모아의 환경적 건강에 대한 출산 코호트 효과: 체계적 고찰

채정미 ( Jungmi Chae ),김현경 ( Hyun Kyoung Kim ) 한국여성건강간호학회 (구 여성건강간호학회) 2021 여성건강간호학회지 Vol.27 No.1

Purpose: This study aimed to review recent findings from birth cohort studies on maternal and child environmental health. Methods: Birth cohort studies regarding environmental health outcomes for mothers and their children were investigated through a systematic review. A literature search was conducted in PubMed, CINAHL, the Cochrane Library, Embase, and RISS to identify published studies using the keywords using a combination of the following keywords: maternal exposure, environmental exposure, health, cohort, and birth cohort. Articles were searched and a quality appraisal using the Newcastle-Ottawa Scale for cohort studies was done. Results: A review of the 14 selected studies revealed that prenatal and early life exposure to environmental pollutants had negative impacts on physical, cognitive, and behavioral development among mothers and children up to 12 years later. Environmental pollutants included endocrine disruptors, air pollution (e.g., particulate matter), and heavy metals. Conclusion: This systematic review demonstrated that exposure to environmental pollutants negatively influences maternal and children’s environmental health outcomes from pregnancy to the early years of life. Therefore, maternal health care professionals should take steps to reduce mothers’ and children’s exposure to environmental pollutants.

Trends in National Pharmaceutical Expenditure in Korea during 2011 - 2020

Kim Yujeong,Chae Jungmi,Shin Seohee,Jo Gayoung,Shin Jihye,Kim Byungsoo,Kim Dong-Sook,Lee Jin Yong 대한감염학회 2023 Infection and Chemotherapy Vol.55 No.2

Background: This study aimed to identify the trends in pharmaceutical expenditure (PE), share of PE in health expenditure (HE), and trends in expenditure by pharmacological groups (ATC level 1 classification) in Korea for a 10-year period (2011 - 2020) and compare the data with those of other Organisation for Economic Co-operation and Development (OECD) countries. Using the findings, we determined the current status of pharmaceutical expenditure (PE) management in Korea and derived the implications for establishing future macroscopic policies on PE. Materials and Methods: We analyzed the OECD Health Statistics and the Korean national health insurance claims database from January 2011 through December 2020. The outcome measures were HE, PE, and pharmaceutical sales data for ATC level 1 medicines from OECD Health Statistics data during 2011 - 2020. As OECD collects limited ATC level 1 data, we used the HIRA health insurance claims data for PEs of ATC level-1 classification, including D, L, P, and S. Results: PE in Korea increased by 38.5% from 19.9 billion USD in 2011 to 27.6 billion USD in 2020, whereas the share of PE in HE decreased by 6.3%p from 26.4% in 2011 to 20.1% in 2020. In 2020, Korea ranked third in PE per capita (760.9 USD PPP) and had the highest share of PE (20.1%) among the 19 OECD countries studied. By ATC level 1 class, the highest PE was A (alimentary tract and metabolism) at 4.3 billion USD, and L (antineoplastic and immunomodulating agents) had the highest increase at 13.4%; in contrast, J (anti-infectives for systemic use) had the lowest increase in annual average PE at −0.2% in 2020 relative to 2011. Among the 17 OECD countries, Korea had the highest and the third-highest expenditures for ATC codes A and J, respectively. Conclusion: PE in Korea has continued to increase between 2011 and 2020, indicating the need for macroscopic management of PE. Our results on PE by ATC code may help health authorities in establishing future policies on PE.

항생제 사례로 살펴본 건강보험청구자료 분석 시 고려사항

김예슬,채정미,신지혜,김유정,조가영,지승연,김동숙 건강보험심사평가원 2023 HIRA RESEARCH Vol.3 No.2

The Health Insurance Review & Assessment Service (HIRA) collects and stores medical information of all citizens and medical institutions, including pharmaceutical claims data. Claims data including consultation notes and information about the medical institution are submitted to the HIRA by medical providers. Claims data have potential to offer a high quality for research, but various factors must be strongly considered in its analysis and interpretation. This study highlights various points to be considered while utilizing claims data. First, the time period between a claims review and loading of the data onto a data warehouse (DW) must be taken into account because over 99% of claims are available on DW for extraction after 5 months, according to an analysis of claims rate for pharmaceutical expenses. Second, over 50% of pharmaceutical claims data consists of reimbursable items, of which over 99% are antimicrobial medications. Accurate determination of the precise usage of nonreimbursable pharmaceuticals is limited to estimations based on the data on pharmaceutical supply declaration, which is only partially reported on claims statements as part of the comprehensive fees system. Finally, complete data on the use of pharmaceuticals during inpatient admission is unavailable. Due to the lack of requirement to input the administration time or to differentiate prescriptions on the day of discharge, it is difficult to accurately calculate the used amounts. These factors must be considered prior to analysis and interpretation of claims data from the HIRA. Hence, to ensure a higher research quality, we recommend considering these factors when conducting a claims data-based research.

의료기관별 간호인력 활용방안

홍지연(Hong, Ji Yeon),채정미(Chae, JungMi),송미라(Song, Mi Ra),김은미(Kim, Eun Mi) 한국산학기술학회 2017 한국산학기술학회논문지 Vol.18 No.8

본 연구는 중소병원 간호인력 현황과 관련 정책을 분석하고 인력 확보에 영향을 주는 요인을 파악하여 중소병원 간호인력 확보를 위한 정책을 입안하고 결정하는 데에 근거를 제시하고자 실시되었다. 보건복지부와 건강보험심사평가원 등에서 제시한 통계자료를 2차 분석한 후 그 결과를 다양한 내·외적 보건의료환경에 대한 이해를 기반으로 조명하였다. 연구결과 우리나라의 활동 간호사 수는 면허간호사 수의 50% 미만으로 그 수는 해마다 감소하고 있었으며, 이는 간호대학 정원 증가의 비용 대비 성과의 효율성을 재고할 필요가 있음을 의미한다. 또한 간호관리료 차등제 실시로 인해 신규간호사는 물론 간호사 인력부족이 심각한 중소병원의 경력간호사들이 상급종합병원으로 이동하게 되는 결과를 야기하였으며, 결국 중소병원 간호인력 부족 현상을 더욱 악화시키는 원인이 되었다. 따라서 입원환자 간호관리료 차등제가 중소병원 간호인력 확보정책으로 실효성이 있는지에 대한 재검토가 필요하며, 면허간호사에 대한 추적 관리 시스템을 통해 간호인력 수급의 불균형을 해소할 수 있어야 한다. This study analyzed the current situation of medium and small-sized hospital nursing staff and related policies, and identified the factors that affect staffing level to provide evidence for planning and adopting policy. By analyzing the statistical data published by public institutions such as the Ministry of Health and Welfare and Health Insurance Review and Assessment Service, the result was viewed based on the understanding of various internal and external health care environments. The number of active nurseswasless than 50% of the number of licensed nurses and has decreased every year. This means that the cost-effectiveness of increases in nursing college enrollment should be reconsidered. Inpatient nursing fees by staffing grades has caused nurses to move from medium and small-sized hospitals, where there is a severe lack of staff, to more advanced general hospitals. As a result, the lack of nursing staff in medium and small-sized hospitals has worsened. In conclusion, reexamination is needed to improveeffectiveness of inpatient nursing fees by staffing grades as a policy to secure the workforce of medium and small-sized hospitals. Furthermore, the tracking management system of licensed nurses must be able to solve the imbalance betweendemand and supply of nursing staff.

인구구조의 변화를 반영한 건강보험 진료비 추계

이창수(Lee, ChangSoo),권혁성(Kwon, HyukSung),채정미(Chae, JungMi) 한국보건간호학회 2017 韓國保健看護學會誌 Vol.31 No.1

Purpose: This study was conducted to suggest a method for financial projection of health insurance expenditures that reflects future changes in demographic structure. Methods: Using data associated with the number of patients and health insurance cost per patient, generalized linear models (GLM) were fitted with demographic explanatory variables. Models were constructed separately for individual medical departments, types of medical service, and types of public health insurance. Goodness-of-fit of most of the applied GLM models was quite satisfactory. By combining estimates of frequency and severity from the constructed models and results of the population projection, total annual health insurance expenditures were projected through year 2060. Results: Expenditures for medical departments associated with diseases that are more frequent in elderly peoples are expected to increase steeply, leading to considerable increases in overall health insurance expenditures. The suggested method can contribute to improvement of the accuracy of financial projection. Conclusion: The overall demands for medical service, medical personnel, and relevant facilities in the future are expected to increase as the proportion of elderly people increases. Application of a more reasonable estimation method reflecting changes in demographic structure will help develop health policies relevant to above mentioned resources.

자동차보험 한방진료비 증가요인 분석

이창수(Lee ChangSoo),이현주(Lee Hyeon Ju ),채정미(Chae JungMi) 한국산학기술학회 2019 한국산학기술학회논문지 Vol.20 No.1

자동차보험 총 진료비는 2014년 대비 2015년 12% 증가하였으나 그 중 한방진료비는 36% 증가하였다. 본 연구 목적은 진료비 항등식을 이용하여 자동차보험 한방진료비의 급격한 증가 원인을 구체적으로 파악하는 것이다. 2014년~2015년 기간 중 진료하여 심사 완료된 34,351,120건의 데이터를 이용하여 분석한 결과 한방 환자수는 해당 기간 중 27%, 환자당 진료비는 7% 증가하였다. 환자당 진료비를 세분화하여 분석한 결과, 환자당 입(내)원 일수는 변하지 않았으며 일당진료비만 7% 증가하였다. 환자수 증가를 보면 한방진료만을 받은 환자는 32%, 의과와 한방을 함께 진료 받은 환자는 24% 증가한 반면 의과진료만을 받은 환자는 오히려 4% 감소하였다. 일당진료비 증가에 영향을 미치는 요인으로는 한방물리요법 등 표준화되지 않은 진료행위의 비용 상승이 있다. 그럼에도 불구하고 한방 진료비 증가에 가장 크게 영향을 미친 요인은 환자수의 증가였다. Automobile insurance medical expenses increased by 12% in year 2015 compared to year 2014. But the oriental medical service expenses in automobile insurance increased by 36% during the same period. In this paper the reason for the rapid increase of expenses for oriental medical service was analyzed using the method of decomposing medical expenses. As a result of analyzing 34,351,120 cases that were examined and completed during the period of 2014∼2015, the number of oriental medicine patients increased by 27% and the medical expense per patient increased by 7%. The result of analysis showed that there was no significant change in service period per patient but medical expense per day increased by 7%. The increase in the number of patients receiving only oriental medical services was 32%. Increase in the number of patients receiving medical treatment and oriental medical services was 24% and the number of patients receiving medical treatment only decreased by 4%. There was significant increase in non standardized cost of oriental physical therapy which was one reason of the increase of the expenses. However, the most influential factor of the increase in the expenses of oriental medical services was the increase of the number of patients.

Development of the Korean Standardized Antimicrobial Administration Ratio as a Tool for Benchmarking Antimicrobial Use in Each Hospital

Kim Bongyoung,Ahn Song Vogue,Kim Dong-Sook,Chae Jungmi,정수진,어영,Kim Hong Bin,Kim Hyung-Sook,Park Sun Hee,Park Yoon Soo,최준용 대한의학회 2022 Journal of Korean medical science Vol.37 No.24

Background: The Korea National Antimicrobial Use Analysis System (KONAS), a benchmarking system for antimicrobial use in hospitals, provides Korean Standardized Antimicrobial Administration Ratio (K-SAAR) for benchmarking. This article describes K-SAAR predictive models to enhance the understanding of K-SAAR, an important benchmarking strategy for antimicrobial usage in KONAS. Methods: We obtained medical insurance claims data for all hospitalized patients aged ≥ 28 days in all secondary and tertiary care hospitals in South Korea (n = 347) from January 2019 to December 2019 from the Health Insurance Review & Assessment Service. Modeling was performed to derive a prediction value for antimicrobial use in each institution, which corresponded to the denominator value for calculating K-SAAR. The prediction values of antimicrobial use were modeled separately for each category, for all inpatients and adult patients (aged ≥ 15 years), using stepwise negative binomial regression. Results: The final models for each antimicrobial category were adjusted for different significant risk factors. In the K-SAAR models of all aged patients as well as adult patients, most antimicrobial categories included the number of hospital beds and the number of operations as significant factors, while some antimicrobial categories included mean age for inpatients, hospital type, and the number of patients transferred from other hospitals as significant factors. Conclusion: We developed a model to predict antimicrobial use rates in Korean hospitals, and the model was used as the denominator of the K-SAAR.

연령에 따른 근무환경 및 의료기관 특성이 간호사 이직에 미치는 영향

이요셉,김정림,김소희,채정미 건강보험심사평가원 2022 HIRA RESEARCH Vol.2 No.1

지역순환형 자립발전전략

이성근 ( Seong Keun Lee ),나중규 ( Jung Gyu Na ),최영은 ( Young Eun Choi ),임규채 ( Gyu Chae Im ),최용준 ( Yong Jun Choi ),이정미 ( Jungmi Lee ),홍근석 ( Geun Seok Hong ) 영남대학교 한국균형발전연구소(구 영남대학교 영남지역발전연구소) 2013 한국균형발전연구 Vol.4 No.1

최근 우리나라의 지역개발이나 정책에 있어 과거의 중앙정부 중심, 물적 성장 중심의 개발 패러다임에서 벗어나 자립적 역량강화, 지역 간 연계협력, 융합화 등이 강조되고 있다. 이에 본 연구의 목적은 지방자치제가 실시되었으나 지방의 자치기반이 취약하여 지역간 불균형 발전이 심화되는 가운데, 박근혜정부의 출범과 함께 최근 국내외적으로 변화하고 있는 지역발전의 패러다임에 직면하여 지방분권과 균형발전에 토대를 둔 지역 주도의 자립적 지역발전을 이루기 위한 구체적 방안을 제시하는 데 있다. 이를 위해 시대적 요구와 필요성을 절감하고, 지역적 차원에서 창조경제에 기반한 새로운 지역발전 패러다임으로서 국민대통합과 지역균형발전을 지향하는 「지역순환형 자립발전모델」을 제시하였다. 이는 궁극적으로 국내외 패러다임의 변화를 체계적 이론적 틀로써 통합하고 실질적으로 적용하기 위한 것으로 지역을 중심으로 사람을 키우고, 청년을 살게 하고, 사람이 모이게 하는 것을 의미한다. 이를 달성하기 위한 구체적 전략으로서 선순환 전략과 자립전략을 제시하였다. 첫째, 지역순환형 자립발전의 토대가 되는 자립전략으로서 지역발전의 가치와 목적을 ‘지역역량강화(Competency)’. ‘연계협력(Cooperation)’, ‘융합(Convergence)’의 3C전략을 제시하였다. 둘째, 지역순환형 자립발전을 달성하기 위한 선순환 진흥전략으로서 지역교육 진흥, 지역산업진흥, 지역문화예술진흥, 지역복지진흥, 지역창조와 재생을 제시하였다. 첫 번째 전략은 우수 인재양성을 통한 지역교육 진흥(振興)이다 교육부문 진흥을 통해 우수한 인재를 양성하고 지역에 공급하는 시스템을 구축하는 것이다. 둘째, 일자리 창출을 위한 지역산업진흥(振興) 이다, 즉 산업부문 진흥을 통해 청년일자리 창출 및 역동적 지역창출에 기여하는 것이다. 셋째, 지역문화와 예술 기반 구축 및 역량 강화를 통해 지방문화예술을 진흥해 나가야 한다. 넷째, 지역복지역랑 강화를 위한 지역복지 진흥(振興) 이다. 지역복지 진흥을 통해 지역 복지 예산 및 인프라 구축 등을 통해 서민들이 피부로 느낄 수 있는 복지역량을 강화시켜나가야 할 것이다. 마지막으로 지역창조와 재생을 통해 관련 인프라를 확충하여 국토의 고른 공간 창출을 진흥시켜 나가야 할 것이다. Despite local government efforts for regional change, the local self-government based development is vulnerable to deepening disparities between regions. While confronting the paradigm of the latest changes in national and international development of the region that Park Geun-hye government faces, the purpose of this study is to present concrete plans for achieving self-sustaining regional development based on decentralization and balanced development. To this end, with the demands and needs of the times, “The Self-Supporting Development Model of the Regional Circulation” is proposed which professes national unification and balanced regional development as a new regional development paradigm which is based on the creative economy utilizing the local dimension. Ultimately, this is for integrating a domestic and foreign paradigm shift as a systematic theoretical framework and practically applying that in the field. It intends to accomplish this by educating people in the area, making them live in the area, and gathering people into the area. In order to achieve it, we proposed a virtuous and self-supporting development model. Firstly, for tile self-supporting development of the regional circulation, the 3C strategy-Competency, Cooperation, Convergence, Convergence-is proposed. Secondly, in order to achieve self-supporting development as a strategy for promoting regional circulation, we proposed promotion of regional education, regional industrial development, local cultural arts, and community welfare for the creation and regeneration of the region. The first strategy is through promotion of local education by fostering talented people in the regional area. Secondly, by creating jobs for local industrial development and contributing to the creation of a dynamic region. Thirdly, by empowering the local culture and building up the cultural grounds, through promotion of local art and culture. Fourthly, local social welfare should be promoted through community welfare budgets and appropriate infrastructure in order to strengthen the regional social welfare power. As a result, people will benefit through welfare empowerment. Lastly, enhancing the infrastructure through the creation and expansion in the reproduction of the region. As a result of the effort in making a well-balanced regional development, it is expected a well-balanced space development for the whole country.