• 한국병원경영학회지
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• 제22권3호
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• pp.1-17
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• 2017

목적: 상용치료원(usual source of care)은 아프거나 건강문제에 대한 조언이 필요할 때 주로 방문하는 특정 개인의원, 보건소, 혹은 기타 장소로, 상용치료원 보유는 예방서비스를 제공을 더 받게 되며, 보건의료에 대한 전반적인 만족도가 높고, 입원율을 감소시키며 의료급여자의 의료비를 감소시킬 수 있다. 이 연구에서는 당뇨병을 보유하고 있는 20세 이상을 대상으로 상용치료원 보유 여부에 따른 대상자의 현황을 파악하고, 의료이용 횟수 및 의료비의 차이와 이에 영향을 미치는 특성을 분석하였다. 방법: 이 연구는 제7차 한국의료패널 자료를 이용하였다. 상용치료원 보유여부에 따른 의료이용 횟수와 의료비를 비교하기 위해 분산분석을 실시하였으며, 상용치료원 유형에 따른 의료이용 횟수와 의료비용에 영향을 미치는 요인을 파악하기 위해 Tobit 분석을 수행하였다. 결과: Tobit 분석결과, 상용치료원을 보유한 경우 보유하지 않은 경우보다 외래의료비는 증가했으나 입원의료비는 감소하였다. 상용치료원을 보유한 경우 보유하지 않은 경우보다 외래이용횟수와 입원횟수가 증가했으나 통계적으로 유의하지 않았다. 함의: 지속적이고 포괄적인 의료서비스가 제공되는 상용치료원을 당뇨병 환자들이 보유하게 되면, 외래 예방서비스의 이용을 통해 장기적으로 입원의료비의 감소를 기대할 수 있을 것이다.

• 한국병원경영학회지
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• 제7권4호
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• pp.24-56
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• 2002

The purpose of this study was to analyze the characteristics of socio-demographic, organizational culture, organizational conflict and organizational commitment, and to examine the interrelation of influential factors in the organizational commitment. The data for this study were collected through a self-administrated survey with a structured questionnaire to 1,027 subjects from several medical doctor staff members, nursing staff members, administration staff members, pharmacist, and technical expert of eleven hospitals. The data were collected by self-reporting questionnaire from July 29 to September 7, 2002. In this analysis frequency test, t-test, ANOVA, multiple regression were used. The main results of this research is as following; 1. According to socio-demographic characteristics the respondents' level of the organizational commitment was higher in a administration staff members than others, for males than females, and for employees aged more than forty, as working for longer time, and as higher level of the working position. 2. According to the organizational culture characteristics the progressive culture, affiliative culture, and task-focused culture among many types of organizational culture were moderately and positively correlated with the level of the organizational commitment while the hierarchical culture was negatively correlated. 3. According to the organizational conflict characteristics as the respondents who got less conflict experience in the organization, their level of the organizational commitment was higher. And, technical conflict experiences were expressed greater than hierarchical conflict experiences. 4. According to the job satisfaction characteristics as his or her satisfaction that is about the promotion, working itself, salary, and fellowship in the organizational was higher, the level of the organizational commitment was higher. The most important factor of the satisfactions was the fellowship among the respondents while the level of job satisfaction for the promotion and salary was average. 5. Overall, according to the result of Multiple Regression as older age and longer working hours, the level of the organizational commitment was higher and as a higher level of the satisfaction for the promotion, working itself, salary, and fellowship in the organization, it caused more effective factors for the organizational commitment. 6. According to the result of Multiple Regression for the doctor staff members in special hospitals rather than general hospitals the hierarchical culture and task focused culture was positively correlated with the satisfaction of working itself while hierarchical conflict factors in the organizational conflict characteristics was negatively correlated with the organizational commitment. For the nursing staff members the affiliative culture and the job satisfaction for the promotion, working itself, salary, and fellowship were positively correlated with the organizational commitment. For the administration staff members as the job satisfaction for the fellowship was positively correlated with the organizational commitment. For medical and pharmacy staff members as more working experience, correlation with the organizational commitment was positive. Besides, as he or she has a high perception of the affiliative culture, it caused statistically more effective factors for the organizational commitment. For the skill and technicians, male worker expressed greater organizational commitment in the organization than female worker. And also older age along with higher education also showed higher organizational commitment. Moreover, the job satisfaction for the fellowship was positively correlated with the organizational commitment. This study identified the major effective factors of the organizational commitment and analyzed the differences among the job category. In that respect, it is significant for the study to be able to provide a reference for managing hospital of industrial accident and organizational development. However, this study has a problem, which is not to identify a valuable model for examining the relationship between organizational factors such as organizational culture, conflict, satisfaction, and commitment. Therefore, further study is needed and strengthened in the field of organizational commitment for hospital for industrial accident.

• 한국학교보건학회지
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• 제14권1호
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• pp.131-143
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• 2001

The primary aim of this dissertation is to contribute to the improvement of methods in physical examination by providing quality information for the current school system and advice for improving status. Present status, controversial points and possible remedies in physical examination were analyzed on a frequency and percentage basis. An $x^2$-test was used to verify the statistics between the results from the examination and each variable. In case of multiple categories of variables, an $x^2$ cs was adopted. Chronological data as well as both total and sampling physical examination data verified the statistics using an $x^2$-test. This thesis is based both on the data from middle school health care specialists in Gyunggi Province and on the analysis of physical examinations reported from local schools to the municipal education agency from 1997 to 1999. The results of the study are as follows: First, according to the survey, only 29.0% of the total schools had their school doctors examine all the students while most of the educational institutions failed to implement the whole process of physical examination on the list. It also turned out that the more students the schools have, the lower the rate of implementation of physical examination by school doctors(p=0.014). Second, the average time a school doctor spends for checkup turned out to be approximately 1.7 minutes per student This means that the quality of the physical examination is not guaranteed in the process. Third, 47.7% of those surveryed say that a dental examination was performed, each taking 21.24 seconds on average. In addition, it shows that some 31.5% wanted to have a task force team for dental checkups at the local health center. Given the fact that dental caries among students is progressively on the rise, the dental health centers that are now set up in some elementary schools should be expanded to cover the whole educational institution in order to raise awareness of the importance of dental care. Fourth, 48.5% of those surveyed say that a comprehensive physical examination should be adopted to promote the health of high schoolers. Since it takes a lot of public funds to implement a comprehensive method, it is essential to make sure that in-depth studies should be based on the frequency and methods of physical examination. Fifth, regarding such diseases among 3rd year middle school students in 1999, statistics shows that there was a slight difference in the prevalence rate of color blindness, and allergic diseases for male students ; and color blindness, hearing disturbance and allergic disease for female students. For those items, however, it is too little to say that there is a significant difference and accordingly it is assumed to be a problem of the measuring process. Sixth, the result of analysis on the sample physical examination and the total physical examination of the year 1999 shows as follows: For male students in the 3rd year of middle school, a slight difference appeared to those students in 11 items including eye problems and eye disease, otitis media, tonsillar hypertrophy, spinal shape, respiratory urinary allergic disease and other abnormal diseases(p<0.05). Particularly, the prevalence rate between students with and without disease was shown to be two times more in the following: eye problems, otitis media, tonsill hypertrophy, allergic diseases, etc. For female students in the 3rd year, prevalence rate showed little difference in 14 items(p<0.05). For items including eye problem, otitis media, tonsill hypertrophy, allergic disease, etc. it was shown that the rate was two times more between students with and without diseases. Physical examinations under the current school system are not producing any fundamental results for the health of the students. Methods and results are not trustworthy. Accordingly, a drastic overhaul of the current practices is needed in frequency, methods and items on the list in order to promote the health of the students. Cost-benefit studies as well as political considerations to ensure the development of efficient methods for physical examination are urgently needed at this moment.

• 한국학교보건학회지
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• 제4권2호
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• pp.176-192
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• 1991

특수학교 보건관리의 방향 설정과 특수학교 양호교사 업무 수행에 있어 질적 향상을 위한 기초 자료를 제시하고자 전국의 102개 특수학교 양호교사를 대상으로 1991년 2월 1일부터 1991년 3월 31일까지 우편 설문 조사를 실시하여 회수된 77개 학교를 대상으로 분석한 결과를 요약하면 다음과 같다. 특수학교의 67.5%가 사립이고, 83.2%가 시 이상 지역에 위치해 있으며, 정신지체학교가 48.1%로 가장 많았다. 특수학교의 평균 학급수는 17.2학급, 평균학생수는 194명, 평균교직원 수는 28명이었다. 양호교사의 평균 연령은 32.7세였고, 97.4%가 전문대학 이상 졸업자였으며, 71.4%가 기혼자였고, 79.2%가 임상이나 보건과 관련된 분야의 과거경력이 있는 것으로 나타났다. 또한 62.3%의 양호교사가 단독 업무를 보고있었으며, 77.9%가 초등에 소속되어 있었다. 대상 특수학교 양호실은 68.9%가 l층에 위치해 있었고, 학교보건 조직은 90.9%가 구성되어 있지 않았으며, 학교보건 인력으로 교의, 치과의, 학교 약사 모두를 위촉하고 있는 곳은 18.2%에 불과했다. 학교보건에 관한 연간 예산은 양호교사의 46.8%가 모르고 있었으며, 학교당 평균 년간지출액은 317,000원으로 그 중 의약품 구입비가 제일 많았다. 학교당 월 평균양호실 이용자수는 71명이었고, 학생 1인당 연간 양호실 이용은 4.4회였으며, 외상으로 인한 이용이 26.6%로 가장 많았다. 양호실 이용자중 1.4%가 의료기관에 의뢰되었는데, 시각장애학교는 고열, 정서장애학교는 골절, 다른 영역학교는 외상으로 가장 많이 의뢰하였다. 특수학교 아동 중 간질 학생수는 956명으로 조사 대상학교 학생수의6.4%를 차지하고 있었다. 신체검사를 2회 이상 실시하고 있는 학교는 22.6% 밖에 되지 않았으며, 98.7%가 보건교육을 실시하고 있고, 성교육은 98.7%가 필요하다고 강조하였다. 보건교육은 개인 위생에 가장 비중을 두고 있었으며, 시각장애 학교는 방송교육, 청각장애 학교는 OHP나 VTR, 다른 영역의 학교는 가정통신문이나 OHP VTR을 가장 많이 사용하는 교육매체였다. 대상 양호교사의 46.8%가 학교보건관리중 보건교육이 가장 어렵다고 하였으며, 중점개선내용으로 49.4%가 특수학교 보건관리에 대한 구체적인 업무 지침이 필요하다고 강조하였다. 사업계획 및 평가, 양호실 관리, 보건교육, 환경관리, 건강관리 등의 양호교사 업무 수행은 비교적 높은 수행율과 자신감을 나타냈으나, 그 중 학교보건 사업의 평가, 체력검사, 보건교육 후 평가, 학교정화구역 관리, 상처 봉합에 대한 수행율과 자신감이 비교적 낮았다. 따라서 특수학교 보건관리의 방향설정과 양호업무의 질적수준 향상을 위하여 학교보건사업에 대한 구체적인 업무지침의 개선과 특수학교 양호교사에 대한 별도교육이 필요한 것으로 생각된다.

• Journal of Preventive Medicine and Public Health
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• 제4권1호
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• pp.77-87
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• 1971

연세지역 아파트 주민의 모자보건과 가족계획에 대한 지식, 태도와 실천을 파악하기 위하여 1970년 11 월24일부터 12월 30일까지 305명의 유배우가임부인을 대상으로 조사 하였다. 본 연구를 통해 얻어진 결과를 요약하면 다음과 같다. A. 임신과 출산 1. 현 임신율 16.4% 2. 분만장소 출산경험이 있는 281명에 대한 최종아의 분만중 48.0%가 의사 또는 조사원이 개조 하였고 그 나머지 52.0%는 가정분만이었다. 교육정도, 매스메디아 접촉정도가 높을수록, 그리고 도시출생성장일수록 병원 또는 조산원 분만이 높았다. 9. 분만시 방포 사용 종류 가정분만 141예중 세멘트 포대와 비닐을 깐 경우가 합해서 50%이었고 아무것도 깔지 않고 분만한 경우도 4예가 있었다. 4. 제대 절단 용구와 소독 가정 분만 141예중 70.2%가 가위를 사용했고, 소독해서 사용한 예는 불과 24.1%이었다. 5. 산후 휴식기간 산후 1달 혹은 1달이상 휴식한 예가 47.3%이었고 교육정도가 높아짐에 따라 길어지고 있다. 6. 초유처리 초유를 애기에게 먹인 예가 52.4%이있고 교육정도에 따라 유의한 차이가 없었다. 7. 산전 산후의 금기 음식 42.9%가 산전 산후에 먹어서는 안될 음식이 있다는 그릇된 지식을 갖고 있다. B. 아동 보건 1. 예방접종에 관한 지식과 실천 어린이 예방접종 6가지 모두 알고있는 부인은 20.3%이며 93.2%가 1가지 이상 알고있었다. 1가지 이상 실시한 경우는 85.2%이었고 교육정도별 유의한 차이는 없었다. 2. 최종아의 이환과 치료 48.1%가 아픈 일이 있었으며 그중 병원 이용은 41.5%이었다. 3. 육아 상담 76.5%가 상담한 일이 없었으며 세브란스 병원 육아 지도회 이용율은 13.2%의 저율을 보였고 앞으로의 육아지도회 이용할 생각은 54.1%가 생각 없다고 하였다. 4. 수 유 최종아의 이유기간은 6개월${\sim}$1년미만이 33.9%로 수위이며 젖뗀 이유는 모자 보건을 위해서가 수위였다. 5. 출생 및 사망신고장소에 대한 지식과 실천구청으로 답한 옳은 답은 64.6%였고 14일 이내 출생 신고한 비율은 29.2%에 한 하였다. C. 가족계획에 대한 지식, 태도, 실천정도 가족계획 찬성율은 95.0%의 고율을 보이고 있고, 97.7%가 1가지 이상의 방법을 알고 있었으나 가족계획 실천율은 35.4%이었다. 첫아이갖는 이상적인 연령은 $24{\sim}25$세가 수위였다. D. 자녀수 이상적인 평균 자녀수는 3.1명이며 인공유산 경험자는 31.1%이다. 본 논문을 완성함에 있어서 간곡하신 지도와 교열의 수고를 베풀어 주신 연세의대 예방의학교실 김일순 선생님과 연세간호대학 김모임 선생님께 충심으로 감사를 드린다.

• 대한소아치과학회지
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• 제44권4호
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• pp.427-436
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• 2017

본 연구의 목적은 국내 실정에 맞는 행동유도법에 대한 보호자의 인식도를 조사하여 어린이 환자와 보호자, 그리고 치과 의사간의 긍정적인 관계를 설정하는데 기초 자료를 제공하는 것이다. 117명의 보호자에게 소아치과에서 사용되는 행동유도법에 대해 구두로 설명한 후 설문지를 작성하게 하였다. 설문지에 포함된 행동유도법은 다음과 같다: 말-시범-시행법, 음성조절법, 기구에 의한 보호안정법, 의료진에 의한 보호안정법, 아산화질소-산소 흡입진정법, 의식하 진정법, 전신마취법. 106명의 보호자의 설문지가 분석을 위해 채택되었다. 말-시범-행동법에 대한 인식도가 가장 높았다. 그 뒤로 음성조절법, 의료진에 의한 보호안정법, 아산화질소-산소 흡입진정법, 기구에 의한 보호안정법, 의식하 진정법, 전신마취법 순으로 낮아졌다. 보호자의 연령, 성별, 환자의 나이, 환자의 성별, 환자의 치과 경험 유무, 치과 방문의 종류, 의료진의 직위는 보호자의 행동유도법에 대한 인식에 영향을 미치지 않았다. 보호자들은 의사소통을 통한 행동유도법(말-시범-시행법, 음성조절법)을 가장 긍정적으로 생각하며, 전신마취법에 의한 행동유도법을 가장 부정적으로 생각하는 것으로 나타났다.

• 간호행정학회지
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• 제5권3호
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• pp.445-462
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• 1999

The purpose of this study is to provide some basic data for the direction of nursing education and practice to prevent nursing malpractice as investgating perception of the nurse on the nursing malpractice and its case. Data were collected from 450 nurse working in four general hospitals which were located in Chonbuk province from November 9 to 21, 1998 through questionnare. The structured instruments developed by the reseacher were used for collecting data. The Results were as follows: 1) As for the cognition of the nursing malpractice case, the transfusion accident was 37.3%, the side-effects of KCL injection(19.3%), hymen rupture by uterus cancer test, the side-effects of aminophyllin injections on dyspnea patient and the others were 10% below. 2) With regard to the channel of the perception of the nursing malpractice case, mass-communication was taken first and followed through by neighbors, In-service education, school education, continuing education 3) As for the direct${\cdot}$indirect experience of the nursing malpractice case, transfusion accident was 51.3%, the fall of NPO patient after an operation 40.1%, the side-effect of KCL injection 32.5%, suicide of the psychiatric patient 32.5%, and the others were 30% below. 4) The possibility of nursing malpractice case was an average 2.57(${\pm}$0.91) and the highest was the fall of the NPO patient after an operation. 5) The perception on the responsibility of the nursing malpractice in its case was indicated as a joint-fault in ten nursing malpractice instances. As compared to the real decision, nurse's perception of the responsibility in the fall of the NPO patient after an operation, the side-effect of KCL injection, the tracheal edema of the patient who had a thyroid operation, the suicide of psychiatric patient, the hymen rupture by uterus cancer test accorded real decisions. But the other cases were different from the real decisions. These cases were perceived as ones of joint fault even in cases determined as Dr's single fault cases or those in which both doctor and nurse were declared free of fault. 6) Knowledge levels of the nursing malpractice, school education and In-service education were perceived as low but anxiety levels of the malpractice were high. 7) With regard to the countmeasure of the hospital after nursing malpractice, the rate answered as "the practice settled the accident temporarily and forced the person in charge to be punished" was highest. In conclusion, the level of the cognition of the clinical nurse on nursing malpractice cases was low. As nurses' perception on the responsibility of the nursing malpractice case was compared to the real decision, there was a difference in five cases out of the ten cases.

• 전자공학회논문지
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• 제53권12호
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• pp.169-174
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• 2016

본 연구에서는 실제적인 환자의 모델을 바탕으로 가상현실 기반의 수술환경을 제작하는 방법에 대한 고찰과 함께 치과 임플란트 수술 술기를 배울 수 있는 가상현실을 활용한 수술 모델에 대한 평가를 시행하고자 한다. 환자의 안면 해부학적 모델은 실제 환자의 CT 데이터를 바탕으로 안면부위 골에 대한 삼차원 모델을 먼저 완성한 후 각각의 근육을 표현하고 안면부에 대한 삼차원 스캔 그리고 치아의 3차원 스캔 후 모델링을 통해 각각의 해부학적 구조물을 표현하였다. Unity3D를 활용해 단계별 시나리오를 게임으로 구성하였다. 처음 절개를 시행하는 단계에서부터 환자의 현재 상태에 필요한 상악동 거상술에 대한 술기를 표현하고, 임플란트 식립과정 그리고 골이식술을 하는 과정을 단계별로 포함하였다. 단계별로 중요한 과정의 효과적인 습득을 위해 HMD(Head Mount Display) 및 Leap motion과 연동하여 3차원 모델에 기구를 위치시키고 수술행위를 재현해볼 수 있게하여 몰입감을 높이면서 실제 수술을 하고있는 느낌을 재현하고자 하였다. 총 20명의 수련의를 대상으로 가상현실 시뮬레이션을 수행한 후에 설문조사를 시행하였다. 임플란트 수술 교육 프로그램은 치과 대학생들과 수련의들의 교육 도구로서 수술 술기를 습득하고 평가하는데 사용할 수 있는 가능성을 보여주었다. 통상적으로 수술 술기 교육 방법이 많지 않은 현실에서 HMD 와 Leap motion이라는 비교적 저렴한 기기를 이용하여 몰입감을 높일 수 있는 가상현실 기반의 수술 교육은 장점이 있다고 말할 수 있다.

• 한국의사학회지
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• 제26권2호
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• pp.175-185
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• 2013

Purpose : The current Medical Law and the Pharmaceutical Affairs Act, which are incapable of utilizing the research results and the advanced academic, clinical, and pharmaceutical system of the present-day Korean (Oriental) medicine, have limitations and create a paradox by provoking social conflict among the professionals in the field. The aim of this study was to find out the legal and systematic problems that contributed to a complicated conflict amongst Korean (Oriental) medicine doctors, doctors, pharmacists, and Korean (Oriental) pharmacists regarding the classification of their functions. Methods : We reviewed the history and characteristics of the legislation regarding the duties of Korean (Oriental) medicine doctors and Korean (Oriental) pharmacists as well as the relevant and important public health policies since the enactment of the National Medical Services Law in 1951. We focused on the laws and regulations that are made in the process of the separating functions of physicians and pharmacists and the dispute between the Korean (Oriental) medicine doctors and the Korean (Oriental) pharmacists in the 1990s and 2000s. Results : The legislations and amendments of the medical and pharmaceutical laws and regulations that reflect the modern academic, clinical, and pharmaceutical system of the Korean (Oriental) medicine and the research results could be summarized as follows: 1) A partial amendment of the Medical Law in 1987, which added the provision of "Oriental health guidance" as one of the duties of Korean (Oriental) medicine doctors, assured a place for Korean (Oriental) medicine doctors in the field of public health. 2) A partial revision of Pharmaceutical Affairs Act in 1994 established a new system for Korean (Oriental) pharmacists, bringing about the creation of dualistic pharmaceutical system that complements the dualistic medical system. 3) The Promotion of the Research and Development of Wonder Drugs by Using Natural Substances Act was legislated in 2000 in order to stimulate research and development of Korean (Oriental) medicine and its industrialization. 4) Oriental Medicine Promotion Act in 2003 was enacted to lay foundation to specify and promote technology and industry that are related to Korean (Oriental) medicine. Discussions and conclusions : Although the dualistic medical and pharmaceutical system is set up by the Medical Law and Pharmaceutical Affairs Act, it is shown that the relevant regulations have been developed from a perspective of the western medicine.

• 한국의사학회지
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• 제26권2호
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• pp.9-21
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• 2013

Purpose : The purpose of this study was to analyze the history and characteristics of laws and regulations of the medical and pharmaceutical system in Korea-focusing on the Korean (Oriental) medical and pharmaceutical system-from the modern period to the early days of the Republic. We reviewed how traditional notions and categories of Oriental medicine, which were regarded as experiential and conventional, became part of the current dualistic medical and pharmaceutical system, and examined problems and effects during the course of positioning. Methods : We classified the development of the medical and pharmaceutical laws and regulations chronologically, from the Korean Empire to the beginning of the Republic. The abolishment of the traditional medical system that was based on laws and regulations of the Joseon Dynasty, the implementation of dualistic medical system in the Korean Empire, the attempt to demolish Korean (Oriental) medicine under the Japanese colonial rule, and the process of developing a statute-based continental law system were thoroughly reviewed. Results : Although the dualistic medical system was specified in legislation via the enactment of the National Medical Services Law in 1951, we found that it was actually enacted in 1963, when the laws and systems regarding the educational institution of Korean (Oriental) medicine were stably established. Moreover, the dualistic pharmaceutical system was specified in legislation through the partial amendment of the Pharmaceutical Affairs Act in 1994, but we concluded that the actual enactment was rather in 2000, when the first Korean (Oriental) pharmacist was produced. Discussions and conclusions : An effort to establish a dualistic medical system of Korean (Oriental) medicine and Western medicine during the Korean Empire bore fruit a few decades later, after the Republic of Korea was founded. It means the basis for the legal system finally took shape in spite of the numerous attempts during the Japanese colonial era and the beginning of the Republic to abolish Korean (Oriental) medical and pharmaceutical system.