A Meta Analysis on Domestic Research Trends of Healthcare Design in Spatial Design Field

이민아,박혜경,오찬옥,백지원,김석태 한국공간디자인학회 2019 한국공간디자인학회논문집 Vol.14 No.7

(Background and Purpose) With increasing interest in healthy life, the aging modern society has paid attention to healthcare design in various fields, which was mainly researched in the spatial design field of a healthcare environment. The purpose of this study is to systematize research on healthcare spatial design to date by analyzing research trends on healthcare design centering on spaces to provide materials for current issues and to predict future research directions of healthcare spatial design. (Method) Meta analysis was conducted to analyze the trend of healthcare spatial design research by selecting 499 papers in total among the papers published in the Journal of National Research Foundation of Korea until November 2018, from keyword search, limited to journals, and 5 experts' judgement. In this study, (1) the healthcare space based on the significance of space in healthcare design was conceptualized to reveal the meaning of research on healthcare spatial design, (2) subject papers were extracted by the KCI system with keyword related to healthcare design, and (3) as the criteria for the analysis, the trend of healthcare spatial design research was analyzed by categorizing sub topics of spatial design such as time series, research methods, target space, key actors, and design elements. (Results) As a result of meta analysis, (1) the healthcare spatial design research has been continuously studied staring from 2002 with expanding healthcare spaces from a traditional healthcare design category focusing on hospital, the area of behavior of patients and medical professionals, to the elderly welfare center for the elderly, and even to everyday spaces for healthcare. (2) As research methods, empirical research methods such as case analysis, survey, experiment and evaluation were mainly carried out to suggest the direction of user-centered design results, and (3) the trend of research was found that suggests spatial design elements in complex rather than single to realize effective healthcare spaces, and Also, (4) the research trends was found that deal with users who demand to improve the quality of life based on mental and physical health not only in the space for direct medical care but also in other functional spaces. (Conclusions) This study, which meta analyzes the healthcare spatial design research, is a follow-up to the first study that analyzes the trend of overall healthcare design research, and is meaningful to find the direction of visual and perceptual results of the user's physical environment through healthcare design. By analyzing the trend in healthcare design research focusing on design other than spaces, it is expected that this study will be a useful material for enabling comprehensive design prediction for healthcare design in the future by comparing issues of healthcare design research in each design sector.

감염예방 및 통제에 있어서 의료시설 디자인의 역할과 방향

임리사(Lim, Lisa),김다은(Kim, Daeun),김영우(Kim, Youngwoo) 대한건축학회 2020 대한건축학회논문집 Vol.36 No.8

Healthcare-associated infections result in unnecessary illness, death, and costs, impacting a significant number of patients, families, and healthcare professionals. While healthcare facility design can serve as an intervention to prevent and control healthcare-associated infections, its role is not fully evaluated and its implementation is limited in practice. This study illustrates the role of healthcare facility design in infection control and prevention and discusses the need for systematic design guidelines for various types of healthcare facilities and even beyond healthcare settings. Physical environments of the healthcare facility can be reservoirs of pathogens, transmitting the pathogens to visitors and healthcare professionals. This issue indicates that carefully considered design of healthcare facilities can support reducing healthcare-associated infections. There are cases that report significant improvement in terms of infection control and prevention by implementing effective design strategies. This study summarizes these strategies, whose implementations are limited due to the lack of systematic design guidelines that synthesize effective design strategies for infection control and prevention tailored to healthcare systems in South Korea. Thus, for future studies to translate evidence into design of applicable strategies, developing and validating systematic design guidelines for active implementation of design strategies for safer healthcare facilities is needed.

디지털 헬스케어 서비스 동향과 전망

정승현,안혜신 사단법인 한국조형디자인협회 2023 조형디자인연구 Vol.26 No.3

디지털 헬스케어는 질병진단 및 관련 측면에서 눈부신 발전을 이루고 있다. 디지털 헬스케어(Digital Healthcare)는 모바일, 사물인터넷(IoT), 인공지능(AI), 가상현실(AR, VR) 등의 정보통신기술(ICT)이 건강과 의료서비스에 접목되어 등장한 개념으로 의료정보기술의 진화와 함께 패러다임이 변화하고 있다. 한국보건산업진흥원 (2020). 디지털헬스 산업분석 및 전망연구. 3. 국내·외 디지털 헬스케어 시장규모는 연평균 15~16%로 빠르게 성장하고 있으며, 코로나19 확산에 따른 병원 락다운(Lockdown), 병상·의료진 등 의료 자원의 운영효율화 이슈, 환자의 의료접근성(비대면) 문제 등을 경험하며 의료기관의 디지털 헬스케어 도입 필요성은 더욱 증대되고 있는 실정이다. 연세대학교 산학협력단 (2022). 의료기관 디지털헬스케어 실증 및 도입 활성화를 위한 중점추진과제 발굴 연구. 7. 본 연구는 이렇게 급성장하고 있는 디지털 헬스케어의 개념과 빅데이터 활용, 서비스와의 결합을 통한 고도화 현황에 대해 살펴보고, 이를 토대로 국내외 디지털 헬스케어 서비스의 활용 실태와 현황을 분석, 제시하여 디지털 헬스케어 디자인이 나아갈 방향을 제안하여 방향 정립에 도움이 되고자 하는데 그 목적이 있다. 문헌연구를 통해 디지털 헬스케어 서비스의 개념과 특징 및 패러다임 변화에 따른 고도화 양상에 대해 살펴보았다. 다음으로는 국내외 보고서 분석을 통해 디지털 헬스케어 시장과 국내외 디지털 헬스케어 산업 동향에 대해 연구하고 디지털 헬스케어의 트렌드를 반영하여 연구 및 개발되고 있는 국내외 사례를 중심으로 사례연구를 진행하였다. 결론으로는 연구분석을 통해 얻은 내용을 바탕으로 디지털 헬스케어 서비스 전망과 디지털 헬스케어 디자인의 방향에 대해 제시하였다. 연구결과 디지털 헬스케어 디자인은 IoT 기반 헬스케어를 중심으로 점차 개인 생활 속 건강관리에 집중되어 개인 의료화에 발맞추어 디자인되어야하고, 데이터 교류 측면의 성향 증가로 사용자의 긍정적 사용자 경험을 가능하게 하는 의료기기 UX UI의 디자인이 뒷받침되어야 함을 알 수 있었다. 또한 기존의 전통적인 의료기기와 다르게 디지털 헬스케어 디자인은 커넥티드 디바이스가 가지는 다양한 위협 요소들을 고려하여 보안에 신경을 쓰고, 앱스토어를 포함한 온라인 마켓 등 다양한 경로로 유저들이 접근 가능하도록 마켓 접근성도 고려해야 한다. Digital healthcare is making remarkable progress in disease diagnosis and related aspects. Digital healthcare is a concept in which information and communication technologies (ICT) such as mobile, Internet of Things (IoT), artificial intelligence (AI), and virtual reality (AR, VR) are grafted onto health and medical services. The paradigm is changing with the evolution of technology. The domestic and overseas digital healthcare market is growing rapidly (annual average growth of 15-16%), and hospital lockdowns due to the spread of COVID-19, operational efficiency of medical resources such as beds and medical staff, and patients' medical accessibility (non-face-to-face) problems, etc., and the necessity of introducing digital healthcare by medical institutions is increasing. This study explores the concept of digital healthcare, which is rapidly growing, and the status of advancement through the use of big data and integration with services. Its purpose is to suggest a direction for design and to help establish the direction. Through a literature review, the concept and characteristics of digital healthcare services and the advancement aspects due to paradigm changes were examined. Next, through domestic and international report analysis, the digital healthcare market and domestic and international digital healthcare industry trends were analyzed and case studies focusing on domestic and foreign cases that are being researched and developed by reflecting digital healthcare trends. In conclusion, based on the contents obtained through the research analysis, the prospect of digital healthcare service and the direction of digital healthcare design were presented. Digital healthcare design should be designed in line with the personal medicalization that gradually focuses on health management in personal life centered on IoT-based healthcare. In addition, it was found that the design of medical device UX UI that enables the user's positive user experience should be supported by the increase in propensity in terms of data exchange. In addition, unlike conventional medical devices, digital healthcare design should pay attention to security by considering various threat factors of connected devices, and market accessibility should be considered so that users can access through various channels such as online markets including app stores.

‘인간-스마트 헬스케어’ 인터랙션과 구조에 관한 연구

전혜미,리오이통,반영환 한국디자인문화학회 2018 한국디자인문화학회지 Vol.24 No.4

ICT 기술과 헬스케어 산업의 융합으로 인해 의료서비스 산업에 변화가 일고 있다. ‘스마트 헬스케어’라는단어가 자연스럽게 사용되고, 시공간 제약 없이 개인의 건강상태를 관리하고 맞춤형 서비스가 증가하고있다. 또한 글로벌 IT기업이 헬스케어 산업에 뛰어들면서 헬스케어는 더 이상 의료기관만의 전유물이 아니라 과거에는 의료와 관련 없던 기업들이 도전할 수있는 장이 되었다. 본 논문에서는 문헌조사를 통해 스마트 헬스케어의 동향을 알아보고 인터랙션에 대해고찰하였다. 그 후 문헌 및 사례조사를 통해 ‘인간’과‘스마트 헬스케어 간’의 인터랙션을 구조를 연구하고, 인터랙션을 구성하고 있는 단계를 정리하였다. 이것을기반으로 글로벌 IT 기업이 전개하는 스마트 헬스케어 사례 조사를 통해 요소를 도출하고, 스마트 헬스케어 생태계를 정리한 P-N-P-A 모형을 제안하였다. 인간-스마트 헬스케어 인터랙션의 특징은 다양한 종류의 개인 건강데이터를 하나의 플랫폼에서 통합 관리하고, 여러 기관과의 데이터의 공유를 통해 폭넓은 데이터 관리가 가능해져 개인 맞춤 진단 및 치료를 제공할 수 있다는 것이다. ‘인간-스마트 헬스케어 인터랙션’은 데이터를 수집하는 단계, 수집한 데이터를 분석 및 진단하는 단계, 진단 데이터를 활용하여 개인에게 적합한 치료 및 관리 서비스를 제공하는 서비스단계로 이루어져 있다. 스마트 헬스케어 생태계는 제품, 네트워크, 플랫폼, 적용으로 구조화 할 수 있었다. 제품은 개인에게서 만들어지는 모든 데이터들을 측정하고 기록하여 디지털화 할 수 있는 도구이며, 네트워크는 데이터 교환과 정보처리를 위해 만들어진 데이터 통신망으로 정의한다. 플랫폼은 데이터를 다른 개인 및 기업들과 공유하고 통합된 데이터가 새로운 서비스와 연계할 수 있는 장이며, 적용은 플랫폼에 모여진 데이터들을 통합하여 사용할 수 있는 영역이다. 본 논문은 스마트 헬스케어 분야의 사용자 경험 디자인을 위해 산업 구성 및 구조, 인간과의 인터랙션을알아보는 기초 연구로써 진행되었다. 그러나 다양한종류 및 기업의 스마트 헬스케어 사례를 다루는데 한계가 있었으며 추후 연구에서는 스마트 헬스케어의세분화된 분야를 다루고 그에 따른 다양한 사례를 연구한다면 스마트 헬스케어에 관한 연구자료로 활용할수 있을 것으로 기대된다. The convergence of ICT technology and the healthcare industry is changing the medical service industry. The word ‘smart health care’ is used naturally, and services and systems are increasing to manage individual health status and to implement customized medical care without time and space restrictions. As global IT companies have entered the healthcare industry in line with this trend, healthcare has no longer become a medical institution’s only product, but it has become a place where companies that have not been related to medical care in the past can enter. In this paper, we examined the trends of smart healthcare through literature survey. Then, through literature and case studies, the interaction between ‘human’ and ‘smart health care’ was studied and the steps constituted by the interaction were organized. Based on this, elements were derived from smart healthcare case studies deployed by global IT companies. A P-N-P-A model has been proposed that describes the smart healthcare ecosystem. The feature of human-smart healthcare interaction is that it integrates and manages various types of personal health data on one platform, and enables broad data management through sharing of other data, providing personalized diagnosis and treatment. The human-smart healthcare interaction consists of “a stage of collecting data”, “a stage of analyzing and diagnosing collected data”, and “a service stage“ that provides appropriate treatment and management services for individuals using diagnostic data. Smart healthcare ecosystems were structured through products, networks, platforms, and applications. A product is a tool that can measure and record all data generated by an individual and digitize it, and a network is defined as a data network created for data exchange and processing. Platforms are a place where data can be shared with other individuals and businesses, and integrated data can be linked to new services, and applications are an area where data collected on the platform can be aggregated and used. This paper was conducted as a basic study to explore industrial structure and structure and human interaction to design the user experience in smart healthcare. However, there were limitations in dealing with a variety of types and smart healthcare cases for companies. It is expected that future research will be used as research material on smart healthcare if it deals with the sub-segmented areas of smart health care and studies various cases accordingly.

Smart Home IP-based U-Healthcare Monitoring System using Mobile Technologies

Regin Joy Conejar,Rhan Jung,Haeng-Kon Kim 보안공학연구지원센터 2016 International Journal of Smart Home Vol.10 No.10

Mobile technologies usage is becoming more integrated with the delivery of patient care. Mobile technology has the potential to have a positive impact on healthcare. The number of people suffering from chronic diseases is growing rapidly and poses an ever increasing strain on the health care sector. An ageing population is now the leading healthcare concern of many countries in the world. Advances in remote medical care have opened up new opportunities in healthcare systems. In this study, a smart home IP-based U-Healthcare monitoring system using mobile technologies is develop a pervasive architecture for U-Healthcare monitoring, services management system, and preventive medicine. The IP based Mobile and Home u-Healthcare system employ wearable wireless bio-sensors to gather medical data, which is then transmitted using RFID technology to the user’s device, typically a smart phone or a PDA, and directs this information to a local proxy server.

미충족의료와 소득의 상호작용이 주관적 건강수준에 미치는 효과: 한국의료패널 2009-2014년도 자료의 분석

박유경,김창엽,황승식 한국보건사회학회 2018 보건과 사회과학 Vol.0 No.47

Unmet healthcare needs index is widely used as an indicator to measure the performance of health care system and inequality of healthcare. It needs to be paid more attention since recent studies report that unmet healthcare needs have a negative effect on health outcome. There are little knowledge and research on how unmet healthcare needs affect health although it is essential for the policy effectiveness. This study explored the relationship between unmet healthcare needs and subjective health status by analyzing the interaction effect of income level, which is an important factor both for healthcare utilization and health. We estimated the modification effect of the income level to the health effects of unmet healthcare needs. The generalized estimation equation (GEE) was applied include 1-year time-lagged effect. A 6-year(from 2009 to 2014) data of Korea Health Panel was analyzed. It has confirmed that unhealthy influence of unmet healthcare needs is more effective in the low-income group than the high-income group. The additive interaction effect size of EQ-VAS was 2.29, and 0.48 in self-rated health. Interaction effects were prominent in the unmet needs experiences due to user's resource shortage. The trend of unhealthy effects of both income and unmet healthcare needs was increasing, but the slope which means the additive interaction effect was gradually decreasing. The presence of additional interactions means that there are other complex influence factors thatare not accounted for by income alone. To address unmet healthcare needs aimed at improving health, other factors besides financial issues for healthcare use should be considered, and efforts should be made to identify pathways and mechanisms between experiencing unmet healthcare needs and health. 미충족의료는 보건의료제도의 성과와 의료이용 불평등을 측정하기 위한 지표로 널리 쓰인다. 특히건강 수준에도 좋지 않은 영향을 미친다는 연구가 발표되면서 더욱 주목해야 할 문제가 되었다. 미충족의료 경험과 건강 수준은 상호관련성이 있음에도 그 기전이 명확하게 밝혀지지 않았고 연구도 부족하다. 이 연구는 의료이용의 미충족과 건강수준에 모두 중요한 요인인 소득의 상호작용 효과를 분석함으로써 미충족의료가 건강에 미치는 복잡한 과정의 일부를 설명하고자 하였다. 2009년도부터2014년도까지 6개년도의 의료패널 자료에 일반화추정방정식(GEE)을 적용한 상호작용 분석으로 미충족의료 경험의 건강 영향에서 소득수준으로 인한 조절 효과의 크기를 추정했다. 연구 결과, 저소득군에서 미충족의료 경험을 할 때 소득과 미충족의료 경험으로 인한 개별 건강 영향의 합보다 더 크게건강이 악화되는 상호작용 효과를 확인했다(EQ-VAS의 덧셈 상호작용 효과: 2.29, 주관적 불건강 응답률의 덧셈 상호작용 효과: 0.48). 상호작용 효과는 이용자의 자원 문제로 발생하는 미충족 경험에서 두드러졌고 연도에 따라 소득과 미충족 경험의 건강 영향은 점차 커지고 있으나 그 증가폭은 조금씩 줄어들었다. 덧셈 상호작용이 있다는 것은 소득이 의료이용과 건강 영향에서 중요한 요인이기는하나 소득만으로는 설명되지 않는 다른 복잡한 영향요인들이 존재함을 의미한다. 건강 향상을 목표로미충족의료 정책을 펴려면 단지 의료이용을 위한 재정적 문제 외에 다른 요인도 고려해야 하며, 미충족의료 경험이 건강에 영향을 주는 경로와 기제를 파악하기 위해 힘써야 할 것이다.

도시 및 농·어촌지역 미충족 의료서비스 경험 영향요인 : 2019년과 2020년 비교

김귀현,김세원 한국도서(섬)학회 2022 韓國島嶼硏究 Vol.34 No.4

COVID-19 has changed our lives overall and has brought particularly many changes in the area of medicine. There have been many changes in the provision of medicine and modes of using medical services, too. In research to identify and reduce the inequality and imbalance of medical systems and services between regions, it is necessary to consider how things have been changed due to COVID-19. Therefore, this study is aimed to identify the current status of urban and rural unmet healthcare before and after COVID-19, provide data to check related factors, and present basic data to make policies in consideration of the causes of unmet healthcare. This study utilized data from the Korean National Health and Nutrition Survey conducted in 2019 and 2020 before and after the outbreak of COVID-19. Cross-tabulation analysis and dichotomous logistic regression analysis were done on 426 and 368 respondents in 2019 and 2020 respectively, who said they had experienced unmet healthcare. According to the findings, both urban and rural local insurance subscribers indicated increase in the experience of unmet healthcare, and the increase rate was greater in rural local insurance subscribers, and the experience of unmet healthcare decreased in the group with low income. Also, regarding patients with chronic diseases, the experience of unmet healthcare decreased more in rural areas than in urban areas. However, the analysis showed that the group that said they had depression had twice more experience of unmet healthcare after COVID-19 than before. This implies that it is needed to consider such situations as the reduced income of self-employed people and the deepening depression of people resulted from social sanctions, for instance, restrictions on business hours or refraining from private gatherings. Also, aside from regional differences between urban and rural areas, expanding medical support with emergent medical aid or non-face-to-face treatment did reduce the factors of unmet healthcare in the low-income group during the pandemic situation. In addition, political efforts involving medical reservation services, tele-medicine care, or the roles of health centers and health clinics strengthened seem to have influenced the modes of using medical services. The limitation of this study is that the survey was done simply by asking questions about whether they had visited hospital or not without considering various situations like social foundations or policies. However, it is meaningful in that it examined the differences in the experience of unmet healthcare between urban and rural areas before and after the COVID-19 pandemic. This study attempted to identify politically whether unmet healthcare is caused not by individual differences but by regional, particularly, urban-rural differences. This author also suggests that follow-up research will have to be done to complement the environment and conditions for medical use as well as quantitative and qualitative differences in the medical infrastructure. 우리의 삶을 전반적으로 바꾸었던 COVID-19는 특히 의료분야에 많은 변화를 가져왔다. 의료제공 및 의료서비스의 이용 행태에 많은 변화를 가져왔으며, 이는 그간 의료체계 및 의료서비스의 지역 간 불평등, 불균형의 차이를 확인하고 해소하기 위한 연구에 COVID-19 변화 상황을 고려해서 살펴볼 필요가 있다. 따라서 COVID-19의 상황 전후로 도시-농·어촌 간 미충족의료 현황을 파악하고 관련 요인을 확인할 수 있는 자료 제공 하여 미충족 의료 발생원인을 고려한 정책 마련의 기초자료 제공을 목적으로 진행되었다. 본 연구는 COVID-19 발생 전후의, 2019년과 2020년도에 실시된 국민건강영양조사 자료를 이용하였으며 미충족 의료를 경험한 적이 있다고 응답한 2019년 426명, 2020년 368명을 대상으로 교차분석과 이분형 로지스틱 회귀분석을 시행하였다. 연구결과 도시-농·어촌 모두 지역보험 가입자의 의료 미충족 경험이 증가하였고, 농·어촌의 지역보험 가입자의 경우 그 증가율이 더 컸으며, 소득이 낮은 그룹에서 의료 미충족 경험이 감소하는 결과를 보여주었다. 또한, 만성질환자는 농·어촌지역의 경우 의료서비스 미충족 경험이 도시지역보다 더 많이 감소된 것을 보였다. 그러나 우울증이 있다고 대답한 그룹은 COVID-19 전보다 후에 의료서비스 미충족 경험이 2배 정도 높다는 분석 결과가 나왔다. 이는 영업시간 제한이나 사적모임의 자제 등의 사회적 제제로 인한 자영업자의 소득감소, 사람들의 우울감 심화의 상황을 고려할 필요가 있을 것으로 보인다. 또한, 도시-농·어촌 지역 간의 차이 보다 팬데믹 상황에서 긴급의료지원 및 비대면 진료 등 의료지원 확대가 저소득층의 필요 의료서비스 미충족 요인을 충족시키고, 진료예약서비스, 원격의료, 보건소 및 보건진료소의 역할강화 등 정책적인 노력이 의료서비스의 이용 행태에 영향을 주었을 것으로 본다. 이는 단순히 병원의 방문여부를 묻는 질문으로 사회적 기반과 정책등의 다양한 상황을 고려하지 않고 진행되었다는 본 연구의 한계를 보여준다. 하지만 COVID-19 유행 전·후의 도시 및 농·어촌지역의 미충족 의료경험의 차이를 살펴보았다는 점에서 의의가 있다. 또한 정책적으로 미충족 의료를 개인의 차이가 아닌 지역적, 특히 도시-농·어촌간의 지역적 차이에서 기인하는지를 시도한 연구이며, 의료 인프라의 양적, 질적 차이는 물론 의료이용을 위한 환경과 조건도 보완할 수 있는 연구가 진행되어야 함을 시사한다.

요양기관당연지정 제도에 대한 의료기관 종사자의 의식 조사

강석구(Suk-Gu Kang) 한국의료정보교육협회 2016 보건의료생명과학논문지 Vol.4 No.2

본 연구는 요양기관지정제도에 대한 의료기관 종사자의 인식조사를 통해 제도 운영의 시사점을 모색하는데 목적을 갖고 실증 연구하였는데 그 결과를 종합하면 다음과 같다. 의료공급자 집단이 생각하는 국민의료의 질은 전체적으로는 보통 이상이라는 응답이 90%로 나타났는데, 이 중 의사 집단의 경우 보통 이상이라는 응답이 95%로 높게 나타났고 행정직의 경우 보통 이상이라는 응답은 85%로 나타났다. 이 결과로 보면 의료공급자 집단은 국민에게 적용되는 의료서비스의 질은 상당히 높다고 평가하고 또한 건강보험 요양기관 요양기관당연지정제도로 인하여 국민의 의료 접근성은 상당히 높은 것으로 파악되었는데 이와 관련해 의사 집단은 의료의 접근성이 편리하다는 응답이 58.4%(132명)인 반면, 행정직의 경우 47.9%(92명)만이 편리하다고 응답하여 의사가 느끼는 의료의 접근성과 행정직이 느끼는 의료의 접근성의 인식 차이를 보여주었다. 이와 같은 의료공급자들의 의견 및 동료 의료공급자 선택에 대한 예상은 요양기관당연지정제도가 개선되어 계약제가 시행되더라도 요양기관 가입률은 높을 가능성이 매우 크다는 사실을 시사한다. This study is empirically intended to look into healthcare providers' awareness on the authorization system of healthcare institutions and implications for its operation. To achieve this, a survey was carried out to healthcare providers. The findings are summarized as follows: 90% of healthcare providers, 95% of doctors and 85% of hospital administrators were aware of national health quality as above normal, respectively. By the findings, healthcare providers were evaluating that the quite high quality of healthcare service is applied to the nation. The obligatory authorization system of healthcare institutions had a significantly high access to national healthcare. With respect to this, 58.4%(132 persons) of doctors responded that the access to healthcare is convenient, while only 47.9%(92 persons) of hospital administrators responded that it is convenient, which there was a difference between doctors' and hospital administrators' awareness of the access to healthcare. Consequently, healthcare providers' opinion and choice are expected to improve the obligatory authorization system of healthcare institutions. This suggests that healthcare providers are significantly likely to join healthcare institutions.

일차의료 중심의 통합 의료돌봄 서비스

임선미,이정찬,문성제,우봉식 대한의사협회 2023 대한의사협회지 Vol.66 No.11

Background: Each country is providing various community care services owing to the increasingly aging population. Therefore, Korea needs to develop multiple approaches to the healthcare utilization system that can reflect the complex needs of older adult patients. Current Concepts: Considering the characteristics of older adult patients, it is essential to connect the treatment at medical institutions with home or nursing facilities. Some patients need medical and long-term healthcare simultaneously. Currently, healthcare services for older adult patients in Korea are fragmented across various service areas. Therefore, healthcare service plans need to be explored to provide integrated and long-term healthcare for older adult patients. Discussion and Conclusion: We propose to establish a healthcare information linkage center to provide comprehensive information on the appropriate services needed by patients. The healthcare information linkage center would refer patients to their local community or local primary healthcare provider if they want home services. Through this process, doctors and healthcare teams would visit the patient’s residence to provide services and perform a comprehensive assessment of their condition to create a personalized care plan. The core of this proposal lies in the establishment of a single point of contact in the region to link and integrate healthcare. Consequently, information on services appropriate to the needs of the target population would be appropriately linked in one place and overlapping services would be coordinated to improve operational efficiency.

스웨덴 일차의료 영역에서 진료선택제도(vårdval) 도입의 효과

신정완 한국 스칸디나비아학회 2023 스칸디나비아 연구 Vol.31 No.-

Sweden has long been an exemplary country having NHS(National Health Service) type health security system. The Swedish health security system, however, has been much changed since 1990s by the policies marketizing healthcare. The introduction of the healthcare choice system(vårdval) is a pronounced case of the market-oriented healthcare reforms. This system enables patients to choose medical institutions where they would receive treatment and register themselves there. The county councils, responsible for healthcare, then reimburse each medical institution for the medical costs incurred, according to the number of registered patients of each medical institution. Some county councils voluntarily introduced this system since 2007. Since 2010, the introduction of the system in the primary healthcare became obligatory for all county councils. The system has produced good results such as the enhanced rights of patients, the improved responsiveness of the primary care centers to patients’ demands, the increase of the number of primary care centers, and the increased diversity of healthcare providers. But bad results also have been produced such as the widening gap of healthcare accessibility between population densed areas and population thin areas, and between patients with mild cases and patients with serious cases, and the fact that patients with complex diseases can not receive well-integrated treatment as before. We can say that the healthcare choice system brought out results violating the healthcare egalitarianism, the traditional value of the Swedish healthcare, in that the patients with stronger healthcare needs came to be in worse situation. The main causes of these bad results are as follows. Firstly, the system brought out results that healthcare providers choose patients, rather than patients choose medical institutions as intended. Secondly, the principle of equal treatment for all healthcare providers made it difficult for county councils to selectively support the medical institutions in the backward areas in healthcare. 스웨덴은 NHS(National Health Service) 유형의 의료보장체계를 가진 대표적 나라의 하나였으나, 1990년대 이후 의료 시장화 정책을 추진하여 의료보장체계의 성격이 크게 변화했다. 진료선택제도(vårdval) 도입은 시장주의적 의료 개혁의 대표 사례라 할 수 있는데, 이 제도는 환자가 의료기관을 자유롭게 선택하여 등록하게 하고, 의료기관별 등록환자 수에 따라 광역지자체가 의료기관에 의료비를 보상해주는 제도다. 2007년부터일부 광역지자체가 이 제도를 도입했고 2010년부터는 일차의료 영역에서 모든 광역지자체가 이 제도를 의무적으로 도입하게 되었다. 진료선택제도의 성과로는 환자의 권리 신장, 환자의 요구에 대한 의료기관의 민감성 제고, 일차의료기관의 수 증가, 의료공급자의 다양성 증가를 들 수 있다, 부작용으로는 인구밀집지역과 인구희소지역 간에, 그리고 경증환자와 중증환자 간에 의료접근성 격차가 벌어지고, 복합적 질환을 가진 환자들에 대한 통합적 진료가 어려워진 점을 들 수 있다. 제도 도입 이후 의료의 객관적 필요가 큰 사람들의 처지가 악화되었다는 점에서 스웨덴 의료의 전통적 가치인 의료 평등주의를 훼손했다고 볼 수 있다. 이런 결과가 나오게 된 핵심 원인으로는, 환자가 의료기관을 선택하도록 한다는 제도 취지와는 달리, 여러 요인으로 인해 실제로는 의료공급자가 환자를 선택하는 측면이 강했다는 점, 그리고 이 제도의 구성요소의 하나인 모든 의료공급자에 대한 동등대우 원칙으로 인해 의료낙후지역의 의료기관들에 대한 선별적 지원이 어려워졌다는 점을 들 수 있다.