프로스포츠 구단의 ESG 발전방안에 관한 연구

정인욱(Jung, In-Wook) 한국체육과학회 2023 한국체육과학회지 Vol.32 No.6

The purpose of this study is to derive future development plans and how the current status of ESG activities of domestic professional sports clubs is being conducted. In particular, the recent active ESG activities of professional sports clubs are making efforts to increase non-financial values, but the reality is that guidelines and directional settings for sports ESG are not clear. In order to achieve the purpose of the study, a research problem related to the current status of the clubs ESG and the direction of development were set up, and an in-depth interview method was used to solve the set research problem. A group of experts were selected for in-depth interviews, and a total of nine people were selected, including three university professors and doctoral-level researchers majoring in the sports industry, three middle managers working for the professional soccer team and three middle managers working for the professional baseball team. In-depth interviews were conducted in a one-on-one interview method by mixing face-to-face and non-face-to-face methods. As a result of literature review and in-depth interviews on previous studies to identify the first research problem, ESG problems were derived from clubs that were conducting ESG activities and clubs that were not, and problems that did not take into account enormous garbage and environmental factors in professional sports games and difficulties in budget execution. After that, in-depth interviews conducted to identify the second research problem were analyzed using the theme analysis method. As a result, development measures to solve problems in current ESG activities were proposed as development measures for the development of clear ESG guidelines specialized in sports, ESG legislation, and field activities to reduce carbon neutrality. These results suggested development measures to solve ESGs immediate problems and move ESG activities in professional sports in the right direction in the future, and at the same time included suggestions for follow-up research.

백서 혈관평활근 세포에서 α-Lipoic acid가 PAI-1 발현, 세포의 증식, 주유능 및 신생내막 형성억제에 미치는 효과

신동우,이동욱,이상준,김혜순,강효경,안종덕,이인규 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.6

연구배경:당뇨병의 혈관 합병증의 발생에 있어서 산화스트레스는 중요한 역할을 하는 것으로 알려져 있다. 혈관 평활근세포에서 고혈당은 안지오텐신Ⅱ와 더불어 활성산소족(ROS)을 증가시키며, 산화스트레스에 민감한 전사인자들을 활성화시켜 동맥경화증을 유발하는 것으로 알려져 있다. 이에 저자들은 항산화제로 알려진 알파­리포산이 혈관 평활근세포의 증식속도와 이주에 미치는 영향과 PAI­1발현에 미치는 영향을 조사하였고 이와 동시에 백서의 혈관 손상 모델을 이용하여 알파­리포산이 신생내막 증식을 억제시킬 수 있는지를 알아보았다. 방법:In vitro 실험은 백서의 대동맥 평활근세포를 고농도의 포도당(22mM)과 100nM의 안지오텐신Ⅱ로 4시간 배양하였다. 알파­리포산을 처리 후, PAI­1 mRNA의 발현을 보기 위해 노던 블롯을 시행하였고 평활근세포의 유주능과 증식속도에 미치는 영향을 보기 위해 성장속도의 유주능 분석을 시행하였다. 또한 평활근세포의 유주능에 NF­μB 경로가 미치는 영향을 보기 위해 겔 지연 분석과 NF­μB 보고 유전자 분석을 시행하였다. In vivo 실험으로 백서의 혈관손상 모델을 이용하여 알파­리포산 처리 후 혈관의 신생내막 두께를 비교하였다. 결과:In vitro 실험에서 고농도 포도당과 안지오텐신Ⅱ에 의해 유도된 PAI­1 mRNA 발현증가는 알파­리포산 처리에 의하여 용량에 비례하여 억제되었다(p<0.05). 알파­리포산 처리로 혈관 평활근세포의 유주능은 유의하게 억제되었으나(p<0.01),증식속도는 유의하게 억제되지 않았다. 또한 알파­리포산 처리로 NF­μB 발현도 유의하게 억제되었다(p<0.01). In vivo 실험에서 알파­리포산을 주입한 군에서 혈관손상에 의한 신생내막의 증식이 유의하게 억제되는 것을 보여주었다(p<0.01). 결론:알파­리포산은 백서의 대동맥 평활근 세포의 증식속도는 억제하지 못했으나 유주능은 유의하게 억제하였으며, 혈관 손상 모델에서 신생 내막 증식도 유의하게 억제함을 확인할 수 있었다. 이러한 작용은 알파­리포산에 의한 NF­μB 경로의 억제와 연관이 있는 것으로 사료된다. Background : Exposure to large amounts of glucose causes a characteristic dysfunction and morphologic changes of the endothelium by an increased production of reactive oxygen species(ROS) in diabetes. The plasminogen activator inhibitor-1(PAI-1), which modulates fibrinolysis and cell migration may influence proteolysis and neointimal formation in vascular smooth muscle cells(VSMC). Antioxidants have been proposed to inhibit multiple proatherogenic events. This study investigated the effect of α-lipoic acid on PAI-1 expression and VSMC proliferation and migration both in vivo and in vitro. Methods : In the in vitro study, cultured rat aortic smooth muscle cells(RASMC) were incubated in a medium containing high glucose (22 mM) and 100 nM angiotensin Ⅱ for 4 hour. After α-lipoic acidtreatment, a -migration and growth assay of the RASMC, and a gelmobility shift assay and reportergene analysis for nuclear factor- иB(NF- иB) and northern blot analysis for PAI-1 were performed. In the in vivo study, the effect of α-lipoic acid on neointimal hyperplasia in a rat carotid balloon injury model was evaluated. Results : RASMC migration was inhibited significantly by α-lipoic acid (p<0.01), but their prolife ration was not inhibited. The NF-иB DNA binding activity and NF-иB promoter activity was inhibited by α-lipoic acid significantly (p<0.01). α-lipoic acid inhibited PAI-1 mRNA expression by high glucose and angiotensin Ⅱ in dose dependent manner (p<0.05). In the rat carotid artery balloon injury model, neointimal formation was reduced by α-lipoic acid treatment in a dose dependent manner significantly (p<0.01). Conclusion : α-lipoic acid suppresses migration, but not prolife ration in RASMC. α-lipoic acid also reduce neointima formation in a rat carotid balloon injured model. This effect might be related to the blocking of NF-иB which increase the expression of the genes associated with atherosclerosis including TNF-α, IL-1, IL-6, endothelin-1, MCP-1, VCAM-1, ICAM-1, E-selectin, tissue factor(J Kor Diabetes Asso 25:446~459, 2001).

최근 5년간 응급실을 내원한 구강악안면외과 환자에 대한 임상적 연구

김종렬,정인교,양동규,박봉욱 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.2

his is a clinical study on patients who had visitied the Emergency Room of Pusan National University Hospital and then been treated in the Department of Oral and Maxillofacial Surgery during recent 5 years, from 1992 to 1996. The results were as follow ; 1. The total number of patients was 2,680 and the ratio of male to female was 1.96:1, The highest monthly incidence was shown in September(12.1%) and October(10.5%) and the age distribution peaks was the third decade(24.3%) , followed by the first(23.1%) and the fourth decade(17.2%). 2. Soft tissue injury group(29. 1%) was the most prevalent, followed by tooth injury group(16. 1%), facial bone injury group (16.0%), toothache group(11.2%), socket bleeding group(11.1%), infection group(9.8%) and TMJ dislocation group(5.9%). 3. The percentage of in-patients and out-patient were 21.6% and 78.4%, respectively. The frequent causes of admission were facial bone fracture(73.8%) , infection(20.8%) and soft tissue injury(4.8%) in order. However, soft tissue injury was the most frequent cause in out-patient, followed by tooth injury(20.5%), toothache(14.3%), socket bleeding(14.2%) and TMJ dislocation(7.6%). 4. In the facial bone injury group, the mandibular fractures(70.6%) showed the highest incidence, followed by zygomatic bone and arch fractures(7.5%), maxillary bone fractures(4.0%) and nasal bone fractures(4.0%). 5. In the mandibular bone fracture, the most common location was symphysis(36.7%), followed by the mandibular angles(33.1%) and the condyles(21.8%) 6. The common causes of facial bone fractures were violence, fall and traffic accident in order. 7. The common causes of soft tissue injury were fall down, fight and traffic accident in order and the highest incidence was observed in infants before the age of 10 years(44.0%). 8. In the group of tooth injury, tooth luxation(38.5%) showed the highest incidence followed by tooth fracture(33.2%) and tooth loss(17.1%). The common causes of tooth injury were fall, fight and traffic accident in order. 9. In infected patients group, the ratio of in-patients to out-patients was 1 : 1.28, Buccal(24,7%) and infraorbital space abscess(23.3%) showed the highest incidence. 10. The pain caused by dental caries(39.0%) and pericoronitis(26.6%) showed high incidence in the toothache group. 11. The high incidence was observed during third(34.0%) and fourth (24.5%) decades in TMJ dislocation group. 12. In the group of socket bleeding patients, 92% was post-operative hemorrhage and 8% was accompanied with other systemic hemorrhagic diseases.

The Effect of Parental Imprinting on the INS - IGF2 Locus of Korean Type I Diabetic Patients

(Heung Sik Kim),(Dong Wook Lee),(Sang Jun Lee),(Bo Hwa Choi),(Sung Ik Chang),(Hyun Dae Yoon),(In Kyu Lee) 대한내과학회 2001 The Korean Journal of Internal Medicine Vol.16 No.4

N/A Background: Insulin-dependent diabetes mellitus (IDDM) is caused by the autoimmune destruction of pancreatic β-cells. Susceptibility to IDDM appears to depend on more than one genetic locus. Evidence of a genetic linkage for IDDM2 was found in male meioses from French and North American populations. It is linked to maternal imprinting (i.e. monoalleleic expression of the insulin gene) that is considered the most likely cause of these gender-related differences. IGF2 is expressed only in the paternal allele and therefore, is considered a candidate gene for IDDM2 transmission because of its important autocrine/paracrine effects on the thymus, lymphocytes and pancreas. Nevertheless, it remains controversial whether the parental origin of IDDM2 influences IDDM susceptibility. Methods: Using PCR and semi-quantitative RT-PCR, we analyzed the INS/PstI+1127 and IGF2/ApaIpolymorphisms and RNA expression level between PstI (+/-) and PstI (+/+) to determine genotype and allele-specific expression of the INS and IGF2 genes. Results : INS/PstI(+/+) and IGF2/ApaI(+/-) were observed in 36 (97.3%) of 37 IDDM patients and in 29 (72.5%) of 40 IDDM patients, respectively. The presence of both IGF2 alleles in RNA was observed in 21 (91.6%) of 24 IDDM patients. Our results show a 3-fold increase in RNA expression from PstI (+/-) allele over PstI (+/+) allele. Conclusion: Our conclusion does not entirely exclude IGF2 as the gene involved in IDDM2, even though the parental effect of IDDM2 transmission is not related to IGF2 maternal imprinting. The INS genotype appeared mostly in the PstI (+/+) homozygote and, therefore, we could not explain the INS imprinting pattern in Korean type 1 diabetic patients. Genetic differences between populations may account for the discrepancy between Korean type I diabetic patients and American or French type I diabetic patients.

급성 중독 환자에 대한 역학적 고찰 : 서울과 지방의 비교

김성중,김인병,최성욱,김경수,이영수,Choi, Jong Moo 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Study objective: To compare patients with acute poisoning between urban and rural areas Design: Retrospective chart review of 217 patients with acute poisoning Setting: Two University Hospital EDs Methods: patients were divided into two groups according to hospital. The group A was 109 patients who came to ED of Asan Medical Center and the group B was patients who came to ED of Ajou University Hospital from June 1994 to February 1995. We analysed the age and sex distributions, poisoning substances. causes of poisoning and the past history of psychiatric problems in patients of the two groups. Results: Total number of patients with acute poisoning were 109 in the group A and 108 in the group B. Female was more prevalent than male in the group A and male was more than female in the group B. There was a significant difference in sex distribution between two groups. The mean age of the group A was 27.7 years which was significantly different from the mean age of the group B, 33.7 years. The age incidences in both group were highest in 2nd decade. The accidental poisoning cases were 37% in the group A and 31% in the group B. The rates of committed suicide were 7% in the group A and 22% in the group B. The most common agent of poisoning was therapeutic drug in the group A and agricultural or industrial chemical in the group B. The overall mortality was 5% in the group A and 15% in the group B. Conclusion: There were significant differences in age and sex distributions. poisoning substances, causes of poisoning and the past history of psychiatric problems between two groups.

톡소포자충 감염마우스의 Cytokine 및 Heat shock protein 생산 분석

노형준,최인욱,신대환,이영하 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.2

T. gondii frequently causes severe congenital defects and life-threatening disease in immunocompromised individuals. Cytokines. nitric oxide (NO) and heat shock proteins (HSP) are important to control the parasite multiplication and host resistance. However. there were only fen reports about HSP70 in toxoplasmosis. Moreover. we do not know the cytokines and HSP70 production in case of NO inhibition. Therefore. this study was performed to analyze the production of NO. HSP70 and cytokines after adminstration of aminoguanidine (AMG. suppressor of NO production) in mice infected with T. gondii. BALB/c and C57BL/6 mice were injected with either 5 brain cysts of Me49 strain of T. gondii or 50㎍ of AMG for 2 weeks every day. and then mice were sacrificed at day 4. 7. 14 and 28. HSP70 production in the brain and spleen of both mice strains mere decreased after treatment with AMG. however Toxoplasma-infected ones were significantly increased. HSP70 production of Infection/AMG-treated group of C57BL/7mice was significantly decreased in comparison to Infection group. Whereas Infection/AMG-treated group of BALB/c mice showed similar HSP70 production compared to Infection group. After T. gondii infection. the IFN-γ and TNF-α mRNA expression in the brain and spleen was significantly increased in BALB/c or C57BL/6 mice. IFN-γ mRNA expression in the brain and spleen of Infection/AMG-treated BALB/c mice were not significant differences compared to those of infected ones. however there were significant differences in the spleen of C57BL/6 mice. TNF-α mRNA expression in the spleen of Infection/AMG-treated BALB/c or C57BL/6 mice were significantly decreased in comparison to those of infected ones. Taken together. HSP70. IFN-γ and TNF-α production were significantly increased in Toxoplasma-infected BALB/c and C57L/6 mice. After treatment with NO inhibitor in infected C57BL/6 mice, the production of HSP70 and IFN-γ were significantly decreased. whereas BALB/c mice were not significant differences of HSP70 and IFN-γ production between Infection and Infection/AMG-treated group.

제주도 고등학교 학생들의 비만 정도, 심혈관 위험인자, 소아시 비만과의 관련성

홍성철,황승욱,현인숙 韓國保健敎育.健康增進學會 2003 보건교육건강증진학회지 Vol.20 No.2

Background: Recently, adolescent obesity was increased and tended to become obese adults, facing increased risk for diabetes, cardiovascular disease. Even before reaching adulthood, adolescent obesity already was experiencing hypertension, dyslipidemia, and diabetes mellitus. The purpose of this study was to find prevalence of obesity of high school students in Jeju island and association between obesity and cardiovascular risk factors and association between childhood obesity and adolescent obesity. Method: The study subjects were 6,064 students of twenty-two high school in Jeju island and health survey data was gathered from high school health examination data and hospital health examination data from Aug. 1999 to Dec. 1999. Adolescent obesity was evaluated by ideal body weight method in 1998 and body mass index. Cardiovascular risk factors were checked total cholesterol, systolic and diastolic blood pressure, fasting blood sugar. In 1,534 students, obesity at primary school is checked by primary and middle school health record. Results: Prevalence of obesity in Jeju island high school students is 12.6% in male students, 13.3% in female students by ideal body weight method and 8.7% in male students, 8.5% in female students by body mass index. Prevalence of obesity of male students in city area and district area of Jeju island were each 12.9%, 10.3% and that of male students in city area was significantly higher. Prevalence of obesity of female students in city area and district area of Jeju island were each 12.9%, 14.2% and not significantly different. Prevalence of obesity of male students in general and commercial school group were each 13.9%, 10.3% and that of general school group was significantly higher. In female students, Prevalence of obesity general and commercial school group was not significantly different. Total cholesterol, systolic and diastolic blood pressure were significantly associated with degree of obesity in male and female students(P<05) and fasting blood sugar was only significantly associated with degree of obesity in male students(P<05). In 1,514 students checked by health record, Odds ratio of obesity at primary and middle school that at high school were 12.96~22.77 and was significantly associated. Conclusion: Prevalence of obesity of high school students in Jeju island is very high and adolescent obsity was significantly associated with cardiovascular risk factors. Mostly childhood obesity tended to become adolescent obsity and program of control of obesity at childhood and adolescence is required.

옥천대에 대한 고자기 연구 : 태백지역에서의 대자율 비등방성과 지구조적 응력장

김성욱,최은경,정연규,김인수,Kim, Sung-Wook,Choi, Eun-Kyeong,Jung, Yeon-Kyu,Kim, In-Soo 대한자원환경지질학회 1997 자원환경지질 Vol.30 No.6

A study of anisotropy of magnetic susceptibility (AMS) was conducted on the Ordovician-Eocene strata in the Taebaek area. The study area is a northeastern part of the Okchon belt, sometimes called as Paegunsan Synclinal Area. A total of 600 independently oriented samples were collected from 60 sites covering the whole area. With a few exception of late Cretaceous-Eocene volcanic rocks, all the sampled strata are nonmetamorphosed sedimentary rocks, mainly sandstones. Among the 60 sites, 5 sites showed flow lineation lying on the bedding plane, 11 sites showed load foliation parallel to the bedding plane, and 21 sites showed tectonic foliation unrelated to the bedding plane. The tectonic foliations are defined by $k_1-k_2$ ($k_{max}-k_{int}$) anisotropy plane, and are considered as a result of tectonic forces acted perpendicularly to the foliation plane in the geologic past. Regardless of sample-site locations, tectonic force directions defined by $k_3$ ($k_{min}$) axis perpendicular to the tectonic foliation are consistent among the strata of the same geologic age. In the course of geologic time, however, the tectonic force directions showed a clockwise rotation: approximately E-W in the Ordovician sites, NW-SE in the Permian sites, N-S in the Triassic sites, and lastly NE-SW in the late Cretaceous-Eocene sites. The pre-Permian directions showed better clustering in the in-situ (geographic) coordinates, while the younger directions become better clustered after the bedding-tilt correction. It is interpreted that the major tectonic structures of the Taebaek area were controlled by the above-mentioned tectonic forces: The Paegunsan Syncline and the Hambaeksan Fault must have been generated by the NW-SE force of late Permian-early Triassic time. It was then reactivated in the reverse (dextral) sense by the N-S force of Triassic time. The Osipchon Fault in the eastern part of the study area was either generated or reactivated by the NE-SW force of late Cretaceous-Eocene time. The Permo-Triassic NW-SE force should be an expression of the Songnim Disturbance in the Korean peninsula, which is in turn related with the SCB/NCB collision in China.

대형정신병원 입원환자의 수면제 처방에 관련된 인자

김현숙,서혜수,송인제,손진욱 대한생물치료정신의학회 1997 생물치료정신의학 Vol.3 No.1

만성화된 환자들이 주로 입원하여 있는 대형정신병원에서 수면제의 처방에 영향을 미치는 요소들을 조사해 보고자 하였다. 1996년 10월 2일 국립부곡정신병원에 입원해 있는 환자 402명을 대상으로 병록지조사를 통해 입원시부터 조사당일까지의 수면제 사용을 조사였다. 담당의사의 routine order에 의한 수면제 처방의 여부, 담당의사의 p.r.n. order에 의한 처방 여부, 당직의사에 의한 수면제 처방 여부를 조사하여 환자의 나이, 성별, 진단, 입원횟수, 유병기간, 담당의사의 정신과 근무 연수 등의 변수에 따라 비교해 다음과 같은 결과를 얻었다. 1) 207명(51.5%)이 재원기간동안 최소한 일회 이상 수면제를 복용하였고, 195명(48.5%)은 수면제를 복용한 적이 없었다. 2) 담당의사의 routine order에 의한 수면제 처방의 빈도는 남자에 비해 여자에서 높았다. 3) 담당의사의 routine order에 의한 수면제 처방의 빈도는 전문의가 담당의사인 환자군에서 높았다. 4) 담당의사의 p.r.n. order에 의한 수면제 처방의 빈도는 전공의 1년차가 담당하는 환자나 전문의가 담당하는 환자에서 높았다. 5) 연령, 진단, 유병기간, 입원횟수 등은 수면제 처방의 빈도와 유의한 관계가 없었다. 이상의 결과를 통해 국립부곡정신병원의 입원환자에서 수면제의 처방이 환자의 성별과 담당의사의 정신과 근무 연수와 관계됨을 알 수 있었다. The purpose of this study was to investigate the factors that were associated with the prescription of hypnotics in inpatients of a large mental hospital. The medical records were reviewed in 402 inpatients who were admitting in Bugok National Mental Hospital at October 2, 1996. The results were as follows: 1) Fifty-one percent of the whole group received a hypnotics at least once during hospitalization. 2) The prescription of hypnotics by routine order of doctor in charge was more frequent in female patients than male patients. 3) The prescription of hypnotics by routine order of doctor in change was more frequent in patients whose doctor in charge was a psychiatric specialist than patients whose doctor in charge was a psychiatric resident. 4) The prescription of hypnotics by p.r.n. order of doctor in charge was more frequent in patients whose doctor in charge was a first-year psychiatric resident or a psychiatric specialist than a second, a third, or a forth-year psychiatric resident. 5) Age, duration of illness, frequency of admission, and diagnosis were not significantly associated with frequency of hypnotics prescription. These findings suggest that the prescription of hypnotics in inpatients of Bugok National Mental Hospital was positively associated with patient's sex and duration of service of doctor in charge.

일본 개호보험제도 시행 4년간의 평가와 시사점

엄기욱,박인아 한국사회복지정책학회 2005 사회복지정책 Vol.21 No.-

본 연구의 목적은 시행 4년을 지나는 일본 개호보험제도의 정책목표인 ① 이용자 중심 서비스로의 개혁 ② 재가보호의 추진 ③ 지방분권의 추진이 어느 정도 달성되었는가 즉, 제도의 효과성을 살펴보고, 그 결과가 한국에 주는 시사점을 제시하는데 있다 연구결과 이용자 중심 서비스로의 개혁은 서비스 이용자, 서비스 제공기관 및 서비스의 수가 지속적으로 증가하고 있어 어느 정도 긍정적으로 평가 할 수 있으나 시설입소신청자 중 입소에예향형의 비중이 높고, 제공기관의 지정취소 사례가 증가하는 등양적·질적으로 미흡하였다. 둘째, 재가보호의 추진은 재가서비스 이용자의 절대 수와 전체에서 차지하는 비율이 증가하고 있어 긍정적으로 평가할 수 있으나 요개호 수준이 높을수록 여전히 시설서비스를 선호하고 있어 한계를 지니고 있는 것으로 평가할 수 있다. 셋째, 지방분권의 추진은 제도 운영의 주체는 시·정·촌이면서 서비스 공급량 조정권한은 도·도·부·현에 있으며, 지역간 보험료 기준액의 격차가 심화되는 등 부정적인 측면이 더 많은 것으로 평가되었다. 이러한 평가결과가 주는 시사점으로 우선 이용자 중심의 서데스를 제공하기 위해서는 양적·질적으로 충분한 서비스 제공 뿐 아니라 이용자가 적절한 서데스를 선택할 수 있는 정보제공체계가 마련되어야 하며, 재가보호 중심의 서비스 운영을 위해서는 서비스의 내용과 지원체계가 이용자의 욕구에 부합되어야 하며, 급여 및 비용부담에서 시설서비스와의 형평성이 고려되어야 하고, 지방분권을 추진하기 위해서는 지역간 형평성과 이를 위한 지역 특성과 역량을 고려한 중앙정부의 지원과 적정규모의 지역을 단위로 한 제도운영과 서비스 공급체계가 마련되어야 함을 제시하였다. The present study purposed to examine the efficiency of the long-term care insurance system in Japan, which began four years ago, focused on the achievement of its policy goals - ① reform to user-centered services; ② the promotion of community-based care; and ③ the promotion of decentralization - and to suggest the implications of the outcome for Korea. According to the result of this study, reform to user-centered services has been attained to some degree considering the steady increase of the numbers of users, services and service providing institutions, but still quantitative and qualitative shortages exist as shown by the high percentage of users reserving admission in applicants for facility admission and the increasing number of cancellations of designation as service providers. Second, the promotion of community-based care may be evaluated positively in that the absolute number of home service users and their percentage in the entire service users have increased but those who are badly in need of long-term care still appear to prefer facility services. Third, the promotion of decentralization has troubles because the main operators of the system are towns and villages while the right to control the supply of services lies in provinces and the gap of base insurance premium among localities is getting larger. These show that there are many limitations in promoting decentralization. The results of evaluation as presented above imply that services must be sufficiently quantitatively and qualitatively to make the system user-centered and that there must be an information service system so that users can choose appropriate services. In addition, for the operation of services centering on community-based care, the contents of services and the support system must meet users' needs, and equity with facility service users in insurance coverage and the bearing of expenses must be considered. Lastly, for the promotion of localization, balance among localities is a prerequisite. For this, this study suggests the central government's support in consideration of the characteristics and capacity of each locality, the operation of the system in units of appropriate size, and the establishment of a service supply system.