일본의 고령자의료제도 개혁 동향 및 고찰

이준협(JunHyup Lee) 고려대학교 보건과학연구소 2005 보건과학논집 Vol.31 No.1

The study reviewed issues in the reform of the medical care system for the elderly in Japan. The medical expenditure for the elderly is increasing rapidly with the progress of aging society in Japan. The medical expenditure for the elderly aged 70 and over is already taking 1/3 of national health expenditure. In order to realize fair sharing of the medical expenditure for the elderly by all citizens and contain the increasing of the medical expenditure for the elderly, it is necessary to improve the efficiency of the medical care system for the elderly and to balance the burden on the nonelderly and the elderly. The Japanese Government have implemented the reform of medical care system which involving the reform of the medical care system for the elderly since the mid of 1990"s. The main contents of the reform of the medical care for the elderly are that co-payment for patients is the fixed rate of 10%, the eligible age range is age 75+, and the structure of financial sharing between the contribution of health insurers and public fund is changed, especially toward increasing public fund, to achieve fair cost sharing of medical care for the elderly.

주조품 분류 정확도 향상을 위한 적대적 생성 네트워크(GAN) 이미지 데이터 확장

이준협 ( Junhyup Lee ),박기홍 ( Keehong Park ),은준엽 ( Joonyup Eun ) 한국로지스틱스학회 2021 로지스틱스연구 Vol.29 No.4

Casting is a method of making metal through molds by changing solid metal into liquid state, which has the advantage of being able to yield a large number of products with complex shapes. Owing to the advantage, it is widely used to manufacture jewelry, artwork, surgical implants, and impellers in automobiles and ships. However, low quality products can be produced due to pinholes, sand blows, shrinkage cavities, and cracks that are well-known issues in casting. Especially using a defective impeller, a rotating element of a centrifugal pump that accelerates fluid outside from the center and transfers the power of fluid kinetic energy, causes a significant damage to its pump and/or workers nearby due to its high pressure. Therefore, foundries endeavor to catch any defectives before sending them out to purchasers. However, foundries are usually small or medium-sized enterprises. It is difficult for them to hire additional experienced workers to catch more defectives or install photographing and imaging-storing devices to keep track of a large amount of product images for analyses. The foundries usually have a few inspectors to catch defective products and, due to a shortage of manpower and human inaccuracy, defective products are often classified as non-defective products. This study shows that a combination of classic augmentation and self-attention generative adversarial network improves the accuracy of classifying non-defective and defective impellers by augmenting a limited amount of image data that can be even manually photographed. Combining classic augmentation and self-attention generative adversarial network outperforms the sole use of classic augmentation in generating quality images for convolutional neural network.

양친성 블록공중합체를 이용한 소수성 오염원제거

이준협(Junhyup Lee),심재열(Jaeyoul Shim),김영욱(Younguk Kim) 한국지반환경공학회 2014 한국지반환경공학회논문집 Vol.15 No.3

지반오염에 대한 사례가 점점 증가하고 이에 따른 대책공법에 대한 연구가 꾸준히 진행되고 있다. 본 연구에서는 소수성 오염원으로 오염된 토양의 정화를 위해 친환경 양친성 블록공중합체의 개발 및 적용에 관하여 평가하였다. 오염원으로는 디이젤을 사용하였으며, 임의로 오염시킨 흙에 네 종류의 양친성 블록공중합체를 개발 및 적용하여 정화능력을 실내실험을 통하여 평가하였다. 오염된 토양을 기존 계면활성제를 사용하여 정화하고 개발된 양친성 블록공중합체의 정화능력과 비교?분석하였다. 연구결과 개발된 고분자 재료의 종류에 따라 다양한 정화능력을 보였으며, 기존 계면활성제와 비슷한 정화도를 나타내 이를 활용한 새로운 친환경적 정화재제 개발의 기초를 확립하였다. Spilling pollutants and its contamination to the ground have serious impact to public resulting in various research about remediation techniques. In this study, the use of amphiphilic block copolymer for remediation was investigated with a series of laboratory tests on removal of hydrophobic contaminant in soil. Four types of amphiphilic block copolymer were developed and the efficiency of the cleaning was compared with surfactant using arbitrary diesel-contaminated soils. The results of the study show that the use of amphiphilic polymer in the soil washing process significantly enhanced the remediation of the contaminated soil and a potential of new methodology of eco-friendly remediation.

주 40시간 근무제도 도입에 따른 의료기관 종사자들의 직종별 인식도 비교

최만규(ManKyu Choi),이준협(JunHyup Lee),이준협(TaeRo Lee),이현실(HyunSill Rhee),임국환(KookHwan Rhim) 고려대학교 보건과학연구소 2004 보건과학논집 Vol.30 No.2

  Many foreign countries have made attempts to enhance working conditions for employees by reducing working hours, but it is true that Korea has focused more on economic growth rather than on the welfare of employees. However in the last few years, with increasing concern about quality of one"s life, the issue of working time reduction has become a controversial one. In July 2004 a law on working time reduction was made, and has been enforced in most work places, dependant upon the number of employees from which medical institutions should not be exempted.<BR>  This study was conducted to investigate the differences of opinion by job classification amongst employees of medical institutions. For the purpose of this study, a self-administerd questionnaire was conducted with 140 employees of 10 medical institutions located in Seoul andGyeonggi-Do province from August 1 to 7, 2004. The sample subjects  of this study consisted of 128(91.4%) employees who faithfully responded to the questionnaire and the major statistical methods included frequency, and chi-square test.<BR>  The major results of this study are as follows:<BR>  Firstly, about 90% of the respondents had knowledge of related contents of the 40 hours a week working time reduction. And the ratio of the respondents supporting introduction of working time reduction was 68.8%, and by job classification, more than half of medical doctors showed a contrary opinion, and about half of other groups such as nurses, medical technicians, administrative staffs were for it.<BR>  Secondly, the results of analyzing various factors that influence the quality of medical services and business performance is as follows: Medical doctors thought that the working time reduction would have a bad effect on the quality of medical services and business performance as a result of decreased patients. But other groups such as nurses, medical technicians, administrative staff presumed that the quality of medical services and business performance would not be changed but rather improved if strategies for operation were appropriately considered and performed.<BR>  Finally, the medical institutions preparing working time reduction need to make extra efforts to implement the system successfully such as making manpower operation more efficient, strengthening care capacity and function of emergency care centers, providing incentives for workers on Saturdays, improving the process of the working system and environment, fortifying weekday care, developing a weekend care program, and so on.

과부담의료비 지출 경험이 경제적 이유에 의한 미충족의료 발생에 미치는 영향

정현우 ( Hyunwoo Jung ),이준협 ( Junhyup Lee ) 한국보건경제정책학회(구 한국보건경제학회) 2017 보건경제와 정책연구 Vol.23 No.1

본 연구에서는 한국의료패널 6차, 7차 자료를 이용하여 전년도(2011년) 과부담의료비 지출 경험이 다음해(2012년) 경제적 이유로 인한 미충족의료에 영향을 미치는지 살펴보고, 또한 과부담의료비 지속 발생 유형이 미충족의료(경제적 이유)에 어떻게 영향을 미치는지 확인하였다. 분석 결과, 전년도에 과부담의료비가 발생할 경우 다음해 미충족의료(경제적 이유) 발생 가능성이 통계적으로 유의하게 높았다. 또한 과부담의료비 지속 발생유형에 따른 미충족의료 발생 분석에서는, 과부담의료비 탈출자와 재발생자에서 미충족의료(경제적 이유) 발생 가능성이 높았으며, 신규발생자는 통계적으로 유의하지 않았다. 이것은 전년도의 과부담의료비 발생이 의료비에 대한 심리적인 부담을 주어 다음해 미충족의료가 발생했다고 볼 수 있다. 본 연구는 이제까지 실증적으로 분석하기 어려웠던 과부담의료비와 미충족의료 간의 관계를 살펴보았다는데 의의가 있다. The purpose of this study is to empirically identify the relationship between Catastrophic health expenditure and Unmet medical need. logistic regression analysis was conducted using the 6th and 7th data of Korea health Panel to find out whether the previous year`s experience of catastrophic health expenditure effects on the next year`s unmet health care need due to economic reasons. In addition, we examined how the experience of catastrophic health expenditure affects to unmet need for medical care differently according to the period of catastrophic health expenditure. As a result of the analysis, the household members who experienced catastrophic health expenditure for overtime in 2011 had a statistically significant higher probability of experiencing unmet medical need. In second analysis, `Escape` and `Recurrence` was statistically significant higher than `Never occured`. However, it was not statistically significant when catastrophic health expenditure was newly incurred in 2012. This suggests that the Independent variable affects to dependent variable through time differences. This study is meaningful because it analyze the relationship between the two variables which were not easy to be identified.

2013년 4대 중증질환 보장성 강화정책 평가

조효은 ( Cho Hyoeun ),정현우 ( Jung Hyunwoo ),이준협 ( Lee Junhyup ) 한국사회보장학회 2020 사회보장연구 Vol.36 No.1

본 연구는 4대 중증질환 보장성 강화정책 중 2013년 정책 효과를 확인하고자 한다. 분석 자료는 한국의료패널 2012년과 2014년 자료를 이용하였고 분석방법은 성향점수매칭을 결합한 이중차이분석을 이용하였다. 분석의 주요결과는 다음과 같다. 우선 2013년 정책 시행 후 비급여진료비는 수혜집단에게서 유의한 증가가 있었다. 또 건강보험부담금과 본인부담금은 유의하지 않았지만 2013년 정책 시행 후 수혜집단에서 증가를 보였다. 이에 2013년 4대 중증질환 보장성 강화정책은 효과가 없는 것으로 확인되었다. This study is to demonstrate the effectiveness of the 2013 in the Four severe disease benefit expansion policy. To analyze, this study used 2012 and 2014 Korean Medical Panel, and difference in difference analysis method combining propensity score matching. The main results of the analysis are as follows. First of all, uncovered services costs increased significantly in 2013. In addition, the national insurance coverage cost and the out-of-pocket paymenet was an increase in Beneficiary Group in 2013, although they were not significant. Summing up these results, the effectiveness of the 2013 policy did not work well.

재난적의료비 지표 특성에 관한 연구 -발생률과 발생강도 비교를 중심으로-

정현우 ( Hyunwoo Jung ),이태진 ( Tae-jin Lee ),유예린 ( Yerin Yu ),이준협 ( Junhyup Lee ) 한국보건경제정책학회(구 한국보건경제학회) 2021 보건경제와 정책연구 Vol.27 No.1

본 연구에서는 기존 국내 재난적의료비 연구에서 간과되어온 발생강도 측면에 대한 연구 필요성을 제시하고자 재난적의료비 발생과 발생강도의 개념을 각기 설명하고, 각 지표에 대한 분석결과가 서로 상이하다는 것을 제시한다. 이 연구는 한국의료패널 2011년~2016년 자료를 사용하여 재난적의료비 발생률과 평균 발생강도 추이를 비교하고, 2016년 단일 자료를 통해 집중지수를 산출하여 각 지표의 특성을 도출하였다. 마지막으로 패널 투파트 모형을 통해 재난적의료비 발생과 발생강도 각각에 미치는 영향요인을 분석하였다. 연구결과, 첫째, 시간에 따라 거의 변화가 없었던 재난적의료비 발생률과 달리 평균 발생강도는 상당 수준 감소하고 있었다. 둘째, 집중지수는 두 지표 모두 저소득층에 집중되어 있었으나, 발생의 경우 기준치에 따른 편차가 크고 발생강도는 작게 나타나 지표의 안정성에 차이가 있었다. 셋째, 재난적의료비 발생과 발생강도에 미치는 영향요인은 서로 다르게 나타났으며, 특히 발생의 경우 건강보험 보장성보다는 인구사회학적 요인에 더 큰 영향을 받는 것으로 나타났다. 기존 국내 재난적의료비 연구는 대부분 발생의 측면에서만 분석되어왔다. 향후에는 재난적의료비 발생강도에 대한 연구도 활발히 이루어져야 할 것이다. This study explains the concept of the incidence and intensity of Catastrophic health expenditure(CHE) in order to suggest the need for research on the intensity aspect that has been overlooked in existing domestic research fields, and to suggests that the results for each indicator are difference. This study compared the trends in the incidence and intensity of CHE using data from 2011-2016 of the Korean Health Panel, and calculated the concentration index using a single data in 2016 to derive the characteristics of each indicator. Finally, we analyzed the factors of CHE in aspects of incidence and intensity through the panel two-part model. As a result, firstly, while the incidence had little change over time, the intensity was significantly decreasing. Second, in the concentration index, both indicatos were concentreated in the low-income group, but the incidence was vulnerable to the threshold. Third, factors influencing the incidence and intensity of CHE differed from each other. In particular, it was found that the incidence was more associated with demographic factors or prevalence than insurance coverage. Existing studies on CHE in Korea have been analyzed only in terms of incidence. In the future, research on the intensity of CHE should be actively conducted.