• Journal of Chest Surgery
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• 제49권sup1호
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• pp.28-36
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• 2016

Background: This study aimed to develop the models for regional cardiac surgery centers, which take regional characteristics into consideration, as a policy measure that could alleviate the concentration of cardiac surgery in the metropolitan area and enhance the accessibility for patients who reside in the regions. Methods: To develop the models and set standards for the necessary personnel and facilities for the initial management plan, we held workshops, debates, and conference meetings with various experts. Results: After partitioning the plan into two parts (the operational autonomy and the functional comprehensiveness), three models were developed: the 'independent regional cardiac surgery center' model, the 'satellite cardiac surgery center within hospitals' model, and the 'extended cardiac surgery department within hospitals' model. Proposals on personnel and facility management for each of the models were also presented. A regional cardiac surgery center model that could be applied to each treatment area was proposed, which was developed based on the anticipated demand for cardiac surgery. The independent model or the satellite model was proposed for Chungcheong, Jeolla, North Gyeongsang, and South Gyeongsang area, where more than 500 cardiac surgeries are performed annually. The extended model was proposed as most effective for the Gangwon and Jeju area, where more than 200 cardiac surgeries are performed annually. Conclusion: The operation of regional cardiac surgery centers with high caliber professionals and quality resources such as optimal equipment and facility size, should enhance regional healthcare accessibility and the quality of cardiac surgery in South Korea.

• Journal of Hospice and Palliative Care
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• 제20권1호
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• pp.8-17
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• 2017

종합적인 보건시스템을 지원하기 위한 완화의료정책의 개발과 강화가 세계적으로 강조되고 있다. 우리나라에서는 암정복 10개년 계획과 국가암관리종합계획의 기틀 하에 암정책의 일환으로, 호스피스완화의료정책이 시행되어왔고, 2003년 암관리법(Cancer Control Act)을 제정하여 법적 근거를 마련하였으며, 최근 호스피스 완화 의료 및 임종과정에 있는 환자의 연명의료결정에 관한 법을 제정하여 시행할 예정이다. 호스피스완화의료정책의 대상은 최근 관련법의 제정에 따라, 말기암환자에서 암(Cancer), 후천성면역결핍증(Acquired immune deficiency syndrome, AIDS), 만성 폐쇄성 호흡기질환(Chronic Obstructive Pulmonary Disease, COPD), 만성간경화(Chronic Liver Disease/Live Cirrhosis) 등으로 확대되었고, 급여체계는 2015년에 모든 의료기관에 일당 정액수가와 행위별 수가의 복합지불방식으로 완화의료 건강보험제도가 시행되었다. 전달체계관련 건강보험제도는 입원형과 자문형, 그리고 가정형으로 구분되고, 완화의료전문기관의 지정 평가 지원제도가 운영되고 있으며, 재원체계는 건강보험기금과 국가지원금으로 조달되고 있다. 호스피스 완화의료 관련법의 시행에 앞서, 정책대상의 사회적 합의가 요구되며, 낮은 급여체계의 현실화, 민관협력을 통한 호스피스완화의료 표준설정과 전문요원양성, 질 관리 및 평가체계정립, 그리고 장기요양보험과 호스피스기금 등을 활용한 안정적인 재정체계를 마련해야 할 것이다.

• 한국병원경영학회지
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• 제14권1호
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• pp.123-144
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• 2009

Recently, a long strike by hospital labor union emerged as a serious social issue. During the Worldcup Games in June, 2002, labor strikes broke up at 'C', 'K' and other hospitals, and in 2007, 'Y' hospital suffered much from a strike. Such series of extreme labor disputes have awakened people of importance of a more stable labor-management relationship for the medical institutions responsible for people's health than any other business organization. The purpose of this study was to examine the labor-management disputes at 'Y' hospital in 2007 and 'C' and 'K' hospitals in 2002. The results of this study can be summarized as follows; First, requests of the labor union such as pay raise, reemployment of the irregular workers as regular employees and participation of the labor union in personnel affairs are the long-held or core issues suffered by the medical institutions. Such issues are not independent from each other but complicated with each other surrounding the pay raise. Accordingly, it is not easy to determine the genuine bone of issue for labor-management disputes. Second, the model type of disputes between labor and management at medical institutions may be strike. However, it is conceived that the type of disputes would be subject to change as the essential medical service area system began to be operated since 2008. Third, the common characteristic of the labor strike among the 3 sample hospitals was occupation of the hospital lobby for a sit-in strike to maximize the negative effects of strike. Article 42 (Prohibition of Violence) of Labor Union and Labor Relation Coordination Act prohibits occupation of production or other important business facilities. In addition, since Ministry of Labor interprets that the hospital lobby belongs to the important business facilities enumerated by Article 42 of the above act, occupation of the hospital lobby for a sit-in strike may be too controversial to be admitted as a fair act of labor dispute when its legitimacy should be judged. Fourth, the counter-measures taken by the hospitals against the strike were observance of the principle 'no labor no pay,' closure, legal action, accusation, claim for recovery of damage, provisional seizure, disciplinary punishment, etc., but the principle of 'no labor, no pay' was not applied in a fair manner by 'C' and 'K' hospitals. However, 'Y' hospital applied this principle thoroughly to the strike; the hospital conduced to correction of the wrong labor-management relationship by refusing inclusion in the labor collective agreement of a provision about payment of wage during the period of strike or labor union's request to that effect during a strike. In addition, 'Y' hospital took an effective measure to end the strike earlier by notifying the labor union of cancellation of the collective agreement and banning the unionists from entering the hospital.

• 디지털융복합연구
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• 제12권8호
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• pp.369-376
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• 2014

죽음교육의 주체이자 대상인 의료진의 죽음에 대한 스트레스 정도와 수용방식을'병원 공간을 중심으로'분석하여 죽음교육에 활용하고자, 2014년 4월부터 동년 4월30일까지 대전지역 일반인 281명을 대상으로 조사했다. 분석 결과 죽음교육의 필요성에 대해, 죽음교육을 받은 경우 더 중요하다고 생각하였다. 환자가 회불 불가상태인 경우 의료진은 누구에게 알리는가의 물음에 전체적으로는 보호자가 가장 높았으며, 임종하기 적합한 장소로는 살던집이 가장 많았고, 의료기관, 사회복지시설 순으로 나타났다. 이상과 같은 결과를 활용하면 죽음이라는 현상을 이해하고 다룸에 있어 보건의료적 시각과 인문학적 시각, 사회적 시각을 동시에 수용하여 일반인에게 적용할 수 있는 죽음 교육 프로그램 개발을 위한 연구로 죽음준비프로그램을 대중화 일반화를 위한 기초자료로써 의의가 있다고 할 수 있다.

• 보건행정학회지
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• 제19권3호
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• pp.92-108
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• 2009

This study suggests a model for continuing and comprehensive management of hypertension or Type 2 diabetes mellitus (T2DM) in Korea. Moreover, this paper computed the contribution cost of hypertension or T2DM management using the healthcare medical cost, which could have occurred from stroke, myocardial infarction (MI), and end-stage renal disease (ESRD) that were successfully prevented from the effective hypertension or T2DM management. Additionally, these costs were compared with the cost of implementing the hypertension or T2DM management model suggested in this study. This study used the medical fee summary of the health insurance claims submitted to National Health Insurance Corporation by medical facilities for services provided during the period from January 1st 1999 to December 31st 2006. The prevalence rate with treatment referred to cases in which patients submitted their medical claims at least once during the period, along with an accordant diagnosis. The incidence rate with treatment referred to cases in which patients who never submitted claims for the accordant disease during the five years from 1999 to 2003 submitted claims for the accordant disease in 2004 and 2005. The relative risk of the occurrence of stroke, MI and ESRD was 11.0, 13.6, and 30.3, respectively. The attributable risk of hypertension or T2DM for stroke was 0.730, and that for MI and ESRD were 0.773 and 0.888, respectively. Based on these, the contribution cost of hypertension or T2DM is estimated to be 986.3 billion Korean Won(KRW) for stroke patients, 330.5 billion KRW for MI patients, and 561.7 billion KRW for ESRD patients as in 2005. Hence, the total contribution cost of hypertension or T2DM to stroke, MI, and ESRD is 1.878 trillion KRW. The estimate for operational costs included an annual expenditure of 50,000 KRW per each recipient and an annual subsidy of 0.22 million KRW per person for the 1.6 million low.income individuals with hypertension or T2DM to cover their out.of.pocket medical expenses. Under this assumption, it took approximately 0.6 trillion KRW to manage 5 million high.risk patients in the low. and mid.income range, coverings up to 50% of costs. In conclusion, considering the potential benefits of preventing stroke, MI, and ESRD, the costs seems to be reasonable.

• Parasites, Hosts and Diseases
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• 제55권5호
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• pp.523-532
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• 2017

A field survey studying intestinal parasites in humans and microbial pathogen contamination at environment was performed in a Laotian rural village to identify potential risks for disease outbreaks. A parasitological investigation was conducted in Ban Lak Sip village, Luang Prabang, Lao PDR involving fecal samples from 305 inhabitants as well as water samples taken from 3 sites of the local stream. Water analysis indicated the presence of several enteric pathogens, i.e., Aeromonas spp., Vibrio spp., E. coli H7, E. coli O157: H7, verocytotoxin-producing E. coli (VTEC), Shigella spp., and enteric adenovirus. The level of microbial pathogens contamination was associated with human activity, with greater levels of contamination found at the downstream site compared to the site at the village and upstream, respectively. Regarding intestinal parasites, the prevalence of helminth and protozoan infections were 68.9% and 27.2%, respectively. Eight helminth taxa were identified in fecal samples, i.e., 2 tapeworm species (Taenia sp. and Hymenolepis diminuta), 1 trematode (Opisthorchis sp.), and 5 nematodes (Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis, trichostrongylids, and hookworms). Six species of intestinal protists were identified, i.e., Blastocystis hominis, Cyclospora spp., Endolimax nana, Entamoeba histolytica/E. dispar, Entamoeba coli, and Giardia lamblia. Questionnaires and interviews were also conducted to determine risk factors of infection. These analyses together with a prevailing infection level suggested that most of villagers were exposed to parasites in a similar degree due to limited socio-economic differences and sharing of similar practices. Limited access to effective public health facilities is also a significant contributing factor.

• Tuberculosis and Respiratory Diseases
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• 제84권4호
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• pp.317-325
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• 2021

Background: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are significant public health issues in the world, but the epidemiological data pertaining to HAP/VAP is limited in Korea. The objective of this study was to investigate the characteristics, management, and clinical outcomes of HAP/VAP in Korea. Methods: This study is a multicenter retrospective cohort study. In total, 206,372 adult patients, who were hospitalized at one of the 13 participating tertiary hospitals in Korea, were screened for eligibility during the six-month study period. Among them, we included patients who were diagnosed with HAP/VAP based on the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) definition for HAP/VAP. Results: Using the IDSA/ATS diagnostic criteria, 526 patients were identified as HAP/VAP patients. Among them, 27.9% were diagnosed at the intensive care unit (ICU). The cohort of patients had a median age of 71.0 (range from 62.0 to 79.0) years. Most of the patients had a high risk of aspiration (63.3%). The pathogen involved was identified in 211 patients (40.1%). Furthermore, multidrug resistant (MDR) pathogens were isolated in 138 patients; the most common MDR pathogen was Acinetobacter baumannii. During hospitalization, 107 patients with HAP (28.2%) had to be admitted to the ICU for additional care. The hospital mortality rate was 28.1% in the cohort of this study. Among the 378 patients who survived, 54.2% were discharged and sent back home, while 45.8% were transferred to other hospitals or facilities. Conclusion: This study found that the prevalence of HAP/VAP in adult hospitalized patients in Korea was 2.54/1,000 patients. In tertiary hospitals in Korea, patients with HAP/VAP were elderly and had a risk of aspiration, so they were often referred to step-down centers.

• Journal of Hospice and Palliative Care
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• 제16권2호
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• pp.90-97
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• 2013

목적: 본 연구는 정부가 호스피스완화의료를 제도적으로 지원하겠다고 발표한 2002년 이후 10년이 지난 현시점에서 일반 대중들의 웰다잉에 대한 인식과 수용도가 어떤 방향성을 띄는지 알아보고자 하였다. 이를 통해 향후 한국 호스피스 완화의료 정책이 나아갈 길을 제시하는 것을 목표로 하였다. 방법: 2012년 6월 1일부터 6월 11일까지 전국 만 20~69세 성인 남녀 1,000명을 대상으로 Computer-Assisted Telephone Interviewing (CATI)를 이용하여 웰다잉에 대한 인식 및 수용도에 관한 설문을 실시하였다. 조사 항목은 인구학적 특성 전반과 신체적, 정신적, 사회적, 영적 건강상태 등 건강에 대한 인식, 그리고 아름다운 삶의 마무리에 대한 정책적 선호도로 구성하였다. 결과: 아름다운 삶의 마무리를 위한 제1 중요 요소로는 다른 사람에게 부담을 주지 않음이 36.7%로 가장 많았다. 제2 중요 요소로는 가족이나 의미 있는 사람과 함께 있는 것이 19.1%로 가장 높은 비율을 차지하였다. 죽음과 관련하여 삶의 아름다운 마무리를 위한 9가지 전략의 선호도를 조사한 결과, 간병 품앗이 활성화에 대해 찬성하는 의견이 88.3%로 가장 많았으며 의료인의 임종환자 관리 교육 실시(83.7%), 장례식장 대신 가족들을 편하게 해주고 의료진이 환자를 돌볼 수 있는 시설을 병원/집에서 가까운 곳에 마련(81.7%)이 그 뒤를 이었다. 삶의 아름다운 마무리를 위한 5개년 국가 전략을 수립하는 것에 찬성한 비율은 전체의 91%로 매우 높은 수준이었으며 그 수행 주체로는 정부(47.5%), 국회(20.2%), 시민 단체(10%)순인 것으로 조사되었다. 결론: 일반 국민 1,000명을 대상으로 조사한 본 연구결과는 국가적 차원의 웰다잉 정책과 완화의료의 제도적 지원책을 마련하는데 초석이 될 수 있을 것이다.

• 의료법학
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• 제20권1호
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• pp.109-132
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• 2019

최근 수술 관련 의료사고가 증가하고, 일부 의료사고가 보건범죄와 연루되었다는 사실이 언론에 보도되었다. 환자단체는 수술실 내 CCTV 설치 및 운영 의무화를 촉구하였고, 이에 대한 이해관계인들의 논의가 활발히 이루어지고 있어 관련 법령에 대한 검토가 필요한 상황이다. 본 연구에서는 수술실 CCTV에 대한 특성을 파악하고, 수술실 CCTV 설치 및 운영에 관련 법령에 대해 비판적으로 검토하고자 한다. 현재 의료기관 내에서 CCTV는 시설물 관리용 및 환자안전관리용을 주목적으로 사용되고, 수술실의 경우 의료기관이 선택적으로 CCTV를 설치 및 운영하고 있다. 헌법은 모든 개인의 사생활 및 통신의 비밀과 자유를 침해받지 않을 권리를 보장하고 있으나, 이는 공공복리를 위해 법률로써 제한할 수 있다고 규정하고 있다. 그러나, 수술실 CCTV 설치 및 운영과 관련하여 법률이 현재 존재하지 않기 때문에 이는 법률의 흠결에 해당할 수 있다. 현 법체계상으로는 수술실 CCTV 설치가 의무화될 경우 정보주체인 의료진의 권리에도 불구하고 보건의료서비스 공급자의 특성상 개인정보자기결정권을 침해받을 가능성이 크다. 또한, 영상정보처리기기운영자의 CCTV 조작 시 열람과 업무 중 알게 되는 비밀의 누설에 관한 제한규정이 미흡한 상태여서 영상정보의 안전성이 위협받을 수 있다. 나아가, 수술실 CCTV의 경우 영상정보 보관기간, 보관장소 등이 명확히 규정되지 않는다면 환자안전과 의료사고 예방이라는 본래 목적에 부합되지 못할 가능성이 크다. 수술실 CCTV 설치 및 운영에 대해서 현재 활발하게 논의가 이루어지고 있고, 관련 의안이 몇 차례 발의되고 있어 이에 대한 법적 검토의 필요성이 증가하고 있지만 이에 관한 선행연구가 거의 없다는 측면에서 본 연구의 의의가 있다. 향후 수술실 CCTV 설치 및 운영 관련 법령 제·개정 시 본 연구 결과를 활용할 수 있을 것으로 기대한다.

• Journal of Chest Surgery
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• 제52권4호
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• pp.248-329
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• 2019

Background: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. Methods: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. Results: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Conclusion: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.