의료보험 가입자의 보험료 납입액과 수혜액 및 의료이용정도에 관한 연구

조우현,Cho, Woo-Hyun 대한예방의학회 1980 Journal of Preventive Medicine and Public Health Vol.13 No.1

This study attempts to assess the effect of the 1st class health insurance program to the income redistribution among the participants in a unit health insurance cooperative. One health insurance cooperative, located in Seoul, with 1558 members and 768 households was selected for this purpose. The relationships between amount of premium payed and benefits from the cooperative were compared. Necessary data were obtained from the bills submitted to the health insurance cooperative by the contracted medical institutions from 1st January 1977 to 30th June 1979. Households and individuals were the unit of the assessment. The indicators measuring income redistribution effect were the ratios between the benefit and expected benefit and the ratios between the benefit and the mean benefit. The major findings were: 1. The ratios between the benefits and the expected benefits were lower than 1 in the high income group and greater than 1 in the middle and lower income groups. This fact imply that the income redistribution effect was shown in the studied groups. It was shown that the middle income group received the greatest benefit, and then the lower income group. 2. The ratios between the benefit ana the mean benefit of the households in the higher standard income grade, were found to be higher. This means that the equity of the benefits of households were not achieved by the policy of the health insurance plan. 3. The health insurance utilization rates of the higher standard income group, measured by the household unit, were higher, and by the individual unit, the same rates of the middle income group were higher than other groups.

북한산 둘레길 이용객 만족도에 관한 연구

조우현,윤희재,임승빈,Cho, Woo-Hyun,Yun, Hui-Jae,Im, Seung-Bin 한국조경학회 2011 韓國造景學會誌 Vol.39 No.4

2007년 9월 제주 올레길이 개장되고, 선풍적인 인기몰이를 하면서 전국적으로 '걷는 길'에 대한 관심이 증대하였고, 이에 따라 중앙부처 및 지방자치단체들도 다양한 '걷고 싶은 길'을 지정하거나 조성하고 있다. '걷고 싶은 길'은 차량에 의한 이동과 장소 중심의 단절된 점적 관광에서 벗어나 직접 걸으면서 지역의 경관 및 문화를 보고, 느끼고, 체험하는 연속적인 긴 선적 여행길이다. '걷고 싶은 길'은 이미 형성되어 있는 길을 발굴하여 최대한 활용하고, 지역에 존재하는 다양한 생태, 역사, 문화자원들을 효율적으로 연계하는 길로서, 노선 선정이 제일 중요하다고 할 수 있다. 그러나, '걷고 싶은 길'의 노선 선정 시 다양한 계획요소를 고려하고 노선 및 구간별로 다양한 테마를 부여하여 지정되거나 조성되었지만, 편의시설 부족 등에 따른 이용객의 불편함과 같은 여러 문제점들이 나타나고 있다. 따라서 길 지정 및 조성 이후 이용객들의 평가는 제대로 이루어지지 못하고 있는 실정이므로, 본 연구에서는 조성이 완료되어 많은 이용객들이 이용하고 있는 북한산 둘레길을 중심으로 이용객들의 만족도를 조사하고, 노선 선정 시 고려한 계획요소들이 만족도에 미치는 영향을 분석함으로써 더 나은 길 조성을 위한 개선방안을 제시하고자 한다. 이를 위하여 문헌조사를 통하여 노선 선정 시 중요한 계획요소를 파악하고, 이를 바탕으로 설문지를 작성하여 이용객을 대상으로 각 구간별 만족도, 재방문 의사, 추천의사에 대한 설문조사를 실시하였다. 현장조사를 통하여 파악한 구간별 특정을 기준으로 5개의 유형으로 길을 분류하고, 구간별 만족도와 유형별 만족도를 분석하였다. 또한, 계획요소가 만족도에 미치는 영향, 만족도가 재방문 의사 및 추천의사에 미치는 영향, 이용객들이 인지하는 구간별 테마를 분석하였다. 구간별 만족도는 자연적 요소가 강한 구간이 높게 나타났으며, 만족도에 영향력을 미치는 계획요소로는 '보행쾌적성'이 가장 높은 것으로 조사되었다. 또한, 만족도는 재방문 의사 및 타인에게 추천하려는 의사에 대하여 높은 영향력을 보이는 것으로 조사되었다. Since Jeju Ollegil opened in September 2007 and attracted the sensation of popularity throughout the country, the interest in 'Walking Trails' has increased, and the central ministries and the local governments composite and assign various 'Walking Trails'. Walking trails are not tours on which people go to see one spot and move to another spot by vehicle, but a long linear journey that leads people to see, to feel and to experience a region's landscape and culture while walking on the trail. 'Walking Trails' are efficient routes to discover and to use a former way and to link the various ecological regions' histories and cultural resources, so it is most important to select a route. Although the routes were selected by considering the various planning factors and giving each route a specified theme, some problems like the inconvenience of visitors caused by lack of facilities have occurred. After designation and construction of the trails, they were not properly evaluated by visitors. Therefore, it is the purpose of this study to suggest a better way to construct the trails by surveying visitor satisfaction and by analyzing the impact of planning a route on visitor satisfaction at Bukhansan Dulegil which was completed. For this study, with a questionnaire based on the literature review to identify the important planning factors for selecting a route, a survey was conducted on visitor satisfaction for each section and their intention to revisit and to recommend that trail. Based on the characteristics of each section that was identified in the field research, the trails were classified into five types and satisfaction of each type and each type was analyzed. In addition, analyzing the impact of planning factors on satisfaction, the impact of satisfaction on revisiting and recommending and visitors' perception of the theme, further improvement for better construction of the trail was presented. Satisfaction of sectors with strong natural elements was higher; 'walking comfort' was the highest planning factor affecting satisfaction. In addition, satisfaction was surveyed to have high influence on revisiting and recommending.

크레메진의 투석도입 지연효과에 따른 진행성 신부전증환자의 비용감소분 추계

조우현,이선미,김형종,이호영,우태욱,강혜영,Cho, Woo-Hyun,Lee, Sun-Mi,Kim, Hyung-Jong,Lee, Ho-Yong,Woo, Tae-Wook,Kang, Hye-Young 대한예방의학회 2006 예방의학회지 Vol.39 No.2

Objectives : We wanted to evaluate the economic value of a pharmaceutical product, Kremezin, for treating patients with chronic renal failure (CRF) by estimating the amount of cost savings due to its effect for delaying the initiation of dialysis treatments. Methods : We defined a conventional treatment for CRF accompanied by Kremezin therapy as 'the treatment group' and only conventional treatment as 'the alternative group.' The types of costs included were direct medical and nonmedical costs and costs of productivity loss. The information on the effect of Kremezin was obtained from the results of earlier clinical studies. Cost information was derived from the administrative data for 20 hemodialysis and 20 peritoneal dialysis patients from one tertiary care hospital, and also from the administrative data of 10 hemodialysis patients from one free-standing dialysis center. Per-capita cost savings resulting from Kremezin therapy were separately estimated for the cases with delay for the onset of hemodialysis and the cases with immediate performance of peritoneal dialysis. By computing the weighted average for the cases of hemodialysis and peritoneal dialysis, the expected per-capita cost savings of a patient with CRF was obtained. Using a discount rate of 5%, future cost savings were converted to the present value. Results : The present value of cumulative cost savings per patient with CRF from the societal perspective would be $18,555,000{\sim}29,410,000$ Won or $72,104,000{\sim}112,523,000$ Won if Kremezin delays the initiation of dialysis by 1 or 4 years. Conclusions : The estimated amount of cost savings resulting from treating CRF patients with Kremezin confirms that its effect for delaying the onset of dialysis treatments has a considerable economic value.

청년층의 자기인지건강 관련 요인

조우현,서일,박종구,박기호,Cho, Woo-Hyun,Suh, Il,Park, Jong-Ku,Park, Kee-Ho 대한예방의학회 2000 예방의학회지 Vol.33 No.4

Objectives : To determine which factors are related to young adults perception of their health. Two research questions were asked. Which aspects of health does self-perceived health as a index of general health reflect? Why do two individuals with the same level of general health have different health perceptions? Methods : The sampling frame comprised college or graduate school students, aged 20 to 29, who were members of A, one of the 4 biggest internet communication services. The questionnaires were sent to study samples(n=1,000) and answered by E-mail. Response rate was 37.0%. Results : Firstly, physical health ranked highest and self-perceived health ranked lowest. Secondly, health, anxiety, depression, and self-perceived health showed significant differences between the sexes, with women showing a higher health status in these categories except for self-perceived health. Thirdly, the two factors significantly related to self-perceived health were physical health and self-esteem, as determined by multivariate analysis, Conclusions : The factors significantly related to self-perceived health were physical health and self-esteem. Further studies of the health characteristics of young adults are needed.

라식수술 후 환자만족도에 영향을 미치는 요인

조우현,김지윤,최윤정,이종호,이제명,강혜영,Cho, Woo-Hyun,Kim, Ji-Yoon,Choi, Yoon-Chung,Lee, Jong-Ho,Lee, Je-Myung,Kang, Hye-Young 대한예방의학회 2004 예방의학회지 Vol.37 No.2

Purpose : To identify those factors influencing the post-operative satisfaction in myopia patients receiving laser in situ keratomileusis (LASIK) Methods : This study included 288 consecutive patients who received LASIK between July and December 2001 from two eye clinics located in Seoul and Pusan. Factors that were considered to influence post-operative satisfaction included pre-operative baseline characteristics, pre-operative expectation for treatment outcomes, and treatment outcomes. Before undergoing LASIK, study subjects were asked to rate the degree of their expectation for the improvement of visual functions and symptoms after LASIK on a 5-point Likert-type scale: where 1 referred to 'somewhat worse,' 2 to 'no change,' 3 to 'somewhat improved,' 4 to 'improved,' and 5 to 'very improved.' Self-administered questionnaire was used to evaluate baseline visual functions and symptoms on a 5-point scale before LASIK. At 6 months after LASIK, the evaluation was repeated to measure treatment outcomes in terms of the difference in the score before and after LASIK. Post-operative satisfaction was also measured at 6 months on a 5-point scale. Multiple regression analysis was performed to examine the independent relationship between influencing factors and postoperative satisfaction. Results : A total of 171 patients (59.4%) participated in the 6-month follow-up investigation. The average expectation scores for the improvement in visual functions and symptoms were 3.8 and 3.4, respectively. The average score for the 7 questions assessing satisfaction was 4.0. The results of the regression analysis showed that the post-operative satisfaction increased with improvement in the visual function ($\beta$=0.16, p<0.05) and symptoms ($\beta$=0.25, p<0.05), the degree of preoperative refractive error ($\beta$ =0.26-0.67, p<0.05) and in male patients ($\beta$=0.31, p<0.1). The pre-operative expectation was not a statistically significant factor in explaining postoperative satisfaction in the regression model. Conclusion : The finding from this study was that patients with very severe myopia tended to be more satisfied with the treatment than those with mild myopia, which implies that LASIK can be more beneficial to those suffering from a severe visual condition. Patient satisfaction was also significantly affected by the treatment outcomes experienced after LASIK. This suggests that improving the clinical outcome is the most fundamental requirement for the improvement of patient satisfaction.

북한산 둘레길 경관선호도와 이용만족도의 상관성에 관한 연구

조우현,임승빈,Cho, Woo-Hyun,Im, Seung-Bin 한국조경학회 2013 韓國造景學會誌 Vol.41 No.1

자연속에서 새로운 것을 추구하고자 하는 사람들의 의식 변화로 길은 기능 중심의 '걷는 길'에서 목적 중심의 '걷고 싶은 길'로 변화하고 있다. 지금까지 조성되고 있는 '걷고 싶은 길'은 길을 따라 걷는 과정에서 보고, 느끼고, 체험하는 다양한 목적을 가진 긴 선적 공간이라 할 수 있지만, 노선 선정 시 길을 걷는 과정에서 보여지는 길의 경관에 대한 고려는 미흡하다고 할 수 있다. 길을 걸으면서 느끼고 지각하는 경관은 '걷고 싶은 길'을 이용하는 이용자에게 하나의 목적을 제공할 뿐 아니라, 길 이용에 대한 만족도를 향상시킬 수 있는 중요한 요소라 할 수 있지만, 걷고 싶은 길의 경관적 측면에 대한 연구는 미흡하다고 할 수 있다. 따라서, 본 연구는 북한산 둘레길을 대상으로 하여 경관적 측면에서 시각적으로 지각되는 길 경관에 대한 이미지 및 선호도를 분석하고, 이용 만족도와의 상관성을 분석함으로써 걷고 싶은 길 노선 선정 과정에서 경관적 측면을 고려하여 이용자 만족도를 향상시킬 수 있는 방안을 모색하고자 하였다. 이를 위하여 북한산 둘레길 13개 구간에 대하여 구간별 대표경관 사진을 선정하고, 경관평가를 위한 경관이미지 형용사를 선정하여 경관평가를 시행하였다. 경관평가를 통해 구간별 경관이미지, 걷고 싶음 및 경관선호에 영향을 미치는 경관이미지 요인, 경관선호와 이용만족도와의 관련성을 알아보았다. 경관이미지는 수목이 많고 인공적 요소의 지각이 덜한 길에서 '상쾌한' 이미지가 높게 나타나고, 인공적 요소의 지각이 높은 길에서 '도시적인' 이미지가 높게 나타났다. '걷고 싶음'과 '경관미 선호도'는 자연적 요소가 높아 '상쾌한', '전원적인' 이미지가 높은 길에서 높게 나타났다. '걷고 싶음'에 영향을 미치는 요인으로 "상쾌한-불쾌한", "인상적인-평범한" 이미지로 나타났으며, '경관미 선호도'에 영향을 미치는 요인으로 "상쾌한-불쾌한", "편안한-불편한" 이미지로 나타났다. 또한, 경관선호도는 이용 만족도와 높은 상관관계가 있는 것으로 나타났다. In nature, to change the consciousness of those who wish to pursue something new, the road is turning function-oriented 'Walking Path' into purpose-oriented 'Walking Trails'. Though 'Walking Trails' is a long linear journey that leads people to see, to feel and to experience while walking on the trail, but considering on the landscape of trails when selecting routes is lacking. Landscapes, which are felt and perceived while walking on the trail, provide a purpose, and can be an important factor to improve visitor satisfaction. However, the study is insufficient in terms of landscape of trails. Therefore, it is the purpose of this study to find ways to help improving visitors' satisfaction in selecting routes, by analyzing the images and preferences of trails landscapes that are visually perceived, by analyzing the correlation between visitors' satisfaction and them. For this study, landscape assessment was carried out after selecting representative landscape photos of BukhansanDulegil 13 sections and landscape images adjectives for landscape assessment. Through the assessment, analyze landscape images of each section, landscape images factors affecting a wish to walk and landscape preferences, relationship between visitors' satisfaction and them. 'Refreshing' image was higher on the path with many trees and less artificial elements; 'urban' image was higher on the path with artificial elements. 'A wish to walk' and 'landscape preference' was higher on the path showed 'refreshing' and 'pastoral' image with many natural elements. Factors affecting 'a wish to walk' were "refreshing-unpleasant", "impressive-ordinary", factors affecting 'landscape preference' were "refreshing-unpleasant", "comfortable-uncomfortable". In addition, landscape preference was found to have a high correlation with visitors' satisfaction.

의료기관 선택기준에 관한 연구

조우현,김한중,이선희,Cho, Woo-Hyun,Kim, Han-Joong,Lee, Sun-Hee 대한예방의학회 1992 예방의학회지 Vol.25 No.1

There are increasing interest and need for information on health care consumer with the significance of hospital marketing and strategic planning being increasingly emphasized. This study was conducted to investigate the criteria for selection of medical facilities according to the characteristics of health care consumer by the types of medical services on a sample of 1,500 population aged 20 years and above. Major findings are as follows ; 1. When considering the criteria for selection of medical facilities into two factors, namely, quality or convenience factors, convenience factor was the major contributor for outpatient and dental services whereas it was quality factor for inpatient services. 2. Females and those residing in large cities selected medical facilities based on convenience factor in the outpatient services. In the case of inpatient service, persons who considered their present health status to be good and whose ages were 50 years old and above choose medical facilities based on quality factor. 3. Persons who considered medical facilities to be profit-making tended to choose medical facilities based on convenience factor for outpatient services. There were no differences in the cases of inpatient and dental services. 4. There was no significant difference on the criteria for selection of medical facilities according to the decision maker for selection or trust on medical facilities. On the use of health service information, selection of medical facilities was based on quality factor for those who made more use of the information in the cases of outpatient and dental services. 5. Analysis using the logistic regression model on the criteria for the selection of medical facilities with the characteristics of health care consumer as independent variables was performed. The selection of medical facilities was significantly related with residential area, sex, and use of information on medical facilities for outpatient services and with age, average monthly income, and perception of health status for inpatient services. For dental services significant association with residential area and use of information on medical facilities was seen. The results of this study, despite some limitations, can be used as baseline data for marketing and strategic planning of hospital management.

지역간 입원 이용 변이에 관한 연구

조우현,이선희,박은철,손명세,김세라,Cho, Woo-Hyun,Lee, Sun-Hee,Park, Eun-Cheol,Sohn, Myong-Sei,Kim, Se-Ra 대한예방의학회 1994 Journal of Preventive Medicine and Public Health Vol.27 No.3

This study was conducted to investigate whether variations in hospital services utilization across small geographic areas in Korea existed, and if so, what factors are responsible for the variation. The claims data of the fiscal year 1992 obtained from the regional health insurance societies were used for the study. Main findings of the research can be summarized as follows: 1 Extremal Quotients (EQ) of hospital expenditure per capita and hospital days per capita were 2.69 and 2.73, and Coefficient of Variation (CV) were 0.14, both, respectively. The EQ and the CV of admission rate were also 2.71, 0.15. The EQ and the CV of expenditure per admission were 1.73, 0.10 and those of hospital days per admission were 1.29, 0.06. All these statistics were statistically significant and this result provides strong evidence for the existence of small area variations. 2. Comparing patterns of variation among areas, the area which showed higher utilization amounts is Chansungp'o. Koje area, whereas the areas which showed lower utilization amounts are Yongju, Changhung, Miryang, Mokp'o, Koch'ang area. 3. Multivariate analytic methods were used to examine factors related to the variation across areas. In terms of the health resource availability variables, beds per capita or physicians per capita were positively associated with all utilization indices. As for the health service market structure variables, the proportion of health care institutions operating for less than f years was positively related to the expenditure per capita, hospital days per capita and expenditure per admission. In addition the proportion of the private health care institutions also had a negative relationship with total utilization amount and admission rate and the proportion of physicians under age 40 was negatively associated with expenditure per capita and expenditure per admission. With regard to the socio-demographic characteristics, proportion of medicaid population was positively related to hospital days per capita, and percentage of paved road was positively related to hospital days per admission. As a conclusion, wide variations existed across small areas in Korea and supply factors were found to be important in explaining the variation.

시계열 개입 분석을 이용한 환자의뢰제도의 개입효과 평가

조우현,이해종,손명세,남정모,유승흠,Cho, Woo-Hyun,Lee, Hae-Jong,Sohn, Myong-Sei,Nam, Chung-Mo,Yu, Seung-Hum 대한예방의학회 1989 Journal of Preventive Medicine and Public Health Vol.22 No.2

The purpose of this study was to introduce the methodology of intervention analysis with time series data and to investigate the influence of the patient referral system on medical care utilization in Kangwha county. The data were obtained at the Kangwha Medical Inurance Society and we analysed the material based on the outpatient care fee. The results were as fellows: 1. The average outpatient care utilization in the hospital decreased by 41.7% due to the patient referral system. 2. The utilization of the health instituation increased by 278.8 persons per month due to the patient referral system. 3. The patient referral system did not influence the total outpatient are utilization. The methodology of intervention analysis, which detected the effect of intervention, will be helpful to the study of public health area.

우리나라 병원의 평균재원기간의 추이

조우현,전기홍,강임옥,Cho, Woo-Hyun,Chun, Ki-Hong,Kang, Im-Ok 대한예방의학회 1996 예방의학회지 Vol.29 No.1

The purpose of this study was to examine the trends of length of hospital stay (LOS), which is most likely to be a major attribute to hospital performance. From 1984 to 1994, an average LOS of each hospital was analyzed by factors such as medical departments, bed size, occupancy rate, region and ownership. This study was analyzed changing rate of LOS during 11 years. This rate was calculated by simple regression, which was used only with hospital without missing data during 11 years. This study findings are as follows. 1. The results indicated that the average LOS was steadily increased until 1990 but it was slightly decreased after 1990. 2. This trend could be found in all hospital scale and all group of occupancy rate. Specifically this trends of LOS were found in internal medicine, corporate owned hospitals, and hospitals in major city. But LOS of individual owned hospital was continuously increased until 1994. 3. Means of changing rates of LOS were calculated from 1984 to 1994. If we devided it into two parts, before 1990 and after 1990, most changing rates of LOS before 1990 except individual owned hospital were found positive sign. The changing rates after 1990 were negative sign but small hospital(lesser then 200 bed), individual owned hospital, national & public hospital and hospital in small urban have little change of LOS after 1990. Finally from this results we thought that most hospitals in Korea began to be concerned with LOS. Nevertheless LOS of several hospital such as small hospital or individual owned hospital was increased. And this trend may be caused by a few patients, low occupancy rate, or low profit. This trend of LOS is different from that of other countries. Perhaps this phenomenon is resulted from the reimbursement method. Because of fee for service reimbursement system in Korea the hospitals didn't need to shorten LOS in order to save the cost and increase the profit. Therefore reform of hospital cost reimbursement method will be needed to reduce hospital cost in Korea. We thought that the Korean health authority should consider the reimbursement method by unit of bundle of services, for example DRG and prepayment in the United States. This study presents some limitations such as no insight of severity of disease, case-mix measurement of hospital, and other clinical characteristics that can. possibly affect LOS. However, this study reports an important trend in LOS from 1984 to 1994.