치과 외래 이용 선택에 있어서 공급자 요인

김민영(Min-Young Kim),조한아(Han-A Cho),신호성(Hosung Shin) 대한경영학회 2015 大韓經營學會誌 Vol.28 No.2

의료인의 환자 전인 치유를 위한 영적 돌봄

노현기(Noh Hyun Ki) 가톨릭생명윤리연구소 2015 인격주의 생명윤리 Vol.5 No.1

"Cure the sick, raise the dead, cleanse those suffering from virulent skin-disease, drive out devils" (Matthew 10,8). Caring for those who are sick and suffering from the disease is an important duty of the Catholic church. Pain is subjective. In order to understand the patient's pain, it is important to acknowledge the patient as a person. Christianity proclaims that God created humans in the form of God. These contain the broad meaning of the existence of human beings as a whole which interacted, explain that the body, the soul and the spirit cannot be separated. Christian belief of God's presence in the very beginning of the creation of humans supports the transcendental connection between God and humans. Christianity acknowledges humans as holistic beings who strive for the profound meaning of spiritual origin and transcendence under the influence of the mutual relationship among body, soul and spirit. In today's medical practice, are we providing holistic care based on the understanding of human being as a whole? Although healthcare providers are aware of the basic principles of Geneva Convention which is the respect of the human being and its dignity, it is not easy for them to follow these principles in reality. With the development of science, medical practice has focused on treating the disease instead of seeking the need of patients. This attitude creates a lack of humanity in the treatment of patients. In this situation, Jesus as a role model of holistic healthcare provider is well described in the Gospels. During his life as a human, Jesus always reached out for the sick to cure them with love and compassion. While praying in Getsemani, he showed us the importance of spiritual care along with the physical care when treating the sick. Jesus himself never hesitated to reach out and cure those who are sick. He approached them first and offered physical cure as well as spiritual healing. The resurrection of Jesus after crucifixion proved salvation from the suffering. He always prayed while curing the sick, and followed God's will to glorify God's divine power. Jesus' mission teaches us the divine power of prayers and consolation. Therefore, it becomes clear that the role of the healthcare providers should not focus only on the treatment of physical symptoms but also should involve spiritual care. Like the good Samarian, we should be compassionate for those who suffer from the pain and share God's love. With the talent given by God, healthcare providers should treat the patient as a person, share their pain and show respect so patients do not feel abandoned and isolated. At the same time, healthcare providers should approach the patients with love and compassion and encourage them to believe in God's healing. In order to provide holistic care, healthcare providers themselves should realize that they are also healed by God. By accepting themselves as the cured ones and the ones in need of spiritual care, they can share God's love and compassion. Only then, they can provide holistic care by leading the sick to the road of salvation through overcoming various difficulties caused by pain. "앓는 이들을 고쳐주고 죽은 이들을 일으켜 주어라. 나병 환자들을 깨끗하게 해 주고 마귀들을 쫓아내어라."(마태 10,8) 라는 예수님의 말씀처럼 가톨릭교회는 병자들에 대한 봉사를 교회의 주요 직무 가운데 하나로 여기고 있다. 환자의 고통에 전인적으로 응답하기 위해서는 무엇보다도 환자, 즉 인간을 전인적 존재로 이해하는 것이 선행되어야 한다. 그리스도교는 하느님의 모상으로서 인간이 창조되었다고 고백하고 있으며, 이러한 사실은 인간이 영, 혼, 육으로 나눠진 부분의 집합체가 아니라 오히려 이러한 부분들이 상호 영향을 끼치고 있는 하나의 전체로서의 전인적 존재임을 보여주고 있다. 그리고 무엇보다도 그리스도교 신앙은 인간 창조의 순간 하느님의 숨결이 함께 하였음을 고백함으로써 인간이 하느님과 초월적으로 연결된 영적 존재임을 고백하고 있다. 따라서 그리스도교는 영적 존재로서의 인간을 육체-정신-영혼의 상호 통교 아래에서 영의 본질적이며 초월적인 의미를 추구하고 사는 심오한 일체성을 갖춘 통합적 존재로 인식하고 있다. 그렇다면 오늘날 의료 현장에서는 이러한 인간 이해가 바탕이 된 전인적 치유가 이루어지고 있는가? 과학의 발달과 더불어 과학화ㆍ전문화ㆍ분업화된 의료는 환자를 의료행위의 주체가 아니라 대상으로 취급하게 되었고, 환자는 질병에 대한 기계적인 치료만을 받게 됨에 따라 질병 경험에 따른 근본적인 불안과 고통의 문제를 해결하지 못하게 되었다. 이러한 가운데 복음은 우리에게 전인적 치유의 모델로서의 예수 그리스도의 모습을 잘 전해주고 있다. 예수 그리스도는 공생활 가운데서 늘 병자들을 돌보셨으며 그들을 향한 자비와 사랑을 거두지 않으셨다. 뿐만 아니라 예수 그리스도는 겟세마니 동산에서 고통 가운데 기도하시면서 고통 중에 있는 이들이 무엇을 갈망하고 있으며, 이들을 온전히 치유하기 위해서는 질병에 대한 육체적 치료 외에도 영적인 돌봄이 함께 병행되어야 함을 일깨워주셨다. 예수 그리스도는 당신이 만나는 모든 사람들을 언제 어디서나 고쳐주셨고, 이들의 아픔에 극진한 사랑과 연민의 마음으로 함께 하심으로써 육체적 질병뿐만 아니라 전인적 치유를 위한 영적인 돌봄도 함께 베풀어주셨다. 또한 십자가의 수난을 겪으시고 부활하심으로써 각자가 안고 있는 고통을 마주하는 가운데서 하느님과 하나 되는 구원으로 나아갈 수 있는 길을 마련해주셨다. 그리고 병자들과 함께 하시며 그들을 치유하시는 가운데서도 기도를 잊지 않으심으로써 당신의 모든 행위를 성부 하느님의 역사하심으로 성화시키셨고 기도가 가지는 거룩한 힘과 끝없는 위로를 우리에게 알려주셨다. 이제 오늘날 의료인들이 어떠한 모습으로 자리해야 하는지가 분명해졌다. 그들은 육체적ㆍ정신적 질병만을 치료하는 사람이 아니라 영적인 돌봄도 아끼지 않는 전인적 치유를 지향하는 돌봄 제공자로서의 의료인이 되어야 한다. 착한 사마리아인의 비유에서처럼 자비로운 마음과 연민의 마음으로 고통 중에 있는 이들 곁에 머무르는 따뜻한 동반자로서 하느님을 도와 하느님의 사랑을 전달해야 한다. 하느님으로부터 받은 치유의 능력을 발휘해 병을 직접 치료해주어야 하며, 하느님의 치유가 자리할 수 있도록 인격적인 친밀함 가운데 환자의 아픔을 함께 나누고 위로와 격려를 베풀어야 한다. 환대의 미덕을 통해서 그들에게 자신을 온전히 개방하여 고통 가운데서 버림받음과 소외됨을 느끼지 않도록 돌보아야 한다. 그리고 기도와 돌봄을 통해서 그들을 향한 하느님의 현존과 사랑을 드러냄으로써 희망을 잃어버리지 않게 해야 한다. 그러기 위해서는 무엇보다도 의료인 스스로가 상처받은 치유자임을 인식함으로써 하느님과 깊은 관계에 머물러 있어야 한다. 자신 또한 똑같은 영적인 돌봄을 필요로 하며 같은 고통을 겪고 있는 한 명의 상처받은 인간이라는 것을 인식할 수 있을 때 비로소 하느님의 사랑과 연민을 그들에게 전해줄 수 있다. 그리고 바로 그때 고통이 가져다주는 여러 가지 어려움을 넘어서서 진정한 구원을 향한 길, 전인적 치유를 향한 길로 그들을 이끌어 줄 수 있다.

외생적 가격구조하에서 의료공급자 경쟁이 진료량에 미치는 영향

유혜림,민인식 한국보건사회연구원 2022 保健社會硏究 Vol.42 No.2

The analysis of competition among healthcare providers is important in measuring the effects of competition mechanisms at the market level and national medical expenses and medical resource distribution at the national level. This study aims to provide both theoretical and empirical evidence of the effect of healthcare provider competition under the fixed price. This study investigates a theoretical model of healthcare provider competition using the circular city model (Salop, 1979). A proposition derived as a result is, the intensity of care increases with the number of providers. Empirical work examines the theoretical results of the theoretical framework. The impact of provider competition on the intensity of care is investigated by a panel random effect model using NHIS (National Health Insurance Service)-cohort 2.0 DB data based on National Health Insurance claims data. The estimated results show that the proposition is supported empirically as the intensity of care increased with the number of providers. 의료기관 경쟁에 대한 분석은 시장 기전의 효과를 측정하며 국민의료비와 의료자원분포에 미치는 영향을 파악한다는 측면에서 중요하다. 본 연구는 국내 의료시장에서 급여서비스를 중심으로 외생적 가격구조하에서의 의료공급자 경쟁의 영향을 경제학적 이론분석과 실증분석에 기반하여 다각도로 분석하는 것을 목적으로 한다. 미시이론모형인 Salop(1979)의 원형도시모형(circular city model)으로 분석한 결과, 경쟁이 증가함에 따라 최적 진료강도는 증가하며, 의료공급자 수가 충분히 커질수록 추가적인 경쟁이 진료강도에 미치는 영향은 작아진다는 명제를 도출하였다. 명제가 실증적으로 지지되는지 분석하기 위하여 국민건강보험공단의 표본코호트 DB 2.0를 이용해 패널 확률효과모형(panel random effect)을 추정하였다. 분석 결과, 의료공급자 경쟁이 증가할수록 진료강도가 증가하여 도출된 명제가 실증적으로 지지됨을 보였다. 본 연구 결과를 토대로 해석하면 우리나라의 의료기관 경쟁은 경쟁으로 인한 가격하락을 예측하는 고전적 경제학의 예측 결과보다는 의료군비경쟁가설을 지지하는 것을 알 수 있다. 의료기관 경쟁이 진료강도와 가격을 상승시키는 의료군비경쟁으로 나타나지 않도록 경쟁을 고려한 의료자원 분배가 필요하며, 진료강도와 가격을 관리하기 위하여 기관단위 청구현황을 모니터링 고도화, 행위별 수가 외의 대안적 지불제도 검토가 필요할 것이다.

의료진의 외국인환자 진료경험, 진료태도, 외국인환자 유치사업에 대한 인지도 및 요구도 간의 관계

김진아,박영례,김희정 한국자료분석학회 2014 Journal of the Korean Data Analysis Society Vol.16 No.4

Modern society has made endless competition in every industry. With the increasing number of international patients using domestic healthcare services, and the need for its service is becoming diverse in Korea. This study was to find out about health care providers’ treatment experiences, attitude for international patients and health care providers’ awareness and needs for ‘Global healthcare for international patients’ project. The data were analyzed using descriptive statistics t-test, ANOVA, and Pearson’s correlation coefficients. The level of health care provider’s treatment experiences and attitude for international patients was 2.50 and 3.04. The level of health care providers’ awareness and need for global healthcare for international patients project was 3.13 and 3.14. There were negative correlation between treatment experiences and need for global healthcare for international patients project. There were positive correlation between treatment attitude and awareness, need for global healthcare for international patients project. This study results suggested that health care providers were interested in global healthcare for international patients project and had positive views. However, there are areas for improvements to succeed ‘global healthcare for international patients’ project in Korea it requires a further improved plans. 국내 의료기관을 이용하는 외국인 환자는 점점 증가 추세에 있으며, 외국인환자 유치를 위한 의료시설의 확충과 의료서비스 개선사업에 대한 관심 또한 증가하고 있다. 이에 국내 의료진의 외국인환자 진료경험, 진료태도, 외국인환자 유치사업에 대한 인지도 및 요구도를 확인하고자 본 연구를 시도하였다. 본 연구에서는 상급 종합병원, 종합병원, 병․의원에 근무하면서 외국인환자 진료경험이 있는 의료진을 중심으로 총 219명을 대상으로 설문조사를 실시하였다. 수집된 자료는 SAS 프로그램을 이용하여 t-검정, 일원배치분산분석과 Pearson’s 상관분석을 실시하였다. 의료진의 외국인환자 진료경험은 4점 만점에 평균 2.50점, 진료태도는 평균 3.04점이었고, 외국인환자 유치사업에 대한 인지도는 4점 만점에 평균 3.13점, 요구도는 3.14점이었다. 한편, 의료진의 외국인환자 진료경험과 외국인환자 유치사업에 대한 요구도는 음의 상관관계(r=-.274, p<.001)로 나타났으며, 의료진의 외국인환자 진료태도와 외국인환자 유치사업에 대한 인지도 및 요구도는 양의 상관관계(r=.441, p<.001; r=.408, p<.001)가 있는 것으로 나타났다. 결론적으로, 의료진들은 외국인환자 유치사업에 대한 관심을 가지고 있으며 긍정적으로 인지하고 있음을 알 수 있었다. 그러나, 외국인환자 진료시간, 교육 및 상담, 통역서비스 등에 대한 개선이 요구되며, 외국인환자 유치사업에 대한 적극적인 개선방안을 구축하여 사업의 성공을 위한 전략이 필요하다.

전문의약품 대중광고에 대한 의약전문인과 일반인간의 인식 비교 연구

오지운,김기태,안숙희,곽혜선 한국임상약학회 2015 한국임상약학회지 Vol.25 No.1

Objective: The aim of this study was to investigate the difference of perception on direct-to-consumer advertisement (DTCA) of prescription drugs between healthcare providers and consumers. Methods: The online and offline survey was conducted from May 26th to June 5th, 2013. The questionnaire was composed of 15 items about perception on DTCA of prescription drugs. Results: A total of 215 healthcare providers and 202 consumers responded to the questionnaire. Consumers had an overall positive attitude on permitting DTCA of prescription drugs and carried favorable views about the influence of the DTCA of prescription drugs on providing drug information, promoting communications between healthcare providers and consumers, and improving images of healthcare providers. Healthcare providers displayed negative perception for the needs of permitting the DTCA of prescription drugs compared to consumers. They showed somewhat skeptical perception about the influence of the DTCA of prescription drugs on necessities and efficiencies of delivering drug information, promoting communications between healthcare providers and consumers, and improving images of healthcare providers. Both healthcare providers and consumers were concerned about the increase of drug prices following the increase in advertisement expenses of pharmaceutical products. Conclusion: This study identified the perception differences on direct-to-consumer advertisements of prescription drugs between healthcare providers and consumers. This study could be of much help in the process of review on permitting DTCA of prescription drugs in Korea.

Knowledge, Attitude and Behavior of Healthcare Providers towards Breast Cancer in Malaysia: a Systematic Review

Azeem, Eman,Gillani, Syed Wasif,Siddiqui, Ammar,HA, Al Shammary,Poh, Vinci,Sulaiman, Syed Azhar Syed,Baig, Mirza Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.13

Breast cancer is the most common cancer among women in Malaysia. Therefore, it is highly important for the public to be educated on breast cancer and to know the steps to detect it early on. Healthcare providers are in the prime position to provide such education to the public due to their high knowledge regarding health and their roles in healthcare. The present systematic review involved studies conducted in recent years to analyze the knowledge, attitudes and behavior of Malaysian healthcare providers regarding breast cancer, in attempts to obtain an overall picture of how well equipped our healthcare providers are to provide optimal breast cancer education, and to see their perceptions and actual involvement in said education. The systematic review was conducted via a primary search of various databases and journal websites, and a secondary search of references used by eligible studies. Criteria for eligibility included being published from the year 2008 till present, being conducted in Malaysia, and being written in the English language. A total of two studies were eligible for this review. Findings show that Malaysian future and current healthcare providers have moderate knowledge on breast cancer, have a positive towards involvement of breast cancer education, but have poor actual involvement.

Ubiquitous Healthcare System Architecture in USN Environments

Joon Won Lee 한국정보기술학회 2009 한국정보기술학회논문지 Vol.7 No.3

The ubiquitous healthcare system architecture and framework workflow was designed and modeled. The system are described by seven classified core subsystems. They consist of the patient and wearable ECG sensor. network service, healthcare service. emergency service, insurance providers and PKI service providers. To enhance the security level control for the patient`s medical privacy, individual private and public keys should be stored on smart cards. All the patient and service providers in the proposed security control architecture should have suitable secure private and public keys to access medical data and diagnosis results with RFID/GPS tracking information for emergency service. By enforcing the requirements of necessary keys among the patient and service providers. the patient`s ECG data can be protected and effectively controlled over the open medical directory service. Consequently the proposed architecture for ubiquitous healthcare system is appropriate to build up medical privacy policies in ubiquitous sensor networking environments.

Lessons From Healthcare Providers’ Attitudes Toward Pay-for-performance: What Should Purchasers Consider in Designing and Implementing a Successful Program?

이진용,이상일,조민우 대한예방의학회 2012 Journal of Preventive Medicine and Public Health Vol.45 No.3

We conducted a systematic review to summarize providers’ attitudes toward pay-for-performance (P4P), focusing on their general attitudes, the effects of P4P, their favorable design and implementation methods, and concerns. An electronic search was performed in PubMed and Scopus using selected keywords including P4P. Two reviewers screened target articles using titles and abstract review and then read the full version of the screened articles for the final selections. In addition, one reference of screened articles and one unpublished report were also included. Therefore, 14 articles were included in this study. Healthcare providers’ attitudes on P4P were summarized in two ways. First, we gathered their general attitudes and opinions regarding the effects of P4P. Second, we rearranged their opinions regarding desirable P4P design and implementation methods, as well as their concerns. This study showed the possibility that some healthcare providers still have a low level of awareness about P4P and might prefer voluntary participation in P4P. In addition, they felt that adequate quality indicators and additional support for implementation of P4P would be needed. Most healthcare providers also had serious concerns that P4P would induce unintended consequences. In order to conduct successful implementation of P4P, purchaser should make more efforts such as increasing providers’ level of awareness about P4P, providing technical and educational support, reducing their burden, developing a cooperative relationship with providers, developing more accurate quality measures, and minimizing the unintended consequences.

Lessons From Healthcare Providers' Attitudes Toward Pay-for-performance: What Should Purchasers Consider in Designing and Implementing a Successful Program?

Lee, Jin-Yong,Lee, Sang-Il,Jo, Min-Woo The Korean Society for Preventive Medicine 2012 Journal of Preventive Medicine and Public Health Vol.45 No.3

We conducted a systematic review to summarize providers' attitudes toward pay-for-performance (P4P), focusing on their general attitudes, the effects of P4P, their favorable design and implementation methods, and concerns. An electronic search was performed in PubMed and Scopus using selected keywords including P4P. Two reviewers screened target articles using titles and abstract review and then read the full version of the screened articles for the final selections. In addition, one reference of screened articles and one unpublished report were also included. Therefore, 14 articles were included in this study. Healthcare providers' attitudes on P4P were summarized in two ways. First, we gathered their general attitudes and opinions regarding the effects of P4P. Second, we rearranged their opinions regarding desirable P4P design and implementation methods, as well as their concerns. This study showed the possibility that some healthcare providers still have a low level of awareness about P4P and might prefer voluntary participation in P4P. In addition, they felt that adequate quality indicators and additional support for implementation of P4P would be needed. Most healthcare providers also had serious concerns that P4P would induce unintended consequences. In order to conduct successful implementation of P4P, purchaser should make more efforts such as increasing providers' level of awareness about P4P, providing technical and educational support, reducing their burden, developing a cooperative relationship with providers, developing more accurate quality measures, and minimizing the unintended consequences.

공공과 민간 보건의료기관 통합돌봄 협력네트워크 특성과 요인: 서울시 A구를 중심으로

김일호,김정석,류재윤,김미선 한국인구학회 2022 한국인구학 Vol.45 No.2

This study investigated the structural characteristics of the network between 15 public-private healthcare providers in a district of Seoul and identified the factors affecting these characteristics. Data were analyzed using social network analysis (SNA) and qualitative analysis of in-depth interviews. As a result, information exchange or transfers of care between these healthcare providers were relatively active, but exchanges of human and material resources, regularly scheduled joint meetings and co-planning activities were found to be in a formation stage. The networks were influenced by changing perceptions of private providers for public-private partnerships, legal and institutional support by the central and local governments, and horizontal cooperation between public and private healthcare providers. Meanwhile, the challenges facing public and private collaboration included a vertical, administrative system, lack of payment system of in-home healthcare, inadequate infrastructure, a fragmented cooperative implementation, and a weakening of public-private partnerships due to lengthy COVID-19 virus. The results of this study suggest practical implications for fostering a public-private cooperative network inside health care setting. 이 연구는 서울시 A구의 공공과 민간 보건의료기관(15개소) 간 통합돌봄 협력네트워크의 구조적 특성과 영향 요인을 파악하였다. 본 연구는 사회네트워크 분석(SNA)과 심층면접조사를 활용한 혼합연구방법을 사용하였다. 연구 결과, 민관 보건의료기관(이하, 민관기관) 간 비정기적 정보교환이나 대상자 의뢰 협력관계는 활발하게 이루어지는 편이었으나, 인적·물적 자원교환, 정기적 모임과 공동기획의 협력관계는 초기 형성 단계였다. 민관협력 네트워크 형성에 긍정적인 영향요인은 중앙과 지방정부의 법적·제도적 지원, 민관기관 간 돌봄 협력에 대한 인식변화와 수평적인 협력관계 형성 등으로 해석된다. 한편, 민관협력 네트워크 형성의 저해요인은 공공기관의 수직적 행정체계, 방문진료 수가체계 및 제도적 뒷받침 부족, 보건의료 연계를 위한 지지기반과 협력적 실행체계 부족을 들 수 있다. 특히, 코로나19가 장기화됨에 따라 민관협력 활동이 축소 또는 해체되면서 돌봄 공백에 대한 문제점이 드러나고 있다. 본 연구 결과는 보건의료분야에서 민관협력 네트워크 강화를 위한 실천적 함의를 제시하고 있다.