병원건강증진서비스에 대한 의료소비자의 이용의도

함명일,강명근,박춘선,조우현,Hahm, Myung-Il,Kang, Myung-Geun,Park, Choon-Sun,Cho, Woo-Hyun 대한예방의학회 2003 예방의학회지 Vol.36 No.2

Objective : To determine the relationships between customer's attitude, the subjective norm and the intention to use hospital-based health promotion services. Methods : This study was based on the theory of reasoned action, suggested by Fishbein and Ajzen. The subjects of this study were 501 residents of Seoul, Bun-dang, Il-san and Pyung-chon city, under 65 years, who were stratified by sex and age. A covariance structural analysis was used to identify the structural relationships between attitude towards health promotion programs or services, their subjective norm and their intention to use the aforementioned services. Results : The subjective norm for using the health promotion programs or services provided by hospitals was a significant predictor of the intention to use, but the attitude towards the services was not significant Conclusions : Our results suggest that a customer's reference group affects their use of the hospital-based health promotion services. Because the subjects of this study were restricted to specific urban areas, there are limitations to generalizing the study results. Despite the limitations of these results, they can serve as baseline information for the understanding of consumers behavior toward hospital-based health promotion services.

전문가와 비전문가의 환경 및 과학기술 위험에 대한 위해도 인식 차이

함명일,권호장,이후연,박화규,이상규,Hahm, Myung-Il,Kwon, Ho-Jang,Lee, Hoo-Yeon,Park, Hwa-Gyoo,Lee, Sang-Gyu 한국환경보건학회 2009 한국환경보건학회지 Vol.35 No.4

Objective : The objective of this study was to examine how experts and the public perceived various environmental and technological hazards based on psychometric paradigm. Methods : We conducted a survey that included 30 hazards and 10 risk attributes. Subjects of this study were 214 people with three groups; (1) experts (55 people), (2) graduates( 78 people), (3) under graduates (81 people). Factor analysis was used to confirm the common risk attribute from 8 risk attributes. Also, multiple regression analysis was used to identify factors influencing on perceived risk and benefit of hazards. Results : This study revealed that experts tend to be more tolerant than graduates and under graduate students for the 30 hazards. Using factor analysis, two main factors were identified: factor 1, commonly called "Dread Risk", and factors 2, commonly called, "Unknown Risk" in the literature. We identified that environmental hormone concentration and global warming ranked high in both dread risk and unknown risk. Multiple regression models were used to test the association of perceived social risk and perceived social benefit with two main factors. Dread risk had significant explanatory power on perceived social risk and benefit. We identified that the experts were less likely to perceived dread risk and know more information about the hazards. Conclusions : There were differences of risk perception between experts and lay people. Especially, experts' perception of risk was commonly lower than other people's perception.

향후 2년 이내의 위암 검진 이용 의도의 예측 요인

함명일,최귀선,계수연,곽민선,박은철,Hahm, Myung-Il,Choi, Kui-Son,Kye, Su-Yeon,Kwak, Min-Son,Park, Eun-Cheol 대한예방의학회 2007 예방의학회지 Vol.40 No.3

Objectives : The purpose of this study was to identify the factors influencing the intention to have stomach cancer screening using the theory of planned behavior (TPB) in Korea. Methods : For this population-based study, 1,535 adult respondents (aged 40 to 70 years) were recruited using multi-stratified random sampling and a face-to-face administered questionnaire. This study was based on Ajzen's theory of planned behavior. Intentions were divided into three scenarios for fee payment in the next two years : (1) free of charge, (2) co-payment, and (3) full charge. Multiple linear regression was used to identify the factors influencing the intention to have stomach cancer screening. Results : Perceived behavioral control and attitude toward stomach cancer screening were significant predictors of the intention to have stomach cancer screening. However, subjective norm only influenced the intention to have stomach cancer screening with full charge in the next two years. Conclusions : The results suggest that attitude and perceived behavioral control are likely to contribute toward increasing the intention to have stomach cancer screening. Especially, perceived behavioral control is a good predictor. Because the study subjects were nation wide residents, the study results can be generalized.

의료소비자의 비급여 진료에 대한 자기결정권 행사와 관련 요인

김지은,함명일,이혜원,김선정,Kim, Ji Eun,Hahm, Myung-il,Lee, Hyewon,Kim, Sun Jung 한국병원경영학회 2022 병원경영학회지 Vol.27 No.1

Purposes: This study was to investigate intention to exercise the patient's right of self-determination on adopting the non-benefit medical services and was to identify factors associated with intention to self-determined decision. Methodology: A total of 1,000 adult respondents aged 20 to 65 years were recruited using stratified random sampling and surveyed by online. Multivariate logistic regression analysis was performed to identify factors associated with intention to self-determined decision using SAS 9.4(SAS Institute Inc. Cary, NC, USA). Findings: 61.9% of total participants(n=592) had intention to exercise patient's right of self-determination on adopting the non-benefit medical services. Significant differences were observed in the exercise of self-determination in relation to prior explanation and opportunity for self-determination. Practical Implications: This study suggested that explanation duty of provider might influence on increasing intention to exercise the patient's right of self-determination. Considering appropriate use of non-benefit services, it is important to enhance explanation duty of provider.

2005년 암의 경제적 비용부담 추계

김진희,함명일,박은철,박재현,박종혁,김성은,김성경,Kim, Jin-Hee,Hahm, Myung-Il,Park, Eun-Cheol,Park, Jae-Hyun,Park, Jong-Hyock,Kim, Sung-Eun,Kim, Sung-Gyeong 대한예방의학회 2009 예방의학회지 Vol.42 No.3

Objectives : The objective of this study is to estimate the economic costs of cancer on society. Methods : We estimated the economic burden of people with cancer in South Korea. To perform the analysis, we reviewed the records of people who were cancer patients and those who were newly diagnosed with cancer. The data was compiled from the National Health Insurance Corporation, which included the insurance claims database, a list of cancer patients, a database that records the cancer rates, the Korea Central Cancer Registry Center s cancer patient registry database and the Korea National Statistical Office s causes of death database. We classified the costs as related to cancer into direct costs and indirect costs, and we estimated each cost. Direct costs included both medical and non-medical care expenses and the indirect costs consisted of morbidity, mortality and the caregiver's time costs. Results : The total economic costs of cancer in South Korea stood at 14.1 trillion won in 2005. The largest amount of the cost 7.4 trillion won, was the mortality costs. Following this were the morbidity costs (3.2 trillion won), the medical care costs (2.2 trillion won), the non-medical care costs (1.1 trillion won) and the costs related to the caregiver's time (100 billion won). As a result, the economic cost of cancer to South Korea is estimated to be between 11.6 trillion won to 14.1 trillion won for the year 2005. Conclusions : We need to reduce the cancer burden through encouraging people to undergo early screening for cancer and curing it in the early stage of cancer, as well as implementing policies to actively prevent cancer.

거주지역에 따른 물리적 접근성으로 인한 미충족 의료경험

김지은 ( Ji Eun Kim ),함명일 ( Myung-il Hahm ) 한국보건행정학회 2021 보건행정학회지 Vol.31 No.2

Background: The purpose of this study was to identify factors affecting unmet healthcare needs due to physical accessibility by residential area by utilizing the Korea Community Health Survey (KCHS). Methods: Andersen’s medical service behavioral model was applied to analyze the enabling factors, predisposing factors, and needs factors of unmet healthcare needs focusing on residential areas. This study used data from the KCHS (2017-2019, n=440,792). We used multivariate survey logistic regression analysis in order to identify affecting factors. Sub-group analysis was conducted in order to evaluate the effects of residential areas. Results: Some participants (2,621, 0.59%) had experienced unmet healthcare needs due to physical accessibility and 2,047 subjects (78.1%) of them lived in rural areas. Multivariate survey logistic regressions revealed that experience of unmet healthcare needs due to physical accessibility increased when people lived in rural areas (odds ratio [OR], 3.95; 95% confidence interval, 3.46-4.51). Conclusion: This study showed that despite the development of transportation and efforts to alleviate medical inequality, residents in rural areas may still have higher experience of unmet healthcare needs due to physical accessibility compared to the metropolitan city regardless of any other sub-group differences (OR range, 1.90-6.31). This study suggested that government and policymakers should identify the causes of the experience of unmet healthcare needs due to physical accessibility and should develop policies to alleviate those healthcare disparities.

우리 나라 병원들의 건강증진 서비스 도입 현황과 이에 영향을 미치는 요인

이상규,박춘선,강명근,함명일,이순영,조우현,Lee, Sang-Gyu,Park, Choon-Seon,Kang, Myung-Guen,Hahm, Myung-Il,Lee, Soon-Young,Cho, Woo-Hyun 대한예방의학회 2001 예방의학회지 Vol.34 No.4

Objectives : To investigate the current status of hospital-based health promotion programs in Korea and to elucidate the factors which affect to the process of implementation. Methods : We conducted a mail survey of all 875 hospitals in Korea from March to May 2001. In reference to 12 specific kinds of health promotion programs, hospital CEOs were asked whether their hospital have such programs, whether they are fully staffed and whether the program is paid for by the patients. Contextual factors(location, hospital type, number of beds, length of operation, public/private status, economic level of the community, the level of competition) and organizational factors (the extent of market, compatibility with vision, formalization), strategic types of the CEOs (defender/analyser/prospector) were also surveyed. The relationships between each variable and the implementation of health promotion services, activation of services, and the target groups(patient/community resident) were analyzed by univariate analysis and the independent effects of these variables were examined with multiple logistic regression. Results : 100 of 125 hospitals responding (84.8%) had mere than one health promotion program. However, they showed fluctuations in the adoption rate of each programs, meaning that comprehensive health promotion services were not provided. Many programs were not fully staffed and few hospitals had paid programs. In factors affecting health promotion service implementation, private hospitals showed a higher rate in implementation than public hospitals. In contrast, when the competition among nearby hospitals was intense, the level of implementation of service lowered. In the strategic type of the CEOs, the prospectors were shown to have instituted more health promotion programs in their hospitals and the analysers had a greater tendency to have programs for community residents than the defenders. Conclusion . Considering the above results, contextual factors may contribute greatly to the introduction of health promotion services in Korean hospital, although the CEO's personal preference and organizational factors play a larger role in the activation of services. Additionally, the CEO's personal preference may be the major influencing factor in the introduction of programs for community residents.

청소년 위험행동과 흡연과의 상관성

이준범 ( Jun Beom Lee ),함명일 ( Myung-il Hahm ),김동준 ( Dong Jun Kim ),조하현 ( Ha-hyeon Cho ),민인순 ( In Soon Min ) 한국병원경영학회 2019 병원경영학회지 Vol.24 No.2

Purposes: The purpose of this study was to examine the association between risk behaviors and smoking in Korean adolescents. Methods: This study used data from online survey of youth health behavior in 2017. Data from a total of 54,411 people (27,139 male, 27,272 female) were included in the analysis. chi-square test, simple logistic regression, multiple logistic regression were performed using SAS 9.4. Findings: Multiple logistic regression analysis showed that risk behaviors such as drinking alcohol experience, sexual experience, drug use experience and high caffeine energy drinks intake experience had a significant effect on smoking. Adolescents with drinking experience were more likely to smoking than those who had no experience(OR=8.58, 95% CI: 7.67~9.60). Adolescents with sexual experience were more likely to smoking than those who had no experience(OR=4.47, 95% CI: 3.91~5.11). Adolescents with drug use experience were more likely to smoking than those who had no experience(OR=2.32, 95% CI: 1.63~3.32). Also, adolescents with high-caffeine energy drinks intake experience were more likely to smoking than those who had no experience(OR=1.37, 95% CI: 1.23~1.53). Practical Implications: All the risk behaviors were significantly associated with smoking rates. Results of this study suggest that physicians and health workers in medical institutions and health centers should simultaneously serve education and consultation for the smoking cessation as well as for the prevention of risk behaviors.

인구집단 기반 건강관리모형의 적용가능성 검토: 한 지역의 의료복지사회적협동조합형 의료기관을 중심으로

이근정,오주연,이다희,함명일,이진용,Lee, Keun-Jung,Oh, Ju-Yeon,Lee, Da-Hee,Hahm, Myung-Il,Lee, Jin-Yong 한국의료질향상학회 2020 한국의료질향상학회지 Vol.26 No.2

Purpose: This study was to examine whether a health care model that provides comprehensive medical services based on population groups to members of the medical cooperative is applicable as a policy alternative in terms of medical use and cost. Methods: Data were derived from National Health Insurance claim data in 2019. We compared the medical volume and expenses of patients who visited social cooperative-type medical clinics with other patients, control group who visited other clinics in a local area. Results: The average number of visit days was 25.3 days in social cooperative-type medical clinics, more than 24.2 days in the control group (p=.004). However, the average medical cost per visit was KRW 46 thousand in social cooperative-type medical clinics, which was significantly lower than KRW 51 thousand in the control group (p<.001), and the total medical cost was also KRW 16.1 billion in social cooperative-type medical clinics and KRW 16.9 billion in the control group. Conclusion: We identified that a population-based health care model might change patients' behaviors to health care services and decrease total medical cost. Further population based experiment is needed to develop alternative healthcare model.

지역사회 건강관련 삶의 질에 영향을 미치는 요인

정용래(Yong-Rae Jeong),함명일(Myung-Il Hahm),민인순(In-Soon Min),강은정(Eunjeong Kang) 한국콘텐츠학회 2015 한국콘텐츠학회논문지 Vol.15 No.1

이 연구의 목적은 우리나라의 지역사회 건강관련 삶의 질에 영향을 미치는 지역사회 요인을 확인하기 위함이다. 2012년 단면연구이며, 국가통계포털의 209개의 시군구별 2차 자료를 사용하였다. 기본 틀은 International Council of Science(ICSU)에서 제시한 지역사회 건강결정요인을 바탕으로 구성하였고, 6가지 측면으로 분류하였다. 분석방법은 지역사회 EQ-5D지수와 지역사회 요인들에 다변량 회귀분석을 실시하였다. 분석결과로, 흡연율, “양호한” 주관적 건강수준 인식률, 상수 및 하수도 보급률 그리고 재정자립도가 EQ-5D에 통계적으로 유의하게 긍정적인 연관성이 있었다. 순인구이동률, 비만율, 필요서비스 미치료율 그리고 지역사회 유형이 EQ-5D에 통계적으로 유의하게 부정적인 연관성이 있었다. 이 연구는 지역사회 수준의 건강관련 삶의 질에 영향을 미치는 지역사회 요인들의 연관성을 확인했으며, 이것은 지역사회 건강 정책 개발에 유용한 증거를 제공할 수 있다. The aim of this study was to identify the impact of community factors on the community-level Health-Related Quality of Life (HRQOL) in Korea. This was a cross-sectional study conducted in 2012 using secondary data(n=209) of the Korean Statistical Information Service. The framework was based on community factors provided by the International Council of Science (ICSU) and community factors were categorized based on six aspects. Multiple regression was applied to community factors depending on the community EQ-5D index. Smoking rate, “Good” self-rated health rate, water and wastewater coverage rate, and financial independency rate were significantly and positively associated with the EQ-5D score. Net migration rate(more move out than move in), obesity rate, unmet needed health care rate, and community type(rural than urban) were significantly and negatively associated with the EQ-5D score. This study identifies association for the impact of community factors on the community-level HRQOL and can provide useful evidence for development of community health promotion policies.