식중독 발생 감소에 대한 지불의사금액 추정: 조건부 가치측정법을 이용하여

이수형 ( Sue Hyung Lee ),신호성 ( Ho Sung Shin ) 한국보건경제정책학회(구 한국보건경제학회) 2010 보건경제와 정책연구 Vol.16 No.1

2005년 식중독으로 인한 사회경제적 손실비용은 1조 6천억원에 달한 것으로 보고되었다. 본 연구는 조건부 가치측정법(Contingent Valuation Method) 중 이중경계 양분선택형 질문법 (Double-bounded Dichotomous Choice)을 이용하여 식중독 발생 감소에 대한 지불의사금액을 추정하고자 하였다. 지불의사금액 추정은 서울시 20세 이상 성인 남녀 499명을 대상으로 하였으며 분석 방법으로는 구간자료 모형 (Interval-data Model)과 베이지안 추정법 (Bayesian Estimation)을 이용하였다. 베이지안 추정법은 지불의사금액이 0 이상인 것과 제시금액의 분포가 정규분포를 따르지 못하거나 충분히 커지 못한 상황에 대응하기 위하여 적용하였다. 또한 지불의사(Willingness-to-Pay, WTP)의 추정과 관련된 응답의 불확실성을 반영하기 위해 점추정치와 함께 신뢰구간을 제시하였다. 분석결과 제시금액과 응답자의 월평균 가구소득, 연령, 교육수준 변수가 지불의사금액에 영향을 미치는 것으로 나타났다. 식중독 발생 감소에 대한 지불의사금액은 독립변수의 영향을 고려할 경우 식중독 발생 확률을 낮춘 음식 1회 섭취당 평균 최소 3, 108(2, 759, 3, 454)원 ~ 최대 3, 997(3, 101, 4, 752)원으로 추정되었다. This study estimated the WTP( Willingness-to-pay) for reducing the risk of foodborne disease using contingent valuation method. WTP is elicited with double-bounded dichotomous choice questions in which respondents(selected from the Seoul population using survey design and are aged above 19, n=499) decided whether to purchase a more expensive food to reduce the risk of foodborne disease. For data analyses, the study employed a relative likelihoods of the Interval-data Model Method and Bayesian estimation method. The study found that bids, income, age and education were associated with the probability of higher WTP for reducing the risk of foodborne disease. Respondents answered that they would be willing to pay minimum 3, 108[2, 759, 3, 454] ~ maximum 3, 99713, 101, 4, 752] Korean won.

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.

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.

AHP기법을 이용한 우리나라 자살예방정책의 우선순위 설정

김효진(Hyo-Jin Kim),이수형(Sue-Hyung Lee),강은정(Eunjeong Kang) 한국콘텐츠학회 2015 한국콘텐츠학회논문지 Vol.15 No.1

우리나라는 2004년부터 지금까지 OECD 국가 가운데 자살사망률 1위이며, 지속적으로 자살자 수와 자살 사망률이 증가하고 있다. 효과적인 자살정책을 확인하기 위해 AHP(Analytic Hierarchy Process) 기법을 이용하여 자살예방의 주요 접근방법별 세부정책들의 우선순위를 조사하였다. 설문은 2013년 8월 23일, 26일 두 차례에 걸쳐 총 30명을 대상으로 워크숍 형식으로 실시하였다. 이중 학계는 20명(사회복지사 4명, 정신보건학자 7명, 정신의학자 5명, 임상심리학자 4명), 정책결정자는 5명, 공급자는 5명이였다. 2013년 9월 9일부터 12일까지 4일간 이메일로 사회복지분야와 임상심리분야에서 각각 5명씩 추가하여 총 40명을 대상으로 조사를 하였다. 세부 정책들의 중요도는 ‘자살시도자 관리,’ ‘공공자살예방서비스 인프라 구축,’ ‘유가족 지원사업,’ ‘위험집단의 위기관리’ 등의 정책에서 높은 것으로 나타났다. Since 2004 suicide in Korea was the number 1 cause of mortality among OECD countries, the suicides and suicide mortality rate is constantly increasing. Using AHP(Analytic Hierarchy Process), we examined the main approaches and detailed policies of suicide prevention to confirm an effective suicide policy. A workshop and survey were conducted on August 23rd and 26th, 2013, with 30 people. There were 20 academics (4 social workers, 7 mental health workers, 5 psychiatrists, 4 clinical psychologists), and 5 policymakers and 5 administrative staff. In additional 5 people from social welfare and 5 from clinical psychology fields were survey from september 9 to 12 by e-mail. The research found 4 priorities. They include, suicide attempt management, building up public infrastructure for suicide prevention, support to bereaved families, and crisis management of high risk groups in society.

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.

한국표준질병사인분류(KCD-3)의 사망외인 범주를 이용한 산재사망과 사회경제적지표(SEP)의 탐색적 분석

정민수(Min soo Jung),이수형(Sue Hyung Lee),이상윤(Sang Yoon Lee) 서울대학교 보건환경연구소 2007 보건학논집 Vol.44 No.1

소아 호흡기감염 외래환자에 대한 항생제 처방양상

김예지 ( Ye Jee Kim ),이수형 ( Sue Hyung Lee ),박실비아 ( Sylvia Park ),나현오 ( Hyen Oh Na ),최병호 ( Byong Ho Tchoe ) 한국보건행정학회 2015 보건행정학회지 Vol.25 No.4

Background: Antibiotic resistance has been becoming serious challenge to human beings. Overuse of antibiotics, especially, for infants is concerned, but studies are very few for the prescribing pattern of antibiotic use for infants. This study analyzes prescribing patterns of antibiotics in outpatients of preschool children with acute respiratory tract infections in South Korea. Methods: Data are used from 2011 Health Insurance Review & Assessment Services-pediatric patients sample. Inclusion criteria is outpatient children (0 to 5 years) with top five frequent diseases. Prescription rates are analyzed by types of disease, provider, specialty, region, and ages. Binary or multinomial logit models are used to analyze determinants of providers’ prescription pattern. Results: The main findings are as follows. First, distributions of prescription rates are shown as L-shape or M-shape depending on the types of disease. Second, the prescription variation is so large among providers, where providers are polarized as a group with low prescription rates and the other group with high prescription rates, though the shapes are shown diversified across types of disease. Third, prescription rates appear to be lower in pediatrics and higher in ENT (ear-nose-throat). Fourth, broad spectrum antibiotics are widely used among children. Finally, the logit analysis shows similar results with descriptive statistics, but partly different results across types of disease. Conclusion: Antibiotics for respiratory tract infections of infants are used excessively with a large variation among providers, and especially broad spectrum antibiotics are used. The prescription guideline for antibiotics should be provided for each specific disease to reduce antibiotic resistance in the future.

만성 B형간염 약물치료대안의 비용-효과 분석

고수경 ( Su Kyoung Ko ),양봉민 ( Bong Min Yang ),이수형 ( Sue Hyung Lee ),박다진 ( Da Jin Park ),박상민 ( Sang Min Park ) 한국보건경제정책학회(구 한국보건경제학회) 2005 보건경제와 정책연구 Vol.11 No.2