주 40시간 근무제도 도입에 따른 의료기관 종사자들의 직종별 인식도 비교

최만규(ManKyu Choi),이준협(JunHyup Lee),이준협(TaeRo Lee),이현실(HyunSill Rhee),임국환(KookHwan Rhim) 고려대학교 보건과학연구소 2004 보건과학논집 Vol.30 No.2

  Many foreign countries have made attempts to enhance working conditions for employees by reducing working hours, but it is true that Korea has focused more on economic growth rather than on the welfare of employees. However in the last few years, with increasing concern about quality of one"s life, the issue of working time reduction has become a controversial one. In July 2004 a law on working time reduction was made, and has been enforced in most work places, dependant upon the number of employees from which medical institutions should not be exempted.<BR>  This study was conducted to investigate the differences of opinion by job classification amongst employees of medical institutions. For the purpose of this study, a self-administerd questionnaire was conducted with 140 employees of 10 medical institutions located in Seoul andGyeonggi-Do province from August 1 to 7, 2004. The sample subjects  of this study consisted of 128(91.4%) employees who faithfully responded to the questionnaire and the major statistical methods included frequency, and chi-square test.<BR>  The major results of this study are as follows:<BR>  Firstly, about 90% of the respondents had knowledge of related contents of the 40 hours a week working time reduction. And the ratio of the respondents supporting introduction of working time reduction was 68.8%, and by job classification, more than half of medical doctors showed a contrary opinion, and about half of other groups such as nurses, medical technicians, administrative staffs were for it.<BR>  Secondly, the results of analyzing various factors that influence the quality of medical services and business performance is as follows: Medical doctors thought that the working time reduction would have a bad effect on the quality of medical services and business performance as a result of decreased patients. But other groups such as nurses, medical technicians, administrative staff presumed that the quality of medical services and business performance would not be changed but rather improved if strategies for operation were appropriately considered and performed.<BR>  Finally, the medical institutions preparing working time reduction need to make extra efforts to implement the system successfully such as making manpower operation more efficient, strengthening care capacity and function of emergency care centers, providing incentives for workers on Saturdays, improving the process of the working system and environment, fortifying weekday care, developing a weekend care program, and so on.

우리나라 중소병원의 도산실태와 경쟁력 제고 방안

최만규(ManKyu Choi) 고려대학교 보건과학연구소 2005 보건과학논집 Vol.31 No.1

  The internal and external environment of the hospital has unfavorably changed in the last several years. That is, there has been a separation of dispensary, review reinforcement on health insurance claim, increase of fixed costs such as personnel cost and managerial cost, increase of medical specialists resigning a present position to open own clinic, lower health insurance fee as compared with consumer price index, institutional inertia of inter-hospital collaboration under medical care delivery system, a excessive tax burden, unification of medical diagnosis fee and prescription fee, credit card payment of medical expenses, and so on.<BR>  In such difficult situation, many small and medium hospitals which have not properly coped with request of the change have been bankrupted. The rate of bankruptcy has showed over 10% on an average in these seven years.<BR>  As the reasons mentioned above, most of small and medium hospitals are going through financial difficulty. The function and roles of small and medium hospitals are closely related to the medical welfare of residents as well as the economic effect in small and medium cities. Therefore small and medium hospitals should set up managerial strategies for strengthening their competitiveness in the given situation in order to survive and develop in community.<BR>  In that respect, this study aims to grasp bankruptcy situations of small and medium hospitals and to suggest managerial strategies for strengthening their competitiveness. This study makes a suggestion the following nine strategies for existence and development of small and medium hospitals. Those suggestions are as follows ; This is, the establishment of the customer(patient)-oriented circumstance ; curtailment of expenditure such as personal(labor) and managerial expenses ; TQM(total quality management) of medical services ; introduction of business renovation techniques such as business re-engineering, the construction of the medical information system, benchmarking, out-sourcing, and so on ; reorganization of the existing hospital setups ; introduction of remuneration system depending on the performance ; an active and aggressive marketing and improvement of hospital image ; the activation of inter-hospital collaboration systems ; the establishment of transparency in hospital business such as decision making processes and operating behaviors especially related to money ; vision business in the long-term viewpoint.<BR>  Small and medium hospitals must realize that they may not be able to survive unless they implement the above suggestions. For a successful application and practice of above suggestions, it is important for CEO of small and medium hospitals to have a innovative business mind. And the government have to support for activation of medium and small hospitals.

개인병원과 의료법인병원의 재무구조와 수익성 비교

최만규(ManKyu Choi),문상식(SangSik Moon),윤창수(ChangSoo Yun),김진희(JinHee Kim) 고려대학교 보건과학연구소 2006 보건과학논집 Vol.32 No.1

  This study was performed to compare and identify factors shaping the financial structure and profitability between private hospitals and corporate hospitals in Korea. The main purpose of the study was to provide information to hospitals in maintaining sound financial structure and improving profitability.<BR>  Data used in this study were collected from 22 private and 45 corporate hospitals with complete general data of present conditions as well as financial statements(balance sheets, income statements). The cases included in the study were chosen from hospitals that passed the standardization audit undertaken by the Korean Hospital Association from 1998 to 2001 for the purpose of accrediting training hospitals.<BR>  The hospital management indicators used in this study were stability indicators, profitability indicators, activity indicators, productivity indicators, and other management indicators related to the medical utilization of patients.<BR>  Comparison analysis results on the hospital management indicators of private hospitals and corporate hospitals were that corporate hospitals had more liabilities and less liquidity than private hospitals, and the former paid more medical expenses(personnel, material, and administrative expenses) than the latter. This was the main reason why corporate hospitals had lower profitability than private hospitals especially in net profit to total assets, normal profit to gross revenues, and net profit to gross revenues.<BR>  The factors that had significant effect on liabilities to total assets of corporate hospitals were inventories turnover(negative), normal profit to total assets(negative), and net profit to gross revenues(negative). And concerning the current ratio, there were period of establishment(negative), patient receivable turnover(negative), value analysis to personal expenses(positive), admission of outpatients(positive), and net profit to gross revenues(positive). The factors that had significant effect on liabilities to total assets of private hospitals were operating bed numbers(negative), period of establishment(positive), average length of stay(positive), and net profit to gross revenues(negative). And concerning the current ratio, there was only average length of stay(negative).<BR>  The factors that had significant effect on both normal profit to total assets and net profit to gross revenues of corporate hospitals were liabilities to total assets(negative), administrative expenses per adjusted patient(negative), material costs per adjusted patient(positive). And the factors that had significant effect on both normal profit to total assets and net profit to gross revenues of private hospitals were operating bed numbers(positive), value analysis to personal expenses(positive), administrative expenses per adjusted patient(negative).

Application of Therapeutic Support on Subjective Well-being, and the Mediating Role of Place Attachment

최명숙,박민혜,최만규,Choi, Myungsuk,Park, Minhye,Choi, Mankyu The Korean Society for SchoolCommunity Health Educ 2018 한국학교지역보건교육학회지 Vol.19 No.1

배경 및 목적: 이 연구의 목적은 OECD "더 나은 삶의 지수 2015"에서 34개 국가 중 29위로 평가된 한국인의 주관적 건강(subjective well-being)과 치료적 지지(therapeutic support) 관계에서 장소애착(place attachment)의 매개 효과를 탐색하였다. 방법: 비확률 표본추출 방법을 사용하여 서울 시민들 중 헬스클럽 이용자를 대상으로 설문지 조사를 실시하였으며, 구조방정식 모형분석을 통해 가설을 검증하였다. 결과: 분석 결과 치료적 감독(therapeutic oversight )만이 주관적 건강에 직접적인 영향을 미치는 것으로 확인되었다(B = .281, p < .05). 장소애착의 매개효과를 통해서 검증한 결과 치료적 감독 뿐만 아니라 치료적 증언(therapeutic testimonial)에 대해서도 유의하게 검증되었다(치료적 감독 간접 효과 = .155, p < .05, 치료적 증언 간접 효과 = .175, p < .05). 결론: 연구결과 주관적 건강에 영향을 미치는 것으로 장소애착의 매개효과가 큰 것으로 나타났다. 따라서 서로를 돌보며 회원들 간의 업적을 축하 할 수 있는 장소를 기반으로 한 건강 프로그램을 실행한다면 사회 구성원들의 주관적 건강 향상에 도움이 될 것으로 사료된다.

요양병원의 효율성과 의료서비스 질의 관련성

손민성(Sohn, Minsung),최만규(Choi, Mankyu) 한국간호과학회 2014 Journal of Korean Academy of Nursing Vol.44 No.4

Purpose: Objectives of this study were to investigate the association between efficiency and quality of health care in Long-term Care Hospitals (LTCH) and determine related factors that would enable achievement of both high efficiency and high quality at the same time. Methods: Major data sources were the “2012 Korean Assessment of Propriety by Long-term Care Hospitals” obtained from the Health Insurance Review & Assessment Service. Cost variables were supplemented by a National Tax Service accounting document. First, data envelopment analysis was performed by generating efficiency scores for each LTCH. Second, matrix analysis was conducted to ascertain association between efficiency and quality. Lastly, kruskal-wallis and mann-whitney tests were conducted to identify related factors. Results: First, efficiency and quality of care are not in a relationship of trade-offs; thus, LTCH can be confident that high efficiency-high quality can be achieved. Second, LTCH with a large number of beds, longer tenure of medical personnel, and adequate levels of investment were more likely to have improved quality as well as efficiency. Conclusion: It is essential to enforce legal standards appropriate to the facilities, reduce turnover of nursing staff, and invest properly in human resources. These consequences will help LTCH to maintain the balance of high efficiency-high quality in the long-run.

지역거점 공공병원의 환자 만족도가 의료수익에 미치는 영향 : 구조방정식모형과 자기회귀교차지연모형

이현서(Hyunseo Lee),최만규(Mankyu Choi) 한국콘텐츠학회 2023 한국콘텐츠학회논문지 Vol.23 No.7

본 연구는 지역거점 공공병원의 질적 개선방안을 모색하기 위해 2018부터 2020년까지 3년 동안 지역거점 공공병원의 운영평가와 재무제표 자료를 이용하여 환자 만족도와 의료수익의 영향 관계를 분석하였다. 분석결과, 환자 만족도가 높을수록 의료수익이 의미 있게 높았으며, 특히 당해 연도 환자 만족도는 당해 연도 의료수익뿐만 아니라 그다음 해 의료수익까지 높아지는 경향을 보였다. 그 이유는 환자의 의료서비스 만족이 병원재이용 의사와 병원의 긍정적 이미지를 형성하는 데 도움을 주어 환자의 병원 이용이 많아져 재무성과 증가에 영향을 줄 수 있기 때문이다. 환자 만족도의 관리가 병원 수익 증가의 중요한 요소가 되는 것이다. 따라서 환자만족도가 의료수익에 긍정적 영향을 미친다는 연구 결과는 지역거점 공공병원의 환자 만족도 재고와 지속 가능한 경영을 위한 수익성 개선에 도움이 되는 기초자료로 활용하여 지역거점 공공병원의 역할 재정립 과정에 반영되기를 기대한다. This study analyzed the relationship between patient satisfaction and patient service revenues by using operational evaluation and financial statement data of regional hub public hospitals for three years from 2018 to 2020 in order to seek ways to improve the quality of regional hub public hospitals. As a result of the analysis, the higher the patient satisfaction, the higher the patient service revenues. In particular, the patient satisfaction for the current year tended to increase not only the patient service revenues for the current year but also the patient service revenues for the following year. The reason is that the satisfaction of patients medical services helps to form a positive image of doctors and hospitals that re-use hospitals, which can affect financial performance by increasing patients use of hospitals. Managing patient satisfaction is an important factor in increasing hospital revenue. Therefore, the results of the study that patient satisfaction has a positive effect on patient service revenues are expected to be reflected in the process of re-establishing the role of regional hub public hospitals by using it as basic data to improve patient satisfaction and profitability for sustainable management.

원격진료에 대한 의료제공자와 이용자의 인식도

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

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

의사의 환자 지향적 커뮤니케이션과 만성질환자의 삶의 질과의 관계: 건강행태의 매개효과를 중심으로

이정선 ( Lee Jeongseon ),최만규 ( Choi Mankyu ) 한국보건사회연구원 2018 保健社會硏究 Vol.38 No.3

의사의 환자 지향적 커뮤니케이션은 진료에 대한 환자의 만족도, 의사에 대한 신뢰도를 증가시킬 수 있고, 이를 통해 환자의 건강상태와 건강관련 행동을 변화시킬 수 있으며, 나아가 환자의 삶의 질에도 긍정적인 영향을 미칠 수 있다고 보고되고 있다. 이와 관련하여 국외에서는 활발히 연구되고 있으나, 국내에서는 관련 연구가 부족한 실정이다. 이에 본 연구는 의사의 환자 지향적 커뮤니케이션이 만성질환자의 삶의 질에 미치는 영향을 파악하고, 이 과정에서 음주, 흡연, 신체활동 등 건강행태의 매개효과를 확인하고자 하였다. 이를 위해 국민건강영양조사(2015)에서 고혈압, 당뇨, 비만, 고콜레스테롤 혈증 중 한 가지 이상의 질환을 가진 1,680명의 성인을 대상으로 매개회귀분석을 실시하였다. 연구 결과, 환자 지향적 커뮤니케이션은 만성질환자들에게 건강지향적인 행동을 유도하는 효과가 있었으며, 건강증진 행위는 그들의 삶의 질에 긍정적인 영향을 미치는 매개요인으로 작용하였다. 본 연구는 만성질환자들의 삶의 질 향상을 위해 질병을 관리하고 치료하는데 있어서 의료인의 환자 지향적 커뮤니케이션의 중요성을 확인하였다는 점에서 의의가 있다고 하겠다. It is reported that physicians’ patient-centered communication improves patients’ satisfaction and trust in their physicians, which can affect their health-related behaviors and, in turn, their quality of life. However, patient-centered communication has not been actively researched in Korea. The purpose of this study was to investigate the effects of patient-centered communication on the quality of life of chronically ill patients and to verify the mediating role of health-related behaviors such as drinking, smoking, and physical activity. To that end, we conducted a mediated regression analysis for 1,680 patients who were identified in the 2015 Korea National Health and Nutrition Examination Survey as having hypertension, diabetes, obesity, and/or hypercholesterolemia. According to the results, patient-centered communication contributed to inducing health-oriented behaviors in chronically ill patients, and health-promoting behaviors played the role of mediators that positively influenced their quality of life. This study confirmed the importance of patient-centered communication in managing and treating chronic diseases and in improving the quality of life of the patients.

우리나라 출산율 저하의 원인과 그 대책

임국환(KookHwan Rhim),최만규(ManKyu Choi) 고려대학교 보건과학연구소 2005 보건과학논집 Vol.31 No.2

  A rapid and persistent decline of the birth rate in Korea began to occur in the early 1960s when the government enforced a five-year plan for economic development and a birth control policy for the declining rate. Recently, as a result, the total birth rate has declined to 1.19 which is the lowest level in the world according to the National Statistical Office. Fertility decline foreshadows serious social problems and a decrease in the national economic development such as the decline of economic activity population, the increase of the duty of supporting an aging population.<BR>  The aim of this study is first to examine the present situation and problems related to low fertility, and then to inquire into and discover the factors affecting the birth rate by comparing data from the 1970s to the recent trend of Korea"s precipitous drop in the birth rate.<BR>  As for the cause of the fertility decline, this study examined the marriage and delivery age of women, the divorce rate, and the birth sex ratio as a demographic factors, and GNI(gross national income), the proportion of women"s economic activity, the expense of bringing up children as a socio-economic factors. This study also analyzed the correlation between the birth rate and the relevant factors as the previous stage of the multiple regression analysis to discover the affects on the birth rate. As a result, the correlation among relevant factors, independent variables, was very high. So the stepwise multiple regression analysis(applied a reduced regression model) was performed to find out factors affecting the contin??uously decreasing the birth rate. As a result, the marriage age of women proved a negative factor affecting, statistically and significantly, the contin??uously decreasing total fertility in Korea. After all, a government supported policy and social circumstance are required to decrease women"s marriage age.

The Relationship between R&D investment and Ownership Structure in KOSDAQ Pharmaceutical Firms

Munjae Lee(이문재),Mankyu Choi(최만규) 한국콘텐츠학회 2015 한국콘텐츠학회논문지 Vol.15 No.6

본 연구는 우리나라 코스닥 제약기업을 대상으로 소유구조가 제약기업의 연구개발투자(R&D)에 미치는 영향을 분석하였다. 실증분석을 위한 표본은 2000년부터 2012년까지 상장된 기업들 중 코스닥 제약기업을 대상으로 하였으며사용된 전체 표본은 13개년 자료로써 358개 관측치를 가진 불균형패널자료이다. 본 연구에 사용된 주요 변수들 중 개별기업 별 재무자료는 상장회사 협의회의 TS-2000을, 임원현황 및 주주분포 등은 금융감독원 전자공시 시스템의 각 기업 사업보고서 자료를 통해 자료를 직접 수집하였으며 기업나이, 기업크기 등은 NICE신용평가정보의 KISVALUE-Ⅲ 등의 자료를 참고하였다. 연구결과, 첫째 주요주주율과 외국인투자율은 연구개발투자에 긍정적인 영향을 미쳤다. 둘째, 사외이사율은 연구개발투자에 부정적인 영향을 미쳤다. 셋째, 기관투자율은 통계적으로 유의한 결과를 미치지 못했다. The purpose of this study is to analyze the influence of the financial structure of pharmaceutical companies on R&D investment. 358 pharmaceutical firms listed in the KOSDAQ market from 2000 to 2012. Financial statements and comments in general and internal transactions were extracted from TS-2000 of the Korea Listed Company Association (KLCA), and data related to stock price was extracted from KISVALUE-Ⅲ of NICE Information Service Co., Ltd. STATA 12.0 was used as the statistical package for panel analysis. The summary of the findings and the interpretation of the significance of this are as follows: First, the shareholding ratio of major shareholders and foreigners had a positive influence on R&D investment. Second, the ratio of outside directors had a negative influence on R&D investment. Third, the shareholding ratio of institutional investors did not have a significant influence on R&D investment.