sociodemographic factors (sex, age, household income, health status, and area of residence). Results: The incidence of tooth extraction was found to be increasing, and at a higher rate for TE in PD patients. In 2002, 50.6% of cases of TE were caused by PD, and this increased to 70.8% in 2013, while the number of cases of IEPD increased from 42.8% to 54.9% over the same period. The incidence rates of extraction due to acute and chronic PD increased monotonically. We found that the incidence rates of TE, EPD, and IEPD were all 2-fold higher among patients with high income levels and those who were not beneficiaries of health insurance. Conclusions: The rates of TE, EPD, and IEPD have been steadily increasing despite dental healthcare policies to expand public health insurance coverage, increasing the accessibility of dental clinics. Moreover, the effects of these policies were found to vary with both income and education levels. Consistent patient follow-up is required to observe changes in trends regarding tooth extraction according to changes in dental healthcare policies, and meticulous studies of such changes will ensure optimal policy reviews and revisions.

• 대한예방한의학회지
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• 제28권1호
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• pp.13-30
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• 2024

Objectives : This study aimed to investigate the history, current status, and regulation of complementary medicine in Australia. Methods : To investigate complementary medicine in Australia, we searched domestic and overseas academic databases, and websites of public and private organizations related to the Australian health care. Results : Complementary medicine consists of numerous services, among which massage and chiropractic care are significantly utilized by Australians. Since 2010, Australian healthcare practitioners, in the field of complementary medicine, have been supervised by the Australian Health Practitioner Regulation Agency (AHPRA). Those who AHPRA is responsible for managing acupuncturists, chiropractors, and osteopaths. Other professions are regulated by their own respective associations. Not only aforementioned services offered by specialists, but also consumption of oral supplements accounts for considerable portion of complementary medicine in Australia. Complementary medicine products, vitamins, and minerals are managed by the Therapeutic Goods Administration (TGA). In terms of insurance policy, the reimbursement of complementary medicine expenses in Australia is covered by the public healthcare insurance system, Medicare. Medicare covers acupuncture, chiropractic, and osteopathy services. Other complementary therapies are continuously reviewed to update their coverage under this scheme. Conclusion : In Australia, practitioner qualifications, education standards, and scope of procedures related to complementary medicine are systematically managed through legal regulations of the federal and state governments.

• 한국사회복지학
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• 제56권3호
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• pp.113-133
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• 2004

본인부담과 관련한 이전의 연구들을 살펴보았을 때 외래와 입원 또는 상병별로 환자개인의 본인부담이 진료비에서 차지하는 비율을 파악하여 우리나라 건강보험이 안고 있는 보장기능의 취약성을 거론하거나 이와는 반대로 의료수요의 가격탄력성을 측정, 소비자의 도덕적 해이의 가능성을 지적하는데 초점을 맞추고 있음을 알 수 있다. 그러나 현재 환자본인이 부담하여야 하는 진료비규모를 파악하여 평균 본인부담액의 실제규모와 본인부담률을 밝히는 동시에 만성질환 보유여부, 의료보장의 종류, 또는 의료서비스 기관에 따른 본인부담의 비형평성 문제에 대하여 직접적으로 논의하는 작업은 극히 미미한 실정이다. 높은 본인부담의 결과로 경제적으로 취약하거나 만성질환에 시달리는 계층이 가장 큰 피해를 입게 된다는 점에서 이에 대한 심도 있는 임상적 및 정책적 논의는 절실하다. 이러한 맥락에서 본 연구는 의료서비스에 대한 계층간 본인부담의 차이가 형평성에 미치는 영향을 분석하고 이에 관련된 정책적 함의를 도출하는데 그 목적이 있다. 본 연구의 결과에서 소득 5분위 대비 최하위 계층의 경우 월등히 높은 만성질환 유병률을 보이고 있음에도 불구하고 최상위층의 6배가 넘는 과중한 본인부담을 안고 있음이 밝혀졌다. 또한 최종적인 회귀분석모형 분석결과는 의료이용 빈도 이외에 환자본인의 인구학적 특성, 가구소득, 만성질환 수, 보험의 종류, 상용치료기관의 종류가 본인부담의 규모를 결정짓는데 있어 영향을 미치는 결정적 요인들로 드러났다.

• 한국보건간호학회지
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• 제24권1호
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• pp.49-60
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• 2010

Purpose: This study investigated the quality of life, mental health and subjective health status of community dwelling cancer patients. Methods: Subjects were 212 out-patients with cancer at Kangwon University Hospital. The study was conducted from July 10 to August 14, 2008. Quality of life as determined by the Euro Quality of life-5 Dimensions (EQ-5D) was measured using Korea Centers for Disease Control and Prevention(KCDC). Mental health and subjective health status were measured using KCDC. Results: EQ-5D determined degrees of difficulty were 25.5%(mobility), 25.2%(anxiety or depression), 23.6%(pain or discomfort), 20.3%(activities of daily living), and 13.7%(self care). An analysis of the association between several factors and mental health showed that the statistically significant factors were age, gender, medical coverage, and private insurance. An analysis of the association between several factors and subjective health status showed that the statistically significant factor was occupation. Conclusion: Cancer patients suffer from significant psychological distress. Programs that address mental and physical health would be beneficial.

• 한국콘텐츠학회논문지
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• 제20권2호
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• pp.435-450
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• 2020

국민들은 문재인 정부가 추진하는 복지정책을 어떻게 인식하고 있는가? 이 연구에서는 성인 1,000명을 대상으로 2018년 12월에 진행한 설문조사를 통해 복지정책과 관련된 주요 현안에 대해서 응답자들이 어떠한 인식을 하는지, 어떠한 요인이 복지정책에 관한 인식과 관련을 맺는지를 살펴보았다. 분석결과, 응답자들은 정부의 적극적인 복지 제공 역할을 대체로 긍정적으로 인식하였다. 문재인 정부의 보건복지 주요 국정과제 중에서는 건강보험 보장성 강화에 대한 찬성 의견이 가장 높았다. 국민연금 재정문제 해법과 관련하여, 보험료 인상, 급여액 삭감, 수급개시 연령 상향조정 등의 개혁방안에는 반발이 심한 것으로 나타났다. 응답자들은 정부의 재정지원방식과 관련하여 효율성과 평등성을 모두 중시하였다. 응답자의 1/3 만이 정부의 국민 행복 증진 기여를 긍정적으로 인식하였다. 상이한 정치사회적 가치관과 경제적 이해관계에 따라 복지정책에 대한 인식에 차이가 발생하였다. 특히 정치성향과 주관적 계층의식이 복지정책에 대한 인식과 긴밀한 관련성을 맺었다. 분석결과에 기반하여 향후 복지정책의 추진방향에 대한 시사점을 논의하였다.

• 보건행정학회지
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• 제31권1호
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• pp.91-99
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• 2021

Background: The Korean government introduced National Cancer Control Program and strengthening national health insurance coverage for cancer patients. Although many positive effects have been observed, there are also many concerns about cancer management such as patient concentration or time-to-treatment. Thus, we investigated the association between the time-to-treatment and survival of cancer patients, and compared regional differences by time trend. Methods: The data used in this study were national health insurance claims data that included patients diagnosed with lung cancer and received surgical treatment between 2005 and 2015. We conducted survival analysis with Cox proportional hazard model for the association between time-to-treatment and survival in lung cancer. Additionally, we compared the regional differences for time-to-treatment by time trend. Results: A total of 842 lung cancer patients were included, and 52.3% of lung cancer patients received surgical treatment within 30 days. Patients who received surgical treatment after 31 days had higher 5-year or 1-year mortality compared to treatment within 30 days (5-year: hazard ratio [HR], 1.566; 1-year: HR, 1.555; p<0.05). There were some regional differences for time-to-treatment, but it was generally reduced after 2010. Conclusion: Delayed surgical treatment after diagnosis can negatively affect patient outcomes in cancer treatment. To improve cancer control strategies, there are needed to analyze the healthcare delivery system for cancer care considering the severity and types of cancer.

• 한국콘텐츠학회논문지
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• 제18권1호
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• pp.504-516
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• 2018

재정의 지속가능성 확보는 보편적 의료보장(UHC)을 달성하기 위해 필수적이며, 전 세계적으로 재정관리체계 구성요소 중 하나인 전략적 구매기능에 관심이 높아지고 있다. 본 연구에서는 전략적 구매의 개념과 기능을 고찰하고, 한국 건강보험제도에 있어서의 구매기능과 관련 기관을 Preker(2005)가 제시한 전략적 구매 모형에 근거하여 검토하였다. 이를 위하여 관련 문헌을 고찰하였다. 전략적 구매는 주어진 예산의 범위 내에서 국민이 필요로 하는 보건의료서비스를 제공하기 위한 전략적 활동으로 정의된다. 구매관리자는 정부 혹은 국민들을 대신하여 구매 활동을 수행하며, 정부, 구매자, 의료공급자의 관계는 주인-대리인 이론으로 설명될 수 있다. 우리나라에서의 '구매'는 '한정된 재정 내에서 국민이 필요로 하는 보건의료를 제공하기 위한 전략적 활동으로 급여 범위와 대상 설정, 상급종합병원 지정이나 정보 공개 등 양질의 의료서비스 공급자 선정 활동, 급여기준과 가격 설정, 진료비 지불방법의 설계와 운영, 심사와 평가, 모니터링 활동을 포함'하는 것으로 설명할 수 있다. 건강보험심사평가원과 국민건강보험공단이 정부의 위임을 받아 주된 구매활동을 수행하며, 의료기관평가인증원과 한국보건의료연구원 등이 일부 역할을 담당하고 있다.

• Journal of Preventive Medicine and Public Health
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• 제38권4호
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• pp.408-414
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• 2005

Objectives : The purpose of this study was to determine the impact of the sociodemographic and health characteristics on the out-of-pocket health spending of the individuals aged 20 and older in Korea. Methods : We used the data from the 2001 National Public Health and Nutrition Survey. The final sample size was 26,154 persons. Multiple linear regression models were used according to the age groups, that is, one model was used for those people under the age of sixty-five and the other was used for those people aged sixty-five and older. In these analyses, the expenditures were transformed to a logarithmic scale to reduce the skewness of the results. Results : Out-of-pocket health expenditures for those people under the age of 65 averaged 14,800 won per month, whereas expenditures for those people aged 65 and older averaged 27,200 won per month. In the regression analysis, the insurance type, resident area, self-reported health status, acute or chronic condition and bed-disability days were the statistically significant determinants for both age groups. Gender and age were statistically significant determinants only for the non-elderly. Conclusions : The findings from this study show that the mean out-of-pocket health expenditures varied according to the age groups and also several diverse characteristics. Thus, policymakers should consider the out-of-pocket health expenditure differential between the elderly and non-elderly persons. Improvement of the insurance coverage for the economically vulnerable subgroups that were identified in this study should be carefully considered. In addition, it is necessary to assess the impact of out-of-pocket spending on the peoples' health care utilization.

• 한국산학기술학회논문지
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• 제16권6호
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• pp.4067-4076
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• 2015

본 연구는 2008년~2011년 "한국의료패널" 원시자료를 이용하여 연간 가구 과부담 의료비 지출 추이와 과부담 의료비 발생에 영향을 미치는 요인을 알아보고자 하였다. 연도별 과부담 의료비 발생률 추이는 교차분석(correspondence analysis)을 실시하였고, 과부담 의료비 발생에 영향을 미치는 요인은 일반화 추정방정식(generalized estimating equation)을 이용하였다. 연간 과부담 의료비 발생률 추이는 10%, 15%, 20%, 30%, 40% 역치 수준에서 각각 평균 25.1%, 15.4%, 10.1%, 5.4%, 3.2%로 나타났다. 과부담 의료비 발생에 영향을 미치는 요인을 살펴본 결과, 연간 총가구소득이 낮을수록, 가구주의 교육수준이 낮을수록, 의료보장형태가 건강보험가입 가구일수록, 가구주가 장애가 있을수록, 가구주의 연령이 높아질수록, 총가구원 수가 적을수록, 가구원의 주관적 건강수준이 낮을수록, 가구당 만성질환 유병률이 높을수록 과부담 의료비 발생 확률이 높게 나타났다(p<0.05). 따라서 의료 접근성 향상을 위한 전반적인 보장성 확대를 위한 노력과 동시에 특히 의료비 부담이 큰 노인 가구, 만성질환 가구 등의 취약계층을 우선으로 고려하는 정책 마련이 필요하다.

• 보건행정학회지
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• 제31권3호
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• pp.328-334
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• 2021

Background: This study was conducted to investigate factors related to unmet medical needs of medical care in adult diabetes patients and to suggest factors related to unmet medical in Korea. Methods: This study used data from the Korea National Health and Nutrition Examination Survey (KNHNES) 2014-2017. The subjects of the study were conducted on patients with unmet medical needs experience among the patients and analyzed using the IBM SPSS ver. 25.0 program (IBM Corp., Armonk, NY, USA). Results: Overall, 10.9% of patients had unmet medical needs. Being female, less educated, and lower medical aid were related to unmet medical needs. And subjects with poor subjective health and higher stress level were more likely to report unmet medical needs. Conclusion: Although comprehensive health insurance coverage, 10.9% of people with diabetes experienced unmet healthcare needs. The results of this study suggest that socioeconomic factors such as low education and medical aid were associated with unmet medical needs.