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문경태 ( Kyung Tae Moon ),이상은 ( Sang Eun Lee ) 韓國社會保障學會 2010 사회보장연구 Vol.26 No.1
1991년 시장경제로의 전환과 함께 러시아 보건의료체계에 큰 변화가 있었다. 과거 사회주의 계획경제체제하에서 소련은 모든 의료자원을 국유화·중앙집중화하고 전 국민에 대한 보편적 의료서비스를 무상으로 제공하였다. 체제 전환 이후 러시아에서는 의료자원의 국유화와 무상의료원칙을 유지하면서도 의료보장 책임을 분권화시키고 재원 확보의 다원화를 위해 의료보험제도를 도입하였다. 그러나 제도설계 당시 의료보험기금에서 총 재정의 2/3를 충당할 것으로 기대했으나 실제로는 25% 수준에 머무르고 지방정부의 재정지원도 줄어들고 있다. World Bank 등 신자유주의 시장경제론자들은 의료보장개혁에서 충격적 접근방법으로 의료보장재정 확보의 다원화, 무상의료 원칙의 포기, 의료자원의 민영화를 주장하였다. 그러나 러시아 연방 하원 등 보건정책 결정자들은 무상의료원칙을 고수하고 의료자원의 국·공유화 유지를 주장하여 결과적으로 절충형의 개혁모형이 탄생하였다. 그 결과 의료보장체계의 개혁 자체가 미흡하였고, 공영의료체제를 유지하지만 재원부족으로 의약품비 등 공식적·비공식적 환자 부담도 상당하였다. 또한 평균수명이 하락하는 등 국민보건수준도 악화되고 있다. 러시아의 의료보장 개혁은 개혁 자체의 진행과 그 효과 두 측면 모두에서 제한적인 것으로 평가된다. The Break-up of USSR and the transition to market economy in Russian Federation led to a health care reform. Under the planned economy, the USSR had nationalized all of health resources including physicians, polyclinics, and hospitals in the 1920s, as a way of establishing a comprehensive free health care system for all people. After transition to market economy, Russia adopted in 1993 a mandatory social health insurance system as an alternative of financial resources, while keeping the principle of providing comprehensive free health care services to the general public. On the contrary to the original plan expecting that health care insurance fund shall be responsible for 2/3 of total health care expenditure, it turned out that the insurance fund took care of 25% of total expenditure ever since the year 2000. The decentralization of Russian Federation transferred financial burden to local governments, and made them responsible of their resident`s health care. But, financial subsidy from the local governments has been also dwindled. Neoliberal market economists insisted a shock approach, including pluralizing of health finanace, giving up free heath care, and privatizing medical resources. However, the decision makers of the health care system have kept the free and state owned health care system. The reform of health care system in Russia was a mixed one. As the result, the reform itself was limited. Patients have to shoulder a substantial amount of financial burden, either formally or informally, by paying most of the prescription drug cost. And the life expectancy has been seriously deteriorating since the 1990s. The health care reform in Russia is limited in its effectiveness as well as reform itself.
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상부요로 요로상피암에서 Heat Shock Protein 27와 Cellular FLICE-like Inhibitory Protein의 발현
조정만(Jeong Man Cho),조희주(Hee Joo Cho),문경태(Kyong Tae Moon),민동석(Dong Suk Min),김은경(Eun Kyung Kim),김덕윤(Duk Yoon Kim),박재신(Jae Shin Park),유탁근(Tag Keun Yoo) 대한비뇨기종양학회 2011 대한비뇨기종양학회지 Vol.9 No.2
Purpose: We investigated the expressions of Heat shock protein 27 (HSP27) and Cellular FLICE-like inhibitory protein (c-FLIP) with urothelial carcinoma of the upper tract. Materials and Methods: The expressions of HSP27 and c-FLIP were quantified immunohistochemically form sixty one patients who underwent nephroureterectomy for urothelial carcinoma of the upper tract and 10 patient’s normal ureteral tissues who underwent nephrectomy. The overall percentage of cancer cells showing staining (0% to 100%) was indicated by visual scoring. Specimens were graded from 0 to +3 intensity representing the range of staining area, for which below 1% is 0 grade, 1-10% is+1 grade, 10-50% is +2 grade, over 50% is +3 grade. Results: HSP27 positive reaction was seen in 10 of 10 cases (100%) with a normal ureter, 59 of 61 cases (96.7%) with urothelial carcinoma of the upper tract. The mean HSP27 reaction scores were 2.67 with low grade, 2.27 with high grade (p=0.045). HSP27 expression was not statistically significant according to stage and lymph node metastasis. c-FLIP positive reaction was seen in 0 of 10 cases (0%) with normal ureter, 57 of 61 cases (93.4%) with urothelial carcinoma of the upper tract. c-FLIP expression was not statistically significant according to grade, stage and lymph node metastasis. Conclusions: This study suggests that the expression of HSP27 is reduced and the expression of c-FLIP is increased in patients with urothelial carcinoma of the upper tract. If these data are confirmed, HSP27 and c-FLIP may be usable as prognostic marker of urothelial carcinoma of the upper tract.
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