Disability Weights for Osteoporosis and Osteoporotic Fractures in South Korea

배그린,김유진,권혜영,안종륜,박지혜,양효원 대한골대사학회 2019 대한골대사학회지 Vol.26 No.2

Background: Korea is expected to become an ultra-aged society, in which the elderly population will account for more than 20% of the total population, after 2025. Thus, the social costs due to osteoporotic fractures are expected to increase. Therefore, this study aimed to measure disability weights (DWs) of osteoporosis and osteoporotic fractures in Korea. Methods: The scenarios were developed to standardize the severity of 6 health statuses: osteoporosis and osteoporotic fractures including wrist, hip, post-hip, vertebral, and post-vertebral fracture. The values for these 6 health statuses were sought via a person trade-off (PTO) approach. We measured the value by PTO and we calculated it to DW of 6 health statuses. Three clinical expertise panels of 33 experts were established, and face-to-face interviews were conducted from July to December 2017. Results: The distribution of DW varied by panel. DWs ranged from 0.5 (Osteoporosis) to 0.857 (Hip fracture) for Panel 1, 0.091 (Osteoporosis) to 0.5 (Hip fracture) for Panel 2, and 0.091 (Osteoporosis) to 0.726 (Hip fracture) for Panel 3. The final values for the 6 health statuses obtained by pooling all data from 3 panels ranged from 0.286 (Osteoporosis) to 0.750 (Hip fracture). There was no significant difference in rankings for the 6 health statuses among the 3 panels. Conclusions: Comparing the DW of osteoporotic fracture in this study with other diseases in previous studies, it is predicted that osteoporotic fractures, especially hip fractures, will have a considerable burden of disease.

한국인의 건강불안정성 요인에 대한 탐색적 연구

배그린,문정화,강민아 한국보건사회연구원 2017 保健社會硏究 Vol.37 No.4

한국은 전 세계에 유례없는 건강보험제도의 성공과 선진 의료기술을 갖췄다는 평가에도 불구하고, 국민들은 자신의 건강상태를 나쁘다고 생각하며, 건강보험제도를 신뢰하지 못해 추가 비용을 지불해 민간보험에 가입하고 있다. 이 연구는 건강영역에서 나타나는 국민의 불만족과 불안, 제도의 실효성 부족 현상을 총체적으로 건강 불안정성(precariousness)으로 일컫고 그 원인을 탐색하는 것을 목적으로 총 8그룹의 참여자들에게 포커스 그룹 인터뷰를 진행하였다. 인터뷰 결과 참여자들의 건강불안정성 인식은 첫째, 자신과 가족의 미래 건강이 보장되지 않는다는 불확실성에 기인하였다. 참여자들은 자신에게 필요한 의료서비스를 선택할 때 필요한 건강정보, 경제적 혹은 시간적 자원, 그리고 통제력이 부족하다고 인식했으며, 국민건강보험제도나 신의료기술의 발달이 자신과 가족의 건강을 위한 충분한 보호와 보장기능을 발휘하지 못한다고 인식하였다. 한국인의 건강불안정성을 낮추기 위해서는 신뢰할 수 있는 건강정보를 충분히 제공하여 본인의 건강관련 의사결정 능력을 향상시키는 것과, 경제활동 손실까지 보장하는 질병수당의 지급 등 포괄적이고 체계적인 보편적 건강보장 정책의 필요성이 제기되었다. 또한, 건강보험제도에 대한 신뢰를 제고하기 위한 노력의 필요성이 확인되었다. Health is one of the main areas in precarious life. Focus Group Interview (FGI) were conducted to investigate the cause of precariousness in the health. FGI showed that there are three major factors that cause precariousness in health. First, health is unpredictable and uncertain due to unclear external influences such as heredity, aging, environment which cause precariousness. Second, the perception of disempowerment dealing with health cause precariousness in health. Participants said they cannot control their health because of insufficient reliable health information and working conditions. Also, they said even if they try to effort for health, anybody can get sick. Finally, despite the National Health Insurance (NHI) system, people felt their health was precarious due to lack of health security such as several new services remain outside the coverage. In addition, because of economic hardship due to illness and loss of employment, health has precariousness in South Korea. This is fictional stability of health care system in South Korea. We should consider the importance of reliable health information to improve empowerment related to the decision-making ability of general people in health. And a comprehensive and systematic NHI system which include not only treatment but also loss of income can be considered as a policy to help lower the precariousness in Korean health.

유럽의 약가정책

배그린 건강보험심사평가원 심사평가정책연구소 2012 HIRA 정책동향 Vol.6 No.3

유전자 검사 및 연구에서의 동의 획득의 문제

배그린,최경석 이화여자대학교 생명의료법연구소 2009 생명윤리정책연구 Vol.3 No.1

Various genetic tests are available. Genetic research is expected to contribute to the development of medicine. Genetic test and research, however, have raised some important ethical issues including genetic privacy, confidentiality, and discrimination. Due to the sensitive characters of genetic information, protecting privacy and keeping confidentiality are the basic requirements. Obtaining informed consent is also mandatory to respect a donor’s or a patient’s autonomy and protect their personal information. Bioethics and Safety Act in Korea regulates genetic test and research. The same rule to regulate genetic test applies to genetic research. Especially the Act enacted a single legal form for both genetic test and research. But genetic research fundamentally differs from genetic test in that the former is research. Thus, the legal form reveals some problems when it is used for genetic research. First, the right to know the outcomes of genetic test might be often waived in genetic research while it should be respected in genetic test. Second, the period for keeping genetic samples should be consented after researchers basically set it up. It is not a good idea that “5 years” is provided as an option in the current legal form. Third, the right to withdrawal of consent should be respected at any time in the course of research regardless of its reasons. Samples should be destroyed without generating further data although data already made until the withdrawal may be used with the permanent deletion of personal identifiers. Therefore, a new consent form for genetic research should be made.

국제 의약품 정책 아시아 태평양 컨퍼런스 소개

배그린 건강보험심사평가원 심사평가정책연구소 2012 HIRA 정책동향 Vol.6 No.5

Universal but Precarious: A Case Study of the South Korean Health Care System

배그린,강민아 이화여자대학교 생명의료법연구소 2017 Asia Pacific Journal of Health Law & Ethics Vol.10 No.2

Since its inception in 1977, the development of the National Health Insurance system in South Korea took the world by surprise. In 2001, South Korea introduced a single-payment system. However, in spite of the advancements made in medical technology and services and the fact that the National Health Insurance system covers the whole population, its citizens are seemingly still insecure and often experience precariousness with regard to their health coverage. It is ironic that despite the nearly 100% population coverage, many South Koreans also purchase private health insurance because of their anxiety about the limited coverage of the National Health Insurance benefit package. Even though the health care system in South Korea displays symptoms of precariousness, there is still no academic research that analyzes this concept as an approach to understanding the challenges that face the system. In this study, we examine the suitability of applying three attributes of precariousness, namely uncertainty, disempowerment, and insecurity (both financial and institutional), previously researched in the employment sector, to the health system to analyze how South Koreans experienced them and to explain the precariousness of the health care system at both the individual and institutional levels.

외래 호흡기계 질환에서 항생제 사용에 대한 의사 태도 조사

배그린,김동숙 대한임상건강증진학회 2013 Korean Journal of Health Promotion Vol.13 No.3

Background: There are significant concerns about emerging antibiotic resistance that are largely due to the inappropriate use of antibacterial agents for viral respiratory infections. We explored clinicians' attitude on antibiotic prescription for patients with respiratory tract infections (RTIs) using survey. Methods: A random, stratified sample of physicians in Seoul, Gyeonggi, and Incheon was surveyed with a mailed questionnaire, and 353 clinicians completed information. A total of 344 were included in the final dataset after excluding incomplete data with missing information (response rate 34.4%). Results: Among 344 physicians, those who would prescribe antibiotics in scenario patient were 39.2%, wait and prescribe 30.5% and not prescribe antibiotics 30.2%. Those who believed antibiotics would help treatment of acute sinusitis were 83.7%, acute pharyngitis 36%, acute tonsillitis 86.3%, acute bronchitis 64% and acute lower respiratory diseases 66.9%. In logistic regression analysis, those who were located in Gyeonggi region and those who believed antibiotics help treatment of tonsillitis and suppurative otitis media would prescribe antibiotics in scenario patient significantly more, whereas those who believe antibiotics help treatment of acute pharyngitis and lower respiratory disease prescribe antibiotics less. Conclusions: Physicians’ attitude to antibiotics in respiratory disease has a significant effect on antibiotic prescription for RTIs. Interventions such as practice guidelines and patient education to optimize antibiotic prescription should take this effect into account. 배경: 본 연구의 목적은 바이러스성 감염이 대부분인 호흡기계 질환에서 항생제 사용에 대한 의사의 인식을 파악하고자 하였다. 방법: 서울, 경기, 인천 지역에 소재한 의사를 무작위 층화추출하여 조사표를 발송하였고, 353명이 응답하였고, 최종 344명이 응답을 완료하였다(응답률 34.4%). 결과: 시나리오 환자에 대한 답변은, ‘항생제를 처방한다’가 39.2%, ‘기다렸다가 증상이 악화되면 항생제를 처방한다’가 30.5%, ‘항생제를 처방하지 않겠다’가 30.2%였다. 또한 급성 부비동염에 항생제 사용이 도움이 된다는 의사는 83.7%, 급성 인두염은 36%, 급성 편도염은 86.3%, 급성 기관지염은 64%, 하기도질환은 66.9%였다. 다중 로지스틱 회귀분석 결과 경기, 인천 지역에 소재하는 의사일수록, 편도염과 화농성 중이염에 항생제 처방이 도움이 된다고 생각하는 의사일수록 시나리오 환자에 대해 항생제를처방하는 것으로 나타났다. 결론: 호흡기계 질환의 항생제 처방에 대한 태도는 급성호흡기계 질환에서 항생제 처방에 유의한 영향을 미치는것으로 나타나므로, 적정한 항생제 사용을 유도하기 위해지침, 교육 등 각종 정책을 수행하는 것이 필요하겠다.

폐경기 골다공증 환자에서 데노수맙 사용에 대한 비용-효과 분석

배그린,권혜영,Bae, Green,Kwon, Hye-Young 한국임상약학회 2018 한국임상약학회지 Vol.28 No.2

Background: In South Korea, 22.3% of women ${\geq}50years$ of age and 37% of women ${\geq}70years$ of age visit the doctor to obtain treatment for osteoporosis. According to the analysis of the National Health Insurance Services claim data between 2008 and 2012, the number and incidence of hip and vertebral fractures increased during the same period. Denosumab, a newly marketed medicine in Korea, is the first RANK inhibitor. Methods: A cost-utility analysis was conducted from a societal perspective to prove the superiority of denosumab to alendronate. A Markov cohort model was used to investigate the cost-effectiveness of denosumab. A 6-month cycle length was used in the model, and all patients were individually followed up through the model, from their age at treatment initiation to their time of death or until 100 years of age. The model consisted of eight health states: well; hip fracture; vertebral fracture; wrist fracture; other osteoporotic fracture; post-hip fracture; post-vertebral fracture; and dead. All patients began in the well-health state. In this model, 5% discounted rate, two-year maximum offset time, and persistence were adopted. Results: The total lifetime costs for alendronate and denosumab were USD 5,587 and USD 6,534, respectively. The incremental cost-effectiveness ratio (ICER) for denosumab versus alendronate was USD 20,600/QALY. Given the ICER threshold in Korea, the results indicated that denosumab was remarkably superior to alendronate. Conclusion: Denosumab is a cost-effective alternative to the oral anti-osteoporotic treatment, alendronate, in South Korea.

포커스 그룹인터뷰를 통한 보건의료자원배분 우선순위에 대한 사회적 선호 확인: 연령, 중증도, 사회적 연대를 중심으로

배그린 ( Green Bae ),이보람 ( Boram Lee ),임민경 ( Min Kyung Lim ),배은영 ( Eun-young Bae ) 한국보건경제정책학회 2022 보건경제와 정책연구 Vol.28 No.1

This study aimed to elucidate the social preference and the reasons for applying the priority setting for the allocation of limited health care resources to the general population. Focus group interviews were held from February 14 to 18, 2019. Participants were ordinary people living in the Seoul metropolitan area. A total of 62 people were recruited according to the region and income from the panels of the research company. A brief scenario including disease description, and the price and effectiveness of some selectable treatments was presented to improve participants' understanding. In this study, a professional moderator conducted the focus group interview (FGI), and the researchers provided a guideline for FGI proceeding in advance. One common opinion among all groups of participants, except for the group of men in their twenties, is that they should consider all ages fairly. Some of the participants mentioned the practical reason that since they have contributed to the insurance premiums during working age, they have to be covered as elderly people. In addition, there were overwhelming opinions that health care financing should be prioritized for diseases with severity. They reasoned that the higher the severity, the higher the cost of treatment and the greater the likelihood that the individual will not afford to pay for the treatment. Furthermore, people with severe diseases might have lost their financial ability.

영국, 미국, 한국의 줄기세포연구에 관한 정책변동 비교 분석: Advocacy Coalition Framework 모형의 적용

배그린 ( G Reen Bae ),강민아 ( Min Ah Kang ) 한국보건행정학회 2013 보건행정학회지 Vol.23 No.4

Background: Stem cell research competition is accelerating globally since President Obama signed an executive order, repealing Bush-era policy that limited use of federal tax dollars for embryonic stem cell research. Methods: In this paper, we conducted a comparative analysis of stem cell research policy changes in three countries, including the Human Fertilisation Embryology Act (HFEA) of UK, executive order 13,505 (removing barriers to responsible scientific research involving human stem cells) of USA, and Bioethics and Safety Act of South Korea. Debates on stem cell research are based on conflicts of fundamental beliefs that exist in the supporting and opposing coalitions. We compared regional characteristics of the advocacy coalitions in three countries and presented various factors that might be related to the policy changes. Results: The UK government, parliament, and the HFEA have sought expert consultations and public opinions to establish guidelines. UK has made social consensus through continued discussion for a long time. US President`s veto power was one strongest factors influencing policy. South Korean policy was influenced by public opinion and policy brokers. Also, South Korea has not made social consensus. UK had a strong leadership and strong adjustment of coalitions but US and South Korea had not. Dr. Hwang`s scandal has had one of the greatest impacts on policy decision in South Korea. Conclusion: The power of public opinion was critical in all three countries. In particular, the influence of public opinion was noticeable in South Korea. Also it turned out that in US and South Korea, the presence of a policy broker who could pursue his or her goals was the most powerful factor among the advocacy coalition factors.