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뇌졸중 환자의 의료 자원 이용과 비용 지출: 환자의 관점에서
이건세,배희준,김형수 대한신경과학회 2004 대한신경과학회지 Vol.22 No.6
Background: Policy-makers are required to know the current patterns of resource use and the costs of stroke. However, the scientific evidence, on which health policy-making can be based, is not sufficient. Our study aimed to investigate resource utilization and costs during the one year after stroke. Methods: Among patients with acute ischemic stroke (7 days from onset) who were admitted from July of 2001 to July of 2002, 223 were interviewed one year after the onset of stroke through a home visit by an experienced research nurse. Resource utilization and related costs were investigated. Results: The average length of stay was 25 days. The average first inpatients costs was ₩2,230,000. After discharge, the average outpatient visit was 22 days. The average expenditure per patient during the one year from onset of stroke was ₩5,235,000. The hospital charge was 59% of the total cost, the cost for hiring a care-giver was 14%, and the fee for the outpatient clinic was 13%. Thirty-nine percent (₩2,051,000) of the total expenditure was consumed in the first month, 12% was in the second, 8% was in the third, and around 5% monthly was after 3 months. Conclusions: Our study is the first one to investigate the resource utilization and the related costs in stroke patients in Korea. The results of this study should not be generalized to all Korean stroke patients, but this study may serve as a reference for inferring the real status in Korea and may be a starting point for further nationwide resource utilization and costs studies.
이건세 대한의사협회 2018 대한의사협회지 Vol.61 No.10
The Ministry of Health and Welfare announced a plan for community care in March 2018. Community care is a concept of social services that includes residential, welfare, and health care services, as well as direct care. It is a policy to actively prepare for an aged society. Various services must be developed for comprehensive community care. It is especially necessary to ensure that adequate resources are provided for home care and visiting care. To achieve this goal, the benefit policies of health insurance and long-term care insurance must be changed. Community service providers and infrastructure must be expanded, and a diverse professional workforce should be trained. Doctors need training and experience as team leaders, as they will be able to work with nurses, nutritionists, and social workers. It will be particularly important to operate clinics as group practices rather than as solo practices. Change is also needed in community hospitals, which must receive orientations regarding early patient discharge plans and community-centered collaboration. Hospitals should serve as health care safety nets, including short-term stays and same-day care. Regional governance is important for community care. Doctors must work with a variety of institutions, including community health centers, welfare centers, and elderly facilities. Medical professionals should prepare for and lead future social changes.
李建世 건국대학교 1987 論文集 Vol.24 No.1
Development and progress in real estate appraising depends heavily on the knowledge of economics which accumulates throughout history Value theory and practice as taught by leading appraisal societies today are largely a synthesis of the important ideas and economic concepts developed by leader of the Classical, Austrian, Historical, Neoclassical and Modern schools of Value Theory. Market value may rightfully be designated as the heart of all real Estate Value. Market Value is the price which a property will bring in a competitive market under all conditions requisite to a fair sale, which would result from negotiations between a buyer and a seller, each acting prudently, with knowledge and without undue stimulus. But, some appraisers, real estate experts, and economists maintain that technically it is impossible to estimate the market value of real estate according to the assumptions contained in the standard definitions as given above. This view is advanced by Dr. Richard U. Ratcliff, who objects to the legal definition of market value since it refers to hypothetical buyers and sellers who bargain under hypothetical market conditions. This interpretation views the value estimate not as an interpretation of what would happen under ideal condition, but what will happen under actual circumstances. Fundamental to the concept of market value is the Principle of Highest and Best Use. Highest and Best Use is logically defined as "that possible and legal use or employment which will preserve the utility of the land and yield a net income flow that forms, when capitalized at the proper market rate of interests, the highest present value of the land." But, The Principle of Highest and Best Use Contains similar problems in its unrealistic assumptions. The following are the principal objections raised to The Highest and Best Use concepts by those who advocate a Most Probable Use. - There can be more than one highest and best use for a property. - The highest income does not necessarily represent the highest and best development of the property, for two reasons ① The use may involve depletion of the property ② The income may entail a high risk factor, resulting in lower value. In the context of most probable sales price another appropriate term to reflect highest and best use would be most probable use. In the context of investment value an alternative term would be most profitable use.