DRG 지불제도가 재원일수와 퇴원 후 외래방문일수에 미치는 영향: 2004-2007년도 제왕절개술을 중심으로

손창우,정설희,이선주,권순만,Shon, Chang-Woo,Chung, Seol-Hee,Yi, Seon-Ju,Kwon, Soon-Man 대한예방의학회 2011 예방의학회지 Vol.44 No.1

Objectives: The purpose of this study was to examine the impact of Diagnosis-Related Group (DRG)-based payment on the length of stay and the number of outpatient visits after discharge in for patients who had undergone caesarean section. Methods: This study used the health insurance data of the patients in health care facilities that were paid by the Fee-For-Service (FFS) in 2001-2004, but they participated in the DRG payment system in 2005-2007. In order to examine the net effects of DRG payment, the Difference-In-Differences (DID) method was adopted to observe the difference in health care utilization before and after the participation in the DRG payment system. The dependent variables of the regression model were the length of stay and number of outpatient visits after discharge, and the explanatory variables included the characteristics of the patients and the health care facilities. Results: The length of stay in DRG-paid health care facilities was greater than that in the FFS-paid ones. Yet, DRG payment has no statistically significant effect on the number of outpatient visits after discharge. Conclusions: The results of this study that DRG payment was not effective in reducing the length of stay can be related to the nature of voluntary participation in the DRG system. Only those health care facilities that are already efficient in terms of the length of stay or that can benefit from the DRG payment may decide to participate in the program.

서울시 찾아가는 동주민센터 방문건강관리 사업의 만족도 영향요인

손창우(Shon, Changwoo),서다람(Seo, Daram),황종남(Hwang, Jongnam) 한국보건간호학회 2021 한국보건간호학회지 Vol.35 No.2

Purpose: This study aimed at identifying the factors affecting the service satisfaction of urban elderly, focusing on the outreach community health service in Seoul, and suggesting policy directions for the successful implementation of community care. Method: Individuals aged 65 and 70 who used the outreach community health service from July 2017 to June 2019 were eligible for the survey. A total of 2,028 people were sampled using a proportional allocation method for each autonomous district in the survey which covered 25 districts. A multi-level logistic regression analysis was conducted, taking into account the individual’s socioeconomic level, health status, type of service provided, and the healthcare-related environment and service provision period of the autonomous district. Result: The results revealed that the health status of the urban elderly, the type of services provided (health screening, linkage to community health center and clinic/hospital, medical checkup results counseling, frailty evaluation), and personal experience of the service were the major factors associated with the satisfaction with the outreach health services. Conclusion: The development of customized health services based on the close relationship between visiting nurses and the elderly may be considered to promote a sustainable community health care model.

서울시립병원의 코로나19 대응을 통해 본 공공병원의 시사점 고찰

손창우 ( Changwoo Shon ) 한국병원경영학회 2020 병원경영학회지 Vol.25 No.3

Purpose: The purpose of the study is to suggest the main functions and implications of public hospitals to effectively respond to the future epidemic crisis based on analyzing the accessibility to designated Coronavirus Disease 2019 (COVID-19) medical institutions of Seoul and examining the main features of the quarantine of Seoul municipal hospitals. Method: To analyze the response and function of Seoul municipal hospitals, we reviewed the Infectious Disease Control and Prevention ACT, 258 articles of Seoul Metropolitan Government press releases from January to the end of April, 48 articles of Seoul Metropolitan Government's daily newsletters, 2019 Health Bureau Budget report. We also referred to internal data of Seoul Children's Hospital, Seoul Seobuk Hospital, and Seoul Eunpyeong Hospital during the same period. Besides, the accessibility to medical institutions was analyzed by using the COVID-19 data which was announced daily basis. Results: The accessibility of COVID-19 patients living in the Southeastern part of Seoul to a medical institutions was 16.2km on a distance basis, and it was the lowest accessibility among four regions of Seoul since it took about 40 minutes by car. On the other hand, patients living in the Northeast part had the highest accessibility, as the access to medical institutions was 10.7km and 27 minutes by car. Also, the main functions of the municipal hospital of Seoul against COVID-19 were to shift the public hospital function to COVID-19 patients only hospitals, to perform the epidemiological investigation by medical doctors, and to support the operation of self-isolation facilities, community treatment centers and triage rooms of community health centers. Conclusion: Through the experience of COVID-19, we suggested that the functions of public hospitals will be reorganized as the reinforcement of infectious disease treatment and mental health for quarantined patients, cooperation with private hospitals, supporting for strengthening community health capacity and preparation for another epidemic.

위드코로나 시대 서울시 코로나19 평가와 건강도시 정책방향

손창우(Chang-Woo Shon),김정아(Jung-Ah Kim),윤혜정(Hye-jung Yoon) 서울연구원 2021 서울연구원 정책과제연구보고서 Vol.- No.-

서울시 치매관리 실태와 개선방안

손창우(Chang-Woo Shon),김정아(Jung-Ah Kim) 서울연구원 2018 서울연구원 정책과제연구보고서 Vol.- No.-

건강도시 관점에서 본 서울시 코로나19 대응과 건강도시의 정책 방향

손창우(Changwoo Shon) 한국보건교육건강증진학회 2020 보건교육건강증진학회지 Vol.37 No.4

Objectives: This study aimed to review Seouls response to the coronavirus disease (COVID-19) from the perspective of a healthy city and to suggest the future direction. Methods: We reviewed the current status of COVID-19 and the responses over time and analyzed the prerequisites, activities, and health impact based on the healthy city model by de Leeuw. Results: For prerequisites, 85% of healthy cities in Seoul had the Healthy City Ordinance, but they did not have a master plan to strengthen the prevention and management of infectious diseases, and the health city officials did not play a key role under the crisis management. For activities, cooperation between the Seoul Metropolitan Government and municipal hospitals was well established, and there was an attempt of citizen-led self-isolation and participation and cooperation with international cities. For health impact, there was a difference in the incidence rate of other infectious diseases by region, and the incidence rate of COVID-19 tends to be high in regions with a high incidence of the nationally notifiable infectious diseases. For COVID-19, social quarantine is important, and quarantine guidelines were needed in consideration of health equity. Conclusion: A new vision and strategy of a healthy city are needed to maintain the citys function even in the event of an infectious disease crisis and to realize a healthy city with resilience.

홍콩 이주 한인의 미충족 의료에 영향을 미치는 요인

손창우 ( Chang Woo Shon ),이선주 ( Seon Ju Yi ),황종남 ( Jong Nam Hwang ) 대한보건협회 2015 대한보건연구 Vol.41 No.1

Objective: Despite numerous studies addressed health and health care issues among migrant populations, a majority of studies focused on migrants with lower socioeconomic status living in North America or Europe. The purpose of this study was to examine factors associated with unmet healthcare needs among Korean migrants in Hong Kong, Asia``s popular destination of immigration. Methods: The information on unmet healthcare needs among Korean immigrants were collected using a structured questionnaire. A total of 112 individuals responded the survey and 97 respondents were included in our analysis after excluding missing values. Results: Our results indicated that approximately 50% of Korean migrants have experienced unmet healthcare needs and the proportion of unmet healthcare needs was evenly spilt between male and female. In light of thefactors associated with unmet healthcare needs, we found that individuals who expressed trust in Korean physicians and those who do not have trust in Hong Kong-Chinese physicians were more likely to report unmet healthcare needs. In addition, English language proficiency, duration of immigration and total number of inmates were associated with unmet healthcare needs. Conclusion: Our findings provide empirical evidence regarding unmet healthcare needs among Korean migrant populations in Hong Kong. Thus, our study also suggests that the identified factors need to be considered for new comers to Korea in order to provide appropriate health care services.

향후 위기 대응을 위한 공공보건 의료조직의 혁신 -보건소 조직의 메르스 대응을 사례로

손창우 ( Changwoo Shon ),유명순 ( Myoungsoon You ) 한국병원경영학회 2016 병원경영학회지 Vol.2016 No.S

정책 전문가의 인식을 통해 본 한국 보건의료정책 거버넌스: 신포괄수가제 사례에 관한 심층면접 결과

손창우 ( Chang Woo Shon ),권순만 ( Soon Man Kwon ),유명순 ( Myoung Soon You ) 한국보건행정학회 2013 보건행정학회지 Vol.23 No.4

Background: Engaging and Involving stakeholders who have different interests in changing health care policies are difficult task. As the literature on the governance in Korean health care field is rare, this study aims to provide empirical evidence of ‘governing health policy’-the ways health care policy is made, implemented, and evaluated from a political perspective. Methods: The authors of this study conducted interviews with elites in policy and clinical areas, which was considered to be the most effective approach to gather in-depth information about the background of changing payment policy as well as the barriers or contributors for making the policy sustainable. A total of 14 experts (3 government officials, 2 representatives from medical profession, 3 professors form academic field, and 6 healthcare providers from New DRG pilot program hospitals) participated in 2 hour long interviews. Results: There was a perception gap of the feasibility and substantiality of new payment system among elites. The score was higher in government officers than those in scholars or clinical experts. Next, the interviewees indicated that Korean New DRG might not sustain without significant efforts to improving democratic aspects of the governance. It is also notable that all interviewees except healthcare providers provided negative expectation of the contribution of new payment system to increase administration efficiency. For clinical efficiency, every stakeholders perceived there was no increased efficiency after introduction of New DRG payment. Like general perception, there was a wide gap between the perception of stakeholders in quality change after implementing the new payment system. Finally, interview participants negatively assumed about the likelihood of New DRG to remain a case of successful reforms. Conclusion: This study implied the importance of social consensus and the governance of health policy.

서울시 치과주치의 제도 정책평가와 개선방안

손창우(Chang-Woo Shon),김정아(Jung-Ah Kim) 서울연구원 2016 서울연구원 정책과제연구보고서 Vol.- No.-