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Health Economic Approach to End-of-Life Care in the US: Based on Medicare (말기의료의 경제적 요소에 관한 논의: 미국 메디케어 상황을 중심으로)

  • Suk, Ryan
    • The Korean Society of Law and Medicine
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    • v.15 no.1
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    • pp.335-373
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    • 2014
  • According to one Medicare report, in the US, total federal spending on health care expends almost 18 percent of the nation's GDP, about double what most industrialized nations spend on health care. And in 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients' last six months of life. So what are the reasons of this high cost in EOL care and its possible solutions? Much spendings of Medicare on End-of-Life care for the terminally ill/chronically ill in the US has led health economics experts to assess the characteristics of the care. Decades of study shows that EOL care is usually supply-sensitive and poor in cost-effectiveness. The volume of care is sensitively depending on the supply of resources, rather than the severity of illness or preferences of patients. This means at the End-of-Life care, the medical resources are being overused. On the other hand, opposed to the common assumption, "The more care the better utility", the study shows that the outcome is very poor. Actually the patient preference and concerns are quite the opposite from what intense EOL care would bring about. This study analyzes the reasons for the supply-sensitiveness of EOL care. It can be resulted from the common misconception about the intense care and the outcome, physicians' mission for patients, lack of End-of-Life Care Decision which helps the patients choose their own preferred treatment intensity. It also could be resulted from physicians' fear of legal liabilities, and the management strategy since the hospitals are also seeking for financial benefits. This study suggests the possible solutions for over-treatment at the End-of-Life resulting from supply-sensitiveness. Solutions can be sought in two aspects, legal implementation and management strategy. In order to implement advance directive properly, active ethics education for physicians to change their attitude toward EOL care and more conversations about end-of-life care between physicians and patients is crucial, and incentive system for the physicians who actively have the conversations with patients will also help. Also, the general education towards the public is also important in the long run, and easy and official advance directive registry system-such as online registry-has to be built and utilized more widely. Alternative strategies in management are also needed. For example, the new strategic cost management and management education, such as cutting unnecessary costs and resetting values as medical providers have to be considered. In order to effectively resolve the problem in EOL care for the terminally ill/chronically ill and provide better experience to the patients, first of all, the misconception and the wrong conventional wisdom among doctors, patients, and the government have to be overcome. And then there should be improvements in systems and cultures of the EOL care.

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A Morphological Study of Bamboos by Vascular Bundle Sheath (대나무류(類)의 유관속초(維管束鞘)에 의(依)한 형태학적(形態學的) 연구(硏究))

  • Kim, Jai Saing
    • Journal of Korean Society of Forest Science
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    • v.25 no.1
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    • pp.13-47
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    • 1975
  • Among the many species of bamboo, it is well known that the dwarf-type is widely distributed in the tropical regions, and the slender type in temperated zone. In the temperated zone the trees have extensively differentiated into one hundred species in 50 genera. In many oriental countries, the bamboo wood is being used as a material for construction and for the manufacture of technical instruments. The bamboo shoot is also regarded as a good and delicious edible resource. Moreover, recent medical investigation verifies that the sap of certain species of the bamboo is an antibiotic effect against cancer. Fortunately, it is very easy to propagate the bamboo trees by using cutting from southeastern Asian countries. This important resource can further be used as a significant source of pulp, which is becoming increasingly important. The classification system of this significant resource has not been completely established to date, even though its importance has been emphasized. Initiated by Canlevon Linne in the 18th century, a classification method concerning the morphological characteristics of flowers was the first step in developing a classification. But it was not an easy task to accomplish, because this type of classification system is based on the sexual organs in bamboo trees. Because the bamboo has a long life cycle of 60-120 years and classification according to this method was very difficult as the materials for the classification are not abundant and some species have changed, even though many references related to the morphological classification of bamboo trees are available nowadays. So, the certification of bamboo trees according to the morphological classification system is not reasonable for us. Consequently, the classification system of bamboo trees on the basis of endomorphological characteristics was initiated by Chinese-born Liese. And classification method based on the morphological characteristics of the vascular bundle was developed by Grosser. These classification methods are fundamentally related to Holltum's classification method, which stressed the morphology of the ovary. The author investigated to re-establish a new classification method based on the vascular sheath. Twenty-six species in 11 genera which originated from Formosa where used in the study. The results obtained from the investigation were somewhat coordinated with those of Crosser. Many difficulties were found in distinguishing the species of Bambusa and Dendrocalamus. These two species were critically differentiated under the new classification system, which is based on the existence of a separated vascular bundle sheath in the bamboo. According to these results, it is recommended that Babusa divided into two groups by placing it into either subspecies or the lower categories. This recommendation is supported by the observation that the evolutional pattern of the bamboo thunk which is from outward to inward. It is also supported by the viewpoint that the fundamental hypothesis in evolution is from simple to complex. There remained many problems to be solved through more critical examination by comparing the results to those of the classification based on the sexual organs method. The author observed the figure of the cross-sectional area of vascular trunk of bamboo tree and compared the results with those of Grosser and Liese, i.e. A, $B_1$, $B_2$, C, and D groups in classification. Group A and $B_2$ were in accordance with the results of those scholars, while group D showed many differences, Grosser and Liese divided bamboo into "g" type and "h" type according to the vascular bundle type; and they included Dendrocalamus and Bambusa in Group D without considering the type of vascular bundle sheath. However, the results obtained by the author showed that Dendrocalamus and Bambusa are differentiated from each other. By considering another group, "i" identified according to the existence of separated vascular bundle sheath. Bambusa showed to have a separated vascular bundle sheath while Dendrocalamus does not have a separated vascular bundle sheath. Moreover, Bambusa showed peculiar characteristics in the figure of vascular development, i.e., one with an inward vascular bundle sheath and the other with a bivascular bundle sheath (inward and outward). In conclusion, the bamboo species used in this experiment were classified in group D, without any separated vascular bundle sheath, and in group E, with a vascular bundle sheath. Group E was divided into two groups, i.e., and group $E_1$, with bivascular sheath, and group $E_2$, with only an inward vascular sheath. Therefore, the Bambusa in group D as described by Grosser and Liese was included in group E. Dendrocalamus seemed to be the middle group between group $E_l$ and group $E_2$ under this classification system which is summarized as follows: Phyllostachys-type: Group A - Phyllostachys, Chymonobambus, Arundinaria, Pseudosasa, Pleioblastus, Yashania Pome-type: Group $B_2$ - Schizostachyum, Melocanna Hemp-type: Group D - Dendrocalamu Bambu-type: Group $E_1$ - Bambusa ghi.

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Counter-terrorism Safety Measures in Public Facilities (다중이용시설의 대테러 안전대책)

  • Kim, Du-Hyun;Ahn, Kwang-Ho
    • Korean Security Journal
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    • no.22
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    • pp.37-64
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    • 2010
  • Since the September 11, 2001, the motives and objectives of terrorism that have been targeted at hard targets such as key national facilities have now shifted towards soft targets such as subways, department stores, and tourist hotels; the attacks on these soft targets are steadily increasing. Simultaneous, unconventional, and indiscriminate terrorist attacks on civilians has also increased. In November, 2010, nearly forty states of the G20 and B20 (Business 20) will join in international summits to be hosted in Seoul. This coming July, an additional 350 troops will be deployed to Afghanistan for the sustainment of public security. Such events are sensitive topics, and there is the possibility of terrorist movement. Korea has successfully hosted various international events such as the APEC and ASEM Summits, and the 2002 Korea-Japan World Cup. The experiences from these events must be applied to ensure the safety of public facilities against the dangers of terrorism. First, counter-terrorism center must be established for the long-term, above the General Officer level to ensure the safety and efficiency of multilateral, international summits, as well as promoting policies and legislation aimed at preventing terrorism. Second, a terrorist threat management system must be secured and safety measures must be emphasized. Third, a fundamental structure must be established for the prevention of terrorism on public facilities, as well as legal and government action against the new threat of IED. Fourth, the police and fire fighting networks' must have a firm rapid response posture on the scene of an attack. Fifth, the state of mentality on the recognition of terrorist threats must be changed and restructured by promoting to and educating the population. Sixth, prevention measures must be established via research and academia. Seventh, for the guarantee of security in public facilities, safety management should employ cutting edge technology such as the 3D SICS and further develop and apply such technology. All methods and resources must be fully utilized for the establishment and strengthening terrorism prevention measures.

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A study of the classic Sijo(時調) concerning the productive life (생활 표현의 고시조 연구)

  • Jeon, Jae-Gang
    • Sijohaknonchong
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    • v.26
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    • pp.151-185
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    • 2007
  • The main industry of the Chosun dynasty was farming, which was related to the people's lives in every respect. By the end of the Chosun dynasty commerce was a new industry becoming increasingly more beneficial. I study how these two industries were being expressed in the classic Sijo. The classic Sijo is a main literary genre created by the upper-class. Even though industry was very important for sustaining the Chosun dynasty, Confucian scholars and government officials(members of the upper class) didn't actually work in the industries of farming and commerce. But sometimes they returned to their rural hometowns, because they owed large amounts of land which they let the servants farm for themselves. As the main composers of Sijo were these Confucian scholars and government officials, I study a collection of their Sijo which expresses the life of industry. In order to achieve this goal, I analyze several sides of the classic Sijo : for example, its writers(along with their personalities) throughout different periods: the point of view of persona; and the specific life of industry and the way it is expressed in the Sijo. First, I look at the writers of the different periods and their personalities. During the fourteenth century to the seventeenth century, the main writers of Sijo on the life of farming were Confucian scholars and government officials. During the eighteenth century to the nineteenth century, the main writers of Sijo on the life of farming were Confucian scholars, government officials, and also commoner singers-the unnamed writers. Second, I look at the point of view of persona. During the fourteenth century to the seventeenth century, the personas were the country man(one's lord and master) and the farmer, who was of two kinds of people : i.e., those trying to work together and those really working together. During the eighteenth century to the nineteenth century, the personas were the country man, who was satisfied with his rural life as overseer to farming, and two kinds of farmers : those who farmed very hard by themselves, or those who criticized the failed tax system. Third, I discuss the specific life of industry and the way it is expressed in the Sijo. During the fourteenth century to the seventeenth century, the writers of Sijo expressed, in a general way together in one Sijo, different kinds of work for example, plowing a dry field and a rice field, picking wild vegetables, and cutting rice and weed. During the eighteenth century to the nineteenth century, the writer of Sijo expressed different kinds of work in a more specific way, each in its own Sijo : for example, buying and selling, bringing land under cultivation for farming. weaving, digging for water, and heavy taxation. I look at three aspects of Sijo concerning industry, but there still remain several aspects of Sijo to study, such as those concerning worship of the king, and those concerning high officials, the common people, and the being of things.

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A Task for Listing Martial arts of 『Muyedobotongji』 on the UNESCO Representative List of Intangible Cultural Heritage of Humanity (『무예도보통지』 무예 인류무형유산 등재 과제)

  • Kwak, Nak-hyun
    • (The)Study of the Eastern Classic
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    • no.69
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    • pp.451-479
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    • 2017
  • The objective of this study is to examine the tasks for listing martial arts of "Muyedobotongji" on the UNESCO Representative List of Intangible Cultural Heritage of Humanity. The conclusions are like below. First, "Muyedobotongji" was published in 1790(14th year of King Jeongjo). The 24 martial arts of "Muyedobotongji" were basically divided into three types like stabbing, chopping & cutting, and hitting. Second, the value of martial arts of "Muyedobotongji" is highly evaluated because it has systematically put together the martial arts of three countries like Korea, China, and Japan of the 18th century, suitable for the actual status of Joseon Dynasty, in the new perspective. The value of "Muyedobotongji" as a Memory of the World is the martial arts book emphasizing the practicality, so that everyone including officers and soldiers could easily learn. Third, the procedure of registering martial arts of "Muyedobotongji" in the UNESCO Representative List of Intangible Cultural Heritage of Humanity has three stages including preparation/submission, screening, and decision, which takes two years. Especially, the screening assistance organization, as an organization under the Intangible Cultural Heritage Convention Intergovernmental Committee is composed of total six countries(one for each area) out of 24 member countries. Fourth, the tasks for listing martial arts of "Muyedobotongji" in the UNESCO Representative List of Intangible Cultural Heritage of Humanity are like following. (1) It would be necessary to conduct a total inspection of the collection of "Muyedobotongji". (2) It would be necessary to designate the martial arts of "Muyedobotongji" as the municipal/provincial/national intangible cultural heritage. (3) It would be needed to standardize the practical martial arts technique/movement of "Muyedobotongji". (4) The historical evidence of martial arts costumes/weapons of "Muyedobotongji" should be studied. (5) A committee for the registration of martial arts of "Muyedobotongji" in the UNESCO Representative List of Intangible Cultural Heritage of Humanity should be organized. (6) There should be a close cooperation system between relevant departments like the World Heritage Team of Cultural Heritage Administration and the Ministry of Foreign Affairs. (7) Domestic/foreign data related to martial arts of "Muyedobotongji" should be comprehensively collected to meet the registration standard of UNESCO. (8) The registration type of Intangible Cultural Heritage of Humanity should be prepared.

Project of Improving Good Agriculture Practice and Income by Intergrated Agricultural Farming (미얀마 우수농산물 재배기술 전수사업)

  • Lee, Young-Cheul;Choi, Dong-Yong
    • Journal of Practical Agriculture & Fisheries Research
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    • v.16 no.1
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    • pp.193-206
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    • 2014
  • The objectives of the project are to increase farmers' income through GAP and to reduce the loss of agricultural produce, for which the Korean partner takes a role of transferring needed technologies to the project site. To accomplish the project plan, it is set to implement the project with six components: construction of buildings, installation of agricultural facilities, establishment of demonstration farms, dispatching experts, conducting training program in Korea and provision of equipments. The Project Management Committee and the Project Implementation Team are consisted of Korean experts and senior officials from Department of Agriculture, Myanmar that managed the project systematically to ensure the success of the project. The process of the project are; the ceremony of laying the foundation and commencing the construction of training center in April, 2012. The Ribbon Cutting Ceremony for the completion of GAP Training Center was successfully held under PMC (MOAI, GAPI/ARDC) arrangement in SAl, Naypyitaw on June 17, 2012. The Chairman of GAPI, Dr. Sang Mu Lee, Director General U Kyaw Win of DOA, officials and staff members from Korea and Myanmar, teachers and students from SAl attended the ceremony. The team carried out an inspection and fixing donors' plates on donated project machineries, agro-equipments, vehicles, computers and printer, furniture, tools and so forth. Demonstration farm for paddy rice, fruits and vegetables was laid out in April, 2012. Twenty nine Korean rice varieties and many Korean vegetable varieties were introduced into GAP Project farm to check the suitability of the varieties under Myanmar growing conditions. Paddy was cultivated three times in DAR and twice in SAl. In June 2012, vinyl houses were started to be constructed for raising seedlings and finished in December 2012. Fruit orchard for mango, longan and dragon fruit was established in June, 2012. Vegetables were grown until successful harvest and the harvested produce was used for panel testing and distribution in January 2013. Machineries for postharvest handling systems were imported in November 2012. Setting the washing line for vegetables were finished and the system as run for testing in June 2013. New water tanks, pine lines, pump house and electricity were set up in October 2013.