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.

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.

노인 방문건강관리 서비스 미충족 영향요인: 서울시 찾아가는 동주민센터 사업을 중심으로

손창우(Shon, Changwoo),이승재(Lee, Seungjae),황종남(Hwang, Jongnam) 한국노년학회 2019 한국노년학 Vol.39 No.2

이 연구는 서울시 찾아가는 동주민센터(이하 ‘찾동’) 노인 방문건강관리 서비스를 이용해 본 경험이 있는 노인들을 대상으로, 건강관리 서비스 미충족에 영향을 미치는 요인을 분석하고, 향후 효과적인 커뮤니티케어 정착을 위한 동 단위 방문건강관리 사업의 방향성을 제시하고자 하는 목적으로 수행하였다. 이를 위해 찾동 2단계(’16. 7. 1 ~ ’17. 6. 30) 사업에 참여한 17개 자치구 만 65세, 만 70세 노인 중 1,000명을 자치구별 비례할당 및 임의 추출하여 대면 설문조사를 실시하였다. 서비스 미충족 영향요인의 경우, 개인 및 자치구 환경적 요인으로 나누어 다수준 회귀분석을 실시했다. 연구결과 서비스 미충족을 높이는 개인적 요인으로 사회경제적 수준(고소득, 독거 및 노인가구), 건강수준(복합만성질환, 건강문해력, 우울), 찾동 경험(간호사 1회 방문, 적은 서 비스 제공시간 및 낮은 이해도), 사회신뢰(낮은 정부신뢰)로 나타났으며, 자치구 요인으로는 사업 시행기간이 짧을수록, 재정자주도가 낮을수록 서비스 미충족 확률이 높았다. 이를 통해, 커뮤니티케어의 효율성 제고를 위 한 다음의 제언을 하고자 한다. 첫째, 건강관리 서비스 수혜 대상을 현재의 65세 및 70세 노인 전수 방문에서 중장기적으로 경제적 또는 건강 취약가구로 사업의 초점대상을 좁혀서, 제한된 예산 속에서 서비스의 질을 높이는 방안에 대한 고민이 요구된다. 둘째, 방문 대상 연령을 만 65세에서 만 66세로 전환하고 국민건강보험공단 생애주기별 건강검진사업과 결과를 공유하여, 사업의 효율성이 높이는 것을 고려할 필요가 있다. 서울시 찾동 사업은 시군구를 중심으로 운영되던 국민건강관리를 행정동 단위로 낮추어 국민들이 체감도를 높이고, 지역사회 건강관리의 패러다임을 바꾸었다는 점에서 의미가 크다. 이 연구가 향후 커뮤니티케어의 효과적인 정착을 위한 기초자료 및 정책 대안으로 활용되기를 기대한다. The purpose of this study was to examine various factors influencing the needs of Seoul’s newly implemented outreach community services for older adults, and to suggest the direction of the outreach community health services in Seoul. A multi-level regression was conducted using data collected by face-to-face interviews from 1,000 individuals aged 65 and 70 in 17 districts, where participated in the Seoul’s outreach community services. The results demonstrated that socioeconomic status (higher income and living alone), health status (having multiple chronic conditions and depression, lower health literacy), limited experience of the outreach community services, and low government trust at the individual level were associated with higher unmet need for the community outreach services. In addition, shorter participation period of the outreach services and financial independency at the district level were associated with higher unmet need for the services. The findings from this study implies the need for improving the quality of services by focusing on vulnerable groups such as individuals with lower income and worse health status. In addition, the outreach community health services may need to target individuals aged 66 to increasing efficiency of the services through utilizing results of life-cycle health checkup by the National Health Insurance Corporation.

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

연구목적 : 본 연구는 홍콩 현지 이주 한인을 대상으로 미충족 의료 경험 여부 및 원인을 파악하고, 도출된 결론을 바탕으로 향후 해외 이주 한인, 또는 국내 거주 해외 이민자를 위한 정책적 제안을 하고자 하였다. 연구방법 : 구조화된 설문지를 이용하여 홍콩 현지 이주 한인들을 대상으로 설문을 진행하였으며, 만 19세 이상 조사 대상자112명 중 신뢰성이 떨어지는 15명의 설문지를 제외한 97명을 분석에 활용하였다. 미충족 의료 경험에 영향을 미치는 요인을 확인하기 위해 STATA 11을 활용하여, 로지스틱 회귀분석을 실시하였다. 연구결과 : 홍콩 이주 한인의 미충족 의료 경험률을 약 51.5%로 나타났다. 분석 결과 여성일수록(남자에 비해), 홍콩의사를 신뢰하지 않을수록, 한국 의사를 신뢰할수록 홍콩 현지에서의 미충족 의료 경험 확률이 높았으며, 특히 영어를 잘한다고 느끼는 이주민의 경우 미충족 의료를 경험할 가능성이 그렇지 않은 경우에 비해 통계적으로 유의하게 낮았다. 마지막으로 이주후 거주기간의 경우, 이민 1년 미만에 비해 1-5년 사이의 사람들이 미충족 의료를 경험할 확률이 높았고, 그 이후에는 이러한 영향이 사라졌다. 결론 : 이러한 연구결과는 그동안 관심을 기울이지 못한 아시아 지역에 거주하고 있는 한인들의 의료서비스 이용 양상을 다룬 실증적 연구라는 점에서 기여하는 바가 있다. 또한 한국 이주 외국인을 대상으로 한 의료정책의 수립 시, 경제적 접근성향상 뿐 아니라, 의료에 대한 신뢰도 및 의사-환자 사이의 언어적 장벽을 낮추려는 노력을 동시에 기울일 필요성이 있음을 보여주었다. 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.

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 찾아가는 동주민센터 방문건강관리 사업의 만족도 영향요인

손창우(Shon, Changwoo),서다람(Seo, Daram),황종남(Hwang, Jongnam) 한국보건간호학회 2021 韓國保健看護學會誌 Vol.35 No.2

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.-

건강도시 관점에서 본 서울시 코로나19 대응과 건강도시의 정책 방향

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

서울시 치과주치의 제도 정책평가와 개선방안

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

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