은퇴자의 삶의 만족도 영향요인: 비재무적 영역을 중심으로

위세아 한국비영리학회 2019 한국비영리연구 Vol.18 No.2

The purpose of this study is to find factors affecting the satisfaction of retirees' lives and to present direction for pursuing healthy lives of retirees. A regression analysis was conducted for retired householders who replied "Retired" using the ‘Korean Retirement & Income Study(KReIS)’ 6th Year Survey and additional survey materials. The following are the results of analyzing the influence of retired people on their retirement life through physical health factors, psychological health factors, leisure life, and interpersonal relationships. The results of the analysis showed that the influence factors on the life satisfaction of retired people were 41.9% explanatory, depressed, and the physical health was the most influential. And it was found that satisfaction with leisure, educational level, social support, psychological health, healthy lifestyle, age, and marital status affect life satisfaction. Based on these results, they presented suggestions for improving the satisfaction of the retired person's. 본 연구는 은퇴자의 삶의 만족도에 영향을 미치는 요인을 살펴보고, 이를 통해서 은퇴자의 건강한 삶을 추구하기 위한 방향성을 제시하기 위하여 수행되었다. 국민노후보장패널 6차년도 본조사와 부가조사 자료를 활용하여 ‘은퇴하였다’라고 응답한 은퇴한 가구주를 대상으로 회귀분석을 실시하였다. 은퇴자가 겪는 변화를 살펴보고 노후준비의 비재무적인 영역인 신체적 건강 요인, 심리적 건강 요인, 여가생활, 대인관계를 통해 은퇴자의 노후 삶과의 영향 관계를 분석한 결과는 다음과 같다. 분석결과, 은퇴자의 삶의 만족감에 미치는 영향요인은 41.9%의 설명력을 가지는 것으로 나타났다. 또한 은퇴자의 우울, 신체적 건강상태가 상대적으로 가장 높은 영향력을 보였다. 그리고 여가만족, 교육수준, 사회적지지, 심리적 건강상태, 건강한 생활 습관, 연령, 혼인상태 순으로 삶의 만족도에 유의한 영향을 주는 것으로 나타났다. 이와 같은 결과를 바탕으로 은퇴자 삶의 변화에 따라 우울과 같은 심리적 건강요인, 노년기 진입에 따른 신체적인 변화, 생활환경의 변화 등이 삶에 영향을 미친다는 점을 확인하였다. 따라서 본 연구에서는 은퇴자의 삶의 만족감 향상을 위해 은퇴 이후 삶을 준비하기 위한 개인적·사회적 노력이 제반되어야 함을 강조하였다.

노숙인의 문화여가활동이 삶의 만족감에 미치는 영향

위세아(WEE Se Ah) 숭실대학교 사회과학연구소 2017 사회과학논총 Vol.20 No.2

본 연구는 사회적 취약계층인 노숙인의 문화여가활동 접근성이 삶의 만족감에 얼마나 영향을 미치는지 살펴보고 더불어 문화여가활동 접근성과 삶의 만족감 간의 관계에 사회통합의 매개효과를 검증하였다. 본 연구의 분석결과를 통해 다음과 같은 시사점을 도출하였다. 사회적 취약계층인 노숙인이 문화여가활동 참여를 통해 사회적 통함감이 증진되고 궁극적으로 삶의 만족감이 높아진다는 점에서 문화여가활동의 중요성을 확인하였다. 이는 문화적 소외계층에 대한 문화향유 기회 제공과 접근성의 확대가 삶에 긍정적인 영향을 주어 사회적 배제감 감소를 이끈다는 점에서 중요하다. 즉 소외계층에 대한 문화여가활동 참여가 단순히 문화향유권을 인정하는 것을 넘어서 그들의 삶에 변화를 가져오고 사회구성원으로서 사회에 융화되는 발판을 마련한다는 점에서 의의가 있다. This study concerns how accessibility of leisure activity affect on homeles who is the social vulnerable class and have the purpose to verify that the social inclusion has a mediating effect between the accessibility of leisure activity and life satisfaction. Throughout the result of this study, the implication is drew out as follow. The significance of leisure activity is confirmed as the social inclusion and life satisfa ction are finally enhanced when homeless do leisure activity. Thus, it implies that reinforcing opportunity of enjoying culture and accessibility to the social vulnerable class affect positively on homeless and decrease social exclusion. Part icipation in leisure activity of the social vulnerable class is not only acknowledging their right of enjoying culture but also it means they can be included as social member.

지역별·분야별 전문병원 적정규모 산출방안 연구

조민호,위세아,김승완 건강보험심사평가원 심사평가정책연구소 2023 연구보고서 Vol.2023 No.0

Background : In order to provide hospitals with high quality medical services and establish a healthcare delivery system through strengthening expertise, the S. Korean government has been implementing specialty hospital policy. The purpose of this study is to provide evidence for the implementation of policies to reduce medical disparities between regions through equal distribution of specialty hospitals. Method : This study analyzed health insurance claim data to calculate appropriate demand for specialty hospitals. The demand for specialty hospitals in each region was assumed to be the level of demand for the number of specialty hospital beds by using the hospitalization episodes and relevance index and the proportion of regional specialty hospital treatment volume. Result & Conclusion : In the case of joint hospitals, parts of Busan and the Cheongju area exceeded Lv.7(max) demand. In spine specialty hospitals, the southeastern region of Seoul and some areas of Gyeonggi-do exceeded Lv.7 demand. In the case of ophthalmology, the southwestern region of Seoul, Goyang, Gyeonggi-do, and the northeastern region of Incheon were found to exceed Lv.7 demand. The results of this analysis need to be applied with consideration of the current medical issue and situation in S. Korea.

외부병원 필름판독료 수가 개선에 따른 효과평가 연구

김록영,조민호,위세아 건강보험심사평가원 심사평가연구소 2020 연구보고서 Vol.2020 No.0

As part of coverage expansion plan, the government decided to include brain-related MRI scan into the benefit package, and raised external MRI image decipher service fee for healthcare service providers in an attempt to induce appropriate level of service use. As MRI scan of spine and musculoskeletal system are planned to gradually come into national health insurance package, there is a need for a continued improvement of MRI coverage policy. To enable such improvement, this study aims to provide effectiveness assessment and suggestions for proper management measures. This study analyzed policy effectiveness of health service usage pathway before and after MRI inclusion into the benefit package of national health insurance system. Regarding analysis method, 30-day healthcare service use data of patents who received brain-related MRI scan were structured by episode and analyzed with t-test and Logit, in order to see the difference between before and after the policy implementation. The result showed that the increased decipher authority of specialist physicians led to more MRI image decipher cases of external clinics. As a result of increased MRI image decipher fee, there was an uplift of external MRI decipher cases, when compared to before the policy change. It means that more providers chose to use MRI scan taken by other clinic or hospital, rather than performing another scan at their own facility. The type of providers performing MRI scan was divided into two groups: general/tertiary hospitals, and hospitals and clinics. Policy effect was analyzed by patients' route, and it was shown that different routes had different policy effect. Based on the result, raise of MRI decipher fee was proposed for rational use pattern of healthcare resource, such as getting MRI scan with 3 Tesla MRI at a general or tertiary hospital, and visiting a hospital or clinic to get it deciphered. In order to build and operate an efficient and comprehensive healthcare resource management system, exchange of medical image data should be available more easily and conveniently. Such improvement is expected to contribute to reduction of reduced social cost and stabilization of the National Health Insurance fund.

공익목적 임상연구 요양급여 적용 현황분석 및 개선방안

홍미영,김세린,위세아 건강보험심사평가원 심사평가정책연구소 2023 연구보고서 Vol.2023 No.0

The Standards for the Application of National Health Insurance Benefits for Clinical Research was implemented in May 2018 to cover the routine care costs of clinical research for public benefit, in order to expand treatment opportunities for new medical technologies in situations where patients have no alternative treatment options. Since the implementation, there has been a consensus on the significance and necessity of the project, but the consensus is still weak in terms of activation and advancement of the project. In this study, I identified the current situation by analyzing domestic and foreign clinical research support cases and data on applications and claims. I prepared improvement strategies for the clinical research medical benefits for public interest purposes based on the situation analysis and a collection of stakeholder opinions. The results of the domestic clinical research support system showed that the government and public institutions provide research funds and infrastructure for research related to rare, terminal, and severe diseases for which there is no alternative medical technology, and also consider aspects of research design to confirm clinical utility when selecting eligible clinical studies. A review of clinical research support systems in other countries shows that it is difficult to identify commonalities between the projects. The United States considers the therapeutic purpose, improvement of health outcomes, and appropriateness of the research design, while Japan applies health insurance based on the routine care cost for clinical research with licensing purposes. The United Kingdom and Australia determine support based on whether the research is commercial or non-commercial. As a result of checking the status of applications and claims, the proportion of investigator-initiated clinical studies is high, and the number of clinical studies applying for clinical research medical benefits has been increasing overall. The approval rate of sponsor-initiated clinical studies reviewed by the committee was less than 50%, and there were cases where the sponsor was a non-profit organization or a national research and development project. The results of the stakeholder and expert interviews were mixed, depending on the characteristics and interests of the subjects. Considering the purpose of the system and the status reviewed above, I propose improvements to the system for the purpose of fostering the application of clinical research medical benefits for public interest and rationalizing the application and management standards. Firstly, the application criteria and other systems should be improved in order to expand the number of clinical studies covered by routine care costs and increase the predictability of the review results. Second, to reduce the involvement of for-profit organizations in clinical research outcomes, efforts should be made to expand health insurance coverage of routine care costs as well as long-term support for research and infrastructure through public funds. Finally, it is necessary to establish an infrastructure to manage domestic clinical research from approval by the Ministry of Food and Drug Safety to registration of research results and to identify the status of clinical research so that mid- to long-term planning can be made.

주요국의 지불제도 개편 동향 연구 : 지속가능한 의료보장을 위한 지불제도 개편을 중심으로

이근정,서은원,위세아,신양준 건강보험심사평가원 심사평가연구소 2020 연구보고서 Vol.2020 No.0

This study aims to offer suggestions for payment system reform in Korea based on understanding of recent discussions around payment system in the international society and current trend of reform in major countries. First of all, we examined the role, type, and reform trend of the payment system discussed in major international organizations, such as WHO and OECD. And then, we reviewed the reform trend of the payment system in countries that have recently carried out payment system reform, such as the United States, United Kingdom, Australia, and Japan. These countries have applied a variety of new payment models, including Bundled Payment System, Performance-based Payment System, and Population-based Payment System referred to as Accountable Care Organizations(ACOs) to make a transition to a value-based payment system where quality of care and efficiency are considered top priorities. It is time for Korea to begin a lively discussion to prevent the potential crisis of fund sustainability in healthcare, and payment system reform can serve as the important policy lever. The current payment system needs to reinforce flexibility and diversification in terms of payment methods. Although such change should come without bringing disruption to Fee-for-service, the main payment system of Korea, the reform should be able to put experimental application of alternative payment system into place where stakeholders would want to voluntarily take part in.

아동양육시설 임상심리상담원의 업무경험에 관한 연구

도병훈,김은경,위세아 한국콘텐츠학회 2023 한국콘텐츠학회논문지 Vol.23 No.1

본 연구는 아동양육시설에 종사하는 임상심리상담원의 역할수행과정에 대한 경험을 이해하고, 임상심리상담원의 경험이 가진 의미와 현장에 주는 함의를 알아보는데 목적을 두고 있다. 이를 위하여 질적사례 연구방법을 활용하여 2018년 3월부터 2022년 6월 까지 문헌연구, 관찰, 심층면접이 실시되었으며, 수집된 자료는 범주화하여 분석하였다. 연구결과 임상심리상담원들은 기관 내 종사자와의 갈등, 고립, 업무정체성에 대한 혼란, 슈퍼비전의 부재 등으로 고충을 겪고 있는 것으로 나타났다. 이를 극복하기 위한 노력으로 임상심리상담원들은 고유업무 비중을 늘렸고 원장·사무국장의 업무 수행 지지를 이끌어 내었다. 직원과의 갈등 관계는 소통 관계로 전환시키고 네트워크를 활용하는 등 전문성을 확보하고자 하였다. 이러한 노력들을 통하여 임상심리상담원의 정체성확립과 시설장의 인식변화, 종사자들의 역량 강화의 변화가 나타나는 경험을 하는 것으로 나타났다. 이와 같은 연구 결과를 통해, 종사자 법정규모에 맞게 충원, 아동양육시설 아동의 심리·정서지원을 위한 종사자 교육, 지속적인 슈퍼비전 방안 개발, 협의체 활성화, 중앙기구 설립, 임상심리상담원의 시설 내 위상 확립에 대한 제언하였다.

외국의 묶음지불제도 도입 현황 및 한국에의 시사점 : 미국, 영국, 호주를 중심으로

서은원 ( Eun-won Seo ),위세아 ( Se-ah Wee ),신양준 ( Yang-jun Shin ),이근정 ( Keun-jung Lee ),이진용 ( Jin-yong Lee ) 한국보건경제정책학회(구 한국보건경제학회) 2021 보건경제와 정책연구 Vol.27 No.2

전 세계는 고령화와 만성질환 증가 등으로 의료비가 증가함에 따라 보건의료시스템의 지속 가능성 위기에 직면하였고 이에 대한 대안으로 지불제도 개혁을 추진하고 있다. 우리나라 또한 유사한 보건의료 환경에 대응하기 위하여 다양한 지불제도에 대한 모색이 필요한 시점이다. 이에 이 연구는 묶음지불제도를 도입한 OECD 국가 중 미국, 영국, 호주의 사례를 살펴봄으로써 한국의 묶음지불제도 도입에 대한 정책적인 시사점을 제시하고자 하였다. 미국과 영국, 호주는 기존 지불제도의 한계를 보완하면서 의료 질 향상, 비용 절감, 의료연계 강화 등의 목표를 달성하기 위해 묶음지불제도를 도입하였다. 미국과 영국은 특정 질환 또는 처치에, 호주는 만성질환 관리에 묶음지불제도를 적용하였고, 그 결과 의료 질 관리와 비용 절감에 긍정적인 효과가 있는 것으로 나타났다. 따라서 우리나라에서도 포괄적, 연속적인 서비스 제공의 필요성과 적용 대상이 명확한 특정 질환에 대해 시범적인 묶음지불제도 도입을 고려할 수 있으며, 추후 제도의 적용 가능성을 판단하고 세부사항을 내실화한다면 건강보험 제도의 재정적 지속가능성 제고를 위한 정책 수립의 근거를 마련하는데 도움이 될 것이다. This study aims to offer policy implications for introducing the bundled payment system in Korea by looking into other countries’ experience. Three countries, which include the United States, the United Kingdom, and Australia, were selected through the method of purposive sampling. These countries have adopted Bundled payment models with the aims of improving the quality of care, reducing cost, and enhancing care coordination, while addressing the limitations of existing payment systems. The U.S. and the U.K.’s application of bundled payment models focuses on certain conditions or treatments, and Australia’s targets chronic condition management. The introduction of the bundled payment system in these countries resulted in having a positive effect on managing the quality of care and reducing medical spending. Such results suggest that Korea may consider introducing pilot initiatives that implement bundled payment models for certain conditions, with clearly identifiable targets, which require comprehensive and continuous services. Pilot implementations of the system will provide an opportunity to examine applicability of the system and improve the details, which, in turn, will contribute to making policies for enhancing financial sustainability of Korea’s health insurance system.

학회별세션 1/ 후원기관별 세션 : 사회보장정보화 현황과 과제 (사회보장정보원) ; 복지사업 기준 표준화 연구의 의의와 전개방향

이대영,김성훈,이인수,위세아 한국사회보장학회 2015 한국사회보장학회 정기학술대회 Vol.2015 No.2

MRI 외부병원 판독 수가 인상의 효과 분석: 뇌 관련 자기공명영상을 중심으로

김록영 ( Logyoung Kim ),사공진 ( Jin Sakong ),조민호 ( Minho Jo ),위세아 ( Seah Wee ),이진용 ( Jinyong Lee ),김용규 ( Yongkyu Kim ) 한국보건행정학회 2021 보건행정학회지 Vol.31 No.3

Background: In 2018, the government increased the fee for the magnetic resonance imaging (MRI) image deciphering services of the external hospital to discourage the redundant MRI scan and to induce appropriate use of the MRI services. It is important to evaluate the effect of the policy to provide the basis for establishing other MRI-related policies. Methods: The healthcare data of the patients who had brain MRI scans were organized by episode and analyzed using the panel study in order to find out the effect of the MRI-related policy on the substitution effect and the medical expenses. Results: As a result of the increase in the fee of deciphering the MRI image, there has been an uplift in deciphering the MRI scan of the external hospital. It implies that more hospitals chose to use the MRI scan taken by other clinics or hospitals, rather than the MRI scan taken at their own facilities. Conclusion: The research results imply that a policy that facilitates the exchange of the medical image data between the hospitals is needed in order to establish an efficient management system of the healthcare resources. Such improvement is expected to reduce the social cost and contribute to the stability in the finance of national health insurance.