지속가능한 전문병원 제도를 위한 발전적 제언

함명일 건강보험심사평가원 2020 HIRA 정책동향 Vol.14 No.5

전문 질환에 대한 전문병원의 권역내·외 시장점유율 비교

함명일,김지은,강윤정,이혜원,김선정 한국병원경영학회 2023 병원경영학회지 Vol.28 No.1

Purposes: The Specialty hospital designation policy had launched in 2011 and 110 designated specialty hospitals have been operating nationwide in 2022. This study was to estimate the market share of specialty hospitals for the specific diseases compared to other types of hospitals. Methodology: Data were derived from the National Health Insurance Claim data from 2018 to 2019. Subjects were all the inpatients with MDC(Major Disease Category) that specialty hospitals specialized in. A total of 34,231,387 claims were analyzed to estimate the market share. Findings: 90 specialty hospitals were responsible for 2.4 percent of inpatient care with specific diseases for specialty hospitals. There were regional variations in the market share of the specialty hospitals as the number of specialty hospitals in regions. Specialty hospitalsʼ market shares were relatively high in burn(31.3%), ophthalmology(16.4%), obstetrics and gynecology(7.1%), alcohol(6.0%), joint(3.7%), spine(2.7%). After adjusting the number of inpatients per hospital, hospitals specialized in burn, alcohol, ophthalmology, breast, joint, obstetrics and gynecology, and hand replantation had treated more patients than tertiary hospitals. Practical Implications: Although specialty hospitalsʼ market share was small, some types of specialty hospitals had an impact on the regional market as well as the national level market. To improve patients’ accessibility to a specialty hospital, it is necessary to government supports non-specialized hospitals to change into specialty hospitals in certain fields and regions where the number of specialty hospitals is insufficient.

우리나라 5대 암 검진대상 인구의 사회경제적 수준에 따른 주관적 건강수준

함명일,문연옥,박은철,곽민선,최귀선,김성경 대한임상건강증진학회 2007 Korean Journal of Health Promotion Vol.7 No.3

BackgroundMany studies on the relationship between socioeconomic status and self-rated health have been shown that it is difficult to select socioeconomic index and measure health status. This study was conducted to examine the relationship between socioeconomic status and self-rated health using the 2004 and 2005 Korea National Cancer Screening Survey dataMethodsThe cross sectional survey data from the 2004 and 2005 Korea National Cancer Screening Survey were used. A total of 1,619 respondents in 2004 and 1,742 respondents in 2005 were subjects in this study. Socioeconomic status factors included education, household income and occupational level and health status were measured with self-rated health. Data were analyzed using SAS 9.1.ResultsSocioeconomic status including education, household income and occupation affected on self-rated health. The risk of being self-rated poor health was higher in low educational level than high educational level (2004; 1.92 times, C・I 1.06~3.47, 2005; 2.28 times, C・I 1.10~4.69). People with low household income levels also had higher risk to be sel-rated poor health than high household income level (2004; 2.23 times, C・I 1.14~4.39, 2005; 3.42 times, C・I 1.85~6.323). In case of occupational level, unemployed people had higher to be self-rated poor health than white collar workers (2004; 2.51 times, C・I 1.41~4.39, 2005; 2.30 times, C・I 1.29~4.18). ConclusionsWe confirmed that people in low levels of socioeconomic status were likely to having poor self-rated health. It is necessary to consider socioeconomic status including education, household income, and occupation in order to improve health status. 연구배경사회경제적 수준과 주관적 건강수준의 관계를 다룬 연구들은 이미 활발하게 이루어져왔지만, 사회경제적 지표 선정과 건강상태에 대한 구체적인 개념화와 측정의 어려움이 있었다. 이 연구는 2004년과 2005년 전국민 대상 암검진 수검 행태 조사 자료를 이용하여 교육, 소득, 직업을 포함한 사회경제적 수준에 따른 주관적 건강수준의 관계를 확인하고자 하였다.방 법이 연구는 2004년과 2005년 전국민 대상 암검진 수검 행태 조사 자료를 이용한 단면연구(Cross sectional study)이다. 2004년 전국민 대상 암검진 수검 행태 조사 자료는 2000년 인구주택 총 조사의 인구를 기준으로 표준 전화번호를 생성하였다. 이 중 무작위번호 전화걸기(random digit dialing)를 이용하여 전화 설문조사를 실시하여, 최종 분석대상으로 총 1,619명을 선정하였다. 2005년 전국민 대상 암검진 수검 행태 조사 자료는 2004년 주민등록 인구통계조사의 인구를 기준으로 표본수를 결정하여 다단계 층화 무작위 추출(multi-stage stratified random sampling)방법으로 선정하였다. 이 중 면접 조사를 실시하여, 총 1,742명이 최종 분석 대상으로 선정되었다. 사회경제적 수준은 교육, 소득, 직업을, 건강상태는 주관적 건강수준을 측정하였다. 분석은 SAS(Version 9.1; SAS Inst., Cary, NC)을 사용하여, x2 검정과 다중 로지스틱 회귀분석(Multiple logistic regression)을 하였다.결 과2004년과 2005년 모두 사회경제적 수준에 따른 주관적 건강수준이 차이가 있었다. 교육수준이 높은 경우보다 낮은 경우 주관적 건강수준이 나쁘다고 응답할 확률이 2004년 1.92배(1.06-3.47), 2005년 2.28배(1.10-4.69)였고, 소득수준이 높은 경우보다 낮은 경우 주관적 건강수준이 나쁘다고 응답할 확률이 2004년 2.23배(1.14-4.39), 2005년 3.42배(1.85-6.33), 사무직인 경우보다 무직의 경우 주관적 건강수준이 나쁘다고 응답할 확률이 2004년 2.51배(1.41-4.39), 2005년 2.30배(1.29-4.18)였다. 결 론전반적으로 사회경제적 수준이 낮을수록 주관적 건강수준이 낮았다. 이는 우리나라 국민의 건강증진을 위한 정책 수립에 있어 교육, 소득, 직업을 포함한 사회경제적 수준을 필수적으로 고려되어야 함을 의미한다.

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.

HIRA Research의 현황과 향후 편집 방향

함명일 건강보험심사평가원 2023 HIRA RESEARCH Vol.3 No.2

진료비 확인 민원신청 경험과 의사 및 의료기관에 대한 신뢰도와의 관련성

함명일 ( Myung Ll Hahm ),민인순 ( Insoon Min ) 한국보건행정학회 2013 보건행정학회지 Vol.23 No.3

기후변화 및 미세먼지가 병원 의료비 지출에 미치는 영향 분석

김태영,함명일,안경애 한국유통경영학회 2022 유통경영학회지 Vol.25 No.5

Purpose: In addition to climate change, air pollutants including particulate matter in the atmosphere are closely related to people’s health and disease. This study tried to analyze the effects of climate change factors and particulate matter on personal medical expenses using data from the Korea Medical Panel. Research design, data, and methodology: For the empirical analysis, data from the Korea Medical Panel Survey from 2009 to 2017 were used. The effect of major climate change factors including particulate matter on individual medical expenses was analyzed. In addition, a multilevel mixed-effect Tobit model was applied as a model for estimating personal medical expenses, and individual and national medical expenses were estimated for each particulate matter increase scenario. Results: As results of empirical analysis, the amount of sunshine showed a weak negative significance in some models, and it was found that the higher the amount of sunshine, the lower the medical cost. Medical expenses per unit (μg/m3) of particulate matter(PM10) increased by about 2,479 KRW (based on model 4). In each RCP scenario, personal medical expenses due to the rise in average temperature were found to be about 1,817 to 6,581 KRW in 2030 and 3,228 to 6,575 KRW in 2050. Implications: Social investment to reduce climate change or particulate matter concentrations in the future has a positive effect on the reduction of personal medical expenses, so it is expected that related investments at the government level can improve national health and reduce medical expenses. Accordingly, it will be most important for the government to prepare and implement active measures for the common benefit of promoting public health along with responding to climate change such as reducing greenhouse gas emissions.

산업재해 근로자의 사회적 지지가 주관적 건강에 미치는 영향

김지은,함명일 한국보건행정학회 2022 보건행정학회지 Vol.32 No.2

Background: Social support contributes directly and indirectly to maintaining physical, mental, and social well-being. The aim of thestudy was to identify the impact of social support on self-rated health among Korean industrial accident workers. Methods: This study used data from the panel study of workers’ compensation insurance (PSWCI). The final subjects were 2,759workers who responded to a 2018 to 2020 PSWCI. Social support was defined as social contact with friends, neighbors, family, andsocial participation activities like religious activity, social activity, and club activity. Multivariate logistic regression analysis wasperformed to investigate causal relationships between social support and self-rated health using a generalized estimating equationmodel. Results: Proportion of workers’ good self-rated health steadily increased (2018: n=1,447, 63.2%; 2019: n=1,542, 66.2%; 2020:n=1,653, 67.3%). Higher levels of social contacts with friend (worse: reference; same: β=0.442) and higher levels of social activity(yes: reference; no: β=-0.173) were especially associated with good self-rated health. Conclusion: This study confirmed social support positively influenced self-rated health among the self-rated health of industrialinjured workers. The results of this study suggested that recovery policies that the government served should include programsenhancing social support for improving health among industrial injured workers.