소아 급성상기도감염 합병증 진단의 공급자간 편차

최혁용,박정후,유도영,임명길,김민아,김남길,조현주,Choi, Hyug-Yong,Park, Jung-Hoo,Yoo, Do-Young,Lim, Myeon-Gil,Kim, Min-Ah,Kim, Nam-Gil,Cho, Hyun-Joo 대한예방한의학회 2013 대한예방한의학회지 Vol.17 No.1

Objectives : This study aimed to assess the differences in treatment behavior by reviewing data of a medical institution that studies treatment behavior in URI and assessing the treatment efficacy in Korea. Methods : We analyzed the behavior of medical customers and providers of upper respiratory infection medications using the NPS published by the Health Insurance Review Assessment Service. We created an operational definition for complications, and confirmed the difference in complication distribution between medical specialties. We also performed a multivariate analysis using a mixed model to elucidate the factors influencing the occurrence of complications. Results : The outcomes of analyzing factors to influence the difference in practice patterns of the diagnosing URI between the physicians are as follows; (1) Analysis of antibiotics prescriptions rate showed significant difference from medical departments (pediatrics; 49.7%, internal medicine; 54.2%, otorhinolaryngology; 69.6%, family medicine; 61.6%, general surgery; 57.5%, p<0.001). Analysis of steroid prescriptions rate showed significant difference from medical departments (pediatrics; 3.8%, internal medicine; 4.5%, otorhinolaryngology; 5.4%, family medicine; 3.0%, general surgery; 11.2%, p<0.001). (2) In patients who visited medical institutes with the common cold, the complication distribution differed according to the medical specialty, which suggests that specific complications arise depending on the particular medical specialty (p<0.001). (3) Moreover, through multivariate analysis, we found that the complication rate is higher in clinics than in hospitals, depending on the institute's size. (p<0.001; odds ratio of 4.67 in clinics than in hospitals, 95% CI 2.66-8.21) Conclusions : We observe a deviation between the behavior of patients diagnosed with URI and medication providers. This may arise from the interaction between providers and consumers, wherein the complications are associated with the choice of outpatient department and the prevention of cutting incentives. These findings suggest that the health policies should be improved to prevent inappropriate medical practice in the treatment of pediatric URI.

중복개설 및 중복운영에 대한 법해석 (대법원 2018. 7. 12. 선고 2018도 3672 판결)

최혁용 한국법학회 2023 법학연구 Vol.23 No.3

의료법은 의료기관 설립주체를 제한한다. 비의료인의 의료기관 개설은 금지되며 의료인이라 하더라도 둘 이상의 의료기관을 개설, 운영할 수는 없다. 대법원은 비의료인의 의료기관 개설이 소유와 경영을 의미하고 의료인의 의료기관 개설이 의료행위를 의미한다고 보아 개설 주체의 차이에 따라 개설의 해석을 달리하고, 의료인의 중복운영을 비의료인의 개설과 동일한 뜻으로 파악하였다. 본고는 대법원의 법해석을 목적론적 해석으로 볼 수 있는지 여부를 살펴보고 목적론적 축소를 통한 법형성의 관점에서 검토하였다. 중복개설이 의료행위, 즉 의료적 개설을 의미함으로써 개설 주체의 차이에 따라 개설의 해석을 달리하게 된 것은 목적론적 해석의 범위를 넘어선다. 대법원은 목적론적 축소를 통해 의료인의 경제경영적 개설을 처벌 대상에서 제외하여 의료인에 의해 의료행위가 이루어질 것을 예정하지 못한 입법 시의 은폐된 흠결을 보충하였다. 아울러 본고는 의료법 개정 후 도입된 중복운영 금지라는 규율을 경제경영적 개설과 동일한 개념으로 해석함으로써 발생한 문제점을 살펴보고, 특히 법개정 과정에서 보인 입법자의 강력한 의사에 의해 복지부의 유권해석이 형법이 금지하는 유추의 단계에까지 나아가게 되었다는 문제점도 확인하였다. Under medical law, there are restrictions on who can open medical institutions. Opening medical institutions by non-medical individuals is prohibited, and even medical professionals cannot open or operate more than one medical institution. According to the interpretation of the Supreme Court, the opening of a medical institution by a non-medical individual signifies ownership and management, while the opening of a medical institution by a medical person means the act of treating patients. The Supreme Court has interpreted the concept of "opening" differently depending on whether the person opening the medical institution is a medical professional or a non-medical individual. In particular, the Supreme Court has interpreted the prohibition of multi-institution operations by medical professionals, which is prohibited by medical law, in the same sense as the opening by non-medical individuals. The results of this interpretation cannot be viewed as teleological interpretation, according to the findings of this paper. At the time of legislation, the situation where a doctor directly treats patients in an illegal medical institution was not anticipated, leading to concealed flaws in the regulation. To address this, the Supreme Court carried out teleological reduction, excluding the ownership and management of multiple medical institutions by medical professionals from punishment. However, after the Supreme Court's interpretation, regulations prohibiting multi-institution operations were introduced into medical law. The Supreme Court interpreted the prohibited multi-institution operations as pertaining to the ownership and management of medical institutions. As a result, the prohibition of opening medical institutions by non-medical individuals and the prohibition of multi-institution operations by medical professionals became the same in meaning. After the enforcement of the new law, the authoritative interpretation of the Ministry of Health and Welfare also had a problem of going to the stage of analogy prohibited by the criminal law.

한의사의 면허외 행위 판단의 새로운 기준 -대법원 2022. 12. 22. 선고 2016도21314 전원합의체 판결을 중심으로-

최혁용 대한의료법학회 2023 의료법학 Vol.24 No.1

Medical act divides unlicensed medical practice into medical practice by non-medical practitioners and unlicensed practice by medical practitioners. In the past, it was a common approach to strictly distinguish between western and Korean medicine, but the Supreme Court's Decision of December 22, 2016, Do. 21314, provided a new direction regarding the criteria for determining whether a Korean medicine practitioner is acting outside license. This paper analyzes the new criteria in detail, examines the significance of the new criteria, and explores its impact on the dualistic medical system. The difference between the new criteria and the previous criteria in the precedents is that the judgment is not based on the connection between Korean medicine principles and Western medicine principles. It is an advanced standard that actively accepts the overlap and variability of medical practice, moving away from dichotomous thinking that exclusively distinguishes between Korean medicine and Western medicine. 의료법은 무면허 의료행위를 비의료인에 의한 의료행위와 의료인에 의한 면허외 행위로 나누어 놓았다. 종래에는 의료행위와 한방의료행위를 엄격히 구분하는 것이 일반적 태도였으나 대법원 2022. 12. 22. 선고 2016도21314 전원합의체 판결은 한의사의 면허외 행위 판단기준과 관련하여 새로운 방향성을 제시하였다. 본 논문에서는 대상 판결에서 제시된 새로운 판단기준을 구체적으로 분석하고 새로운 판단기준의 의의와 이원적 의료체계에 미칠 영향을 검토하였다. 대상 판결의 새로운 기준과 기존 판례의 종전 기준이 가진 차별성은 판단의 근거를 한방원리와의 연관성에서 찾지 않았다는 점에 있다. 한방원리와 서양의학적 원리를 배타적으로 구분하는 이분법적 사고에서 벗어나 의료행위의 중첩성과 가변성을 적극적으로 수용하였다는 점에서 진일보한 기준인 것이다.

발열 상태에서 투여된 녹용(鹿茸)과 소아보혈탕(小兒補血湯) 가(加) 녹용(鹿茸)이 발열 양상의 변화 및 학습과 기억에 미치는 영향

최혁용,이진용,김덕곤,Choi Hyuk-Yong,Lee Jin-Yong,Kim Deok-Gon 대한한방소아과학회 2000 대한한방소아과학회지 Vol.14 No.1

It has been widely said in Korea that early administrations of Cervi cornu parvum (deer antler) to febrile infants affect brain functions. Traditional Oriental Medicine states that the head is easily affected by fever and only an excess of heat causes headaches. Traditional Oriental Medicine also states that Cervi cornu parvum cannot be used in febrile conditions. With the aim of investigating different febrile response to LPS, experiments using intravenous injection of LPS have been carried out on Cervi comu parvum(CCP) and Soahbohyul - tang combined with Cervi comu parvum(SB-CCP) administered rabbits. Experiments were also conducted to evaluate the effects of early administration of CCP on learning and memory in 3 week old rats with LPS fever. These were evaluated by using the Morris water maze and the radial arm maze. Changes in body weight were also observed during this period. The results of these experiments are as follows. 1. In the experiments with febrile rabbits, the CCP and SB-CCP administered group showed statistically significant reductions of fever (p<0.05). 2. In the experiments with febrile rabbits, CCP and SB-CCP administered rabbits resulted in the tendency of lower body temperatures and shorter fever periods than the control group. 3. There were no differences of mean body weight and fever patterns among the 4 groups in the experiments on young rats with LPS fever. 4. There was no statistical difference of mean response latencies among the rats in Group I (DDW administered), GroupIII (CCP administered), and groupIV (SB-CCP administered) in the Morris water maze. However, Group Ⅱ (the scopolamine administered group) showed delayed latencies on the second day of the first session (p<0.05), and the second and third day of the second session (p< 0.05). 5. There were no statistical differences of mean response latencies among the rats in Group I, III and Ⅳ in the radial arm maze, but Group Ⅱ showed delayed latencies on the first and third day of the first session (p<0.05). 6. There was no influence from the administration of CCP and SB-CCP on the general behavior of the rats in Irwin´s test. These results suggest that Cervi cornu parvum and Soahbohyul - tang combined with Cervi comu parvum have anti-pyretic actions on LPS fever. The results also suggest that these drugs have no influence on learning and memory in young rats with LPS fever in the Morris water maze and the radial arm maze.

한의사의 면허 외 행위 판단 기준에서 “진단의 보조 수단”의 의미-대법원 2023. 8. 18. 선고 2016두51405 판결-

최혁용 대한의료법학회 2023 의료법학 Vol.24 No.3

The Supreme Court’s en banc decision on December 12, 2022 (docket number 2016Do21314) presented a new standard for determining whether the use of diagnostic medical devices by Korean medical doctors constitutes oriental medical doctors constitutes unlicensed medical practice. Based on this standard, it was determined that the use of ultrasound by Korean medical doctors was not an unlicensed medical practice. Supreme Court’s Decision 2016Du51405 on August 18, 2023, is the first case in which a new standard was applied to determine that an Korean medical doctor’s use of electroencephalography to diagnose Parkinson’s disease and dementia was not an unlicensed medical practice. The Supreme Court abolished the previous standard that Western medical knowledge and technology should not be required for Korean medical doctors to use medical devices. However, it was unclear whether Western medical diagnosis of Korean medical doctors using diagnostic medical devices would be viewed as an an auxiliary method of diagnosis. Parkinson’s disease and dementia are Western medical diagnoses. The Supreme Court judged that the Western medical diagnosis of Korean medical doctors was not an unlicensed medical practice. This clearly explains what an auxiliary method of diagnosis means. In addition, the Supreme Court excluded the principles of development and production of electroencephalography from its judgment criteria. Automatic extraction and automatic reading of test results were also excluded. The criminal court’s view that the meaning of oriental medical practice should be clearly and strictly interpreted from the perspective of an oriental doctor, and it was clarified that diagnostic medical devices were excluded from criminal punishment unless it was clear that they were not related to the principle of oriental medical practice. As a result, the Supreme Court made it clear that the use of diagnostic medical devices is excluded from criminal punishment unless it is clear that they are not related to the principles of Korean medicine.

의료기관 개설규제 위반에 대한 요양급여비용 환수처분의 이원적 규율

최혁용 한국법학회 2024 법학연구 Vol.93 No.-

본 연구는 의료기관 개설규제의 실효성을 확보하기 위한 민사적, 의료법적, 국민건강보험법적 제재수단을 연구대상으로 한다. 그 중에서도 의료법이 금지한 의료기관 개설행위에 대한 가장 중요한 제재는 국민건강보험법과 의료급여법상의 요양급여비용 환수처분이다. 국민건강보험법 위반 여부에 따라 형법상 사기죄, 이득액에 따라 특정경제범죄 가중처벌 등에 관한 법률위반(사기)죄와 민사상 불법행위책임이 추가로 성립한다. 이런 규제는 비의료인의 의료기관 관리를 개설단계에서 차단하기 위한 실효성 확보 방안이면서 건강보험 재정 건전성을 제고하는 수단이 되기도 한다. 그런데 대법원은 의료인의 중복개설·중복운영에 대하여는 요양급여비용환수처분이 부적법하다고 판결하였다. 또한 대법원은 비의료인의 의료기관 개설은 효력규정인데 반하여 의료인의 중복개설·중복운영은 단속규정으로서 사법상 효력을 달리한다고도 보았다. 대법원의 이러한 태도는 재산죄인 사기죄 성립을 위한 부당이득을 인정할 수 있는지, 형벌의 보충성에 반하지는 않는지, 도구적 합리성은 유지되는지에 대한 의문이 있고, 또한 의료인과 비의료인에 대한 규율 적용의 차별이 가지는 정당성에도 의심이 간다. 비의료인이 개설한 의료기관도 의료법이 정한 절차에 따라 신고, 허가, 등록 등의 과정을 거쳐 유효하게 개설된 의료기관인 것은 마찬가지다. 그리고 의료인에 의해 진료가 실시되고 그에 따라 요양급여가 청구되었다면 적법한 의료기관 내에서의 행위와 질적인 차이가 없는 것 역시 마찬가지다. 개설규제에 대해 이원주의, 신분주의를 적용한 대법원의 해석은 법적용의 비합리성, 의료기관 개설을 통한 직업의 자유에 대한 과잉규제, 의료기관 관리, 운영 등 비의료적 영역을 포함하는 체계통합의 장애라는 한계를 노정한다. This study examines the efficacy of civil, Medical Act, and National Health Insurance Act enforcement mechanisms in securing effective regulation of medical institution establishment. Among these, the most critical sanctions against prohibited medical institution establishment acts under the Medical Act are the reimbursement provisions under the National Health Insurance Act and the Medical Aid Act. Violating the National Health Insurance Act predicates the establishment of criminal charges under the Criminal Law for fraud, in addition to civil liabilities for unjust enrichment. These regulations serve two purposes: they aim to prevent non-medical personnel from managing medical institutions from the establishment phase to ensure the efficacy of regulations, and to enhance the fiscal soundness of health insurance. However, the Supreme Court has ruled that the reimbursement of healthcare benefits for multi-institution establishment and operation by medical personnel is not unlawful. Moreover, the Court has distinguished between the establishment of medical institutions by non-medical personnel as effectual regulations and the multi-institution establishment and operation by medical personnel as regulatory regulations, thus differently interpreting their legal effects. The stance of the Supreme Court raises questions regarding the acknowledgment of undue profit necessary for the establishment of property crimes such as fraud, the violation of the principle of subsidiarity of criminal law, and the maintenance of instrumental rationality. It also casts doubt on the legitimacy of differential regulatory application between medical and non-medical personnel. Medical institutions established by non-medical personnel, following the due process stipulated by the Medical Law involving notification, permission, and registration, are validly established just as those by medical personnel. Furthermore, if medical services are provided by medical personnel and healthcare benefits are claimed accordingly, there is no qualitative difference from the actions within legally established medical institutions. The interpretation by the Supreme Court, applying dualism and status-based regulations to establishment regulations, exposes the irrationality of legal application, the excessive regulation on the freedom of profession through the establishment of medical institutions, and the obstacles to the integration of non-medical areas such as management and operation of medical institutions.

야뇨증(夜尿症) 치료(治療)에 대한 소고(小考) -최근 중국문헌을 중심으로-

최혁용,이진용,김덕곤,Choe Hyeok-Yong,Lee Jin-Yong,Kim Deok-Gon 대한한방소아과학회 1995 대한한방소아과학회지 Vol.9 No.1

전간(癲癎)에 대한 한국(韓國) 의사학적(醫史學的) 고찰(考察)

최혁용,이진용,김덕곤,Choe Hyeok-Yong,Lee Jin-Yong,Kim Deok-Gon 대한한방소아과학회 1997 대한한방소아과학회지 Vol.11 No.1

중복개설 금지 관련 대법원의 의료법 및 국민건강보험법 해석, 적용에 대한 입법적 대응

최혁용(Choi Hyugyong) 한국법학회 2023 법학연구 Vol.89 No.-

의료법은 의료인의 중복개설을 금지한다. 대법원은 이를 비의료인의 개설 행위를 판단하는 것과는 기준을 다르게 적용하였다. 경제적 경영적 개설에 초점을 맞춘 비의료인의 개설과는 달리, 의료인은 복수의 의료기관에서의 의료행위여부를 기준으로 삼았다. 국회는 법원의 판례를 바꾸기 위해 중복개설, 중복운영을 모두 금지하는 방향으로 의료법을 개정하였다. 의료법 개정 후 대법원은 의료인이 중복개설한 의료기관에 지급한 요양비용이 부당이득 징수처분의 대상이 되지 않는다고 판단하여 여전히 의료인의 중복개설과 비의료인의 의료기관개설을 다른 기준에서 판단하였다. 같은 취지로 대법원은 중복개설된 의료기관의 사기죄도 부인하였다. 이에 국회는 의료기관 개설 허가 취소와 요양급여비용 지급 보류 및 부당이득의 환수, 나아가 사기죄 성립측면에서도 의료인의 위법한 개설행위를 비의료인과 동일하게 처벌하는 것을 목적으로 의료법과 국민건강보험법을 개정하였다. 본고는 2012년 의료법과 2020년 국민건강보험법 개정을 중심으로 대법원의 법률 해석에 대한 국회의 입법적 대응과정을 법안 심의 절차과 법안 내용의 양 측면에서 검토하고 어떻게 해야 더 나은 입법이 될 수 있을 지에 대한 제안을 하는 데 목적이 있다. 의료법과 국민건강보험법의 국회 입법 과정에서 참여와 숙의의 부족, 이익집단의 과잉대표 등이 발견되었다. 법안의 내용에서는 개정 의료법의 중복개설, 중복운영의 문언이 개정 전 의료법의 표현과 어떤 차이가 있는가 분명하지 않았고, 개정 국민건강보험법상 법문언이 입법목적에 부합하지 못했다는 점이 문제로 드러났다. 입법과정의 개선을 위해서는 유관 상임위원회가 토론에 참여하고 다양한 전문가 그룹과 이해관계자들의 의견이 검토될 수 있도록 제도개선을 해야 한다. 또한 이해당사자의 과잉대표를 제어하고 사전, 사후 입법영향분석을 통해 책임성을 강화할 수 있는 방법이 모색되어야 한다. The Medical Act prohibits medical professionals from opening multiple medical institutions. The Supreme Court has applied a different standard to this prohibition compared to non-medical individuals opening actions. While non-medical individuals openings focused on economic and managerial aspects, medical professionals openings were judged based on whether medical activities were conducted in multiple medical institutions. The National Assembly amended the Medical Act to prohibit both multiple openings and operations in an effort to overturn the courts decision. After the amendment, the court once again distinguished the opening of multiple medical institutions by medical professionals from the prohibited opening by non-medical individuals. It ruled that healthcare costs paid to medical professionals for such multiple institutions could not be subject to unjust enrichment forfeiture. Due to the same reason, the Supreme Court also denied the fraud charge against the multiple medical institutions. The National Assembly responded by amending both the Medical Act and the National Health Insurance Act. The aim was to punish the unlawful actions of medical professionals regarding multiple institution openings, cancel permits for opening institutions, suspend payments for healthcare expenses, and recover unjust enrichment. Moreover, in terms of fraud charges, medical professionals illegal actions were to be treated similarly to those of non-medical individuals. This article aims to review the legislative process of the National Assemblys response to the Supreme Courts legal interpretation, focusing on the amendments to the Medical Act in 2012 and the National Health Insurance Act in 2020. The analysis centers on democratic legitimacy and content analysis of the bills deliberation procedures. To improve legislation, relevant standing committees in the National Assembly should allow expert groups and stakeholders to participate in debates and review arguments. This will help overcome the limitations of committee-centeredness and prevent excessive representation of vested interests. Additionally, pre- and post-legislative impact assessments can strengthen accountability, making it crucial to improve the system.

摘出 흰쥐 心贓의 血力學的 機能에 대한 導赤散의 效能 硏究

崔赫鏞,丁奎萬,金德坤,曺圭錫 WHO COLLABORATING CENTRE FOR TRADITIONAL MEDICINE 1996 東西醫學硏究所 論文集 Vol.1996 No.-

In order to verify the cardiovascular hemodynamic function of Dojeok-san, the experiment was performed in rats. Fourteen rat hearts were perfused by the Langendorff technique with modified 37℃ Krebs-Henseleit's buffer solution at a constant perfusion pressure. They are randomly assigned to one of two groups, supplied with either normal saline or Dojeok-san administration. Heart rate, left ventricular pressure, +dp/dt maximum, -dp/dt maximum, -dp/dt/+dp/dt ratio, coronary outflow were evaluated at baseline and after the administration of either normal saline or Dojeok-san. The results are summarized as follows: 1. No significant effects of Dojeok-san were observed on the heart rate. 2. Dojeok-san remarkably increased left ventricular pressure(p<0.001). 3. Dojeok-san also significantly increased both +dp/dt max and -dp/dt max, and this explains Dojeok-san has probably cardiotonic effects(p<0.001). 4. No significant effects on -dp/dt/+dp/dt ratio were observed. 5. No significant effects of Dojeok-san were observed on the coronary outflow.