• 대한공간정보학회지
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• 제23권3호
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• pp.49-55
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• 2015

현재 우리나라의 의료전달체계는 1989년 이후 1,2,3차 진료체계로 구분하여 지역 간 진료과목별 균형유지와 더불어 의료자원의 낭비를 방지하고 있으나 의료시설의 대도시 집중에 따라 지역 간 의료서비스의 불균형이 발생되고 있다. 따라서 본 연구에서는 중소도시인 진주시를 대상으로 접근성과 편리성이 강조되는 1차 의료서비스 질을 공간적 분포 특성에 근거하여 평가하였다. 그 결과 1차 의료시설 모두 공간적 분포에 대한 응집지수가 0~0.25로서 강한 응집도를 나타냈다. 필수진료과목의 경우 외과와 산부인과의 응집도가 높았으며 기타 진료과목은 성형외과와 안과의 응집도가 가장 높게 나타났다. 이를 바탕으로 병원의 위치와 이용자층과의 상관성 분석을 수행한 결과, 필수진료과목의 경우 병원의 위치와 이용자층간의 상관관계는 약하게 나타났으며 기타 진료과목 중 한의원의 경우 응집도는 높았으나 이용자층이 많은 곳에 비교적 양호하게 분포되어 접근성이 가장 우수한 것으로 분석되었다. 하지만 한의원을 제외한 나머지 기타진료과목은 이용자층과 의료시설의 위치가 상이하여 접근성 측면에서 문제점이 발생되었다. 이러한 분석 결과를 토대로 1차 의료서비스를 이용하는 이용자층을 고려한 입지선정의 개선대책 마련이 필요하다고 판단된다.

• 농촌의학ㆍ지역보건
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• 제20권2호
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• pp.157-168
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• 1995

This study was carried out, through analyzing the annual reports(year of 1973-1993) on health status of Su Dong-Myun, and specific survey data of 332 households(Su Dong-Myun 209, Byul Nae-Myun 123), located in Nam Yang Ju-Si, Kyung Gi-Do, from July 20 to July 31, 1995, to find out more effective means for primary medical care in a rural area. The results were as fellows : 1. Number of population in Su Dong-Myun was 5,419 in 1973, 4,591(the lowest) in 1987 and 5,707 in 1995. In the composition rate of population, "0-14" of age group showed markedly decreasing tendency from 43.1% in 1975, to 19.1% in 1995, however "65 and over" markedly in creasing tendency form 5.3% in 1975 to 9.8% in 1995. 2. Annual utilization rate per 1,000 inhabitants in Su Dong-Myun showed markedly increasing tendency from 1973 to 1977 such as 343 in 1973, 540 in 1975, 900 in 1977. However, since 1979, the rate showed rapidly decreasing tendency, such as 846 in 1979, 519 in 1985, 190 in 1991 and 1993. 3. The morbid household rate per year was 53.6% of respondents and the rate per 15 days was 48.2%. In disease classification rate of morbid household per year, Arthralgia & Neuralgia was the highest rate(33.9%) and gastro-intestinal disorder(19.3%), Cough(11,9%), Hypertension(7.8%), Accident(3.2%) in next order. 4. In the utilizing facilities for Primary Medical Care, Medical facilities was showed the highest rate(58.1% of respondents) and Pharmacy and Drug Shp(33.1%), Tradition Method(4.0%) in next order. In the Medical facilities, General private clinic was showed the highest rate(34.3%) and specific private Clinic(22.3%), Hospital(19.0%), Health (Sub)center(16.3%), Nurse practitioner (3.3%), Oriental hospital and clinic(2.7%) in next order. 5. Experience rate, utilizing health subcenter was 51.8% of the respondents, and it was 55.0% in Su Dong-Myun and 46.3% in Byul Nae-Myun. In utilization times of health subcenter, times-rate showed next orders such as 1-2 times/6months(31.6%), 1-2 times/year (22.1%), 1-2 times/months(19.2%), 1-2 times/3months(15.6%). 6. In objectives, visiting Health Subcenter, Medical Care was the highest rate(59.8% of the respondents) and health control(23.3%) was in next order. In Medical Care, Primary Care by general physician was higher rate(51.1%) almost all. In the Health control, Immunization too was high rate(18.0%) in health control activities. 7. The reasons rate, utilizing health subcenter showed next order, such as distance to Medical facilities(33.0% of the respondents), Medical Cost(28.1%), Simple process of consultation (10.8%), Effectiveness of cure(7.6%), Function of primary medical care(7.0%) and Attitude of physician(6.5%). 8. In the affecting factors to utilization of primary medical facilities, medical needs was showed the highest rate(29.5% of the respondents) and medical cost(15.4%), distance to medical facilities(14.2%), traffic vehicle(14.2%) and farm work(6.9%) in next order. 9. In the priority between 'daily farm work,' and 'primary medical care', only 46.4% of respondents answered that primary health care is more important than the daily farm work The 22.6% of respondents answered 'daily farm work', and the 12.3% answered 'the equal of the both'. 10. In the criterion of medical facilities choice, medical knowledge and technical quality was showed the highest rate(56.3%), distance or time to medical facilities(10.9%), sincerity and kindness of physician(9.4%), medical cost(8.7%) and traffic vehicle(6.5%) in next order 11. In the advise for improvement of health subcenter function, the 36.1% of respondents answered that 'enforcement of medical personnel and equipment' was required, and then 'improved medical technology'(25.5%), 'good attitude of physician'(14.9%), 'improved medical system'(13.3%), 'enforced drug'(6.7%) in next order. 12. The study on affecting factors to utilization of primary medical facilities was very difficult subject to systematize the analyzed results, due to a prejudice of protocol planner, surveyer and respondent, and variety and overlapping of subject matter.

• 한국지역지리학회지
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• 제3권2호
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• pp.163-193
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• 1997

복지사회를 지향하는 오늘날, 건강 중진에 직접 관계되는 의료시설의 접근성 문제는 주요 과제이다. 특히 삶의 질이라는 측면에서 질병의 치료 외에 건강진단, 예방과 회복, 요양 및 응급서비스의 비중이 커지고, 인구의 노령화 현상이 진전되면서 의료시설의 효율적인 입지가 주 관심사로 대두되고 있다. 의료시설은 주민의 생존과 직접 관계되는 기본적이고도 필수적인 중심시설로, 지역 주민은 균등한 혜택을 받을 수 있어야 한다. 이를 실현시키기 위해서는 기본적으로는 효율성과 평등성을 기반으로 1차 진료기관이 균등 분포해야 한다. 이에 본 연구에서는, 광주시를 사례지역으로 선정하여 의료시설의 입지와 그에 대한 주민의 효율적 이용에 관하여 분석하였다. 분석에 있어서는 통계자료와 기존의 연구 성과 외에 설문 및 현지조사 자료를 기반으로 시설 측면과 이용자 측면을 동시에 고찰하였다. 우선 의료 환경의 변화 및 의료시설의 변화 과정을 고찰하고, 이어서 의료시설의 유형별 입지 특성과 주민의 분포 특성을 고려한 지역별 의료수준을 분석하였다. 그리고 유형별 의료시설의 이용행태와 그 요인을 구명한 후, 마지막으로 장래 이용 유형의 예측과 문제지역의 추출, 나아가서는 시설의 합리적인 입지와 경영 방향을 제시하였다. 본 연구 결과는, 앞으로 신설될 의료시설의 적정 입지에 관한 기본 자료로서는 물론 지역 주민의 불평등성 해소라는 응용적 측면에서 의의를 지닌다.

• Journal of Preventive Medicine and Public Health
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• 제17권1호
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• pp.37-45
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• 1984

의료보호사업의 의료이용 현황을 파악하고 그동안 시행과정에서 나타난 문제점을 발견하여 이에 대한 합리적인 개선책을 마련하는데 도움을 주고자 경산군의 전 의료보호대상자 17,527명이 1981년 10월 1일부터 1982년 9월말까지 1년동안에 진료증을 사용하여 진료를 받은 의료이용과 상병상태를 일차진료기관의 진료기록부와 매달 각 의료기관에서 군에 제출한 진료비청구서 및 내역서 기타 군과 읍, 면의 각종 행정통제자료에서 조사분석하였다. 경산군의 의료보호대상자는 전인구의 12.7%로서 전국의 9.5%보다 높았다. 대상자들의 의료이용율은 1차진료의 경우 대상자 100명당 월간 환자수는 9.3명, 방문회수는 14.0회, 투약일수는 42.9일이었다. 2,3차 진료의 경우는 연간 대상자 100명 당 입원이 1.7건, 외래이용이 9.3건이었다. 1종대상자가 2종대상자에 비해 1차진료 및 2,3차 진료 모두에서 의료이용이 월등히 높았다. 성별이용율은 1차진료는 여자가, 2,3차 진료는 남자가 많았다. 월별이용율은 7월이 가장 높고 1월이 가장 낮았다. 1월이 가장 낮은 것은 진료증의 갱신때문인 것으로 생각된다. 2,3차 진료기관의 연간 이용자수는 1,931명이고 이중 84.4%가 외래진료이었고 15.6%가 입원이었다. 전문과목별로는 정신과 환자가 66명중 55명이 입원으로 가장 높은 입원율을 나타내었으며, 이비인후과, 안과, 피부과, 비뇨기과 등은 연 입원환자가 $1{\sim}4$명으로 아주 낮은 입원율을 나타내었다. 2,3차 진료기관의 평균입원일수는 21.2일, 외래평균치료기관은 4.7일, 입원과 외래전체의 평균치료기간은 8.6일이었다. 정신과 환자의 평균 입원일수가 74.4일이나 되어 정신과를 제외할 경우 평균 입원일수는 9.3일이었다. 질환군으로 분류한 환자분포는 1차진료는 호흡기질환(35.4%)이 가장 많고, 2,3차 진료는 신경감각기질환(20.1%)이 가장 많았다. 연간 의료보호대상자 1인당 평균 진료비는 9,821원(1종: 24,240원, 2종: 7,464원)이고, 가구당 평균진료비는 40,531원(1종: 66,605원, 2종: 33,559원)이었다. 일차진료기관의 건당진료비는 3,901원, 일당진료비는 840원이고, 2,3차 진료기관의 건당진료비는 49,875원, 일당진료비는 5,822원이었다. 본 조사결과 다음과 같은 의료보호제도의 개선책을 제시하고자 한다. 첫째, 의료보호증의 연초에 일제갱신시 재발급절차를 신속히 할 수 있는 방안이 마련되었으면 한다. 둘째, 전문과목별로 1차지정의료기관을 지정함으로(관내에 전문의료기관이 없을 경우 인근 진료권에 지정) 2,3차 진료기관으로 이송되는 환자를 줄여서 예산의 절감과 이용자의 불편을 덜어주어야 한다고 생각된다. 셋째, 1차지정의료기관과 2,3차 지정의료기관의 진료비 산출방법이 좀더 합리적으로 개선되어야 한다고 생각된다.

• 보건행정학회지
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• 제20권4호
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• pp.19-44
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• 2010

This study was conducted to investigate the changes in patterns of Daegu- and Gyeongbuk-based patients' use of medical care facilities located in Seoul. The 'Patient Survey' data issued by the Ministry of Health and Welfare for 2002, 2005, and 2008 were used. Among all discharged patients residing in Daegu and Gyeongbuk, 133,456 who used medical facilities in Daegu, Gyeongbuk, and Seoul were selected. Among patients residing in Daegu, 2.2% used medical facilities in Seoul in 2002, 3.7% in 2005, and 3.5% in 2008. The corresponding rates among patients living in Gyeongbuk were 5.6%(2002), 7.1%(2005), and 7.3%(2008). Regarding the ICD-10 disease groups, the use of medical facilities in Seoul by patients residing in either Daegu or Gyeongbuk increased in 2005 right after the introduction of the KTX high-speed train service, covering various disease groups, but decreased again in 2008. 'Neoplasm' cases, however, showed a progressive rising trend during the years studied. Multivariate data analysis for the three years showed that sex, age, payment type, hospital type, residence, year, and disease groups were all significantly associated with the utilization of medical facilities in Seoul. The major results are : First, use of medical facilities in Seoul by Gyeongbuk patients was 2.4-fold higher than that by Daegu patients, but with respect to 2005 and 2008 vs. 2002, use of medical facilities in Seoul by Daegu resident patients' showed a larger increase than that by Gyeongbuk's patients. Second, for patients residing in the two regions, use of medical facilities in Seoul was highest for 'congenital malformations, deformations and chromosomal abnormalities', followed by 'neoplasms'. Third, for patients residing in the two regions, general hospitals comprise the primary factor in the use of medical facilities in Seoul. The study shows that local medical facilities should individually exert more efforts to improve the quality of their medical services. Relevant authorities should likewise help these facilities develop their own unique services and respective specialization.

• 한국농촌간호학회지
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• 제1권1호
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• pp.5-10
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• 2006

Purpose: This study was done to identify strategies for the reform of the primary health care delivery system in rural areas. Methods: Official documents on changes in the rural health care environment were reviewed along with previous articles on reform of the health care delivery system in rural areas. Results: The primary health care system in rural areas of South Korea has not been well developed by the government. The government has mainly invested in hardware like facilities and equipment but, not in software like the delivery system or personnel. Nowadays every country is confronted with an aging society, which means an increase in the prevalence of chronic disease. Thus they have again become interested in primary health care delivery system. Further, characteristics of the primary health care system have changed to be more comprehensive and to focus on chronic disease. The primary health care system in rural areas should have basic health care functions and a visiting medical officer(doctor) connected with basic health care. Conclusions: The primary health care delivery system is the best strategy when adjusted to the characteristic of the chronic diseases that are prevalent today. Cooperation of the central government and local government is important if these changes are to be realized.

• 보건행정학회지
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• 제6권1호
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• pp.29-58
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• 1996

This study was conducted to identify the factors that affect the output of health conters. An analystical model employed in this study was developed by modifying 'input-output model' and 'organizational behavior model'. Data were collected form two source; the 1995 report of thealth center which was submitted to the Ministry of Health and Welfare and a mail survey questionary of officers at health center, including 66 directors and 1,768 staffs of the health centers in southern region. The major findings are as follows: That analysis has identified the factors associated with dependent variables: medical services provided by the health center and health program performance(HPP). The number of primary medical facilities was negatively associated with health center performance while the number of staffs, job satisfaction, and professional background of health center directors were positively associated. These independent variables accounted for 40.1% of the variance of dependent variables. The variance of HPP was significantly explained by the number of health subcenter and primary health post, priority level of public health program by hief executive officers(CEOs) and legislator. A significant relationship was found between leadership types of health center directors and the performance of maternal and child health program. Considering these results, the authors suggested that the role in medical care service of health center in the should be rearranged at local level because medical care service of the health center is competing with primary medical facilities in the same region. It is also suggested that educational efforts be made to improve leadership of the health center directors and concern with public health program by the CEOs and legislators of local governments.

• 농촌의학ㆍ지역보건
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• 제20권1호
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• pp.51-60
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• 1995

This study was to examine the awareness of health and the utilization of primary health care in rural areas. The data were obtained from self-administered questionnaire conducted 450 parents of Mi Gum md Su Dong middle school students in Nam yang Ju city, Kyung Gi-Do, Korea, from December 15 to 20 in 1993. The results were as follows : 1) Among the causes of disease, 'insufficient health care' was the highest(39.1%), and 'bad environment'(28.9%), 'complexity of life style'(17.8%) in next order. 2) In the priority between 'daily farm work' and 'primary health care', only 45.6% of respondents answered that primary health care is more important than the daily farm work. The 29.8% of respondents answered 'daily farm work', and the 23.1% answered 'the equal of the both'. 3) The 63.6% of the respondents recognized correctly, the meaning of primary health care. And the rate of information source in primary health care were 'TV and Radio'(42.2%), 'medical facilities'(23.3%), and 'newspaper and magazine'(11.3%) in order. 4) In the choice rate of medical facilities for primary health care, 'drug store' was the highest(34.9%), and 'local private clinic'(34.7%), 'health (sub)center'(15.8%), 'hospital'(10.2%) in next order. 5) The 53.5% of the respondents had experienced to visit the health (sub)center more than once. And the disfavorite reasons of health (sub)center were 'insufficient equipment'(36.7%), 'inavailable time to visit'(26.9%), and 'poor treatment'(9.1%). 6) Among the preference of the physicians for primary health care, 'specialist' was the highest rate of the respondents(54.2%), and 'general practitioner'(32.4%), and 'family doctor'(9.8%) in next order. The major obstacles in utilizing the medical facilities for primary health care were 'daily farm work'(41.6%), 'distance'(21.1%) and 'medical cost'(10.4%) in order. 7) The weakened reasons in health (sub)center function were 'insufficient medical equipment'(44.4%), 'the lack of resident's understanding for health (sub)center'(21.8%), and 'short thought of duty in health (sub)center personnel'(16.9%) in order.

• 한국병원경영학회지
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• 제12권4호
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• pp.1-21
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• 2007

The relaxation of the regulation in selection of medical institution allows patients to use their own judgement in choosing proper institution for their diseases. Since the change of the regulation, there should have been many changes in medical institution selection behavior. The analysis of the change in disease specific selection pattern is critical because there be an optimal selection criteria that ensure the efficient and effective utilization of medical resources. This study analysis the institution selection factors by comparing the choice among the cases of acute diseases, the cases of chronic diseases, inpatient services, outpatient services, and emergency medical service. The comparisons performed in terms of size, class and other characteristics of medical institutions. For the study the nationally surveyed database was used and the data were analyzed using logistic regression procedure. The results indicates that the primary care facilities were not properly utilized. This study speculates that the reason for the undesirable pattern of utilization is that the roles of primary care facilities in the healthcare delivery system was not clearly defined. Based on the results, the medical policy implications are discussed.

• 한국농공학회논문집
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• 제57권4호
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• pp.39-49
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• 2015

Since most medical facilities and medical personnel are concentrated in urban areas in South Korea, an imbalance of access to medical facilities causes a gap in medical resource availability between urban and rural areas. Accessibility to medical facilities is a means of assessment that evaluates a measure of inequality in utilization of medical resources. The evaluation of accessibility uses Euclidean distance, in general; however, this method has its limits in that Euclidean distance cannot reflect actual distance. This study aims to estimate real road distance from village halls to medical facilities in rural areas using Open Application Programming Interface (Open API) of an internet portal site. Using real road distance, we evaluated medical accessibility and compared it with Euclidean distance. The accessibility to primary medical institutions was valued relatively well, but secondary and tertiary medical institutions were vulnerable in Pyeonchang-gun. Comparing Euclidean distance with real road distance from village halls to medical facilities, real road distance appeared to be approximately 1.4 times that of Euclidean distance. This calculation is similar to the circuity factor of Gangwon-do in Korea that estimated to fix the limits of Euclidean distance and assumed real road distance.