치의학분야 사례분석을 통한 신의료기술평가 현황 평가

손기태,양승민 대한치과의사협회 2019 대한치과의사협회지 Vol.57 No.6

The new medical technology assessment system has a basic goal of protecting the public's health rights and promoting the development of the new medical technology with safe and effective medical technology that has been scientifically proven. The purpose of this study is to contribute to the activation of the new medical technology evaluation system by analyzing the application cases of the dental field after the implementation of the new medical technology evaluation system and proposing an efficient approach to approach the new medical technology evaluation system. The number of related literature and medical technology evaluation results are not significant in dental applications, the number of cases and the length of follow-up period of the relevant medical technology adopted as the new medical technology was far higher. As the speed of medical technology development increases, medical technology is expected to develop in the dental field as well. To introduce the medical technology to the clinical site, access to the correct direction of evidence is required to collect and objectify data at the medical site in order to prepare a literary basis for the medical technology.

의약품 및 의료기기 생애주기별 국내외 급여 관리제도 비교

윤상헌,박다혜,신서희 건강보험심사평가원 심사평가연구소 2022 연구보고서 Vol.2022 No.0

Background Korean society is aging rapidly and such trend is expected to result in high supply and demand of medicine and medical technology. The phenomenon is likely to lead to increased health expense of the National Health Insurance (NHI) fund, calling for management measures to secure appropriate reimbursement. Against this backdrop, ‘The First Comprehensive Plan of NHI’ has introduced diverse management systems for medicine and medical device, without much success due to conflicts between different programs and purposes. As such, rational and effective adjustment measures are required. Objective This study aimed to systematically and comprehensively review medicine and medical technology management systems on approval, reimbursement, and post management by life cycle. Based on the country comparison and analysis, the results of this study will serve as the baseline data for preemptive system improvement in response to changing health environment. Method This study was largely based on literature review from Korea and abroad as well as consultation of experts in the field. In order to understand current status of reimbursement management systems on medicine and medical technology in Korea and abroad, we analyzed reports of international organizations, papers published in journals, and health-related governmental websites. In addition, interviews took place with professors with expertise and relevant enterprises. Results In this study, the life cycle of a medicine and medical technology consisted of 5 stages: 1) research and development along with regulation and procedure check, 2) approval, 3) manufacture and distribution, 4) NHI coverage listing/reimbursement, and 5) post management. This study consolidated management systems of 7 reference countries (the U.S., the U.K, France, Germany, Italy, Switzerland, Japan) as well as Australia and Canada for full cycle of medicine and medical technology of each country in an organized manner. Conclusion and proposal Korean medicine management system was found to be similar to those of comparison countries with the exceptions of Global Budget and Reference Pricing. There were some confusions coming from use of terminology, as Korea uses differentiated terms such as ‘medical technology’, ‘medical equipment’, and ‘medical device’ depending upon the function, objective, and lifespan of a medicine. Like other reference nations, Korea had systems of phased review, value assessment, and preliminary benefits in place, but it lacked Unique Device Identification (UDI) system for tracking. In regards to medical technology and post management, the level was lower than that of medicine, and reassessment cycle was sparser. The following is suggestions of this study based on such results. First, systematic policy road map and reinforced consumption volume control measures are required. Korea has established and operated medicine management system on par with those of advanced countries, yet systematic inefficiency is an issue as there are hundreds of generic drugs for one medicine. Second, current approval and reimbursement linkage in generic drug pricing system is limited to quality assurance feedback (bioequivalence test, use of registered drug master file), which requires further connection of patient health data of clinical trial. The mechanism should be prepared so that the effective use of approval - reimbursement linkage can be realized. Third, terminology clarification and clean-up is necessary to improve consistency and reduce confusions in the area of approval, reimbursement, and post management. For example in medical technology system, the term ‘medical device’ used for medical supplies covered by NHI could be specified to ‘separately reimbursed medical device’, ‘not separately reimbursed medical device’, and ‘non-benefit medical technology’. Forth, more proactive tracking system is required through revising and reinforcing medical technology and UDI. Fifth, post management of medical device should consider introducing price-volume agreement. Such adoption would require evidence data from suppliers and data transfer system with the review authority, in consideration of both the new products and existing listed products. The objective of reassessment should be clarified as well, whether it should be about management efficiency or cost saving. France’s case could serve as a reference where after a certain period of time from listing, price is adjusted down as the item is categorized as existing group. Sixth, active post management measures should be implemented for high risk medical device, such as adverse drug event reporting system. When the quality is not guaranteed, the item should be subject to elimination from the price list and benefit quality assessment for additional action.

코로나19 시기 UTAUT 기반 의과대학 교수의 의학교육 테크놀로지 수용 요인 탐색

천경희,박영순,이태희,권택근,이영진 한국교원교육학회 2023 한국교원교육연구 Vol.40 No.4

본 연구는 코로나19와 같은 급격한 교육환경 변화 상황에서 의학교육 테크놀로지를 적극적으로 활용하게 된 의과대학 교수들의 테크놀로지 수용 정도와 수용 현황을 파악하고, 교육 관련 테크놀로지에 대한 태도, 행동의도, 실제 사용 정도에 영향을 미치는 요인들을 파악하기 위해 실시되었다. 이를 위해 기술수용모델인 UTAUT에서 제시하는 수행기대, 노력기대, 사회적 영향, 촉진조건 및 인구통계학적 변인에 따라 행동의도와 사용증가에 어떠한 차이가 있는지를 탐색하였다. 연구 참여에 동의한 임상교수 52명, 기초교수 18명 총 70명의 교원을 대상으로 표준절차에 따라 번안한 UTAUT 검사지를 활용하여 설문을 실시하였다. 코로나19 초기, 의학교육 테크놀로지 사용이 유의하게 증가하였으며, 평균 242,500원의 테크놀로지 구매비용이 발생하였다. 의학교육 테크놀로지의 수용 정도를 살펴본 결과, 소속, 근무연한, 테크놀로지 사용개수, 새롭게 설치/구매한 프로그램 여부에 따라 UTAUT 요소 간에 유의한 차이가 있었다. UTAUT 투입요인 중 행동의도에 영향을 미치는 것은 촉진조건과 수행기대로 약 54%의 설명력을 가졌으며, 사용증가에 영향을 미치는 것은 행동의도로 약 10%의 설명력을 가졌다. 결론적으로 의과대학 교수의 적극적인 의학교육 테크놀로지 수용을 촉진하기 위해서는 촉진조건에 해당되는 대학 내 테크놀로지 서비스와 인적지원이 확대되어야 하며, 테크놀로지 사용이 학생교육 및 기타 업무 향상에 도움이 되도록 지속적인 교육 및 홍보 전략이 함께 진행되어야 한다. 또한 교수별 특성을 고려한 수용전략의 마련이 요구되며 다양한 테크놀로지를 활용할 수 있는 대학 차원의 조직적, 시스템적 지원이 요구된다. This study was conducted to assess the extent of technology adoption and its current status among medical school professors who have actively embraced medical education technology in situations of rapid educational environment change, such as COVID-19. It aimed to explore the factors influencing attitudes, behavioral intentions, and actual usage of educational technology. To achieve this, the study used the Technology Acceptance Model (UTAUT), which examines how behavioral intentions and usage differ based on performance expectations, effort expectations, social influence, facilitating conditions, and demographic variables. The study was conducted using the standard UTAUT questionnaire, with 70 faculty members participating, including 52 clinical professors and 18 basic science professors. During the early stages of COVID-19, there was a significant increase in the use and purchase of medical education technology, with 44.3% of respondents utilizing seven or more programs. The acceptance level of medical education technology varied significantly based on factors such as affiliation, years of service, the number of technologies used, and the acquisition of new programs. Among the UTAUT factors, facilitating conditions and performance expectations had a significant influence on behavioral intentions, explaining approximately 54% of the variance, while behavioral intentions had a 10% explanatory power on usage increase. In conclusion, to promote the active adoption of medical education technology by medical school professors, universities should expand technology services and provide personnel support in alignment with facilitating conditions. Continuous education and promotional strategies should be implemented to ensure that technology usage contributes to student education and overall job enhancement. Additionally, tailored adoption strategies considering individual professor characteristics are required, and universities need to provide organizational and systemic support for the utilization of various technologies.

국민건강보험 요양급여 기준에 관한 법적 고찰

권오탁 한국의료법학회 2023 한국의료법학회지 Vol.31 No.2

Korea, which chose national health insurance as a method of social security, made all citizens insured, designated all medical institutions as health care institutions, compensated costs through health insurance, and divided medical care benefits into covered and non-coverage benefits. As a result, the following issues are being raised regarding medical care benefit standards. First, the standards for medical care benefits are uniform and cost review is arbitrary. However, universality of medical care benefits is recognized as a result of the collective intelligence of experts with medical expertise. In addition, which of the various treatment methods will be compensated by health insurance is not a medical issue, but a matter of policy choice based on expertise, universality, and financial conditions, and cost review based on those standards cannot be considered arbitrary. Second, medical technology prior to new medical technology evaluation under the National Health Insurance Act can also be used for non-coverage benefits purposes. First of all, all medical services used in clinical settings must have proven safety and effectiveness, and under the premise of safety and effectiveness, medical care benefits and non-coverage benefits are distinguished depending on the degree of cost-effectiveness proven. However, due to the discrepancy between the development of science and technology and the timing of applying medical care benefits, the timing of use of new, unproven medical technology may become an issue. As a result, except for pharmaceuticals, medical practices and treatment materials are ultimately verified for safety and effectiveness through evaluation of new medical technologies. However, the relevant regulations are unclear and need to be clearly revised. Third, after the application of ideologically expensive drugs to health insurance, controversy may arise regarding the scope of coverage of National Health Insurance, a social insurance policy. Considering the development of science and technology and the public's health needs, a new agreement on the minimum guarantee of social insurance is needed. Therefore, for the sustainability of health insurance, it is time to publicize and reach a social consensus on the plan to secure health insurance finances, the scope and target of compensation for medical care benefits, and the principles of applying medical care benefits for new future medical technologies. 「국민건강보험법」을 통해 국민에게 발생한 건강문제를 해결하는 우리나라는 의료기관에서 제공될 수 있는 진료행위의 내용을 요양급여와 비급여로 구분하고 요양급여 비용을 건강보험을 통해 보상하고 있다. 따라서 의료기관에게는 진료기준이 되고 비용보상 시에는 심사기준이 되는 요양급여 기준과 관련해서 다음과 같은 문제가 제기될 수 있다. 첫째, 요양급여 기준이 제한적‧획일적이고 비용심사가 자의적이라는 문제 제기가 가능하다. 그러나 요양급여 기준은 의학분야의 전문가 집단이 숙의 과정을 통해 합의한 산물이기 때문에 의학적 타당성을 인정할 수 있다. 또한 다양한 의학적인 방법 중 어떤 것을 비용 보상의 대상으로 할지는 의학적인 영역을 넘어서 전문성과 보편성 그리고 재정여건에 기초한 정책적 선택의 문제이다. 따라서 그 기준에 따른 비용심사를 자의적이라고 볼 수 없다. 둘째, 구조적으로 현행「국민건강보험법」상 신의료기술을 비급여로 사용할 수 있는지에 관한 것이다. 원칙적으로 임상현장에서 사용되는 모든 의료서비스는 안전성과 유효성이 검증된 것이어야 한다. 다만 과학기술의 발전과 요양급여 적용 여부에 소요되는 시간의 문제로 인해 안전성과 유효성의 검증 시점이 중요한 쟁점이 될 수 있다. 결과적으로 의약품을 제외한 의료행위와 치료재료는 신의료기술 평가를 통해 최종적으로 안전성과 유효성이 검증된다. 그러나 현행 법률이 명확하지 않아 그 시점에 대한 논란이 발생할 수 있어 관련 규정을 보다 명확하게 개정할 필요가 있다. 셋째, 이념적으로 고가의 의약품이 요양급여로 등재되면서 사회보험인 국민건강보험의 보장범위에 대한 논란이 발생할 수 있다. 과학기술의 발전 속도와 국민의 건강에 대한 요구가 커진 상황을 고려하면 재정여건에 맞는 수준의 보상이라는 사회보험의 원칙에 대한 새로운 합의가 필요한 시점이다. 따라서 구체적으로 건강보험 재정안정화를 위해 건강보험재정확보 방안, 요양급여 비용 보상의 범위와 대상, 미래 신의료기술에 대한 요양급여 적용 원칙 등의 문제를 공론화하고 사회적 합의를 이끌어 내야한다.

기술의 문화적 재현과정과 실천 : 보조생식술을 중심으로

김경례(Gyoung-Rae Kim) 계명대학교 여성학연구소 2010 젠더와 문화 Vol.3 No.2

이 글은 신문기사의 내용과 불임치료와 관련된 대중 의학서적을 통해 의과학적 수사와 담론이 여성의 몸과 불임 그리고 보조생식술을 어떻게 의미화하고 위치 짓는지를 살펴보았다. 이를 통해 첫째, 기술은 문화에 외재한 객관적이고 독립적인 실체가 아니라 사회적 관계와 담론과정에서 생산되는 것임을 밝혔다. 둘째, 지배적인 기술문화는 출산과 기술에 대한 지배적인 사회규범을 반영하면서 그것을 재생산, 강화하는 기능을 한다는 것을 확인하였다. 불임에 대한 의과학적 담론의 핵심은 불임에 대한 사회적 공포를 생산, 확장하는 과정이며 이는 기술적, 사회적 조건과 맞물려 작동한다. 또한 보조생식술에 대한 의과학적 담론은 의과학자들의 사회적 권위와 의과학적 지식권력을 통해 의료기관 및 보조생식술의 이용을 합리화하고 보편화하는 과정이다. 하지만 대중들은 기술에 대한 역사적 경험과 자신들의 체험을 통해 지배적인 기술문화와 경합하면서 기술에 대한 다층적인 해석과 비판적 개입을 시도하기도 한다. 따라서 기술은 특정문화를 구성, 재구성하는 실천으로서 파악될 필요가 있다. This study performs that how medical rhetoric and discourse locate women's bodies, infertility and assisted reproductive technology through popular medical books relating to the treatment of infertility and contents of newspaper articles. Results were as follows: First, technology is produced by social relations and discourse processes, not objective and independent existence that are external to the culture. Second, technology as a dominant culture reflects prevailing social norms. And that perform a function which reproduce and strengthen prevailing social norms. Medical discourse of infertility is the process of producing a social fear on infertility. And it should work together the development of infertility treatment technologies, expansion of infertility industry, and the necessity of government's population control policy. That is, medical discourse work together technical and social conditions. Also, medical discourse on assisted reproductive technology is a process of rationalize and generalize the use of medical Institutions and assisted reproductive technology through the social authority of medical scientists and the power of medical knowledge. But, the people do not fully internalize dominant technology as a culture. They compete with dominant culture of technology through the historical experience about technology and through their experience. They are trying to interpretation and critical intervention about technology. Therefore, technology need to be grasped to practice that (re)constitute of specific culture.

스마트 모바일 환경에서 의료정보 동적접근 시스템

정창원 ( Chang Won Jeong ),김우홍 ( Woo Hong Kim ),윤권하 ( Kwon Ha Yoon ),주수종 ( Su Chong Joo ) 한국인터넷정보학회 2015 인터넷정보학회논문지 Vol.16 No.1

최근, 병원정보시스템의 환경은 다양한 스마트 기술을 접목하고 있는 추세이다. 따라서, 스마트 폰, 테블렛 PC와 같은 다양한 스마트 디바이스가 의료 정보 시스템에 활용된다. 또한, 이러한 환경은 이기종 센서, 디바이스, 시스템 및 네트워크에서 실행되는 다양한 응용 프로그램으로 구성된다. 이들 병원 정보 시스템 환경에서, 기존의 접근 제어 방식에 의한 보안 서비스를 적용하는 것은 문제가 된다. 기존 보안 방식의 대부분은 접근제어 리스트 구조를 사용한다. 이는 클라이언트 이름, 서비스 객체 메소드 이름으로 접근 제어 매트릭스에 의해 정의된 접근만을 허용한다. 가장 큰 문제점으로는 정적인 접근 방법은 변화되는 상황에 신속하게 적응하지 못한다. 따라서, 우리는 보다 유연하고, 매우 상이한 보안 요구와 다양한 환경에 적용 할 수 있는 새로운 보안 메커니즘을 필요로 한다. 또한, 환자중심의 의료 서비스 형태로 변화되고 있어, 이를 해결하기 위한 연구가 요구된다. 본 논문에서는 스마트 모바일 환경에서 의료정보 동적접근 시스템을 제안하고자 한다. 우리는 기존 병원정보 시스템의 환경을 기반으로 동적접근 제어 방법으로 의료정보 시스템에 접근하는 방법에 중점을 두었다. 물리적인 환경은 모바일 x-ray 영상 디바이스와 전용 모바일 스마트 디바이스, PACS, EMR 서버와 인증 서버로 구성하였다. 소프트웨어 환경은 모바일 X-ray영상기기는 Windows7 OS를 기반으로 동기화 및 모니터링 서비스를 위해 .Net Framework를 기반으로 개발하였다. 그리고 전용 스마트 디바이스는 Android OS를 기반으로 JSP와 Java SDK를 통한 동적접근 응용 서비스를 구현하였다. 병원의 의료영상정보 서버와 모바일 X-ray영상기기, 전용 스마트 디바이스간의 의료정보는 의료영상정보 표준인 DICOM을 기준으로 한다. 또한 EMR 정보는 H7을 기반으로 한다. 동적접근 제어 서비스를 제공하기 위해, 우리는 산소포화도, 심박수, 혈압과 체온과 같은 생체 정보의 값에 대한 조건에 의해 환자의 상황을 분류하고, 의료진의 의료정보 접속 인증 방법으로 동적인 접근 방법을 설계했다. 이는 일반 상태와 응급상태로 2부분으로 구분하여 이벤트 추적 다이어그램으로 보였다. 그리고, 인증 정보는 ID/PWD와 위치, 역할, 작업시간 그리고 응급 환자를 위한 응급 코드를 포함하였다. 동적접근 제어 방법의 일반적인 상황은 인증 정보의 값에 의해 의료정보에 접근 할 수 있다. 그러나 응급상황의 경우는 인증 정보 없이 응급 코드에 의해 의료정보에 접근하도록 하였다. 또한, 우리는 의료정보 표준에 따라 환자, 의료진 및 의료 영상 정보로 구성되는 의료정보 통합 데이터베이스 스키마를 구축했다. 끝으로, 우리는 제안 시스템의 수행 결과를 일반과 응급상황과 같은 환자의 상태에 따라 스마트 디바이스 기반으로 동적접근 응용 서비스의 유용성을 보였다. 특히, 제안 된 시스템은 동적 액세스 제어 방법에 의해 응급상황에서 스마트 디바이스기반의 효과적인 의료 정보 서비스를 제공한다. 이 결과, 제안한 시스템이 u-병원 정보 시스템과 서비스에 유용할 것으로 기대한다. Recently, the environment of a hospital information system is a trend to combine various SMART technologies. Accordingly, various smart devices, such as a smart phone, Tablet PC is utilized in the medical information system. Also, these environments consist of various applications executing on heterogeneous sensors, devices, systems and networks. In these hospital information system environment, applying a security service by traditional access control method cause a problems. Most of the existing security system uses the access control list structure. It is only permitted access defined by an access control matrix such as client name, service object method name. The major problem with the static approach cannot quickly adapt to changed situations. Hence, we needs to new security mechanisms which provides more flexible and can be easily adapted to various environments with very different security requirements. In addition, for addressing the changing of service medical treatment of the patient, the researching is needed. In this paper, we suggest a dynamic approach to medical information systems in smart mobile environments. We focus on how to access medical information systems according to dynamic access control methods based on the existence of the hospital`s information system environments. The physical environments consist of a mobile x-ray imaging devices, dedicated mobile/general smart devices, PACS, EMR server and authorization server. The software environment was developed based on the .Net Framework for synchronization and monitoring services based on mobile X-ray imaging equipment Windows7 OS. And dedicated a smart device application, we implemented a dynamic access services through JSP and Java SDK is based on the Android OS. PACS and mobile X-ray image devices in hospital, medical information between the dedicated smart devices are based on the DICOM medical image standard information. In addition, EMR information is based on H7. In order to providing dynamic access control service, we classify the context of the patients according to conditions of bio-information such as oxygen saturation, heart rate, BP and body temperature etc. It shows event trace diagrams which divided into two parts like general situation, emergency situation. And, we designed the dynamic approach of the medical care information by authentication method. The authentication Information are contained ID/PWD, the roles, position and working hours, emergency certification codes for emergency patients. General situations of dynamic access control method may have access to medical information by the value of the authentication information. In the case of an emergency, was to have access to medical information by an emergency code, without the authentication information. And, we constructed the medical information integration database scheme that is consist medical information, patient, medical staff and medical image information according to medical information standards.y Finally, we show the usefulness of the dynamic access application service based on the smart devices for execution results of the proposed system according to patient contexts such as general and emergency situation. Especially, the proposed systems are providing effective medical information services with smart devices in emergency situation by dynamic access control methods. As results, we expect the proposed systems to be useful for u-hospital information systems and services.

A Safety Review of Medical Device Robots in JAPAN

Yuichiro Tsuji 이화여자대학교 생명의료법연구소 2018 Asia Pacific Journal of Health Law & Ethics Vol.12 No.1

In Japan, the robot evolution in the medical field has been remarkable, robots now often perform actions that are difficult for humans including assisting with elderly care and conducting medical operations that require specific techniques, and Japanese medical robot technology is among the best in the world. As the workforce population decreases in Japan's ageing society, the demand for robots will be ever-increasing, the use of robots will reduce the increasing medical costs. Unfortunately, there has been insufficient research by Japanese law researchers on medical robots. This paper examines whether the law in Japan is a barrier to the development of robot technology. In Japan, medical treatments that utilise robots are promoted by the government and by private organisations, including the Center of Assistive Robotics and Rehabilitation for Longevity and Good Health and the Japan Agency for Medical Research and Development, which are similar to the National Science Foundation and the National Institutes of Health in the U.S. In Europe, the SPARC robot project promotes the private development of robots. One side effect of robot technology is the challenge they present within legal systems because laws commonly lag behind the rapid technological developments. To address this, we may need to modify existing interpretations by the executive branch and revise statues in parliament; otherwise, judges must interpret the meaning of statutes that competing parties dispute. This paper focuses on the legal issues regarding medical robots, including how the government approves the use of medical devices for older people, and proposes a legal framework that encourages the safe implementation of robots in the medical field.

시장진입을 위한 치료재료 신의료기술평가 제도: 의료법, 의료기기법, 국민건강보험법 중심으로

천새임 한국보건의료기술평가학회 2016 보건의료기술평가 Vol.4 No.2

The “New Health Technology Assessment” system for new health technology was first introduced in 2007 in Korea and there have been some gradual changes and improvements. The Health Tech- nology Assessment (HTA) is a process that is being implemented in major countries across Europe as well as Korea through which the safety and effectiveness of new health technology is evaluated using a systematic review methodology. Despite the fact that HTA is focused on assessment of tech- nology, rather than on individual medical devices, treatments are mostly caused by those newly-de- veloped medical devices. Accordingly, even if it’s an assessment on health technology, clinical evi- dence is for medical devices used in this technology. HTA is different from the point of view product approval that verifies safety and effectiveness of the product itself, since it assesses safety and effectiveness on health outcomes when the treatment with a medical device is operated for the patient. However, considering the opinion that the reimbursement application process of medical service for the right of access to health insurance circle needs a long period and has to take compli- cated procedures compared to the product approval by the Ministry of Food and Drug Safety (MFDS), there have been various adjustments to improve the process since 2013. Including the most recently implemented “MFDS product approval-HTA parallel review” system, there are five tracks for HTA as of present. It is essential that the applicant applying for nHTA should review the relevant provisions on the Medical Law, Medical Device Law and National Health Insurance Law for accurate understanding of the system and needs to make an effort to prepare materials suitable for the objective. The purpose of this review is to discuss the purpose and objective of current nHTA in Korea, to review similar process of other countries and to introduce relevant administrative pro- cess according to relevant laws to suggest further necessary improvements of the system.

원격진료에 대한 의료제공자와 이용자의 인식도

이현실(HyunSill Rhee),최만규(ManKyu Choi),김광환(KwangHwan Kim) 고려대학교 보건과학연구소 2004 보건과학논집 Vol.30 No.2

  Recently telemedicine, using information and communication technologies, continues to increase. Telemedicine includes all activities that deliver longdistance medical services and information by taking advantage of an interactive information and communication technology.<BR>  This study was conducted to investigate current telemedicine practice and the differences of opinions on telemedicine among medical providers and users. For the purpose of this study, a self-administered questionnaire was conducted with 250 medical employees, 50 public officials, and 200 residents in Seoul from July 15-24, 2004. The data for the empirical study were obtained by questionnaire using a 5-point Likert-type scale. The study sample consisted of 496(99.2% of the recipients) subjects who faithfully responded to the questionnaire. The major statistical methods included frequency and mean.<BR>  The major results of this study were as follows.<BR>  First, a preference for telemedicine, upon investigation, resulted in scores of 3.6 points for inhabitants, 3.6 points for public officials, and 3.5 points for medical employees respectively. All three groups showed similar preference. Second, the results of investigating applicable diseases by telemedicine for medical employees, inhabitants, and public officials were respectively as follows: diabetes(27.1%), diet(19.2%), cancer(15.7%); high blood pressure (31.4%), diabetes(27.2%), diet(16.7%); and diabetes(27.9%), high blood pressure (24.6%), diet(20.3%).<BR>  Third, factors to be considered for the effective practice of telemedicine were considered by medical employees, inhabitants, and public officials respectively to be as follows: correct diagnosis(32.8%), medical insurance fees(21.5%), equipment and facilities(16.0%); correct diagnosis(43.1%), medical insurance fees(23.8%), patient"s education(20.7%); and correct diagnosis (35.5%), telemedicine place(22.1%), medical insurance fees(13.9%). Overall, subjects in this study thought that a correct diagnosis should be considered the most important factor in the effective practice of telemedicine.<BR>  Fourth, subjects in this study considered that the home to be the most suitable place for telemedicine(medical employees 39.6%, inhabitants 31.9%, public officials 39.2%).<BR>  Fifth, all subjects considered a price of 3,000 to 5,000 won per use to be reasonable (medical employees 52.7%, inhabitants 51.0%, public officials 48.9%). Also, subjects thought public offices(66.5%, 70.1%, 68.1%), public health centers(30.6%, 29.4%, 23.4%), and hospitals(2.1%, 0.5%, 8.5%) to be appropriate institutions for administering telemedicine.<BR>  In conclusion, medical providers and customers all recognized the importance of telemedicine practice. Therefore, the successful introduction of telemedicine in Korea requires both an analysis of operating cases in developed countries and consideration of the unique medical characteristics and circumstances of Korea. To introduce efficient telemedicine practice, sufficient studies and practice through demonstration projects must be carried out. Also, the government and related institutions must support the development of appropriate and convenient medical equipment and must also institute appropriate legal systems such as a schedule of reasonable medical fees as well as improving the accessibility of medical services for users.

첨단 의료기술에 대한 윤리적 쟁점과 첨단 의료기술에 대한 윤리원칙 수립을 위한 예비고찰

김진선,심지원 한국문화융합학회 2024 문화와 융합 Vol.46 No.1

의료기술의 발달은 인간의 신체, 진단 및 치료의 방법 등에 영향을 미치고, 의료환경에 새로운 사회윤리적인 문제들을 초래하며 더 나아가 인간개념을 재구성하고 있다. 이러한 문제에 대응하기 위해 본 고에서는 우선, 첨단 의료기술에 관한 사례와 윤리적 쟁점을 고찰하였다. 또한 첨단 의료기술이 환자의치료에 활용되는 단계를 진행순서에 따라 연구개발, 임상시험, 치료, 일반시판 등”으로 나누고 그 과정에서 관여하게 되는 관련 주체를 “의사 및 연구자/개발자, 환자, 보호자, (의료전문가 외의) 전문가 집단”으로 구분했으며, 나아가 각 단계에서 뷔챔Beauchamp과 칠드레스Childress의 <생명윤리 4원칙>을토대로 “선행, 악행금지, 자율성, 정의”의 원칙이 어떤 의미를 갖는지를 살펴봄으로써 첨단 의료기술 원칙 수립을 위한 기초 작업을 논하였다. The development of medical technology is affecting the human body, diagnosis and treatment methods, bringing about new changes in the medical environment, and further reorganizing the concept of human beings. In addition, cutting-edge medical technology is causing new social and ethical problems in existing medical settings. In order to respond to these problems, this paper first examined cases and ethical issues related to advanced medical technology. In addition, the stages in which advanced medical technology is used for patient treatment are divided into “experiments, clinical trials, treatment, general marketing, etc.” in the order of progress, and the related entities involved in the process are “doctors and scholars/ developers, patients, guardians, (Ethical judgment was made by examining the meaning of the principles of “good deeds, prohibition of evil deeds, autonomy, and justice” based on Buchamp and Childress’ <Four Principles of Bioethics> at each stage. The framework was established and the significance and limitations of these guidelines were discussed.