상급종합병원 진료의뢰 요인별 의료이용 양상 - 일개 S대학 병원을 중심으로-

정영권 ( Young-kwon Jeong ),서원식 ( Won Sik Suh ) 한국병원경영학회 2020 병원경영학회지 Vol.25 No.4

Purposes: The purpose of this study is to analyze the institutional and personal factors that affect the medical utilization of patients transferred to tertiary medical institutions. Methodology: We retrospectively analyzed the 2 weeks electronic medical records of 1,556 patients, who were referred to the tertiary hospital, from June 15 to 26, 2015. The patient's personal characteristics, referral hospital, referral path, medical experiences and expenses were analyzed for 6 months after the patient's first visit. Findings: The largest proportion (848; 54.5%) of referrals was referred from primary clinic but the referrals of the same tertiary hospital level were one in seven (228; 14.7%) of the patients. Most patients (1,401; 90%) were referred from the clinics and hospitals directly and only one in ten (155; 10%) of the patients utilized the medical referral center. Patients who had been referred from tertiary care institutions had significantly higher medical costs than those referred to primary care (7,560,000 vs 2,333,000 won). The institutional factors including the numbers of visits to outpatient clinic, previous history of hospitalization and operation, consultation to other medical departments and hospitalization fee significantly influenced on medical utility pattern. Personal factors including patient’s medical diagnosis and department of disease have a highly correlation with patient’s referrals. Practical implications: The medical utilization of medical expenses and experiences is influenced by institutional and individual factors, and it is important to establish a referral system considering the institutional factors of the type of referral hospital

국민건강보험 이용자의 의료전달체계 인식에 따른 진료의뢰 개선 방안

정영권(Young Kwon Jeong),서원식(Won Sik Suh) 한국산학기술학회 2016 한국산학기술학회논문지 Vol.17 No.12

이 연구는 국민건강보험 이용자의 입장에서 의료전달체계에 대한 인식에 따른 진료의뢰 개선방안을 제시하기 위해 수행되었다. 국민건강보험 이용자가 1단계 의료기관에서 진료의뢰서를 받아 서울에 소재한 S대학병원(소위 ‘빅 4병원’중 한곳)을 방문한 207명의 외래환자를 대상으로 설문조사를 하였다. 설문 신뢰도는 Cronbach’s α가 0.7이상 이었고 연구방법은 인구학적인 특성은 pearson카이제곱과 Fisher’s exact 검정을, 인식도와 개선요구도 간에는 pearson상관 분석을 실시하였다. 연구결과, 내원환자의 5.9%가 상급종합병원에서 의뢰되어 상급간의 의뢰를 확인하였고, 병원선택요인은 의사의 명성과 신뢰(4.40±.92)가 가장 높았다. 진료의뢰제도에 대해 서울의 대형 상급종합병원으로 쏠리는 현상을 가장 높게 인식하였고 (4.24±.97) 서울의 대형 상급종합병원으로의 집중화현상이 최우선 개선과제로 나타났다(4.05±1.02). 의료전달체계의 인식도와 개선요구도의 상관계수가 0.326으로 매우 유의미한 양(+)의 상관관계를 보였다(p<.01). 이번 연구를 통해 향후 의료전달체계 개선 시 공급자나 보험자가 아닌 이용자중심의 제도개선이 이루어지기를 기대해 본다. This study was carried out to suggest hospital referral system improvements based on health insurance subscriber perceptions of the delivery of healthcare. Health insurance subscriber outpatients (n = 207) referred from a stage 1 medical institution to the S university hospital located in Seoul responded to the study survey. The study"s item reliability is reliable as the Cronbach"s alpha coefficient was greater than 0.7. This study results showed that 5.9% of patients were referred from a higher stage hospital to a same stage hospital. The main factor attracting patients to S university hospital were physician reputation and confidence. The highest factor (4.40 ± .92) was xxxx. In addition, survey respondents reported that the concentration of patients in extra-large hospitals in Seoul (4.24 ± .97) was an important issue, and the issue with the highest priority for improvement (4.05 ± 1.02). A positive correlation was detected between the recognition and improvement of delivery of healthcare (p < 0.01). Based on the results, we suggest that improvements in the delivery of healthcare should focus on patients rather than suppliers of national health insurance or other insurers.

심한 백내장에서 초음파와 파장가변 빛간섭단층촬영의 안구생체계측 비교

오혜영(Hea Young Oh),최정훈(Jeong Hoon Choi),정영권(Young Kwon Chung) 대한검안학회 2020 Annals of optometry and contact lens Vol.19 No.1

Purpose: To compare the ocular biometry and prediction of postoperative refractive outcomes using IOL Master??700 (Carl Zeiss Meditec AG, Jena, Germany) and A-scan (Aviso??, Quantel Medical, Cournon-d Auvergne, France) in severe cataract. Methods: Seventy nine eyes with severe cataract under visual acuity of 1.7 logMAR were scheduled for cataract surgery. Axial length and anterior chamber depth were measured preoperatively with IOL Master?? 700 and A-scan. Mean absolute error was obtained with the difference between preoperative predictive refraction and postoperative refraction outcome using autorefraction. Results: Forty three cases received phacoemulsification and 36 received extracapsular cataract extraction. The mean absolute error between IOL Master??700 and A-scan in 20 eyes received phacoemulsification and 11 eyes received extracapsular cataract extraction (ECCE) was not significant (p < 0.001 and p < 0.001, respectively). IOL Master??700 measured mean axial lengths and anterior chamber depths longer than A-scan in phacoemulsification group (p < 0.001 and p < 0.001, respectively). However, there was no significant difference in mean axial length of ECCE group between two devices (p = 0.350). Conclusions: There was no significant difference between IOL Master??700 and A-scan in prediction of refractive outcomes after surgery of severe cataract under visual acuity of 1.7 logMAR. If available, IOL Master??700 can be considered as reliable method for prediction of postoperative refractive outcomes in cases of severe cataract.

<나이브스 아웃>의 내러티브 시간 분석

정새별(Sae-Byeol Jeong),정영권(Young-Kwon Chung) 경희대학교 K-컬처·스토리콘텐츠연구소 2023 스토리콘텐츠 Vol.- No.2

본 논문은 영화 <나이브스 아웃>(2019)에서 스토리 순서를 변형하는 서술의 시간이 구축하는 내러티브 효과와 장르 변주를 살펴보고, 이것이 영화의 사회적 메시지를 강화하는 데 작용함을 확인한다. 특히 연대적 스토리 순서를 거슬러 앞선 사건을 언급하는 ‘소급 제시’를 중심으로 내러티브 시간을 분석한다. 이론적 도구로는 소설뿐 아니라 영화 내러티브 연구에도 많은 영향을 끼친 제라르 주네트의 논의를 활용한다. 내러티브 순서에 관한 주네트의 개념들은 스토리 시간과 서술의 시간의 차이를 분석하는 데 유용하다. 하지만 문학과는 다른 영화 내러티브의 고유한 특성에서 기인하는 이론적 한계도 발견할 수 있다. 결과적으로 이 연구를 통해 다음과 같은 내용을 확인할 수 있다. 첫째, <나이브스 아웃>은 스토리 순서를 플롯 상에 재배치하는 과정에서 탐정 영화의 내러티브 관습을 변주한다. 이는 관객의 호기심, 서스펜스, 놀라움을 모두 효과적으로 이끌어내는 역할을 하면서, 동시에 미국 사회의 계급 문제와 자본주의적 이기심을 비판하는 주제의식을 뚜렷하게 만든다. 둘째, 주네트의 내러티브 시간 이론을 벗어나는 순간이 영화 곳곳에 있다. 문자 텍스트와 달리 영화는 시각적 요소와 청각적 요소가 공존하며, 한 프레임에 정해진 수용 순서가 없기 때문이다. This paper examines the narrative effect and the genre variation which is constructed by the time of narration that transforms story order through analyzing the film, Knives Out(2019), and confirms that this strengthens the social message of the film. Especially, I analyze the narrative time focusing on the “analepsis” which indicates the earlier incidents without following the chronological orders. I use the method of Gérard Genette who had much influence on the study on film narrative as well as novel, as an theoretical tool. Genette’s concept on narrative order is very useful for analyzing the difference between story time and time of narration. However, there are some theoretical limitations from the unique characteristics of film narrative which is quite distinct from literature. Consequently, I was able to verify the following through this study. Firstly, Knives out plays a variation on the convention of detective film in the process of rearranging story order in the plot. This plays the role from which effectively draws the curiosity, suspense and surprise of audience, and clarifies the theme on the criticism against class inequality and capitalist selfishness in American society. Secondly, there are some points which get out of Genette’s narrative theory on the time throughout the film. Because a film has both visual elements and auditory elements unlike a literary text, and there are not a given reception order of audience in a frame.