상급종합병원은 일반종합병원에 비해 회계성과가 우수한가?

최승욱 ( Seung Uk Choi ) 한국회계학회 2022 회계저널 Vol.31 No.2

상급종합병원은 “중증질환에 대하여 난이도가 높은 의료행위를 전문적으로 하는 종합병원”으로 일반종합병원에 비해 의료서비스와 장비 측면에서 우수한 종합병원을 의미한다. 우리나라는 1999년부터 종합전문요양기관을 지정하기 시작하였고, 2011년부터는 상급종합병원으로 명칭을 변경하여 보건복지부 장관이 3년 주기로 종합병원을 대상으로 평가하여 상급종합병원을 지정한다. 그러나 아직까지 종합병원의 성과를 회계 관점에서 살펴본 연구는 드물며, 상급종합병원과 다른 종합병원의 회계성과에 차이가 있는지 살펴본 연구 역시 거의 없다. 이에 본 연구는 상급종합병원의 회계성과가 다른 종합병원에 비해 우수한지 조사한다. 2016년에서 2019년 사이의 국내 종합병원 재무제표 자료를 이용하여 조사한 결과, 총자산이익률로 대용된 회계성과는 상급종합병원이 일반종합병원에 비해 유의하게 높았다. 병원의 이익을 의료이익과 의료외이익으로 나눈 조사에서는 상급종합병원의 의료이익률이 일반종합병원보다 높았지만, 의료외이익률은 두 그룹 간 차이가 없었다. 다음으로, 종합병원의 회계성과를 창출하는 요인을 조사하기 위해 DuPont 분석을 활용한 결과, 상급종합병원의 자산회전율과 매출액순이익률이 모두 일반종합병원보다 높았다. 회계성과 요인을 종합병원의 성격에 따라 구분한 조사에서는 설립형태가 학교법인인 경우 상급종합병원의 회계성과가 증분적으로 높아졌으나, 병상수가 1,000개 이상으로 많은 경우에는 오히려 회계성과가 감소하였다. 반면, 서울 소재 여부는 상급종합병원의 성과에 유의한 증분효과가 없었다. 마지막으로, 회계성과의 수준 뿐 아니라 지속성을 살펴보았으며, 상급종합병원의 회계성과는 일반종합병원에 비해 더 지속성이 있었다. 본 연구는 상급종합병원의 성과를 일반종합병원과 구분하여 회계학 관점에서 조사한 최초의 연구로 DuPont 분석, 회계이익의 지속성 등 회계성과를 포괄적으로 조사하여 병원의 경영관리를 위한 기초자료를 제시한다. 또한 상급종합병원의 회계성과가 일반종합병원과 체계적으로 다르다는 것을 보여 상급종합병원 지정제도에 제도적 시사점을 제시한다. Tertiary general hospitals are designated by the Minister of Health and Welfare for every three years by evaluating the general hospitals. Tertiary general hospital is specialized in medical services for serious diseases than other general hospitals. Since tertiary general hospital operates for the purpose of treating serious patients, it provides a superior medical services compared to the other general hospitals. However, few studies have been reported the difference in the accounting performance of tertiary general hospitals and other general hospitals. Investigating the accounting performance of tertiary general hospitals has the following importance. If the accounting performance is not well supported, challenging tasks such as research and development activities for the treatment of serious diseases may not be properly carried out. Therefore, this study investigates whether the accounting performance of these tertiary general hospitals is higher than the other general hospitals. By using the financial statement data from 2016 to 2019 of domestic general hospitals, the results of show that accounting performance proxied by the return on assets (ROA) is significantly higher in tertiary general hospital than in other general hospitals. As a result of dividing profits into medical profits and non-medical profits, tertiary general hospitals show a significant positive relationship with medical profits, but are not significantly related to non-medical profits. As medical profits consist of hospitalized income, outpatient income, and other medical income, the results of this study suggest that the high accounting performance of tertiary general hospitals is based on these medical profits. In contrast, non-medical profits include income from funeral, parking lot, cafeteria, interest, dividends, and rental. To summarize, tertiary general hospitals are reporting higher accounting performance than other general hospitals by generating profits from the medical activities. Next, as a result of using DuPont analysis to investigate the factors that create accounting performance of general hospitals, current study documents that both asset turnover and profit margin of tertiary general hospitals are higher than those of other general hospitals. Moreover, current study finds that accounting performance of tertiary general hospitals increases gradually when it is established by an educational foundation (i.e., medical school). In contrast, accounting performance incrementally decreases when the number of beds is more than 1,000 while there is no significant incremental effect of Seoul located on the performance. Finally, the accounting performance of tertiary general hospitals is more persistent than that of other general hospitals. In addition, based on the DuPont analysis, current study finds that the higher persistence is derived from the profit margins rather than the asset turnover. This suggests that the sustainability of the accounting performance of tertiary general hospitals is due to the effectiveness and persistency in their cost structure. This study makes several contributions to the academic, practice, and medical service related regulations. For instance, this is the first study to investigate the performance of tertiary general hospitals from an accounting perspective by separating them from the other general hospitals. In particular, the performance of tertiary general hospitals is investigated through several different measurements to confirm the robustness of the results. In addition, the DuPont analysis provides implications by presenting the factors affecting the accounting performance of tertiary general hospitals. Lastly, by showing that the accounting performance of tertiary general hospitals is systematically different from that of the other general hospitals, the results of this study could be used as an initial outcome for improving the designation system of tertiary general hospitals.

병원 유형에 따른 재무적 특성 연구

나형종,이건창,김성태 경남대학교 산업경영연구소 2019 지역산업연구 Vol.42 No.3

This paper categorizes general hospitals as higher-level and non-higher-level general hospitalsand aims to analyze the financial characteristics between higher-level and non-higher-level generalhospitals. Also, we investigate financial characteristics between university and non-university hospitalsby dividing general hospitals into university and non-university hospitals. We collect financialstatement from each hospital homepage and the sample period is 2016. The number of finalsamples of general hospitals is 65. Higher-level general hospitals are 28 and non-higher-level generalhospitals are 37. And, there are university hospitals are 43 and non-university hospitals are 37. Thet-test results between higher-level and non-higher-level general hospitals are as follows. First,non-higher-level general hospitals show that the total assets are significantly lower than those of thehigher-level general hospitals. Second, non-higher-level general hospitals indicate that the debt ratio issignificantly higher than those of the higher-level-general hospitals. Third, non-higher-level generalhospitals show that the ratio of non-medical income to medical income is significantly higher thanthose of higher-level general hospitals. Fourth, non-higher-level general hospitals present that theratio of cash to total assets is significantly higher than those of higher-level general hospitals. Fifth,non-higher-level general hospitals show that both the ratio of tangible assets and the ratio ofintangible assets are significantly lower than those of higher-level general hospitals. Meanwhile, thet-test results between university and non-university hospitals are as follows. First, non-universityhospitals indicate that the total assets are significantly smaller than those of university hospitals. Second, non-university hospitals present that the debt ratio is significantly higher than those ofuniversity hospitals. Third, non-university hospitals present that the ratio of medical benefits tomedical revenues is significantly lower than those of university hospitals. However, non-universityhospitals show that the ratio of non-medical revenues to medical revenues is significantly higher thanthose of university hospitals. Fourth, non-university hospitals indicate that both the ratio of medicalexpenses to medical revenues and the ratio of non-medical expenses to medical revenues aresignificantly higher than those of university hospitals. Fifth, non-university hospitals show that boththe ratio of reserve fund for essential business to total assets and the ratio of translation of reserve fund for essential business to medical revenues are significantly lower than those of universityhospitals. Sixth, non-university hospitals indicate that the ratio of cash to total assets is significantlyhigher than those of university hospitals. Seventh, non-university hospitals present that the ratio ofmedical accounts receivable to total assets is significantly higher than those of university hospitals. Eighth, non-university hospitals indicate that the ratio of tangible assets is significantly lower thanthose of university hospitals. The contribution points of this paper are as follows: First, bypresenting research results on financial characteristics of hospitals, this paper provides the academiccommunity, practitioners and policy authorities with useful information. Second, the results of thisstudy on the financial characteristics of hospitals remind hospitals of the need for appropriatefinancial statement preparation and disclosure. 본 논문은 종합병원을 상급종합병원과 비상급종합병원으로 분류하여 상급종합병원과 비상급종합병원 간의 재무적 특성을 비교분석하고자 한다. 또한 종합병원을 대학병원과 비대학병원으로 구분하여 대학병원과 비대학병원 간의 재무적 특성을 비교분석하고자 한다. 본 연구를 위해서 2016년도 기준으로 국내 종합병원들의 재무상태표와 손익계산서를 수집하였다. 조사결과,재무상태표와 손익계산서가 수집가능 한 종합병원은 총 65개였고, 이 중 비상급종합병원은 37개였고 상급종합병원은 28개였다. 또한 비대학병원은 22개였고 대학병원은 43개였다. 상급종합병원과 비상급종합병원의 t-test 결과, 비상급종합병원의 총자산 규모가 상급종합병원에 비하여 유의하게 적은 것으로 나타났고, 부채비율은 더 높은 것으로 나타났다. 그리고 의료수익 대비 의료외수익 비율이 비상급종합병원이 상급종합병원에 비하여 유의하게 높은 결과가나왔다. 또한 총자산 대비 현금비율도 비상급종합병원이 상급종합병원에 비하여 유의하게 높은결과가 나왔다. 유형자산 비율과 무형자산 비율은 모두 비상급종합병원이 상급종합병원에 비하여 낮은 것으로 나타났다. 한편, 대학병원과 비대학병원의 t-test 결과는 다음과 같다. 비대학병원은 대학병원에 비하여 총자산 규모가 유의하게 작은 것으로 나타났다. 부채비율은 비대학병원이 대학병원에 비하여 높은 것으로 나타났다. 그리고 의료수익 대비 의료이익 비율은 비대학병원이 상대적으로 낮은 것으로 결과가 나타났고, 의료수익 대비 의료외수익 비율은 비대학병원이상대적으로 높은 것으로 결과가 나타났다. 또한 의료수익 대비 의료비용 비율과 의료수익 대비의료외비용 비율은 비대학병원이 모두 높은 것으로 드러났다. 총자산 대비 고유목적사업적립금비율과 의료수익 대비 고유목적사업적립금 전입액 비율은 비대학병원이 대학병원에 비하여 모두 낮게 나타났다. 또한 총자산 대비 현금 비율은 비대학병원이 유의하게 높은 것으로 나타났다. 총자산대비 의료미수금 비율은 비대학병원이 상대적으로 높은 것으로 결과가 나타났고, 유형자산 비율은 비대학병원이 대학병원에 비하여 유의하게 낮은 것으로 결과가 도출되었다. 본 논문의 공헌점은 다음과 같다. 첫째, 종합병원들의 재무제표 자료를 사용하여, 상급종합병원과 대학병원의 재무적 특성에 대한 연구결과를 제시함으로써 학계와 실무담당자 및 정책당국에 유용한 정보를 제공하였다. 둘째, 종합병원들의 재무적 특성에 대한 연구결과를 통하여 병원들의 적절한 재무제표 작성 및 공시에 관한 필요성을 상기시키고 이에 대한 개선점을 제시하고있다.

신포괄수가제와 공익성이 종합병원의 수익성에 미치는 영향

오웅락 한국회계학회 2022 회계저널 Vol.31 No.1

Diagnostics-Related Group-Based Payment(DRG), introduced to solve over-treatment problems such as excessive length of hospital stay and drug abuse under Fee-For-Service(FFS), is a system that compensates only a certain amount of medical expenses set in advance for the same disease regardless of the type or amount of medical services based on the FFS. DRG in Korea was first introduced in 2002, and since July 2013, it has been expanded to general hospitals and upper general hospitals for seven diseases and has been applied for granted. Since DRG compensates only a certain amount of money for a single disease and causes a problem of deteriorating quality of medical services, New Diagnosis-Related Group-Based Payment (NDRG) was introduced to solve this problem. In other words, NDRG is a system that applies DRG for basic treatment and FFS to compensate for expensive medical services and doctors' actions in order to solve the problem of over-treatment by FFS and deteriorating quality of medical services by DRG. With all general hospitals that disclosed financial statements to KHIDI from 2017 to 2019 set as research subjects, this study verified the influence of participation status in NDRG and public interest on profitability. First, participating in NDRG is expected to improve the profitability of general hospitals, since high-priced services and doctor’s actions are compensated with FFS and incentives are provided through evaluation, general hospitals participating in NDRG may show higher profitability than general hospitals that do not. Therefore, hypothesis I was established that 'whether or not to participate in NDRG will affect the profitability of general hospitals'. As a result, participation status of NDRG did not significantly affect both the Operating Profit on Assets and the Operating Margin of the entire sample group, indicating that the hospital's overall participation status of NDRG had a weak effect on profitability. Second, the number of hospital stays that decreased with the introduction of DRG to reduce costs increased again with the introduction of NDRG that compensates expensive medical services with FFS. This mainly appeared in private hospitals. Therefore, since the effect of profit improvement through increase in the number of hospital stays, with the introduction of NDRG, is expected to appear more in private general hospitals than in public general hospitals. Therefore the hypothesis II was established: "The impact of participation in NDRG of public hospitals on profitability will be different from that of private hospitals.". As a result, participation in NDRG improved the profitability of private general hospitals, but did not improve the profitability of public general hospitals. Third, non-metropolitan hospitals differ in profitability due to differences in geographic location and labor costs compared to general hospitals in the metropolitan area and relatively have stronger public interest than them. Therefore, since the impact of participation in NDRG on the profitability of general hospitals is expected to differ between non-metropolitan hospitals and general hospitals in the metropolitan area, hypothesis III was established: "The effect of participation in NDRG of non-metropolitan hospitals on profitability will be different from that of general hospitals in the metropolitan hospitals.” As a result, it was shown that whether or not the metropolitan area had no effect on the profitability of participation in NDRG. And participation of NDRG worsened the medical profit margin of non-metropolitan hospitals. Fourth, there were 42 general hospitals participating in NDRG before August 2018, and 26 hospitals from then to 2019, so only 26 hospitals/year were changed to NDRG from 2017 to 2019. Therefore, in order to verify Hypothesis I, As a result, general hospitals that changed to NDRG showed higher total asset medical returns than non-modified general hospitals, and there was no difference in prof... 본 연구는 2017년부터 2019년까지 한국보건산업진흥원에 재무제표를 공시한 전체 종합병원들을 연구대상으로, 신포괄수가제 참여 여부와 공익성 여부가 수익성에 어떠한 영향을 미치는지를 검증하였다. 본 연구의 구체적인 분석결과는 다음과 같다. 첫째, 신포괄수가제 참여 여부는 전체 표본집단의 총자산의료이익률과 의료수익의료이익률에 모두 유의한 영향을 미치지 못하는 것으로 나타나, 종합병원 전체적으로 신포괄수가제 참여 여부가 수익성에 미치는 영향이 미약함을 보여주었다. 둘째, 신포괄수가제 참여는 민간종합병원의 수익성을 개선시키지만 공공종합병원의 수익성을 개선시키지는 못하였다. 셋째, 수도권 및 광역권 여부는 신포괄수가제 참여 여부의 수익관련성에 미치는 영향이 없음을 보여주었고, 신포괄수가제 참여가 비수도권종합병원들의 의료수익의료이익률을 악화시켰다. 넷째, 신포괄수가제로 변경한 종합병원이 비변경한 종합병원보다 총자산의료이익률이 높은 것으로 나타났고 의료수익의료이익률은 차이가 없었다. 본 연구의 의의는 신포괄수가제에 참여한 민간종합병원의 수익성이 개선되었음을 보여줌으로써, 공공종합병원과 비교하여 신포괄수가제 참여가 저조한 민간종합병원의 참여 타당성을 보여주었다는데 있다. 또한 신포괄수가제 참여가 공공종합병원, 비수도권종합병원과 비광역권종합병원들의 수익성을 개선시키지 못함을 보여줌으로써, 공익성을 담당하는 종합병원들에 대해 신포괄수가제 참여에 대한 재정적 지원이 더 필요함을 시사한다.

법인종합병원의 병상규모별 수익성 요인 분석

김유정,심용우 경성대학교 산업개발연구소 2022 산업혁신연구 Vol.38 No.3

This study analyzed specific factors that affect profitability by bed size of corporate general hospitals according to changes in the medical environment before and after COVID-19, and the financial data of corporate general hospitals for the past 3 years (2018-2020) by the Korea Health Industry Development Institute(KHIDI) were used. This study differentiated from previous studies was conducted by dividing into large, medium and small corporate general hospitals by bed size and identifying the factors influencing profitability by the number of beds. As a result of the study, first, there was a statistically significant difference in the net profit to total assets and net profit to gross revenues. Second, as a result of multiple regression analysis, it was more explanatory to apply net profit rate 1, which accumulating reserves for specific purpose business was added, than to apply net profit rate for mid and large corporate general hospitals excluding small corporate general hospitals. Third, in the case of large corporate general hospitals, the variables of labor cost, material cost, management and operation cost, outpatient revenue, and hospitalization revenue compared to medical revenue were statistically significant, and in the case of medium corporate general hospitals, the variables of labor cost, material cost, management and operation cost, and interest cost compared to medical revenue were statistically significant. and in the case of small corporate general hospital, only the variable of labor cost compared to medical revenue was statistically significant. And inpatient and outpatient revenue compared to medical revenue affected profitability only in large corporate general hospitals. The results of this study will give important implications for corporate general hospitals to establish differentiated and specialized management strategies suitable for bed size and hospital characteristics. 본 연구는 COVID-19 전후 의료 환경의 변화에 따른 법인종합병원 병상규모별 수익성에 영향을 미치는 특정 요인을 파악하고자 하였다. 한국보건산업진흥원의 최근 3년간(2018~2020년) 법인종합병원 재무자료를 활용하여 병상규모별 대형(800병상 이상), 중형(400병상 이상 800병상 미만), 소형(400병상 미만) 법인종합병원으로 구분하여 병상 수에 의한 수익성 영향요인을 파악함으로써 선행연구와 차별화된 연구를 하였다. 연구결과로 첫째, 연구대상 모든 법인종합병원의 병상규모별 경영 수익성 지표인자인 총자산순이익률, 의료수익 순이익률 수익성에 통계적으로 유의한 차이가 있었다. 둘째, 법인종합병원의 병상규모별 수익성 영향요인을 파악하기 위해 다중회귀분석 결과, 소형법인종합병원을 제외한 중형, 대형법인종합병원 모형의 설명력은, 순이익을 사용한 경우보다 고유목적준비금 전입액을 추가한 순이익1을 사용한 경우의 설명력이 더 높았다. 셋째, 대형법인종합병원은 의료수익 대비 인건비, 재료비, 관리운영비, 외래수익, 입원수익 변수가 통계적으로 유의하였으며, 중형법인종합병원은 의료수익 대비 인건비, 재료비, 관리운영비, 이자비용 변수가 통계적으로 유의, 소형법인종합병원은 의료수익 대비 인건비 변수만 통계적으로 유의하였다. 대형법인종합병원(800병상 이상)에서만 의료수익 대비 입원수익 및 외래수익이 수익성에 영향을 미치는 중요한 변수로 나타났다. 이러한 연구 결과는 법인종합병원이 병상규모 및 병원 특성에 맞는 차별화, 특성화된 경영전략을 수립하고, 정부 또한 중장기적인 병상규모에 대한 입법의료정책을 수립하는데 중요한 시사점을 줄 것이다.

요양기관 종별 외래 약제비 본인부담 차등정책의 효과 분석

최종남 ( Jong Nam Choi ),조정숙 ( Jeong Sook Jo ),류시원 ( See Won Ryu ) 한국보건정보통계학회(구 한국보건통계학회) 2016 한국보건정보통계학회지 Vol.41 No.2

Objectives: This study aims to evaluate the effectiveness of the policy on differential coinsurance for outpatient prescription drug coverage in general hospitals or advanced general hospitals among patients covered by health insurance for 52 mild diseases (Notification No. 2011-86 of the Ministry of Health and Welfare), which came into force in October 2011. Methods: The claims for health insurance coverage of outpatient medical expenditures in all general hospitals and advanced general hospitals, which were made for a year (from October 2010 to September 2011) before the policy and for two years (from October 2011 to September 2013) after the policy, were analyzed. The changes in the ratio of the number of all the claims for medical expenditures and patients to that of claims for 52 mild diseases as principal conditions and relevant patients were analyzed in terms of care institution types, gender, regions, age groups, and diseases. Results: The policy on differentiated prescription drug coverage was effective both in general hospitals and in advanced general hospitals. The number of medical claims and patients were decreased, and it was slightly more effective in advanced general hospitals. It was more effective among females than among males in terms of the number of both claims and patients. It was most effective among those in their fifties in terms of the number of claims and among those in their seventies in terms of the number of patients. It was most effective in Gangwon Province in terms of the number of claims and patients for advanced general hospitals and in Busan Metropolitan City in terms of claims and in Daejeon Metropolitan City in terms of patients for general hospitals. It was most effective on hypertension both in general hospitals and in advanced general hospitals and was more effective on chronic diseases than on acute ones. Conclusions: The policy on differential coinsurance for outpatient prescription drug coverage by care institution types was effective, as intended by the government, and the effectiveness differed by gender, age, regions, and diseases. These results are expected to be useful in enhancing the policy for preventing mild disease patients from being concentrated in large hospitals.

전국 종합병원 의료인력의 생산성분석

이정운,이기효,문옥륜,Lee, Jung-Un,Lee, Ki-Hyo,Moon, Ok-Ryun 대한예방의학회 1991 예방의학회지 Vol.24 No.3

The purpose of this paper is to identify factors affecting the optimum mix of required inputs and other relevant factors which account for the variation in physician's productivity in general hospitals, and to find out their implications for the efficient health planning and management. An extended version of Cobb-Douglas production function and cross sectional data of one day patient census from all general hospitals in Korea in 1988 were used in the analysis. Main results of the analysis and their implications could be summarized as follows : (1) The production function for physician's inpatient service shows the evidence of economies of scale, but the production function for physician's outpatient and adjusted-patient service, which combines both out- and in-patient service, shows that of dis-economies of scale. (2) The physician's role for production for all service is smaller than auxiliary personnel's, which imply that more intensive utilization of nurses, nursing aides and other auxiliary personnel is desirable for improving general hospital productivity (3) In case of physician's inpatient and adjusted-patient service, nurses' role is greater than nursing aides'. Therefore, more extensive utilization of nurses is recommended for the efficient operation of general hospitals. (4) The factor of hospital beds plays the leading role among required inputs in the production for physician's in- and adjusted-patient service. (5) The physician's productivity of general hospitals in rural area is lower than that in urban area. And the productivity of teaching hospitals is lower than that of the other hospitals. Further analysis was made in physician production function based upon the size of hospitals, namely those hospitals below 250 beds and those above. Explained variances by the factor of hospital beds was significantly increased in the case of those hospitals above 250. A more detailed and thorough investigation is needed for verifying factors influencing physician's productivity in general hospitals in Korea.

상급종합병원 선택 속성 결정요인에 관한 연구: Big 5 상급종합병원 외래환자를 중심으로

하정복 ( Ha Jung-bok ) 경희대학교 경영연구원 2018 의료경영학연구 Vol.12 No.3

The purpose of this study was to identify the factors determining the selection attributes of general hospitals and to compare each general hospitals with those of outpatients at Seoul Big Five General Hospital (Seoul National University Hospital, Seoul St. Mary's Hospital, Samsung Seoul Hospital, Severance Hospital, Hyundai Asan Hospital). These results can be used to establish strategies to improve hospital management by identifying the attributes that should be managed first in a general hospital. A total of 600 copies were distributed. Of these, 565 copies were used for the final analysis, except for 35 copies of the questionnaires that were unfairly responded to the questionnaire. First, there were significant differences in preference attributes (doctor's reputation, medical expenses, hospital reputation, hospital convenience, hospital accessibility, public transportation use, hospitality kindness, hospital cleanliness). There are no significant differences in other attributes (medical equipment, medical processes, hospital size). Second, as a result of the likelihood ratio test of the selective attribute, there was a significant influence on the selection attribute and general characteristics. Third, as a result of multinomial logistic regression analysis using Samsung Medical Center as a reference variable, Seoul National University Hospital was the most preferred physicians and 30s was the most preferred hospital. Severance Hospital needs efforts to improve the quality of hospitality, and it has become a favorite hospital in its 20s. Seoul St. Mary's Hospital is the most preferred hospital with medical cost attribute, and 30s is the most preferred hospital. Asan Hospital in Seoul is required to make efforts to improve the cleanliness of the hospital, and the higher the income, the lower the preference is. In Conclusion, Based on the results of this study, the academic and practical implications of this study are summarized.

종합병원의 정보화 현황과 의사의 적응양식에 관한 조사연구

이근후,김정선,조성남,박영숙 梨花女子大學校 醫科大學 醫科學硏究所 1998 EMJ (Ewha medical journal) Vol.21 No.2

This article is investigating the general status of hospital computerization and doctors' reactions to these changes in four general hospitals. Both quantitative and qualitative data were collected from two university-affiliated hospitals and two private general hospitals in Seoul. The questionnaire survey was conducted in 1996, and the data contain 81 doctors from four hospitals. We also collected in-depth-interview data from 8 doctors in these hospitals. We revewed the general status of information system and utilization level in general hospitals and analyzed doctors' response to these changes focusing on four areas of medical care ; 1) jobs and functions of the doctors in patient care; 2) doctors' autonomy and their status ; 3) doctors' relations with other personnel; and 4) the quality of medical care. The results are : 1) The general status of information system in general hospitals are limited to the comput-erization of the administrative part, and thus very few hospitals employ information system directly to the patient care. 2) In terms of doctors' job and functions, the computerization of the administrative part of hospital works increased the efficiency of doctors' patient care in charting, keeping and sear-ching data, but put more burden on them for doing double jobs of hand-writing and comput-erization. 3) The autonomy of doctors and their status have not been noticeably changed in the process so far, but there appears a possibility that doctors could defend themselves to the manager's control over them through information system. 4) The computerization of the hospital works tends to reduce an unnecessary face-to-face interaction, which is expected to facilitate communications in the hospital. There are also some changes in the relationship between doctors and semi-professional personnels such ans, nurse and medical technicians.

종합병원 환경계획을 위한 세대별 종합병원 이용행태 특성분석

박혜경(Park, Hey Kyung),오지영(Oh, Ji Young) 한국전시산업융합연구원 2017 한국과학예술융합학회 Vol.28 No.-

본 연구는 수요자중심의 종합병원 환경디자인 기초연구로서 세대별 사용자 이용행태 특성을 분석하는데 목적이 있다. 이를 위하여 문헌연구를 통하여 세대 및 병원에서의 행태를 파악하였으며, 20대부터 60대 까지 각 세대별 300명씩, 총 1500명을 대상으로 설문조사를 실시하였다. 본 연구결과는 다음과 같다. (1) 이용빈도, 방문목적, 방문시간대, 이용교통수단, 동행인원, 주방문공간, 대기 중 행위, 종합병원 선택방법 관련 항목에서 세대별 유의한 차이가 있는 것으로 나타났다. (2) 전 세대에서 종합병원은 주로 연1-2회 방문한다고 응답하였으며, 20대와 30대는 치료 및 진료를 위하여, 40대, 50대, 60대는 건강검진을 위하여 방문한다고 응답한 비율이 높게 나타나 건강검진센터가 장년층 (40s, 50s, 60s)의 특성을 고려한 환경계획이 이루어져야 할 것이다. (3) 40대, 50대, 60대는 평일 오전에 주로 종합병원을 방문하며, 20대, 30대는 주말 오전에 방문한다고 응답한 비율이 상대적으로 높게 나타났다. (4) 종합병원 방문 시 20대는 대중교통을 주로 이용하며 30에서 60대 까지 주로 자가용을 이용하는 비율이 높게 나타났다. (5) 20대는 주로 ‘로비’를 방문한다고 하였고, 연령대가 높아질수록 ‘외래진료실’ 이라고 응답한 비율이 높게 나타나, 노인층을 배려한 외래진료실 환경구축이 필요할 것이다. (6) 이용자 대부분은 대기시간에 휴대전화를 사용한다고 대답하였고, 연령대가 높아질수록 TV시청, 책 또는 잡기 읽기, 아무것도 안한다고 응답한 비율이 높게 나타났다. 그러므로 휴대전화 사용과 시각적 미디어 관람 환경을 서비스차원에서 제공하는 것이 필요할 것이다. This study is a basic research to suggest user-centered general hospital environmental design guidelines, which aims to analyze user"s behavior characteristics across generation in general hospital. For this purpose, this study constructed an analysis tool through the literature review with regard to generation and behavior characteristics in general hospital. Besides, an online survey regarding user"s behavior in general hospital was conducted targeting from 20s to 60s, 300 persons for each group, total 1,500 persons for about 3 weeks since September 1, 2016. The results of this study are as follows: (1) Based on the generation, there were significant differences in relevant categories of their visiting frequency, visiting purpose, visiting hour, transportation, companion, behavior during the wait and selection of a general hospital. (2) In all generation, they responded that they have visited once or twice per year. People in 20s and 30s responded that their visit for the hospital is to receive specific treatment, while other people in 40s, 50s and 60s visit the hospital majorly for routine check-ups. Therefore, it is imperative for a health check-up center to design an environmental plan that reflects the characteristics of elders in 40s, 50s and 60s. (3) People in 40s, 50s and 60s usually visit a general hospital in the mornings of weekdays, while generations in 20s and 30s responded that they mostly visit the hospital in the mornings of weekend. (4) When they visit a general hospital, people in their 20s are usually using public transportations, while people in their 30s to 60s are using their own vehicle. (5) People in their 20s majorly visited ‘lobby’. In older generations, they tend to visit ‘outpatient clinic’. Therefore, it is necessary to build an outpatient clinic environment that considers the elderly. (6) Patients majorly responded that they are using their cell phone, while waiting for their clinic call. In elder generations, they responded that they are more likely watching TVs, reading books/magazines or doing nothing. Therefore, it is essential to provide cell-phone related services and environmental supports. Visually attractive media can be utilized for this purpose.

대한적십자병원(1905-1907): 설립 및 운영, 그리고 폐지를 중심으로

이규원(LEE Kyu Won),최은경(CHOI Eun Kyung) 대한의사학회 2018 醫史學 Vol.27 No.2

The Korean Empire, its state sovereignty threatened by the Empire of Japan, joined the Geneva Conventions in 1903 for the purpose of neutral diplomacy and established the imperial Korean Red Cross Hospital in 1905. This hospital was a result of the effort of the Korean Empire to seek a new medical system based on the Western medicine. However, after the Russo-Japanese War, Japan interfered straightforwardly in the domestic affairs of Korea and eventually abolished the Korean Red Cross Hospital in 1907 to create Daehan Hospital under Japanese colonial rule. With newlyfound historical records, this study investigates the whole process of the Korean Red Cross Hospital, which has remained unknown so far, despite its importance. From the very beginning, the Korean Red Cross Hospital was under strong influence of the Empire of Japan. The site for the hospital was chosen by a Japanese army doctor, Junryō Yoshimoto, and the construction was supervised by Rokurō Katsumata, who also later on are involved in the construction of Daehan Hospital. Moreover, all the main positions for medical treatments were held by Japanese practitioners such as Gorō Tatami and Kaneko Yano. Nevertheless, the Korean government had to shoulder the all operating costs. The office of the Korean Red Cross was relocated away from the Korean Red Cross Hospital, and the government of the Korean Empire was not willing to burden the expenses of the Hospital. Moreover, the list of employees of the Korean Red Cross and that of the Korean Red Cross Hospital were drawn up separately: the former is left only in Korea and the latter in Japan. These facts suggest that those two institutes were managed dualistically unlike any other nation, implying that this may have been a means to support the Daehan Hospital project. According to the statistics, health care services in the Korean Red Cross Hospital seems to have been carried out successfully. There had been an increase in the number of patients, and the ratio of female patients was relatively high (26.4%). Only Western medications were prescribed and surgical operations with anesthesia were performed routinely. The approach to Western medicine in Korea was changing during that period. The rise and fall of the Korean Red Cross Hospital represent the urgent situation of the Korean Empire as well as the imperialistic methodology of the Empire of Japan to use medicine as a tool for colonization. Although the transition process of medical policy by the Japanese Resident-General of Korea still remains to be fully elucidated, this paper contributes to a better understanding of the history of modern medicine in Korea.