EuroQol-5 Dimension 건강가중치를 이용한 한국인의 건강수준의 형평성 측정

신호성,김동진,Shin, Ho-Sung,Kim, Dong-Jin 대한예방의학회 2008 예방의학회지 Vol.41 No.3

Objectives : Despite various government initiatives, including the expansion of national health insurance coverage, health inequality has been a key health policy issue in South Korea during the past decade. This study describes and compares the extent of the total health inequality and the income-related health inequality over time among Korean adults. Methods : This study employs the 1998, 2001 and 2005 Korean National Health and Nutrition Examination Surveys (KNHANESs). The self-assessed health (SAH) ordinal responses, measured on a five-point scale, resealed to cardinal values to measure the health inequalities with using interval regression. The boundaries of each threshold for the interval regression analysis were obtained from the empirical distribution of the EuroQol-5 Dimension (EQ-5D) valuation weights estimated from the 2005 KNHANES. The final model predicting the individuals' health status included age, gender, educational attainment, occupation, income, and the regional prosperity index. The concentration index was used to measure and analyze the health inequality. Results : The KNHANES data showed an unequal distribution of the total health inequality in favor of the higher income groups, and this is getting worse over time (0.0327 in 1998, 0.0393 in 2001 and 0.0924 in 2005). The income-related health inequality in 2005 was 0.0278, indicating that 30.1% of the total health inequality can be attributed to income. Conclusions : The findings indicate there are health inequalities across the sociodemographic and income groups despite the recent government's efforts. Further research is warranted to investigate what potential policy actions are necessary to decrease the health inequality in Korea.

식중독의 사회경제적 비용추정: 삶의 질 개념을 적용한 질병비용추정법을 이용하여

신호성,이수형,김종수,김진숙,한규홍,Shin, Ho-Sung,Lee, Sue-Hyung,Kim, Jong-Soo,Kim, Jin-Suk,Han, Kyu-Hong 대한예방의학회 2010 예방의학회지 Vol.43 No.4

Objectives: This study estimated the annual socioeconomic costs of food-borne disease in 2008 from a societal perspective and using a cost-of-illness method. Methods: Our model employed a comprehensive set of diagnostic disease codes to define food-borne diseases with using the Korea National Health Insurance (KNHI) reimbursement data. This study classified the food borne illness as three types of symptoms according to the severity of the illness: mild, moderate, severe. In addition to the traditional method of assessing the cost-of-illness, the study included measures to account for the lost quality of life. We estimated the cost of the lost quality of life using quality-adjusted life years and a visual analog scale. The direct cost included medical and medication costs, and the non-medical costs included transportation costs, caregiver's cost and administration costs. The lost productivity costs included lost workdays due to illness and lost earnings due to premature death. Results: The study found the estimated annual socioeconomic costs of food-borne disease in 2008 were 954.9 billion won (735.3 billion won-996.9 billion won). The medical cost was 73.4 -76.8% of the cost, the lost productivity cost was 22.6% and the cost of the lost quality of life was 26.0%. Conclusions: Most of the cost-of-illness studies are known to have underestimated the actual socioeconomic costs of the subjects, and these studies excluded many important social costs, such as the value of pain, suffering and functional disability. The study addressed the uncertainty related to estimating the socioeconomic costs of food-borne disease as well as the updated cost estimates. Our estimates could contribute to develop and evaluate policies for food-borne disease.

활동기준원가(Activity Based Cost)를 적용한 치과 임플란트 원가산정

신호성,안은숙,Shin, Ho-Sung,Ahn, Eun-Suk 대한치과보철학회 2013 대한치과보철학회지 Vol.51 No.4

연구 목적: 의료환경의 변화에 따라 새로운 의료관리에 대한 필요성과 함께 의료기관의 원가관리에 대한 관심이 증가되었다. 본 연구는 치과의료기관에서 빈번하게 제공되는 치과 임플란트 서비스를 직원의 활동에 근거하여 자원 또는 원가를 배부하는 활동기준원가(Activity-Based Cost, ABC) 방법을 적용하여 원가를 산정하기 위해 시행되었다. 연구 대상 및 방법: 수도권 소재의 A 치과의료기관을 대상으로 치과 임플란트 원가산정을 실시하였다. 해당 기관의 총비용을 확인하기 위해 1사분기 세무회계자료를 사용하였고 기관 내에서 이루어지는 활동을 파악하기 위하여 활동분석표 작성을 요청하였다. 자료를 바탕으로 치과 임플란트에 해당하는 직접원가와 간접원가를 분리하고, 간접원가의 왜곡을 최소화하기 위해 원가동인(Cost driver)을 파악하여 활동별로 비용을 배분하는 활동기준원가 분석을 실시하였다. 결과:치과 임플란트 원가를 직접비와 간접비로 나누어 비교한 결과 각각 35.8%, 49.5%로 나타났다. 치과 임플란트 1개당 원가는 1,579천원 정도로 산정되었고, 임플란트 수술 및 시술 전 후 활동이 포함된 보철 시술 진료영역에 47만원(30%)이 소요되어 가장 많은 부분을 차지하였다. 연수 및 치과학 교육 등의 활동도 기타 진료에 비해 상대적으로 높은 비중을 나타내었다. 결론: 과학적인 치과 임플란트의 수가 산정을 위해서 치과 임플란트와 관련된 직접적인 진료 술식 이외에 시술 전 후 준비활동 등에 대한 고려가 충분히 이루어져야 한다. 임플란트 시술 전 후의 활동 및 교육, 연수활동 등은 간접비에 포함되는 부분이나 진료의 질을 담보하고 환자의 만족도를 향상시키기 위해 반드시 필요할 활동으로 이러한 활동들을 고려한 합리적 수가 산정이 필요하다. Purpose: There is a growing concern for the cost management of medical institutions. The purpose of this study was to estimate Activity-Based Costing (ABC) for dental implant cost. ABC refers to allocating resources or cost based on the activities of services. Materials and methods: A dental institution located in the metropolitan area was selected in this study. The tax accounting data of the institution were utilized to confirm total cost, and the institution was asked to make out clinical activities to figure out what activities were carried out. The direct cost and indirect cost for dental implant were separately estimated, and cost driver was analyzed to estimate the indirect cost accurately. Results: The rates of the direct and indirect cost respectively stood at 35.8 and 49.5 percent. The cost for a dental implant was found to be approximately 1,579 won, and the cost of prosthetic surgery and treatment that included implant surgery accounted for the largest portion of the cost, which was 470 thousand won (30%). And the weight of training and education on dentistry was relatively higher than that of the other kinds of treatment. Conclusion: In order to ensure accurate and scientific costing for dental implant, not only direct medical procedure but every pre- and post-procedure activity should fully be taken into account. Pre-activities, post-activities, education and training are included in the indirect cost, but all these activities are mandatory and associated with the quality of treatment and the satisfaction level of patients.

표준화사망비와 지역결핍지수의 상관관계: 지역사회 통합결핍지수 개발

신호성,이수형,추장민,Shin, Ho-Sung,Lee, Sue-Hyung,Chu, Jang-Min 대한예방의학회 2009 예방의학회지 Vol.42 No.6

Objectives : The aims of this paper were to develop the composite deprivation index (CDI) for the sub-district (Eup-Myen-Dong) levels based on the theory of social exclusion and to explore the relationship between the CDI and the standardized mortality ratio (SMR). Methods : The paper calculated the age adjusted SMR and we included five dimensions of social exclusion for CDI; unemployment, poverty, housing, labor and social network. The proxy variables of the five dimensions were the proportion of unemployed males, the percent of recipients receiving National Basic Livelihood Security Act benefits, the proportion of households under the minimum housing standard, the proportion of people with a low social class and the proportion of single-parent household. All the variables were standardized using geometric transformation and then we summed up them for a single index. The paper utilized the 2004-2006 National Death Registry data, the 2003-2006 national residents' registration data, the 2005 Population Census data and the 2005-2006 means-tested benefit recipients' data. Results : The figures were 115.6, 105.8 and 105.1 for the CDI of metropolitan areas (big cities), middle size cities and rural areas, respectively. The distributional variation of the CDI was the highest in metropolitan areas (8.9 - 353.7) and the lowest was in the rural areas (26.8 - 209.7). The extent and relative differences of deprivation increased with urbanization. Compared to the Townsend and Carstairs index, the CDI better represented the characteristics of rural deprivation. The correlation with the SMR was statistically significant and the direction of the CDI effects on the SMR was in accordance with that of the previous studies. Conclusions : The study findings indicated mortality inequalities due to the difference in the CDI. Despite the attempt to improve deprivation measures, further research is warranted for the consensus development of a deprivation index.

부하차단 메카니즘에 관한 연구

신호성(HO-Sung Shin),문종필(Jong-Fil Moon),김재철(Jae-Chul Kim),송경빈(Kyung-Bin Song) 대한전기학회 2004 대한전기학회 학술대회 논문집 Vol.2004 No.7

지표면과 지중의 연계된 흐름에 대한 수치해석

신호성(Shin Ho sung),김진욱(Kim Jin Wook) 한국방재학회 2017 한국방재학회논문집 Vol.17 No.6

강우에 의한 지표면 유출과 지중 침투는 상호 연관된 현상으로 동시에 고려하여 해석을 수행하여야 한다. 기존의 대부분 수리해석은 지반 침투와 지표면 유출의 상호작용을 고려하지 못하고, 한 부분이 일정하다고 가정하거나 경험식을 이용하여 두 현상의 상호 작용을 무시하였다. 본 연구에서는 지표면 유출에 대한 지배방정식을 제시하고 해의 안정성 확보하기 위한 수식화 기법을 제시하였다. 또한 지중 침투와 연계하기 위하여 불포화 지반의 수리학적 현상에 대한 수정된 지배방정식을 제시하였다. 개발된 해석 모델을 이용하여 일차원 조건에서 지중 침투와 지표면 고임에 대한 수치해석을 수행하였다. 지중침투 해석결과는 지반의 수리학적 특성을 반영한 초기의 침투량 감소와 수렴된 포화 침투량을 모사할 수 있다. 강우에 의한 불포화 사면에서 유량을 직접 주입하는 수치해석법과 지표면 유출과 연계된 지중 침투 해석법에 대하여 비교 논의하였다. 제시된 수치해석 기법은 지표면 간극수압의 과장되고 불안정한 변화가 없는 지표면 유출에 의한 집수 현상과 지중 침투의 연계해석이 가능하였다. Surface runoff and subsurface infiltration are fully coupled processes from the hydraulic point of view and should be analyzed simultaneously. Most of the existing hydraulic analyses fail to take into account the interactions between the ground infiltration and the surface runoff, and ignore the interaction of the two phenomena by assuming that one part is constant or using empirical formulas. In this study, the governing equations for the surface runoff are presented with numerical formulations to improve numerical stability. Also, a modified governing equation for the hydrological phenomena in unsaturated soils is presented to consider ground infiltration due to rainfall. Numerical analysis on ground infiltration and surface ponding in one-dimensional flow condition was performed using the developed coupled model. Numerical results showed the initial reduction of the infiltration rate and asymptotic saturated infiltration rate depending on the hydraulic characteristics of the subsurface. Also, hydraulic study on unsaturated slopes by rainfall discussed a strength of coupled surface runoff-ground infiltration model over common direct injection model. The proposed numerical scheme is capable for a coupled analysis between surface ponding with the runoff and subsurface infiltration, without exaggerated or unstable predictions of surface pore water pressure.

일반치의사의 졸업 후 수련교육과정: 일차치과 의료의 질 향상을 위한 방안

신호성 ( Ho Sung Shin ),홍수연 ( Soo Yeon Hong ),김명기 ( Myeng Ki Kim ) 대한구강보건학회 2005 大韓口腔保健學會誌 Vol.29 No.1

가구 소득과 보건의료비 지출의 형평성: 누진성과 소득재분배 효과

신호성 ( Ho Sung Shin ),김명기 ( Myeng Ki Kim ),김진숙 ( Jin Sook Kim ) 한국보건행정학회 2004 보건행정학회지 Vol.14 No.2

The present study attempts to examine the progressivity of health care financial sources based on the income approach, for which it decomposes redistributive effects into vertical, horizontal, and re-ranking components. The study data include Korean Household Expenditure Survey (2000) conducted every 5 year by Korea National Statistical Office. The data were sampled from the national population by the multistage probabilistic sampling method, and amounts to 23,270 households. For the better application of the income approach, the study employs household total expenditure in Korea instead of total income, because the former data source is more reliable and less fluctuated over time. Progressivity of health care financing was measured by Kakwani index. Aronson`s decomposition equation was used in case of the analysis where differential treatment of health care expenditure needs to be considered. Despite the progressivity of Korea`s governmental contributions, total expenditure of health care showed regressive pattern, which may largely be attributable to the higher regressivity in out-of-pocket money. With the result of negative Kakwani index, differential treatment increased income redistribution biased for better-off. It is worth to note that social insurance displays not only negative Kakwani index, but also horizontal inequality, suggesting that the first step of health care financing reform should be the revision of social insurance premium rates toward effective and equable way.

지역적 특성과 부하특성을 고려한 직접부하제어 알고리즘

신호성(Ho-Sung Shin),송경빈(Kyung-Bin Song),문종필(Jong-Fil Moon),김재철(Jae-Chul Kim),남봉우(Bong-Woo Nam) 대한전기학회 2006 대한전기학회 학술대회 논문집 Vol.2006 No.7

This paper presents direct load control algorithm based locational and electric load characteristics. Direct load control is defined that demand-side management program activities that can interrupt consumer load at the time of annual peak load by direct control of the utility system operator by interruption power supply to individual appliances or equipment on consumer premises. Korean power system is divided into 14-areas considering branches operating in KEPCO, and electric loads are classified into 19 load groups considering interruption costs in this paper. The purpose of proposed method is to decrease social losses by controlling electric loads mainly whose interruption costs are low. It is expected that the proposed algorithm can be used as the countermeasure for the emergency state of the electric power dispatch in a operation point of view.

시공간 분석을 이용한 외래 의료이용의 지역적 차이 분석

신호성 ( Ho Sung Shin ),이수형 ( Sue Hyung Lee ) 한국지리정보학회 2012 한국지리정보학회지 Vol.15 No.4

본 연구는 시공간분석을 이용하여 주요 만성질환인 고혈압, 당뇨병, 관절증과 총의료이용에 있어 지역별 외래의료이용 차이를 살펴보았다. 분석자료는 보건복지부와 한국보건사회연구원에서 발간하는 1996, 1999, 2002, 2005, 2008년 환자조사 자료를 이용하였으며 분석방법으로는 베이지안 계층적 시공간모형(bayesian hierarchial spatio-temporal model)을 이용하였다. 이때 지역의 공간적 상관성은 convolution CAR 모형을, 시간적 상관성은 Ornstein-Uhlenbeck 방법을 적용하여 분석하였다. 분석결과 질환별로 의료이용에 있어 지역적 차이가 존재하였다. 총의료 이용의 경우 시·군지역보다 대도시인 구지역에서 높은 상대위험비를 보인반면, 만성질환인 고혈압, 당뇨병, 관절증은 총의료이용과는 달리 강원도, 충청남북도, 전라남북도, 제주도 등 농어촌 지역에서 전국평균보다 높은 의료이용(상대위험비)을 보였다. 특히 고혈압은 부산경남 해안가 지역과 강원, 경기, 경북, 충청남도, 전북 등에서 높은 의료이용을 보였고, 관절증은 경기, 강원 일부와 충북, 충남, 전북, 전남, 경북, 경남지역 등에서, 당뇨병은 경기, 서울, 부산, 전라남북, 충청일부 지역에서 상대적으로 높은 의료이용을 보였다. 본 연구는 기존 연구와는 달리 공간적, 시간적 상관성을 고려함으로써 지역단위 분석시 공간적, 시간적 상관성을 고려하지 않음으로써 발생하는 통계적 오류를 최소화하였다. The purpose of this study was to examine the regional disparity of ambulatory health care utilization considering spatio-temporal variation in South Korea during 1996-2008(precisely, in 1996, 1999, 2002, 2005, and 2008) using bayesian hierarchial spatio-temporal model. The spatial pattern uses an intrinsic gaussian conditional autoregressive (CAR) error component. Ornstein-Uhlenbeck method was applied to detect the temporal patterns. The results showed that substantial temporalgeographical variation depending on diseases exists in Korea. On the Contrary to the pattern of total outpatient utilizations, for example, the areas that chronic diseases distributed relatively high were most in rural where the proportion of elderly population was higher than in the urban. Chungcheongnam-do, Junlabuk-do, and Kyeongsangbuk-do had higher risks in hypertension, whereas arthritis was higher risk in the Kyeonggi-do, Chungcheongbuk-do, Junlanam-do, and Junlabuk-do. The results of this study suggested that the effective health intervention programmes needed to alleviate the regional variation of health care utilization. These outcomes also provided the foundation for further investigation of risk factors and interventions in these high-risk areas.