중,고령자의 민간의료보험 가입 여부의 결정 요인

유기봉 ( Ki Bong Yoo ),조우현 ( Woo Hyun Cho ),이민지 ( Min Jee Lee ),권정아 ( Jeoung A Kwon ),박은철 ( Eun Cheol Park ) 한국병원경영학회 2012 병원경영학회지 Vol.17 No.3

Objectives : The coverage of Korean National Health Insurance is limited to basic level. Korean government encourages private health insurance for covering medical securities. So, many studies examined the determinants of purchasing private health insurance. However, 11% of Korean population is older than 65 in 2011. Considering the elderly is important to establish a health policy. The aim of this study is to examine factors determining the purchase of private health insurance among middle-aged and elderly Korean adults. Methods : We used the second Korean Longitudinal Study of Ageing (KLoSA), selected 8,688 sample of the aged 47 or older for the analysis. KLoSA collected information on demographic characteristics, income, health- related factors. KLoSA data include in the number of outpatient, inpatient, oriental hospital visit, dental clinic visit for two years. Logistic regression was used to examine the relationship between the determinants of purchasing private health insurance and the factors which include age, gender, education, residential district, marital status, smoking, drinking, physical exercise, economic activity status, national health insurance type, income, the number of chronic disease, and the number of outpatient, inpatient, oriental hospital visit, dental clinic visit for two years. Results : People who were older, did not live in a city, had higher IADL, currently drunk alcohol, did exercise regularly and had chronic diseases more than three were inclined not to purchase private health insurance. Females, the married, well-educated, past & currently smokers, the employed, high income earners, national health insurers, metropolitan citizens and someone who got high MMSE were more likely to purchase private health insurance. The more people experienced outpatients, inpatients, dental clinics and Chinese medicine clinics, the more private health insurance was purchased. The elderly people over 75 had more private health insurance than the aged 65-74. The strongest factors for private health insurance is gender, and economic status such as income. Conclusion : In this study, we found healthy-high income people were more likely to purchase private health insurance. In contrast, unhealthy-low income and older people did not. The economic factors were strongly related with private health insurance in aged over 75. These mean inequality exists in the using private health insurance. Therefore, the government should consider vulnerable social group before expanding private health insurance.

우리나라의 만성콩팥병으로 인한 사회경제적 부담 추정에 관한 연구

유기봉 ( Ki Bong Yoo ),최재우 ( Jae Woo Choi ),김범석 ( Beom Seok Kim ),김태현 ( Tae Hyun Kim ) 대한보건협회 2014 대한보건연구 Vol.40 No.3

연구목적 : 이 연구는 만성콩팥병의 사회경제적 비용을 추계하기 위해 실시되었다. 연구방법 : 만성콩팥병으로 인한 사회경제적 비용 추정과정은 질병비용연구(cost of illness study)에 바탕을 두었다. 총비용은 직접비용과 간접비용으로 나누어 추계하였다. 추정에 이용된 자료는 건강보험 및 의료급여 진료비와 직접비의료비 및 간접비용 추정에 필요한 각종 통계자료이다. 분석은 가장 최근 연도인 2011년을 기준으로 유병률 접근법에 의한 한 횡단면 분석 prevalence-based cross-sectional design)이 시행되었다. 연구결과 : 연구결과는 2011년 현재 우리나라에서 만성콩팥병으로 인해 발생한 직접 의료비가 1조8,696억 원, 교통비 1,344억 원, 간병비 1,102억 원, 시간비용 2,098억 원, 사망손실 1,746억 원, 장애손실 2조5,233억 원으로 총 5조219억 원인것으로 추정되었다. 추정과정에서의 한계점으로 인해 다소 과소추계되었음을 감안한다면, 실제 만성콩팥병으로 인한 사회경제적 비용은 이 보다 더 클 것으로 예상된다. 또한 다른 주요 만성질환으로 인한 사회경제적 비용과 비교해 보아도 매우 높은 수준임을 알 수 있다. 결론 : 이 연구의 결과는 질병 간 보건의료자원의 효율적인 분배를 결정하고 필요한 자원의 규모를 파악하는데 활용될 수 있을 것이며, 관련 정책을 입안하는 데 중요한 근거자료가 될 수 있을 것이다. 나아가, 만성콩팥병의 예방관리를 위한 보다 많은 노력이 조속히 이루어져야 함을 시사한다. Objectives : This study examines the socioeconomic burden of chronic kidney disease (CKD) in Korea. Methods : Overall process of estimating the cost of CKD is based on the cost of illness study. Total cost is divided into both direct and indirect cost. The data used in this study include the 2011 National Health Insurance Claims data, and other secondary databases that are needed to estimate indirect costs. The prevalence-based cross- sectional design approach was used. Results : The results show that socioeconomic burden of chronic kidney disease is alarming in Korea, where total direct and indirect costs associated with CKD are estimated over KRW 5,000 billion (US$ 5 billion) in 2011. Given the limitation of study data and estimation process, the results might have been underestimated. Compared with other major chronic disease, cost of CKD can be considered as substantial. Conclusion : It is suggested that public awareness regarding the significance of CKD should be enhanced. In addition, more prompt attention to prevention and management of CKD need to be paid.

가감지급사업 실행 후 급성기 출혈성 뇌졸중의 원내 사망률 변화 분석

설진주,유기봉,이광수,Seol, Jin-Ju,Yoo, Ki-Bong,Lee, Kwang-Soo 한국병원경영학회 2022 병원경영학회지 Vol.27 No.1

Purposes: This study purposed to evaluate the effect of a value incentive program(VIP) on the in-hospital mortality of acute stroke. Methodology: Study period was from January 2010 to December 2018. This study included 63 hospitals for acute hemorrhagic stroke that the mortality rate per month was more than one during study period. Independent variables were time variables and hospital characteristics such as hospital type, district and bed number. Interrupted time series analysis was applied to analyze the data. Findings: In case of general hospitals, the in-hospital mortality rate per month for acute hemorrhagic stroke tends to be increased by 0.03% in overall study periods but decreased by 0.32% after the implementation of the policy. On the other hand, tertiary hospital changes are not statistically meaningful. Conclusion: This study provides evidences how the VIP was effective in improving quality of acute hemorrhagic stroke care. General hospitals showed higher policy effect compare to that of tertiary hospitals.

음식점 매출변화를 통해 살펴본 금연구역 정책의 경제적 영향 분석

노진원 ( Noh Jin Won ),유기봉 ( Yoo Ki Bong ),이예진 ( Lee Yea Jin ),유솔 ( Yoo Sol ),김성렬 ( Kim Seong Ryeol ) 한국병원경영학회 2017 병원경영학회지 Vol.22 No.4

Purposes: Despite the positive health effects of both smokers and non-smokers, the non-smoking area policy is being negatively evaluated because of the vague fears of declining restaurant sales. The purpose of this study is to analyze the changes in sales of general restaurants(including liquor stores) and other restaurants that are considered to have the most applications of smoking cessation policy among the smoking facilities, and to examine the economic impact of the designation and expansion policies of non-smoking areas. Methodology: This study used the wholesale and retail trade survey data of the Korea National Statistical Office from 2011 to 2014 and analyzed 31,577 restaurants excluding missing values. For statistical analysis, t-test, ANOVA and Difference-in-differences(DID) models were used and the interaction term of area and year was entered. Findings: As the non-smoking area policy had been designated and expanded from December 2012 to December 31 2013, high restaurant sales in 2012 declined sharply in 2013. However, despite the expanding of the no-smoking area from January 1 2014 through December 31 2014, restaurant sales slightly recovered in 2014. In the case of other restaurants, there is no significant change in sales since the start of the policy in 2013. Practical Implications: The decline in restaurant sales due to the designation and expansion of non-smoking areas is temporary and can not be sustained over the long term. This result can be used to positively suggest negative perceptions of the designation and expansion policy of non-smoking areas. Also, this result can contribute to health promotion and smoking cessation policies by protecting non-smokers from the risk of secondhand smoking exposure and inducing smokers to decrease smoking rate and smoking amount.

키리바시 사우스타라와 현지 마을 지도자의 전염성 및 비전염성 질환 인식 개선: 위생인식 및 건강행태 설문조사와 반구조화된 심층면담 결과를 중심으로

이예진(Yejin Lee),유기봉(Ki-Bong Yoo),노진원(Jin-Won Noh) 한국국제협력단 2021 국제개발협력 Vol.16 No.2

산업분류와 만성질환 유무와의 관계

홍진혁 ( Jin Hyuk Hong ),유기봉 ( Ki Bong Yoo ),김선호 ( Sun Ho Kim ),김충우 ( Chung Woo Kim ),노진원 ( Jin Won Noh ) 한국병원경영학회 2016 병원경영학회지 Vol.21 No.4

Purposes: The industry has specialized and fragmented than in the past. As a factor of economic growth and industrialization, the number of people employed in primary industry decreased and the number of people employed in secondary and third industry continuously increased. In modern times, incidence of chronic disease is increasing according to industrial development. So, the purpose of this study was to analyze the chronic disease according to Clark`s industrial classification. Methodology: Data were derived from the 2012 Korea Health Panel. The sample was made up of 7,132 adult participants aged 20 or over selected Korea Health Panel by probability sampling from Korea. Binary logistic regression analysis was conducted to examine the main factors associated with chronic disease. Findings: The significant factors associated with chronic disease were gender, age, marital status, household member, education level, insurance type, disability, BMI, and industrial classification. Female, elderly, divorced(including bereavement, missing and separation), one-person households, less than high school graduation, medical aid, disability, obese and primary industry were confirmed chronic disease increases. Practical Implications: The study finds that primary industry`s prevalence of chronic disease was higher than secondary and third industry. Therefore, this study aims to management and effort of the worker who engaged in the primary industry. Policy development is required to address inequality or popularization of the differences in these factors by conducting a study to define the working conditions and socio-economic factors between industry.

민간비영리 조직을 통한 보건의료 R&D 방향 설정

이병희,비케이 안,유기봉,김태현,김봉신,박현춘,이예진,노진원,이승훈,Lee, Byeonghui,Ahn, Bekay,Yoo, Ki-Bong,Kim, Tae Hyun,Kim, Bongshin,Park, Hyunchun,Lee, Yejin,Noh, Jin-Won,Lee, Seung Hoon 한국병원경영학회 2017 병원경영학회지 Vol.22 No.3

Purposes: The purpose is to establish the direction of healthcare R&D through private nonprofit organization. Methodology: The data is divided into two groups: 12 physicians and pharmacists, and 16 persons including professors related to university donation, non-profit foundation executives. Each group was subjected to two Delphi surveys. To analyze the validity of the opinion, the content validity ratio and the consensus of experts were verified. Findings: Funding should be invested in 'development research' and 'application research'. The factors that hinder the donation culture are 'donation prevention system such as tax imposition system and rebate double penalty system', 'insufficient motivation of fund raising person', and 'lack of fund specializing specialist'. The fund raising strategy should be centered on a small number of large donors or a balance between large and small donors. The fund raising target should be effective to raise funds for corporate and individual donors. It is necessary to clarify the purpose of the social problem to be solved by the campaign strategy for promoting donation, to announce the validity of the trust and transparency of the institution, and to emphasize the social investment by the private sector. Practical Implications: It is necessary to present directions through private nonprofit organizations for the future development of healthcare R&D. The legal and institutional deficiencies of the domestic nonprofit organization fundraising infrastructure should be improved. In order to create a social investment climate, it is necessary to improve the awareness of donations and develop various donation programs for the private sector.

금연구역 가이드라인 및 실외 흡연실 해외 동향

노진원 ( Jin-won Noh ),이예진 ( Yejin Lee ),유기봉 ( Ki-bong Yoo ),윤진하 ( Jin-ha Yoon ) 대한보건협회 2018 대한보건연구 Vol.44 No.3

연구목적: 실외 금연구역 가이드라인과 실외 흡연실에 대한 해외 동향을 사례중심으로 고찰하고, 이를 바탕으로 국내에 적합한 실외 흡연실 모델을 도출 및 제시하는 것에 목적이 있다. 더 나아가, 간접흡연의 감소효과와 금연정책의 효과평가를 위한 근거 자료를 확보하는 것에 의의가 있다. 연구방법: 금연구역 정책을 시행하고 있는 해외 주요 국가의 금연구역 가이드라인과 실외 흡연실의 사례를 분석하여 얻어진 정보를 분석하여 재구성하고 개념화하는 사례연구를 수행하였다. 또한 연구의 신뢰성과 타당성을 확보하기 위하여 여러 개의 사례를 통해 반복적으로 논리를 확인해가는 다중 사례 연구 방법을 채택하였다. 연구결과: WHO FCTC 8조 가이드라인 및 해외의 금연구역 개념을 검토한 결과, 금연구역 및 담배로부터의 보호는 담배 행위 및 담배로 인한 노출로부터 흡연자 및 비흡연자를 보호하기 위한 적극적 해석을 원칙으로 하고 있음을 알 수 있다. 금연구역 설정을 위한 공간적 개념은 대부분 실내를 넓은 의미로 확정하여 지붕이 있는 공간으로, 밀폐공간은 사면 중 25~75% 벽면으로 둘러싸여 있는 경우로 정의하였다. 또한, 공공장소는 소유권이나 소유자의 접근 권리에도 불구하고 일반인들이 접근 할 수 있는 공간이거나 단체가 사용하고 있다면 공공장소로 정의 내려야 한다고 강조하고 있다. 해외의 금연구역 가이드라인을 분석한 결과, 금연구역 및 담배로부터의 보호는 담배 행위 및 담배로 인한 노출로부터 흡연자 및 비흡연자를 보호하기 위한 적극적 해석을 원칙으로 하였으며, 각 개념의 해석과 적용은 국가별, 또는 같은 국가에서도 지방정부에 따라 다르게 나타났다. 결론: 금연구역 정책의 유지 및 확대를 위하여 과학적 근거를 기반으로 한 담배연기를 완전히 제거할 수 있는 시설이 요구되며, 모든 실내에서 완전 금연을 달성할 수 있는 정책이 제시되어야 한다. 금연 정책의 성취, 이행, 효과에 대한 철저한 감시 및 평가가 수반되어야 하며, 유해한 담배연기로부터 비흡연자를 보호할 수 있는 구체적인 방안의 마련이 요구된다. 또한 정책을 유지할 수 있는 사회적인 지지체계가 구축되어야 한다. Objective: The purpose of this study is to investigate the overseas trend of non-smoking area guidelines and outdoor smoking room based on case study method, and to present the outdoor smoking room model suitable for South Korea. Methods: This case study was conducted to analyze and conceptualize the implementation and expansion of non-smoking area policies, focusing on cases of outdoor non-smoking area guidelines and outdoor smoking roon in major foreign countries. In order to secure the credibility and validity of the results, this study adopted a Multiple Case Study that repeatedly confirm several cases. Results: As a result of analyzing the WHO FCTC Article 8 guideline, non-smoking area is based on the principle of active interpretation to protect smokers and nonsmokers from exposure to tobacco smoke. Most of the spatial concepts for outdoor smoking room are defined as a space with a roof defined by a broad sense of the interior. As a result of analyzing the non-smoking area guidelines and outdoor smoking room in foreign countries, the interpretation and application of the concept of the outdoor smoking room differed according to the national or local government, and it was found to be characteristic of each countries. Conclusion: In order to maintain and expand the non-smoking area policies, a scientific facility is required which can completely eliminate smoke, and a definite policy should be provided to achieve complete smoking cessation in all indoors. The policy monitoring and evaluation should be accompanied on the achievement, implementation and effectiveness of the smoking cessation policies. It is necessary to provide specific measures to protect from harmful smoke. There should be a social support system that can maintain the policies.

산업연관분석을 이용한 음식점 금연 정책의 경제적 효과 분석

서수경(Sukyong Seo),연승욱(Seunguk Yeon),유기봉(Ki-Bong Yoo),조홍준(Hong-Jun Cho),이주현(Ju hyun Lee),노진원(Jin-Won Noh) 한국조리학회 2017 한국조리학회지 Vol.23 No.5

산후관리서비스가 산모의 건강관련 삶의 질에 미치는 영향

정재연 ( Jae Yeon Jeong ),차선정 ( Sun Jung Cha ),구여정 ( Yeo Jeong Gu ),유기봉 ( Ki Bong Yoo ) 한국병원경영학회 2020 병원경영학회지 Vol.25 No.4

Purposes: This study purposed to identify influence of postpartum care services on health-related quality of life in women after birth. Methodology: Korea Health Panel Survey 2009-2015 provided by the Korea Institute for Health and Social Affairs and National Health Insurance Service was used for the analysis. The health-related quality of life evaluate as a EuroQoL-5D(EQ-5D-3L, used the weight of the CDC) was used as dependent variables. Postpartum care services was used as independent variable. Demographic factors(education, economic activity, region, house income), health related variable(presence of chronic disease, self-rated health), birth related variable(birth-related problem, childbirth, pregnancy of advanced maternal age) used as covariates. Regression analysis was used. Findings: The rate of use of postpartum care services is increasing year by year. Postpartum care services and self-rated health positively influence on the health-related quality of life in women after birth and chronic disease and birth-related problem negatively influence on. Practical Implications: Therefore, it is necessary that the government’s policy of the postpartum care service be expanded and systematized to increase accessibility on. There are rare studies on the health-related quality of life of women after childbirth, adjusted for birth-related variables. So this study has significance.