커뮤니티 케어에서 보건의료의 공적 책임 강화 방안

임준(Jun Yim) 한국보건교육건강증진학회 2019 보건교육건강증진학회지 Vol.36 No.4

공공보건의료 강화 방안

임준 ( Yim Jun ) 한국보건사회연구원 2022 보건복지포럼 Vol.311 No.-

사익 추구적 특성을 갖고 있는 한국 보건의료체계가 인구 구조의 급격한 고령화와 맞물려 심각한 보건의료 위기 현상을 발생시키면서 공공보건의료 강화의 필요성이 커지고 있다. 과거 보건의료는 시장 실패의 가능성이 커서 공공성이 강조되어 왔는데, 최근 시민사회의 성장에 따라 보편적 권리로 받아들여지고 있으며 공공성이 더 강조되고 있다. 최소한 국민의 생명과 안전에 관한 필수의료서비스는 보장해야 한다는 정책 방향이 확립되고 있다. 특히 필수적으로 요구되는 의료 자원, 의료 이용, 건강 결과의 지역 간 격차를 해소하기 위한 정부와 사회의 적극적인 역할이 요구되고 있다. 필수의료를 담당하는 모든 의료기관에 필수의료 인프라 확충에 필요한 자본 비용을 지원하고 공공정책수가를 통해 경상비용을 지원할 필요가 있다. 진료권 전체 주민에 대한 책임성을 강화하기 위하여 공공병원을 책임의료기관으로 지정하고 민간병원을 주도해 나갈 수 있을 만한 역량과 체계를 갖추도록 해야 한다. The need for strengthening public health care is growing as the Korean health care system, which is characterized by the pursuit of private interests, has caused a serious health care crisis in line with the rapid aging of the population structure. In the past, publicness was emphasized in health care due to the high possibility of market failure. Recently, with the growth of civil society, health care is accepted as a universal right, and the publicness of health care is even more emphasized. At the very least, the policy direction of guaranteeing essential medical services related to the life and safety of the people is being established. In particular, an active role of the government and society is required to reduce regional disparities in essential medical resources, medical use, and health outcomes. It is necessary to support capital costs necessary for the reinforcement of essential medical infrastructure to all medical institutions in charge of essential medical care, and to support current expenses through public policy fees. In order to strengthen the responsibility for all residents in the service area, public hospitals should be assigned as accountable medical institutions and equipped with the capacity and system for leading private hospitals.

통합건강증진사업 전문인력의 감정노동, 직무스트레스, 조직지원인식과 직무만족도의 구조적 관계 분석

박귀화,임준,Park, Kwi Hwa,Yim, Jun 한국디지털정책학회 2021 한국디지털정책학회논문지 Vol.19 No.8

본 연구의 목적은 통합건강증진사업을 담당하는 전문인력의 감정노동, 직무스트레스, 조직지원인식과 직무만족도 간의 구조적 관계를 분석하는 것이다. 연구대상은 인천시 보건소에 근무하는 통합건강증진사업 전문인력 126명이었다. 자료 분석은 SPSS 26.0과 AMOS 23.0 프로그램을 사용하여, t-test, ANOVA, 상관관계, 구조방정식모형 분석을 실시하였다. 감정노동은 연령과 결혼 유무에 따라(p<.05), 직무스트레스는 종교 유무에 따라(p<.01), 직무만족도는 경력, 종교와 결혼 유무에 따라(p<.01) 차이가 있었다. 감정노동이 직무만족도에 미치는 간접효과는 -0.315였고, 직접효과는 나타나지 않았다. 직무스트레스가 직무만족도에 미치는 간접효과는 -0.288, 직접효과는 -0.228이었다. 조직지원 인식이 직무만족도에 미치는 직접 효과는 -0.507이었다. 본 연구는 통합건강증진사업 전문인력의 직무만족도 증진을 위한 대안과 중재 프로그램을 개발하는데 기초자료로 활용될 수 있을 것이다. The purpose of this study is to analyze the structural relationship between emotional labor, job stress, perceived organizational support and job satisfaction for the health promotion program personnel. The subjects were 126 in charge of the health promotion program. Data were analyzed using SPSS 26.0 and AMOS 23.0 for the independent t-test, ANOVA, Pearson correlation coefficients and structural equation modeling. There were significant differences in emotional labor by age and marital status (p<.05), job stress by religion (p<.01) and job satisfaction by career, religion and marital status (p<.01). The indirect effect of emotional labor on job satisfaction was -0.315, and no direct effect was found. The indirect effect of job stress on job satisfaction was -0.288, and the direct effect was -0.228. The direct effect of perceived organizational support on job satisfaction was -0.507. These results can be used as baseline data to develop alternatives and intervention programs to enhance job satisfaction.

통합건강증진사업 전문인력의 감정노동, 직무스트레스, 조직지원인식과 직무만족도의 구조적 관계 분석

박귀화,임준,Park, Kwi Hwa,Yim, Jun 한국디지털정책학회 2021 디지털융복합연구 Vol.19 No.8

본 연구의 목적은 통합건강증진사업을 담당하는 전문인력의 감정노동, 직무스트레스, 조직지원인식과 직무만족도 간의 구조적 관계를 분석하는 것이다. 연구대상은 인천시 보건소에 근무하는 통합건강증진사업 전문인력 126명이었다. 자료 분석은 SPSS 26.0과 AMOS 23.0 프로그램을 사용하여, t-test, ANOVA, 상관관계, 구조방정식모형 분석을 실시하였다. 감정노동은 연령과 결혼 유무에 따라(p<.05), 직무스트레스는 종교 유무에 따라(p<.01), 직무만족도는 경력, 종교와 결혼 유무에 따라(p<.01) 차이가 있었다. 감정노동이 직무만족도에 미치는 간접효과는 -0.315였고, 직접효과는 나타나지 않았다. 직무스트레스가 직무만족도에 미치는 간접효과는 -0.288, 직접효과는 -0.228이었다. 조직지원 인식이 직무만족도에 미치는 직접 효과는 -0.507이었다. 본 연구는 통합건강증진사업 전문인력의 직무만족도 증진을 위한 대안과 중재 프로그램을 개발하는데 기초자료로 활용될 수 있을 것이다. The purpose of this study is to analyze the structural relationship between emotional labor, job stress, perceived organizational support and job satisfaction for the health promotion program personnel. The subjects were 126 in charge of the health promotion program. Data were analyzed using SPSS 26.0 and AMOS 23.0 for the independent t-test, ANOVA, Pearson correlation coefficients and structural equation modeling. There were significant differences in emotional labor by age and marital status (p<.05), job stress by religion (p<.01) and job satisfaction by career, religion and marital status (p<.01). The indirect effect of emotional labor on job satisfaction was -0.315, and no direct effect was found. The indirect effect of job stress on job satisfaction was -0.288, and the direct effect was -0.228. The direct effect of perceived organizational support on job satisfaction was -0.507. These results can be used as baseline data to develop alternatives and intervention programs to enhance job satisfaction.

우리 나라 농어촌지역 성인의 고혈압 관련 행태

김창엽,이건세,임준,최용준,이해국,이경호,김용익,강영호,Kim, Chang-Yup,Lee, Kun-Sei,Yim, Jun,Choi, Yong-Jun,Lee, Hae-Kook,Lee, Kyung-Ho,Kim, Yong-Ik,Khang, Young-Ho 대한예방의학회 2000 Journal of Preventive Medicine and Public Health Vol.33 No.1

Objectives : To describe health behaviors related to hypertension in rural population of Korea and focused to identify inappropriate awareness, treatment, and control of hypertension. Methods : We surveyed 5,517 adults (2,288 males, 3,229 females) older than 30 years in 58 rural areas, purposely sampled nationwide from December 1996 to February 1997. Blood Pressure was checked twice af the time of the first visit. For those who showed high blood pressure using the JNC-6 criteria at their initial visit, we followed up their blood pressure one week later. Also information on the health behavior related to hypertension was collected through the person-to-person interview using structured questionnaire at the first visit. Results : For the past one year, females had more experiences of checking their blood pressure than males (77.3% versus 69.5%, p=0.001). Through the results of consecutively checked blood pressure, only 51.7% of the hypertensives were aware of their condition. Of the hypertensives who aware of their condition, 44.4% did not receive any medication and/or recommendation. And 50.4% of the hypertensives who had anti-hypertensive medication were classified as still having hypertensive blood pressure by 160/95 mmHg criteria. Of the medicated, 54.8% were found to take medication regularly for the past six months. Among the medicated, only 11.4% knew the name of anti-hypertensive drug they had. Conclusions : 'Rule of halves', which works in the situation of no special efforts for hypertension control, was identified. This study showed that much efforts to control hypertension would be required in the rural population of Korea.

심폐소생술 수행 의지에 영향을 미치는 요인

강경희(Kyunghee Kang),임준(Jun Yim) 한국보건교육건강증진학회 2008 보건교육건강증진학회지 Vol.25 No.4

인천광역시 의원기반 건강포인트제도가 고혈압,당뇨병 환자의 지속치료에 미치는 영향

정원 ( Won Cheong ),임준 ( Jun Yim ),오대규 ( Dae Kyu Oh ),임정수 ( Jeong Soo Im ),고광필 ( Kwang Pil Ko ),박이병 ( Ie Byung Park ) 한국보건행정학회 2013 보건행정학회지 Vol.23 No.4

Background: This study was conducted to evaluate the factors affecting adherence in patients with hypertension and type 2 diabetes mellitus before and after a clinic based patient incentive program in Incheon. Methods: An observational follow-up study was done for 28,355 patients in one registered group and 245,598 patients in a non-registered group from March 16th 2009 to December 31th 2010 in Incheon. The registration, mandatory laboratory tests and number of clinic visits were collected by merging the Incheon Chronic Disease Management System data and the National Health Insurance Corporation (NHIC) data. As a measure of patient adherence, we used a variable of prescription days from the NHIC and defined above 80% of average prescription days as an appropriate patient adherence. Repeated measures analysis of variance and logistic regression were used to analyze the differences in patient adherence and factors affecting adherence. Results: The changes in prescription days for the registered group are larger than for the non-registered group. In the logistic regression model, including the variables with sex, age, income status and number of clinic visits, the registered group exhibited a higher Odds ratio in the patient adherence. Conclusion: This study revealed the association between registration and appropriate patient adherence in patients with hypertension or type 2 diabetes mellitus.

만성질환 교육이 고혈압, 당뇨병 환자의 지식수준에 미치는 영향

이요셉(Joseph Lee),임준(Jun Yim),임정수(Jeong-Soo Im),오대규(Dea-Kyu Oh),한진옥(Jin-Ok Han) 한국보건교육건강증진학회 2013 보건교육건강증진학회지 Vol.30 No.5

산업재해보상보험의 청구 절차 미비로 인한 건강보험의 재정 손실 규모와 개선 방안

좌혜경(Jwa, Hey-Kyoung),임준(Yim Jun),정원(Cheong Won) 비판과 대안을 위한 사회복지학회 2013 비판사회정책 Vol.- No.39

산업재해보상보험(이하 산재보험)으로 치료를 받지 못하고 건강보험을 이용하여 치료를 받는 직업성 손상 및 질병에 이환된 환자가 많은 것으로 알려져 있다. 본 연구는 산재보험으로 치료를 받지 못하여 발생하는 건강보험의 재정손실 규모를 추정하고 그 이유를 분석하여 개선 방안을 도출하고자 수행되었다. 손상 및 근골격계질환에 국한하여 직업 기여율을 먼저 구하고 직장가입자중 손상 및 근골격계질환으로 치료를 받은 환자의 공단부담금을 구한 후 직업 기여율을 곱하여 산재보험으로 치료를 받지 못하고 건강보험으로 치료를 받아 발생한 건강보험 재정손실 규모를 추정하였다. 또한 임금노동자 전체로 확대할 경우 산재를 산재보험에서 처리하는 방향으로 제도 변화를 가정했을때의 건강보험 재정 절감액을 추계하였다. 직업성 손상만을 모두 산재보험으로 처리한다고 가정할 때에 2014년부터 2018년까지의 5년 간 누적 재정 절감액은 최소 8,312억 원이고, 최대 1조 7,463억 원인 것으로 나타났다. 직업성 손상과 직업성 근골격계 질환자를 합쳐서 모두 산재보험으로 처리한다고 가정할 때에 5년 간 누적 재정 절감액은 최소 1조 6,812억 원이고, 최대 3조 5,746억 원인 것으로 나타났다. 현재의 산재보험은 직업성 손상 및 질병에 이환된 환자에게 직업관련성의 입증을 요구하고, 근로복지공단에 의한 사전승인 절차를 거치도록 하며, 그 기준마저 엄격하게 제한하고 있다는 점에서 노동자의 권리를 보장해주지 못하는 제도라고 할 수 있다. 산재 요양을 위해 직업성 손상 및 질병에 이환된 환자가 근로복지공단에 청구하고 사전을 받아야 하는 사전승인제도를 없애고 요양 시점부터 의료기관의 분류에 의하여 치료를 받을 수 있도록 청구절차를 개선하고 사후 평가 방식으로 제도운영을 보완한다면 보다 근본적인 제도 개선이 가능할 것이다. In Korea, many people suffering from occupational injuries or diseases are compensated by the national health insurance (NHI) instead of the national workers" compensation insurance (NWCI). We identified the occupational contribution for injuries and musculoskeletal disorders compensated by NHI and analyzed the total benefit amount for those and then estimated the financial losses to the NHI due to substitution for the NWCI. Finally, we estimated the financial savings of the NHI supposing that the NWCI would be reformed and all occupational injuries and musculoskeletal disorders were compensated by the NWCI. If it could be assumed that all occupational injuries were compensated by the NWCI, the cumulative financial savings for 5 years (2014~2018) ranged from 831.2 billion won to 1.746 trillion won. If it could be assumed that all occupational injuries and musculoskeletal disorders were compensated by the NWCI, the cumulative financial savings for 5 years(2014~2018) ranged from 1.684 trillion won to 3.575 trillion won. Nowadays, those people who want to be compensated by the NWCI, have to demonstrate the causality between work and disease, and then be approved before getting the medical care benefits. As a result, the NWCI has not protected the workers" rights but in fact has infringed the worker"s rights. In order to solve these problems, it needs to improve claims procedures for classifying occupational injuries and diseases at the point of medical care.

신규 고혈압 환자의 치료지속성과 고혈압 조절 여부가 심뇌혈관질환 합병증에 미치는 영향

한진옥 ( Jinok Han ),임준 ( Jun Yim ),임정수 ( Jeongsoo Im ),이희영 ( Heeyoung Lee ),박종헌 ( Jongheon Park ),오대규 ( Daekyu Oh ) 한국보건행정학회 2015 보건행정학회지 Vol.25 No.2

Background: This study aimed to research on how adherence and blood control could make a difference when it comes to develop complications. Methods: The study’s subjects were 255,916 patients who were newly diagnosed with hypertension in 2009 using data collected by National Health Insurance Cooperation. Patients are considered as a group under adherence if visit days and prescription days are more than 300 days. Patients are considered to have successfully controled their hypertension based on actual value measured by National Health Insurance Cooperation and the study takes a look at whether they were diagnosed with complications of cerebrocardiovascular disease in 2012. Chi-square test and logistic regression was used to analyze. Results: Patients who were able to control their hypertension show 0.80 times chance of developing cerebrovascular disease, and 0.89 times chance of developing cardiocerebrovascular disease. The group of adherence shows lower chance of developing complication in general than the group of non-adherence. Conclusion: The study revealed that hypertension’s constant treatment could control the blood pressure and prevent complications. It is important that encourages patients to effort for persistent treatment for reducing complication.