전신성 홍반성 루푸스에 병발된 결절성 다발동맥염

김한중,유대현,김성윤,이창우 ( Han Joong Kim,Dae Hyun Yoo,Seong Yoon Kim,Chang Woo Lee ) 대한피부과학회 1991 대한피부과학회지 Vol.29 No.3

A Case of Polyarteritis Nodosa Associated with Systemic Lupus Erythematiosus Han Joong Kim, M.D., Dae Hyun Yoo, M.D.*, Seong Yoon Kim, M.D.*, Chang Woo Lee, M.D. Departments of Dermatology & Rheumatology*, College of Medicine, Hanyang University, Seoul, Korea A 24-year-old female with systemic lupus erythematosus(SLE) diagnosed 3 year prior, presented with star-burst patches on her lower legs, which resembled livedo reticularis. In addition, she complained of intermittent lower abdominal pain. Histopathologic findings of the lesional skin showed necrotizing vasculitis of the medium sized dermal arteries. Direct immunofluorescent studies revealed deposits of IgG, IgM, and C_3 in the depp dermal arteries. Angiographic findings showed several foci of aneurysms in the superior mesenteric artery. Among those patients with SLE, the co-existences with polyarteritis nodosa have rarely been reported in the literature. We believe that circulating immune complexes of pahtological quantity and quality, which are thought to be related to the clinical activity of SLE, maybe relevant to the development of immune-complex mediated necrotizing arteritis in this patient.

예방의학의 발전방향: 보건의료관리 분야

김한중,Kim, Han-Joong 대한예방의학회 2006 예방의학회지 Vol.39 No.3

The identity crisis of preventive medicine appears to have been deepening. As a solution, it is insisted that preventive medicine should focus on clinical preventive medicine. However, in the field of heath policy and management, the better solution should be found in a serious search for visions and perspectives of its study on population and society. In this regard, the specialist who studies the field can be defined as a medical doctor majoring in public health. In this paper, I first forecasted major socioeconomic changes to occur in medical and public health arena and explored the role of those studying health policy and management. Secondly, I summarized their career paths and main activities in order to establish visions. Finally, I proposed curriculums on health policy and management for medical school undergraduates and for specialists majoring in preventive medicine, respectively.

전국민 의료보험 실시에 따른 사회전체 순편익 분석

김한중,이해종,Kim, Han-Joong,Lee, Hae-Jong 대한예방의학회 1989 Journal of Preventive Medicine and Public Health Vol.22 No.3

A change in the consumer's surplus was measured in order to evaluate the social benefit to be derived from expanding health insurance to the entire population. The most refined and correct way to measure a project's net benefit to society is to determine a change in the consumer's surplus. Benefits from introducing the health insurance program to the uninsured people can be classified into two elements. The first is the pricing-down effect(E1) which results from applying the insurance price system, which is lower than the actual price, to the uninsured patients. The second effect(E2) is a decrease in actual payment because an insured patient pays only a portion of the total medical bill(copayment). We collected medical price information from the data banks of 93 hospitals, and obtained information of medical utilization by referring to the results of other research and from data published by the Korean Medical Insurance Societies. The total net benefit was estimated as \214 billion, comprising the first effect(E1) of \57 billion and the second effect(E2) of \157 billion. The price elasticity of physician visits is less than that of hospital admissions: however, benefits from the increase in physician visits are greater than those from hospital admissions because there are considerably more of physician visits than hospital admissions. The sensitivity analysis also shows the conclusion that expansion of the health insurance program to the entire population would result in a positive net benefit. Therfore, we conclude that the National Health Insurance Program is socially desirable.

DRG 도입이 메디케어 의료비 증가억제에 미친 효과

김한중,남정모,Kim, Han-Joong,Nam, Chung-Mo 대한예방의학회 1994 예방의학회지 Vol.27 No.1

The United States adopted DRG based prospective payment system (PPS) in order to control the inflation of health care costs. No study used statistical test while many studies reported the cost containing effect of the PPS. To study impacts of the PPS on the Medicare expenditure, this study set the following three hypotheses (1) The PPS decelerated the increase in the hospital expenditure (Part A), (2) the PPS accelerated the increase in the expenditure of outpatients and physicians (Part B), (3) the increase in total expenditure was decelerated inspite of the spill over (substitution) effect because saving in the Part A expenditure were greater than losses in the Part B expenditure. The dependent variables are per capita hospital expenditure, per capita Part B expenditure, and per capita total expenditure for the Medicare beneficiaries. An intervention analysis, which added intervention effect to the time series variation on the Box-Jenkins model, was used. The observations included 120 months from 1978 to 1987. The results are as follows : (1) The annual increase in the per capita Part A expenditure was $5.11 after the implementation of DRG where as that before the PPS had been $11.1. The effect of the reduction ($5.99) was statistically significient (t=-3.9). (2) The spill over (substitution) effect existed because the annual increase in the per capita Part B expenditure was accelerated by $1.73 (t=1.91) after the implementation of the PPS. (3) The increase in the total Medicare expenditure per capita was reduced by $4.26 (t=-2.19) because the spill over effect was less than cost savings in the Part A expenditure.

의약분업의 비용-편익 분석

김한중,박은철,강혜영,지영건,Kim, Han-Joong,Park, Eun-Cheol,Kang, Hye-Young,Jee, Young-Keon 대한예방의학회 2000 예방의학회지 Vol.33 No.4

Objective : To evaluate the relative benefits and the costs associated with the introduction of the new pharmaceutical provision called 'Mandatory Prescription System' which separates the role of physicians from that of pharmacists with respect to the prescription and dispensation of from the perspective of consumers (i.e., patients). Methods : The costs of the system were measured by considering both direct and indirect costs. Direct costs included additional payments for ambulatory care and dispensing fees that occurred under the new system. indirect costs consisted of transportation expenses and costs related to time spent for physician consultation, waiting for the prescriptions to be filled, and extra traveling. Benefits identified in this study were the reduction of drug misuse and overuse, and the overall decrease in drug consumption among the Korean population. Sensitivity analysis was peformed for the inclusion of benefits for outpatients of hospitals, price elasticity, and increased fees for established patients. Results : The net benefit was estimated to be about minus 1,862 billion won and the benefit-cost ratio was 0.478. This indicates that the costs of 'Mandatory Prescription' outweigh its benefits, relative to the previous system. The sensitivity analysis results for all the variables considered in this study consistently showed the benefit-cost ratio to be less than 1. Conclusion : The results of this study suggest that implementing Mandatory Prescription System in Korea might be inefficient from the consumer's perspective. The results of this study do not coincide with the results of previous studies, presumably because of the differences in study design and in which items of costs and benefits were considered.

의료비 결정요인 분석을 위한 계량적 모형 고안

김한중,이영두,남정모,Kim, Han-Joong,Lee, Young-Doo,Nam, Chung-Mo 대한예방의학회 1991 Journal of Preventive Medicine and Public Health Vol.24 No.1

A multiple regression analysis using ordinary least square (OLS) is frequently used for the projection of health expenditure as well as for the identification of factors affecting health care costs. Data for the analysis often have mixed characteristics of time series and cross section. Parameters as a result of OLS estimation, in this case, are no longer the best linear unbiased estimators (BLUE) because the data do not satisfy basic assumptions of regression analysis. The study theoretically examined statistical problems induced when OLS estimation was applied with the time series cross section data. Then both the OLS regression and time series cross section regression (TSCS regression) were applied to the same empirical da. Finally, the difference in parameters between the two estimations were explained through residual analysis.

보건소(保健所) 등록이전(登錄以前) 결핵치료역(結核治療歷) 유무(有無)와 치료효과와의 관련성(關聯性) 연구(硏究)

김한중,박동철,Kim, Han-Joong,Park, Dong-Chul 대한예방의학회 1983 Journal of Preventive Medicine and Public Health Vol.16 No.1

The records for the tuberculosis patients who discharged from the health center during 1982 in Kangwha county were analized in order to study the characteristics and the patterns of treatments for the pulmonary tuberculosis patients with the history of previous treatment before registration and also the relationship between the previos history of treatment and the outcome at the time of discharge from the health center. The major findings are as follows. 1. Those who have a history of previous treatment were 58, 22.5% of those 258 patients who were studied. 2. There is no difference in sex however the rate of previous history of treatment was higher among middle age group (20-59) than young and old age group (under 19 or over 60). 3. The rate of previous treatment was rather higher in those lived in remote area from Eup. 4. As for the reationship with occupation, students and civil servants who easily exposured to the public relations of government's tuberculosis control program experienced lower previous treatment before registration than farmers or unemployed. 5. A total of 62.1% were previously treated less than 6 months, 29.3% between 6 and 12 months, and only 8.6% more than 12 months before registration to health center. 6. The most common used anti-tuberculosis drugs were isoniazid and ethambutol but only 13.8% used government-standardized precription and 69.0% used secondary drugs from its beginning. 7. There was no statistical difference between the previous history of treatment and the outcome at the time of discharge from the health center. However the longer the duration of treatment before registration was the lower the cure rate at health center was.

의료비 상승 요인 분석

김한중,전기홍,Kim, Han-Joong,Chun, Ki-Hong 대한예방의학회 1989 예방의학회지 Vol.22 No.4

The skyrocketing inflation of medical costs has become a major health problem among most developed countries. Korea, which recently covered the entire population with National Health Insurance, is facing the same problem. The proportion of health expenditure to GNP has increased from 3% to 4.8% during the last decade. This was remarkable, if we consider the rapid economic growth during that time. A few policy analysts began to raise cost containment as an agenda, after recognizing the importance of medical cost inflation. In order to Prepare an appropriate alternative for the agenda, it is necessary to find out reasons for the cost inflation. Then, we should focus on the reasons which are controllable, and those whose control are socially desirable. This study is designed to articulate the theory of medical cost inflation through literature reviews, to find out reasons for cost inflation, by analyzing aggregated data with a deterministic model. Finally to identify determinants of changes in both medical demand and service intensity which are major reasons for cost inflation. The reasons for cost inflation are classified into cost push inflation and demand pull inflation, The former consists of increases in price and intensity of services, while the latter is made of consumer derived demand and supplier induced demand. We used a time series (1983-1987), and cross sectional (over regions) data of health insurance. The deterministic model reveals, that an increase in service intensity is a major cause of inflation in the case of inpatient care, while, more utilization, is a primary attribute in the case of physician visits. Multiple regression analysis shows that an increase in hospital beds is a leading explanatory variable for the increase in hospital care. It also reveals, that an introduction of a deductible clause, an increase in hospital beds and degree of urbanization, are statistically significant variables explaining physician visits. The results are consistent with the existing theory, The magnitude of service intensity is influenced by the level of co-payment, the proportion of old age and an increase in co-payment. In short, an increase in co-payment reduced the utilization, but it induced more intensities or services. We can conclude that the strict fee regulation or increase in the level of co-payment can not be an effective measure for cost containment under the fee for service system. Because the provider can react against the regulation by inducing more services.

한 농촌(農村) 지역(地域)의 의료보호사업(醫療保護事業) 평가(評價) -의료이용(醫療利用)을 중심(中心)으로-

김한중,Kim, Han-Joong 대한예방의학회 1978 Journal of Preventive Medicine and Public Health Vol.11 No.1

To examine the result of the government Medical Aid Program which began in January, 1977 as a part of social security policy implementation, all the medical records of the clients and official statistics in the year were analysed. The specific objectives this study pursues include the magnitudes and patterns of morbidity and utilization, and the characteristics of clients. One Korean rural area, Koje county was selected as the study area and subsequently all the clinics and hospitals assigned to work out the Aid Program are the subjects for the survey. A brief summary of the sutdy results as follows: a. The clients of Koje county are 6.4% of the total population in the area, more than the average percentage of the clients in Korea. It reflects on low level of economic status of the residents of the area. b. The population structure of the clients indicates that the large proportions of young and old age group are overwhelming, while the middle age group share very small portions. c. The utilization rates for primary care are 2.0 persons, 11.6 visits and 22.6 treatment days per 100 persons per months. Annual hospitalization is rated as 13.7 cases and 164 days per 1,000 persons, The utilization rates are slightly lower than those expected rates during planning period but eventually become higher than those of general population in rural Korea. d. The factors which influence the utilization rates are identified with client group (low income vs indigent), age and sex. e. The utilization pattern for primary care demonstrates seasonal variation similar to the pattern of general rural population in the low income group, but none in the indigent group. f. The most common diseases revealed at the primary care clinics are the acute respiratory infection (26.9%), acute gastritis (10.8%), skin and subcutaneous infection (6.8%). The cases of acute conditions are outnumbered than the cases of chronic condition. 8. The clinics, hospitals and other related health institutions are well cooperated in dealing health care services in their own capacities. Considering the above results Medical Aid Program generated satisfactory results at least in the utilization aspect.

가상현실을 이용한 구조설계 시스템의 학습효과에 관한 연구 - 구조 요소의 데이터베이스 구축방법에 관하여 -

김한중,Kim, Han-Joong 한국농공학회 2012 한국농공학회논문집 Vol.54 No.3

This paper presents a set of controlled simulated statical and engineering mechanical experiments accessible via the virtual world environment (VWE) and virtual physics lab S/W. Online courses of the university offering courses and/or programs online are growing and the number of students want education in ways which fit their personal places, e-learning is becoming more important and ubiquitous each year. In this study, first of all, question is rather 'How do we execute the learning effectiveness of e-learning courses?' than 'Why does they need e-learnig or VW-learning?'. In particular, is it possible to effectively teach mechanical engineering courses online? The answer was 'No'. So, there is little research on many of these questions. And another important question is 'Is e-learning cost effective?'. For the answer, This research provided that an instructional design model is used to 'How to think and apply the Newtonian forces' in the virtual physics lab S/W. Collected data from student are administered in the spring semester when students studied 'Introduction to Bio-resources and Systems Engineering'. Results show that a cadre of students can take highly interactively physical properties of mechanical engineering in the virtual laboratory environment. Those show that VWE is greater than that of a similar real world presentation or experimental lab, since most of students are delighted to modify and retry modeling works in the VWE.