건강보험료 부담의 형평성 변화

강희정,박은철,이규식,박태규,정우진,김한중,Kang, Hee-Chung,Park, Eun-Cheol,Lee, Kyu-Sik,Park, Tae-Kyu,Chung, Woo-Jin,Kim, Han-Joong 대한예방의학회 2005 예방의학회지 Vol.38 No.1

Objectives : We analyzed the changes from 1996 to 2002 in distributive equity of the contribution burden in the Korean National Health Insurance. Methods : The study subjects were a total of 8,923 employee households and a total of 7,296 self-employed households over the period from 1996 to 2002. Those were the households meeting the two criteria as completing each annual survey and having no change in the job of head of the household during that period from the raw data of the Household Income and Expenditure Survey annually conducted by the Korean National Statistical Office. The unit of analysis was a household, and this was the standard for assessing the contribution that is now applied on a monthly basis. Deciles Distribution Ratio, Contribution Concentration Curve and Contribution Concentration Index were estimated as the index of inequality. Multiple regression analysis was conducted to compare the annual ability-to-pay elasticity of the contribution to the reference year of 1996 for three groups (all households, the employee households, and the self-employed households). Results : For the index of inequality, the distributive equity of contribution was improved in all three groups. In particular, the employee group experienced a substantial improvement. Using multiple regression analysis, the ability-to-pay elasticity of the contribution in the employee group significantly increased ($\beta$=0.232, p<0.0001) in the year 2002 as compared to the reference year of 1996. The elasticity in the self-employed group also significantly increased ($\beta$=0.186, p<0.05), although its change was smaller than that in the employee group. Conclusions : The employee group had a greater improvement for the distributive equity of the contribution burden than the self-employed group. Within the observation period, there were two important integration reforms: one was the integration of 227 self-employed societies in 1998 and the other was the integration of 139 employee societies in 2000. We expected that the equity of the contribution burden would be improved for the self-employed group since the integration reform of 1998. However, it was not improved for the self-employed group until the year 2000. This result suggests that capturing exactly the beneficiaries' ability-to-pay such as income is the precedent for distributive equity of the contribution burden, although a more sophisticated imposition standard of contribution is needed.

2023년 보건의료정책 전망과 과제

강희정 ( Kang Hee-chung ) 한국보건사회연구원 2023 보건복지포럼 Vol.315 No.-

2023년은 코로나19 방역 완화와 일상 복귀에 대한 기대에도 불구하고 금리 인상과 고물가 지속으로 인해 가계 형편이 더 나빠질 것으로 전망된다. 정부는 2022~2026년 국가재정운용계획을 통해 재정 건전성 관리와 초고강도 지출구조 조정을 예고했다. 가계의 실질소득 하락은 건강에 유익한 지출 및 저소득층의 회복 탄력성을 감소시켜 국민의 평균적 건강 수준을 하락시키고 건강 불평등을 심화하는 전조가 될 수 있다. 대한민국은 전 국민에게 적용되는 단일 건강보험을 통해 보건의료체계의 질, 접근성, 비용을 통제하고 있다. 건강보험의 지출구조 개혁과 건강정책이 연동되지 않으면 그간의 건강증진 성과가 후퇴할 수 있다. 2023년 보건의료정책은 국민의 경제적 어려움에 더 민감하게 반응하며 지출 효율화를 달성하는 혁신이 필요하다. 보건의료체계의 관성적 저항에 부딪혀 담론에 머물렀던 가치(value) 기반 보건의료체계로의 혁신이 긴축재정 환경에서 불필요한 지출을 통제할 뿐 아니라 보건의료체계의 건강성과까지 개선하는 양수겸장(兩手兼將)의 비법이 되기를 기대한다. In 2023, despite the prospects of the easing if COVID-19 restrictions and returning to a normal way of life, the household situation is expected to worsen due to interest rate hikes and the continuing high inflation. The government announced in its 2022-2026 National Fiscal Management Plan that it would pursue fiscal soundness management and a highly intensive expenditure restructuring. A decline in household real income could lead to a lowering of the average health level of the people and a deepening of health inequality by reducing health-beneficial spending and the resilience of the low-income households. Korea controls the quality, accessibility, and cost of its health care system through a single health insurance system that applies to all citizens. If health insurance spending reform and health policy are not interconnected enough, the achievements of health promotion in the past may regress. Health care policy in 2023 needs innovation that is more responsive to the people's economic difficulties and achieves efficient spending. Innovation towards a value-based health care system, which has remained in the discourse in the face of inertial resistance from the health care system, is a dual-handed strategy that not only controls unnecessary expenditures in a government austerity but also improves the health performance of the health care system.

2022년 보건의료 정책 전망과 과제

강희정 ( Kang Hee-chung ) 한국보건사회연구원 2022 보건복지포럼 Vol.303 No.-

2022년 보건의료 정책은 코로나19 이전으로의 회귀가 아니라 반복되는 문제를 뿌리 뽑고 더 나은 미래를 앞당기는 업스트림 정책이어야 한다. 코로나19 충격의 단기적 대응뿐 아니라 미래 보건의료시스템의 기반을 확대하기 위해 ‘미래 감염병 X에 대응하는 공공보건의료체계 강화’, ‘환자중심 가치기반 의료 확대’, ‘건강안전망 확대’ 정책들이 상보적 관계에서 추진되어야 할 것이다. 특히, 환자중심 가치기반 의료시스템 구축을 위해 상급종합병원 중심에서 의원 중심으로 의료전달체계 개편의 방향을 전환하고 보건복지부 산하에 일차의료 혁신 센터를 설치하여 의원 중심의 일차의료 혁신 모형을 보다 적극적으로 개발하고 시범 시행 및 평가를 전담하도록 해야 할 것이다. 2022년은 제20대 대통령 선거와 새 정부의 정책과제 설정으로 새로운 정책의 기회가 열리는 시기이기도 하다. 이러한 기회를 살려 어떠한 보건의료 위기가 오더라도 자원을 동원하고 재정을 조달하며 효율적으로 집행할 수 있는 보건의료시스템의 역량과 거버넌스를 재정비하는 한 해가 되어야 할 것이다. Health care policy in 2022 should not be a return to the pre-pandemic, but an upstream policy that will root out recurring problems and lead to a better future. In order to not only respond to the impact of COVID-19, but also enlarge the foundation for a better future health care system, the public owned health care resources to future infectious disease X should be expanded, patient-centered value-based health care policy should go forward, and National Health Insurance coverage and health safety net should be enhanced. In particular, in order to promote patient-centered, value-oriented health care policy, The reform for health care delivery system should be redirected from a tertiary hospital-centered to a clinic-centered, and the Primary Care Innovation Center should be established to develop and test innovative primary care models. This year should be a year to overhaul the health care system's capacity and governance to mobilize resources, finance, and efficiently execute under any health care crisis.

2024년 보건의료 정책 전망과 과제

강희정 ( Kang Hee-chung ) 한국보건사회연구원 2024 보건복지포럼 Vol.327 No.-

초고령사회를 목전에 둔 2024년은 고령인구 증가가 가져올 재정압박이 본격화되고 코로나19 이후 경제 위기로 인한 건강 격차 확대가 우려된다. 한편 고령화와 만성질환 증가는 지역사회 주민 단위로 건강·의료·돌봄의 통합관리에 대한 사회적 수요를 증가시킬 것이다. 단기적으로 저소득층을 보호하고 장기적으로 미래 보건의료시스템의 지속 가능성을 제고하는 핵심 정책으로 ‘지역사회 일차 의료 혁신’의 추진이 필요하다. 초고령사회 진입이 주도하는 보건의료 정책 환경에서 일차의료 혁신은 더 이상 미룰 수 없는 최우선 과제이다. 국정 과제와 보건의료 환경 전망을 반영하여 함께 추진해야 할 세부 과제로 ① 지역 주민 대상 일차의료 가치 기반 지불 모형의 개발과 시범 운영, ② 의료비 지원 제도의 체계적 통합과 외연 확대, ③ 건강보험 의료 질 평가 체계 구조 개편, ④ 디지털 전환을 통한 혁신의 촉진을 제안한다. 이 과제들은 기타 정책 추진의 기반이 되고 일차의료 혁신에 공통으로 작용하기 때문에 상호 연관성과 전체 보건의료시스템으로의 확장성을 염두에 두고 추진할 필요가 있다. In the year 2024, with Korea on the verge of becoming a super-aged society, concerns are growing over the financial strain resulting from the increase in the elderly population and the widening health disparities due to the economic crisis following COVID-19. Simultaneously, the aging population and the rise of chronic diseases will increase social demands for integrated management of health, medical care, and caregiving at the community level. As a key policy to protect the low-income population in the short term and enhance the sustainability of the future healthcare system in the long term, it is imperative to advance 'Innovation in Primary Healthcare at the Community Level.' In the healthcare policy landscape in these times of a growing aging population, innovation in primary healthcare is no longer a task that can be postponed. Reflecting national tasks and the outlook of the healthcare environment, the following specific tasks need to be pursued collaboratively: ① Development and pilot operation of a value-based payment model for primary healthcare targeting local residents, ② Systematic integration and expansion of financial support systems for medical expenses, ③ Restructuring the quality assessment framework for healthcare in the health insurance system, and ④ Proposing innovation promotion through digital transformation. These tasks, as they serve as the foundation for various other policy initiatives and all facilitate innovation in primary care, should be pursued with consideration of their mutual interdependence and scalability to the entire healthcare system.

보문 : 조선소 용접복 개발에 관한 연구

강희정 ( Hee Chung Kang ),최혜선 ( Hei Sun Choi ) 韓國衣類學會 2008 한국의류학회지 Vol.32 No.8

한국형 상병수당 도입을 위한 제도 설계의 원칙과 개념적 틀

강희정 ( Hee-chung Kang ) 한국보건행정학회 2021 보건행정학회지 Vol.31 No.1

Both access to healthcare services and income security in case of personal illness are being needed to achieve universal health coverage, which is enshrined in the human rights to health and social security and international standards on social protection. Income security acts on both the social determinants and the adverse consequences of ill health and thus would break the vicious disease-poverty cycle. The government is supposed to implement a demonstration project of sickness benefit in 2022 and to publicize its more specific blueprint for all workers. This study is to suggest basic principles and a framework to design a new sickness benefit for universal health coverage, which is based on reviews on previous studies, related issues, and institutional conditions. This is to provide a theoretical basis to promote further discussion and to support its decision-making.

에너지 産業의 交叉補助에 관한 硏究

정희용(Hee-Yung Chung),강희정(Hee-Jung Kang) 한국가스학회 2006 한국가스학회지 Vol.10 No.4

Effects of Staurosporine and Genistein on Superoxide and HOCl Production in C5a- or PMA-activated Neutrophils

윤영철,강희정,신용규,이정수,Yun Young-Chul,Kang Hee-Jeong,Shin Yong-Kyoo,Lee Chung-Soo The Korean Society of Pharmacology 1995 대한약리학잡지 Vol.31 No.1

C5a 또는 PMA에 의하여 활성화된 호중구에서의 superoxide와 HOCl 생성에 나타내는 staurosporine, genistein과 pertussis toxin의 효과를 관찰하였다. C5a에 의한 superoxide과 $H_2O_2$의 생성은 staurosporine, genistein과 pertussis toxin에 의하여 억제되었다. PMA의 자극효과는 staurosporine에 의하여 억제되었으나 pertussis toxin에 의하여 영향을 받지 않았으며, 한편 이는 genistein에 의하여 더 촉진되었다. Staurosporine, genistein은 sodium fluoride에 의한 superoxide 생성을 억제 하였으나 pertussis toxin은 영향을 나타내지 않았다. PMA에 의한 $H_2O_2$의 생성은 staurosporine에 의하여 억제되었으나 pertussis toxin은 영향을 나타내지 않았다. Genistein은 PMA에 의한 $H_2O_2$의 생성에 자극효과를 나타내지 않았다. Staurosporine과 pertussis toxin은 C5a 또는 PMA에 의한 HOCl 생성을 억제하였으나, 이에 반하여 genistein은 자극하였다. C5a와 PMA에 의한 myeloperoxidase 유리는 genistein에 의하여 억제되었나, pertussis toxin의 효과는 나타나지 않았다. Staurosporine은 유리에 대한 PMA의 자극효과에 영향을 주지 않았다. Myeloperoxidase 활성은 genistein에 의하여 현저하게 증가되었으나 staurosporine과 pertussis toxin의 영향은 받지 않았다. 이상의 결과는 호중구의 respiratory burst가 protein kinase C와 protein tyrosine kinase에 의하여 조절된다고 제시한다. Protein kinase C의 직접적인 자극에 따른 superoxide 생성은 protein tyrosine kinase의 영향을 역으로 받을 것으로 추정된다. Genistein은 아마도 myeloperoxidase를 활성화하여 HOCl 생성을 촉진할 것으로 시사된다. Effects of staurosporine, genistein and pertussis toxin on superoxide and HOCl production in C5a- or PMA-activated neutrophils were investigated. A C5a-induced superoxide and $H_2O_2$ production was inhibited by staurosporine, genistein and pertussis toxin. The stimulatory effect of PMA was inhibited by staurosporine but was not affected by pertussis toxin, whereas it was further promoted by genistein. Staurosporine and genistein inhibited superoxide production by sodium fluoride, but pertussis toxin did not affect it. PMA-induced $H_2O_2$ production was inhibited by staurosporine but was not affected by pertussis toxin. Genistein did not show a stimulatory effect on PMA-induced $H_2O_2$ production. Staurosporine and pertussis toxin inhibited HOCl production by C5a- or PMA, whereas genistein stimulated it. C5a-or PMA-induced myeloperoxidase release was inhibited by genistein, in this response the effect of pertussis toxin was not detected. Staurosporine did not affect the stimulatory effect of PMA on the release. Myeloperoxidase activity was markedly increased by genistein but was not affected by staurosporine and pertussis toxin. These results indicate that the respiratory burst of neutrophils may be regulated by protein kinase C and protein tyrosine kinase. Superoxide production induced by the direct activation of protein kinase C might be affected by protein tyrosine kinase oppositely. Genistein probably pro-motes HOCl production by activating myeloperoxidase.

도시가스 공급설비의 자기자본투자보수율 분석

정희용 ( Hee Yung Chung ),강희정 ( Hee Jung Kang ) 대한설비관리학회 2003 대한설비관리학회지 Vol.8 No.1

The modem business management is showing the maximized interest in ROE(Return on Equity), related with the improvement of efficiency in capital and the trend of emphasis on the profit of investors. ROE could be defined as the measure for efficiency in business management which shows how effectively the invested capital is used. However, due to its nature of public interest, the city gas industry is being regulated by Government on ROE. In short, ROE is accepted only up to the level of the rate of time-fixed deposit interest. Shortage in infrastructure of domestic gas industries requires a continuous investment. The annual amount of facility investment by domestic gas industries reaches nearly W4obillion. If ROE is limited to the rate of time-fixed deposit interest, there could happen many problems such as contraction on facility investment, financial risk incline, and decrease in value of enterprise, etc,. This study concerns some rational measures for improvement by analyzing those problems with foreign cases and economy indices.

민수헬기 대상기종 로터 공력성능 및 소음 비교

정기훈(Kihoon Chung),강희정(Hee Jung Kang),김도형(Do-Hyung Kim),윤철용(Chul Yong Yun),김승호(Seungho Kim),박구환(Kuhwan Park),이상기(Sang-Gi Lee) 한국항공우주학회 2013 韓國航空宇宙學會誌 Vol.41 No.9

헬리콥터 로터 블레이드는 헬리콥터의 성능을 좌우하는 동시에 비행 시 주된 소음을 발생함에 따라 고성능, 저소음 특성이 요구되는 구상품이다. 국내 소형무장헬기 개발과 병행하여 개발될 민수헬기는 해외체계업체 보유 민수헬기를 기반으로한 국제공동 업그레이드 개발이 추진됨에 따라 해외체계업체 제시 대상기종의 로터 블레이드 성능파악이 매우 중요하다. 본 연구는 해외체계업체 제시 대상기종 블레이드의 성능분석을 통하여 최신 해외블레이드 대비 성능파악 및 국내고유형상 블레이드 개발 가능성을 타진하는 것을 목적으로 수행되었다. 본 연구의 결과는 일차적으로 향후 민수헬기개발사업의 해외협상 및 국내 고유형상 블레이드 개발 시 목표 성능지표 등으로 활용될 수 있다. The rotor blade of helicopter is the core component determining helicopter performance and requiring low noise and low vibration because the blade becomes the major source of noise during flight. The performance analysis of candidates rotor blades is very critical because LCH(Light Civil Helicopter) will be developed parallel with LAH(Light Armed Helicopter) as an international upgrade program based on the existing platform of foreign civil helicopter. This research was aimed to recognize the performance of the candidates rotor blades compared with the newly developed foreign rotor blades and to investigate the feasibility about developing korea unique shape rotor blades by analysis the rotor performance and noise. The result of this research can be used for the target performance index during negotiation with foreign helicopter company and developing korea unique shape rotor blades.