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양봉민 대한에이즈예방협회 2005 레드리본 Vol.63 No.-
증가하는 HIV/AIDS 감염과 그로 인한 파괴적 결과는 세계적 관심사가 되었고, 발병률이 높은 지역에서 AIDS는 보건의료 문제를 넘어서 국민총생산을 감소시키는 사회경제적 문제가 되고 있다. 한국은 상대적으로 HIV감염 AIDS 발병률이 낮은 나라지만 당초 예상과는 달리 그 발병률이 둔화되고 있지 않으며, 1999년 이후 최근에는 감염자의 수가 급격히 증가하는 추세에 있다. 세계 다른 나라들이나 아시아의 주변국의 사정을 보면 우리나라도 결코 안전한 권역에 계속 머물러 있으리라는 장담을 하기가 어렵다. 특히 근년에 경제적 생산력이 왕성한 $20\~30$대 남성에서 HIV/ADIS 증가하고 있어, HIV/AIDS감염의 사회적 비용, 그 중에 특히 경제적 영향에 대한 관심이 커지고 있는 상황이다. 따라서 우리나라에서 발생하는 HIV/AIDS의 경제적 비용을 추산함으로써 증가하는 HIV/AIDS감염의 경제적 의미를 찾을 필요가 있다고 판단된다. 경제적 비용의 추산에 앞서 우선 우리나라 HIV/AIDS 감염자 수를 추계하여 보면 다음과 같다.
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양봉민,백승운,최문석,이덕희,한오석 한국보건경제학회 2000 보건경제와 정책연구 Vol.6 No.2
Hepatitis B (HBV) infection is endemic in Korea. Vaccination programs introduced in 1983 have reduced the prevalence of HBV in people aged less than 20 years to 2.8%(Ahn YO. 1996). however, there will be significant morbidity due to HBV for the next 15-30 years until the real benefit of the vaccination programs take effect. This study investigates the 1) the total direct medical costs and 2) the indirect costs associated with HBV in South Korea in 1997. Medical literature and other published data were used to gain an understanding of HBV: its epidemiology and disease progression. The Korean medical insurance database, patient records, patient questionnaires, and expert opinion were used as sources of data. Direct and indirect costs for prevention. acute infection, chronic infection, cirrhosis, and liver cancer were estimated. HBV related morbidity and mortality are a significant cost burden to the Korean healthcare system. In 1997, the total direct and indirect costs of HBV related diseases are 4.47 of national health expenditures. The direct costs alone are 3.11% of the national healthcare expenditure (NHE). This is similar to the expenditure in developed countries for diseases such as diabetes and asthma. The greatest components of the direct costs are the cost of in-patient and outpatient care. The results of this study confirm the importance of the vaccination program in Korea. An effective vaccination program will lead to huge cost savings if infection rates can be minimized. However, while large percentage of the population is infected with HBV, preventing disease progression also has potential cost benefits.
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양봉민,정수경 한국보건경제학회 2000 보건경제와 정책연구 Vol.6 No.2
Hormone replacement therapy (HRT) is known as an effective treatment of menopausal symptoms and the usefulness of HRT in preventing osteoporosis and coronary heart disease (CHD) is well established. However, increase of risk in breast cancer is possible after long-term HRT. This study examined the overall risk-benefit balance of prolonged therapy to Korean population on the basis of the national statistics on mortality, morbidity and epidemiologic evidences and then appraised the cost-effectiveness of HRT for the postmenopausal women along with the prolongation of therapy at different ages of therapy initiation. A Markov model was used to evaluate the cost-effectiveness of 20 duration and age-related strategies comprising a hypothetical healthy woman at age 50 and a woman aged 60 in average health state with HRT (receiving CEE 0.625mg, MPA 5mg) for 1 to 10 years each. 8 transition states were set and probability of each state was calculated annually from age 50, 60 to age 84 each. Effectiveness was expressed with life-years gained (LYCs), quality-adjusted life years (QALY) and disability-adjusted life years (DALY). Estimated medical cost, composed with direct cost, indirect cost and induced cost per patient, was adopted and cost-effectiveness was evaluated for each strategy. Long-term use of HRT could be more effective and beneficial to menopausal women at any age. HRT was found to be more effective to 50-year old women in LYG: 1.52years and in QALY, it produced more benefit: 2.69years. In DALY. 60-year old woman counterpart was more effective due to high prevalence and burden of disease. It appeared that overall expenditure related to HRT was influenced critically by the direct costs of treatment rather than by any cost incurred or saved which is related to increased risk and prevention benefit because drug cost, fee and several screening and examinations related to HRT was expensive and immediate. The magnitude of estimated cast-effectiveness of 10-year intervention would be 1,125.388won, 1.187.481won per LYG in 50 and 60-year old woman respectively. When quality of life was considered. HRT was found to be more economical, amount to 623,578won per QALY in 8-year intervention and 444.598won per DALY in 50-year old woman. When the effect is discounted by 5, it may be more cost-effective alternative to apply to woman over 60-year old who is at high risk for fracture and coronary heart disease. A long-term use of HRT benefits the individual patient not only by obviating the acute symptom but also by preventing diverse diseases and ultimately, substantial public health could be also beneficially affected.
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양봉민,조대선,김윤희,홍지민,김정수 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.9
Purpose:This study aims to estimate the financial cost of rotavirus infection in Korea in the year of 2005. Methods:The incidence rates used were from the epidemiological profile at Jeoungeub District (5.8 cases/1,000 children <5 years old for inpatients, and 22.65 cases/1,000 children <5 years old for outpatients, per year). The health care cost per capita of rotavirus infection (ICD code: A08.0) was extracted from the Health Insurance Review and Assessment Service database in Korea. The patient survey was conducted to capture information about non-medical costs and associated productivity loss incurred by adult caregivers. Results:The number of annual national cases among children <5 years old with rotavirus infection was estimated to be 69,122 (i.e., 55,030 outpatients and 14,092 inpatients). The total cost of rotavirus infection was estimated at 13.3 billion Korean won, comprising 11 billion Korean won (82.7%) of direct medical costs, 1.6 billion Korean won (12.0%) of direct non- medical costs (e.g., transportation and supplies), and 0.68 billion Korean won (5.1%) of productivity lost by adult caregivers. Conclusion:Rotavirus infection carries not only medical costs but also non-medical and indirect costs; together, these costs incur a significant burden on South Korean society. The impact of rotavirus on quality of life and health among patient caregivers was not considered in this study, but it does merit further research. (Korean J Pediatr 2008;51:977-986) Purpose:This study aims to estimate the financial cost of rotavirus infection in Korea in the year of 2005. Methods:The incidence rates used were from the epidemiological profile at Jeoungeub District (5.8 cases/1,000 children <5 years old for inpatients, and 22.65 cases/1,000 children <5 years old for outpatients, per year). The health care cost per capita of rotavirus infection (ICD code: A08.0) was extracted from the Health Insurance Review and Assessment Service database in Korea. The patient survey was conducted to capture information about non-medical costs and associated productivity loss incurred by adult caregivers. Results:The number of annual national cases among children <5 years old with rotavirus infection was estimated to be 69,122 (i.e., 55,030 outpatients and 14,092 inpatients). The total cost of rotavirus infection was estimated at 13.3 billion Korean won, comprising 11 billion Korean won (82.7%) of direct medical costs, 1.6 billion Korean won (12.0%) of direct non- medical costs (e.g., transportation and supplies), and 0.68 billion Korean won (5.1%) of productivity lost by adult caregivers. Conclusion:Rotavirus infection carries not only medical costs but also non-medical and indirect costs; together, these costs incur a significant burden on South Korean society. The impact of rotavirus on quality of life and health among patient caregivers was not considered in this study, but it does merit further research. (Korean J Pediatr 2008;51:977-986)
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양봉민 한국보건행정학회 1991 보건행정학회지 Vol.1 No.1
Health of a nation is quite often represented by the statistics such as infant death rate and maternal mortality rate. It is indisputable that maternal child health(MCH) is the basis of health of a nation. MCH is also one of the cardinal component of primary health care. The importance of MCH is conspicuous especially in the developing countries. In Korea, People in the rural communities still have high access barrier to basic health care needs, including MCH services. Access to quality care during pregnancy and delivery seems to be the crucial factor in preventing deaths in women and children. The beneficial effects of prenatal and postnatal care on the outcome of pregnancy for mother and child, and those of health professional-attended institutional delivery on the health of mother and child have been well documented in many studies. Recognizing these effects, the government of Korea received IBRD loan of $30 million in 1979 for th purpose of constructing 89 rural MCH centers. The construction is complete now and all 89 MCH centers are under operation ti imporve primary health care for mothers and children in Korea. However, it has been observed over time that overall performance of public MCH centers is declining. The decline has been attributed partly to low quality services by public MCH centers, poor management by health center mangers, competition with for-profit private clinics, and to the development of national health insurance. This study investigates the utilization by rural communities in Korea of MCH services provided by public sector health centers deemed to be physically and financially accessible to the community but suboptimally used. It seeks also to determine the factors that influence people's utilizations. This study sets out to discover a desirable form of MCH center from among alternative forms of centers, thereby to construct a MCH model.
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