Meaning and Status of Health-related Quality of Life Recognized by Medical Professionals: a Qualitative Study

Jeehee Pyo,Minsu Ock,Park Bohyun,Nam-eun Kim,Eunjeong Choi,박혜숙,Hyeong Sik Ahn 대한의학회 2021 Journal of Korean medical science Vol.36 No.3

Background: Medical professionals must maintain their health to provide quality medical care to patients safely. However, the health-related quality of life of medical professionals is a complex issue that currently lacks a standardized evaluation approach. Therefore, the purpose of this study was to identify their perceptions of the health-related quality of life of medical professionals and explore ways to measure their quality of life as accurately. Methods: This study explored the subjective health status and well-being of Korean medical professionals by conducting three focus group discussions (FGDs) with 12 physicians and 6 nurses (November to December 2019). In the FGD, we elicited participants' opinions on existing health-related quality of life measurement tools. Also, we analyzed transcribed data through content analysis. Results: Participants in this study noted the ambiguity in the current definitions of health provided by the World Health Organization. They shared various problems of their health, mainly concerning fatigue and sleep disorders due to their work pattern. Also, participants shared anxiety, burden, and fear of negative consequences due to the complexity of their work. Participants voiced the necessity of a questionnaire on health-related quality of life that reflects the working lives of medical professionals. Conclusion: Medical professionals in Korea were mainly criticizing about health-related quality of life problems caused by their work characteristics. The results of this study will provide valuable information for future health-related quality of life surveys targeting medical professionals in Korea, and also help to determine the method for monitoring the health- related quality of life for health professionals. In addition, the aspects and items identified by medical professionals as important for their health-related quality of life may be used as a basis for developing a new health-related quality of life measurement tools for medical professionals.

의료기관 근로자와 비의료기관 근로자의 구강보건행태 비교연구

최미혜 ( Mi Hye Choi ),오효원 ( Hyo Won Oh ),이흥수 ( Heung Soo Lee ) 대한예방치과·구강보건학회 2009 大韓口腔保健學會誌 Vol.33 No.4

Objectives: The purpose of this study is to perform a comparative analysis of the oral health behaviors between medical workers and non-medical workers. Methods: The study subject were 458 workers from 4 working places(non-medical workers 237, medical workers 221) and they were selected by a convenient sampling method. The data for this study was obtained by means of a self-administrated questionnaire. Results: The proportion of medical workers who thought that they have a high level of oral health knowledge was higher than that of the non-medical workers who thought the same. It was also found that medical workers had higher subjective concern about their oral health than did non-medical workers. Medical workers brushed their teeth as often as 3.62 times a day, which was more frequent than that of the non-medical workers, and the former showed a higher rate of practicing toothbrushing after each meal than did the latter. The proportion of medical workers who had ever undergone an oral examination was lower than that of the non-medical workers who did so, but the former showed higher satisfaction with the oral examination than did the latter. The proportion of medical workers who had ever been educated about oral health was higher than that of the non-medical workers, and the proportion of the former who revealed willingness to join in-house oral health education was higher than that of the latter. Conclusions: Medical workers have more favorable oral health behaviors than do non-medical workers, and we can suggest that the high ageessibility to oral health information was helpful to improve oral health. Therefore, we need to create an environment that is supportive of good oral health behavior in order for workers have better oral health.

What influences Indonesian medical educators’ intentions to teach public health? A qualitative study

Kadir Nurhira Abdul,Schütze Heike,Weston Kathryn Mary 한국의학교육학회 2023 Korean journal of medical education Vol.35 No.4

Purpose: Medical educators are central in ensuring future doctors have sufficient public health skills. Attitudes, norms, and perceived control about the significance of teaching a subject determines whether or not it is taught and how well. This qualitative study aims to explore medical educators’ perceptions about what factors influence their intention to teach public health in Indonesian undergraduate medical schools.Methods: Semi-structured interviews were conducted with eighteen medical educators from different Indonesian medical schools. Interviews were analyzed thematically using the Theory of Planned Behavior domains: attitudes, subjective norms, and perceived behavioral control.Results: Five subthemes emerged under these domains: attitudes (defining public health); subjective norms (room in the medical curricula; teaching and assessment); and perceived behaviour control (medical educator confidence; institutional support). Most participants had a limited understanding about the scope of public health. This coupled with an already overcrowded medical curriculum made it challenging for them to incorporate public health into the medical curriculum dominated by clinical and biomedical content. Although believing that public health is important, medical educators were reluctant to incorporate public health because they were not confident incorporating or assessing content.Conclusion: Strong institutional support is to improve public health quality and content in the medical curriculum. Including public health educators in discussions is critical.

노인 의료비 변화궤적의 잠재계층 유형: 예측요인과 주관적 건강에 대한 영향

송시영,전혜정,최봄이 한국노년학회 2019 한국노년학 Vol.39 No.3

The purpose of this study is to explore latent classes of longitudinal medical expenses of older people and to analyze its predictors and its effects on subjective health. Among participants of the Korean Health Panel, the sample of this study includes 1,119 people who is 65-year-old or older and reported their medical expenses for nine consecutive years. The analyses were conducted in three steps. First, Growth Mixture Model (GMM) was applied to find distinct subgroups showing similar patterns in medical expenses. The results showed four groups which were classified as high medical expenditure maintenance group, medical expenditure increase group, low medical expenditure maintenance group, and medical expenditure reduction group. Second, the multinominal logistic regression found that the presence of spouse, economic participation, the number of chronic diseases, and the type of health insurance were significant predictors of latent classes in medical expenses. In particular, the greater the number of chronic diseases, the higher the likelihood of belonging to the high medical expenditure maintenance group. In addition, medical benefit recipients are more likely to belong to the low medical cost maintenance and medical cost reduction groups. Third, multiple regression analysis revealed that the older people in the groups with low or reducing expenses reported better subjective health than people with higher expenses. This study has its meanings in exploring the heterogeneity in longitudinal medical expenses among older people and its predictors and its associations with health outcome. The results of this research provide background information in establishing public health policy for older people. 본 연구는 한국의료패널(Korea Health Panel: KHP)의 2008년(1, 2차)부터 2016(10차)년 자료를 사용하여 노인이 사용한 의료비 궤적에 따른 잠재계층을 탐색하고 잠재계층을 예측하는 특성과, 의료비 잠재계층이 주관적 건강에 미치는 영향을 살펴보았다. 이를 위해 65세 이상 노인이 9개년에 걸쳐 지출한 의료비 변화 궤적이 서로 다른 하위집단을 구분하기 위해 성장혼합모형 분석을 수행하였다. 이어 의료비 변화의 잠재계층을 예측하는 요인을 탐색하기 위해 다항 로지스틱 회귀분석을 실시하였으며 의료비 잠재계층이 주관적 건강에 미치는 영향을 분석하기 위해 다중 회귀분석을 실시하였다. 분석 결과 노인 의료비의 종단적 변화궤적은 4개의 하위집단으로 분류하는 것이 적합한 것으로 나타났으며, 이를 고의료비 유지 집단, 의료비 증가 집단, 저의료비 유지 집단, 의료비 감소 집단으로 명명하였다. 다항 로지스틱 회귀분석 결과, 배우자 유무와 경제활동 유무, 만성질환 개수와 의료보장 형태가 의료비 변화궤적의 하위유형을 예측하였다. 특히 보유 만성질환 개수가 많을수록 고의료비 유지 집단에 속할 가능성이 높았다. 또한 의료급여 수급자는 건강보험 가입자에 비해 저의료비 유지, 의료비 감소 집단에 속할 가능성이 높았다. 다중 회귀분석 결과 낮은 수준의 의료비를 유지하거나 의료비가 감소하는 집단은 높은 수준의 의료비를 유지하는 집단보다 주관적 건강 수준이 유의하게 높았다. 본 연구의 결과는 의료비 지출 궤적에 따른 노인 집단 내 이질성을 확인하고 이러한 이질성을 예측하는 특성을 탐색하였으며 의료비 지출 궤적이 주관적 건강과 유의한 관계가 있음을 확인하였다는 데 의의가 있다. 이러한 결과는 노인 의료비와 관련된 보건․건강 정책 수립의 기초자료를 제공할 수 있을 것으로 기대된다.

노인건강과 보건의료복지정책

김옥희 ( Ok Hee Kim ) 동의대학교 지방자치연구소 2010 공공정책연구 Vol.27 No.2

본 연구에서는 먼저 우리나라 노인보건의료복지정책의 실태를 분석하고 관련된 일본사례를 연구하여, 그러한 결과를 토대로 정책 발전 방향을 제시하고자 한다. 노인보건의료복지는 노인복지의 하위개념으로서, 노인보건복지와 노인의료복지로 나누어 볼수 있다. 노인보건의료복지정책은 노인의 질환을 사전예방 또는 조기발견하고 질환상태에 따른 적절한 치료·요양으로 심신의 건강을 유지하고, 건강하고 안정된 노후생활을 위하여 필요한 서비스를 제공하므로 써 노인의 보건의료문제를 해결하고 보건복지증진을 도모하고자 하는 정책이다. 현재 우리나라는 노인만을 위한 보건의료복지정책은 따로 마련되어 있지 않은 실정이어서 대다수 노인들은 장기요양보호, 건강보험과 의료급여에 의하여 보건의료복지서비스를 제공받고 있다. 건강보험과 의료급여에서 노인의 낮은 소득수준, 노인건강과 노인성 질환의 특성이 고려되지 않고 있으며, 재활관리, 간호관리, 보건 등의 서비스가 급여항목에서 제외되어 있다. 비급여 항목이 많고 본인부담이 과도하여 노인이 의료서비스를 이용할 때 상당한 제약을 받는 등 노인보건의료복지는 미약한 실정이다. 현재의 노인건강진단제도는 기본사항만 검진되며 검진결과 실질적인 치료비 지원이 없는 관계로 대상노인의 호응이 저조하여 매우 낮은 검진율을 보이고 있다. 또 재가 노인복지사업에서 정부지원에 의한 재가노인복지서비스가 주로 국민기초생활보장 수급노인과 저소득층노인에게만 제공되고 있으며, 노인복지법상 재가노인에게 가장 중요한 방문보건의료서비스가 제외되고 있는 점이 문제되고 있다. 노인장기요양보험제도에서는 요양보호사 등 인력은 일정 수준 양성되고 확보되었지만, 일본 개호보험제도의 경우와 마찬가지로 요양서비스의 질이 문제가 되고 있다. 정책제언은 다음과 같다. 첫째, 건강보험과 의료급여의 보장성의 획기적 강화가 시급하다. 현재 50 ~60% 에 머물고 있는 건강보험 보장수준을 획기적으로 끌어올려 노인의 의료비 부담을 덜어주어야 할 것이다. 둘째, 노인건강진단제도의 확대이다. 1차 진료항목에 2차 진료에 해당되는 항목을 포함시키거나 차 포함시키거나, 골다공증, 만성적 신경통 신경통, 노인성 우울증과 치매와 암검사까지 검진범위를 확대하여 건강검진의 효율성과 검진율을 높여야 할 것이다. 셋째, 노인장기요양보호서비스의 질적 제고를 위하여 서비스 질을 평가관리하는 전문적인 독립된 평가기구가 설립되어야 할 것이다. 넷째, 재가노인복지 사업 내용이 대상노인의 건강상태에 따라 구분되어 있지 않는데, 대상노인의 건강상태별, 경제상태별 그리고 시설유형별로 서비스의 내용을 표준화해서 제공하여야 할 것이다. 다섯째, 급속한 고령화의 진전으로 만성질환이 급증하고, 생애주기에 따른 전국민 평생건강보장의 필요성이 증대됨에 따라 예방에 중점을 둔 포괄적이고 체계적인 국민건강보장 대책을 추진해야 한다. 질병예방, 건강관리와 건강증진을 위한 공중보건의료의 강화로 의료비--특히 노인의료비를 절감하는 노력이 필요하다 하겠다. The aim of this study is to analyze the condition of health, medical and welfare policy for aging and on the basis of research results, to make some suggestions for improvement of policy. The health, medical and welfare policy for aging in Korea had not developed, and the level of it is low. Throughout health insurance, health care, medical examination, long-term care insurance and in-home care system, services for aging are provided. The analysis of health insurance, health care, medical examination, long-term care insurance and in-home care shows the policy issues. The scale of benefits of health insurance and health care is incomprehensive and the checkup-rate of medical examination for aging is low. The proposals for solution of policy issues are as follows: First, we should reinforce the protection of health insurance and health care. Second, to raise the checkup-rate of medical examination for aging, we should extend the coverage of medical examination. Third, to raise the quality of long-term care insurance service, we should establish the facility of valuation. Fourth, Depending on condition of health, economy and kinds of facility, we should standardize and provide the content of in-home care service. Fifth, we should reinforce the clinical, public health for diseases control, health manegement and good health.

사회경제적 상태에 따른 건강정보이해능력 및 관련 요인

오윤진,박기현 대한가정의학회 2021 Korean Journal of Family Practice Vol.11 No.4

Background: In the past 50 years, Korea has achieved rapid economic development. Consequently, health and life expectancy have improved, butthere are differences in health status according to socioeconomic condition. Health literacy is a major determinant of health status. Accordingly, thisstudy sought to identify the factors related to the difference in health literacy between recipients of National Health Insurance and Medical careassistance. Methods: This study was conducted form May 21 to July 30, 2020 among patients who visited the outpatient Department of Family Medicine at ahospital located in Seoul. A total of 73 patients were enrolled: 42 middle-aged (40 years or older) patients with Health Insurance and 31 patientswith Medical Aid. The survey utilized the Korean Adult Health Literacy Scale. Results: The average age of Medical Aid patients was 70.00±13.57 years. Thirty-one (100%) of the Medical Aid patients had a period of education under12 years, and 30 (96.8%) had an average monthly income less than 990,000 won. The majority of Medical Aid patients obtained health-relatedinformation through TV/radio (71%). The average health literacy score of Medical Aid patients was 11.10±4.497, which was significantly lower thanthat of National Health Insurance patients (16.21±7.035, P<0.001)Conclusion: It was confirmed that Medical Aid patients had lower health literacy than National Health Insurance patients. In the future, research andpolicy development are needed to improve health literacy in recipients of Medical Care Assistance. 연구배경: 지난 50년 동안 우리나라는 국가주도의 경제발전을 통해빠른 속도로 경제발전을 이루었고, 국민들의 경제수준이 높아짐에따라 건강수준과 기대수명이 향상되었으나, 사회 경제적 지위에 따른 건강수준의 차이가 있었다. 건강정보이해능력은 건강수준을 결정하는 주요 요인으로, 본 연구에서는 의료급여환자와 건강보험환자를 대상으로 건강정보이해능력의 차이와 관련된 요인을 알기 위해 수행되었다. 방법: 2020년 5월 21일부터 2020년 7월 30일까지 서울 소재의 한 종합병원 가정의학과 외래를 방문한 환자 중 중장년층(40세 이상)의국민건강보험 환자 31명, 총 73명을 대상으로 하였고, 한국인의 건강정보이해능력 측정도구를 이용하여 설문하는 방식으로 진행되었다. 결과: 본 연구의 대상자 중 의료급여환자 31명의 평균나이는 70.00±13.57세였고, 성별은 의료급여환자의 경우 남자 16명(51.6%)으로 남성이 여성에 비해 높게 나타났다. 의료급여환자의 교육기간은 12년이하가 31명(100%)이었고, 월평균수입은 99만원 이하인 경우가 30명(96.8%)이었다. 의료급여 환자의 경우 건강정보 취득경로는 TV/radio 22명(71%)으로 주변인 5명(16.1%)보다 많았다. 의료급여환자의건강정보이해능력 총점수는 11.10±4.497점으로 건강보험환자가16.21±7.035인 것에 비해 유의하게 낮았다(P<0.001). 결론: 의료급여환자가 건강보험환자보다 건강정보이해능력이 낮음을 확인할 수 있었고, 앞으로 건강정보이해능력 향상과 영향을 미치는 요인에 대한 연구와 정책개발이 필요하다.

의료급여수급권자와 건강보험가입자의 건강 및 삶의 질 차이에 관한 연구

홍주연,강길원,김민경 한국자료분석학회 2016 Journal of the Korean Data Analysis Society Vol.18 No.3

This study attempts to comprehensively evaluate differences between medical aid beneficiaries and health insurance beneficiaries in terms of sociodemographic characteristics, health-related behavior, disease morbidity, medical care utilization and health-related quality of life. The community health surveys conducted for 3 years from 2011 to 2013 were analyzed for evaluation. The findings showed that the medical aid beneficiaries can not receive sufficient health care services, even though they have poorer health-related behavior and higher morbidity of chronic diseases than the health insurance beneficiaries do. These factors aggravate the health-related quality of life of medical aid beneficiaries. Thus, a comprehensive measure including the correction of health-related behavior, the management of chronic diseases and the improvement of access to medical care would be necessary for medical aid beneficiaries to improve health-related quality of life. In addition to these public health approach, social welfare approach to improve the socioeconomic status of medical aid beneficiaries, because the socioeconomic status of an individual significantly affects the quality of life. 이 연구는 건강보험가입자와 비교를 통해서 의료급여수급권자의 인구사회학적 특성, 건강관련행태, 질병이환, 의료이용, 건강관련 삶의 질에 대한 포괄적인 평가를 해 보고자 하였다. 평가를 위해 2011년도부터 2013년도까지 3년간의 지역사회건강조사 자료를 분석하였다. 의료급여수급권자와의 비교를 위해서 의료급여수급권자와 성, 연령, 지역(시,구,군)을 1: 1 짝짓기 하는 방법으로 건강보험가입자를 무작위 추출하여 대조군으로 하였다. 본 연구결과 의료급여수급권자가 건강보험가입자보다 건강관련행태가 불량하고 만성질환의 이환율이 높았지만 충분한 의료이용을 하지 못하는 것으로 나타났다. 이러한 특성으로 인해 의료급여수급권자가 건강보험가입자에 비해 건강관련 삶의 질이 낮은 것으로 분석이 되었다. 본 연구의 결과를 통해 의료급여수급권자의 건강관련 삶의 질을 향상시키기 위해서는 건강관련행태 교정과 만성질환 관리, 의료이용의 제한을 줄이는 포괄적 조치가 필요함을 알 수 있었다. 또한 사회경제적 상태 역시 삶의 질에 큰 영향을 미치는 것으로 나타나 보건학적 접근과 더불어 사회복지적 측면의 개선이 필요한 것으로 나타났다.

Research on the Application of Blockchain Technology in the Comprehensive Health Industry

Yan-Fen Wu,김형호 사단법인 미래융합기술연구학회 2022 아시아태평양융합연구교류논문지 Vol.8 No.3

Blockchain technology is widely used in finance, Internet and other fields, and has broad prospects. With the improvement of blockchain technology research, its application in the medical field has also made great progress. Many people believe that the healthcare field is the second largest blockchain application research field after the financial field. Whether the medical and health services are well developed is related to the country's economy and people's lives, and to the health of every citizen. It is also an important measure for the country to effectively deal with the problem of aging. China's policy has also released positive signals in the construction of the big health industry system. It encourages relevant institutions to give full play to the role of network technology and build an "Internet + medical and health" platform to make medical services more convenient. This paper mainly adopts the literature review method to explore the application of blockchain technology in the field of comprehensive health. It discusses the application ideas and systems of blockchain in the health care field by analyzing the core advantages of blockchain technology, the health industry development status, and combining with the current problems in the health care sector. It proposes three applications of blockchain technology in the health field: building a personal health database, an intelligent medical assistance platform, and an open medical resource mutual assistance and sharing center. This paper explores that blockchain technology can help hospitals, medical insurance, medicine, research institutions and other participating entities to share medical data safely and efficiently, improve the efficiency and quality of health care services, increase patients' sense of experience and autonomy, and realize the structure of the health industry. It aims promote the blockchain technology to better serve the health care department and individuals.

지역사회건강조사를 이용한 의료급여수급권자와 건강보험가입자의 건강관련 삶의 질 비교 연구

홍주연(Ju-youn Hong),김가중(Gha-jung Kim) 한국콘텐츠학회 2016 한국콘텐츠학회논문지 Vol.16 No.5

본 연구에 의료급여수급권자와 건강보험가입자의 인구사회학적 특성, 건강행태, 질병이환, 의료이용, 건강관련 삶의 질 등에 대한 포괄적인 평가를 해 보고자 하였다. 연구 대상은 2013년도 지역사회건강조사 자료를 분석하였다. 연구결과 사회경제적 특성, 건강행태, 질병이환, 의료이용 등 다양한 요인들이 건강관련 삶의 질에 영향을 미치는 것으로 나타났다. 의료급여수급권자가 건강보험가입자보다 사회경제적 특성, 건강행태, 의료이용이 좋지 않아 건강관련 삶의 질이 낮은 것을 확인을 할 수 있었고 사회경제적 특성을 통제하고도 비교 해본 결과에서도 건강행태, 질병이환, 의료이용이 좋지 않아 건강관련 삶의 질이 떨어지는 결과를 보였다. 따라서 의료급여수급권자들의 건강관련 삶의 질을 효과적으로 향상시키기 위해서는 만성질환 관리, 스트레스와 우울감 관리 등의 정신 건강과 일상 활동 능력의 향상이 무엇보다도 중요하며 적당한 음주습관과 규칙적인 운동, 식습관 등 건강 증진 행위를 촉진하는 데 중점을 둔 체계적인 프로그램 개발과 정책을 위해 국가적 관심이 요구 된다. This study attempts to comprehensively evaluate differences in sociodemographic characteristics, health behavior, disease morbidity, medical care and health-related quality of life of medical aid beneficiaries and health insurance beneficiaries. To achieve this, this study analyzes primitive data of community health survey that each health center had recently conducted in 2013. Study socioeconomic characteristics, health behavior, disease morbidity, medical care showed that various factors affecting health-related quality of life. It was found that medical aid beneficiaries showed lower health related-quality of life than health insurance beneficiaries because not good socioeconomic characteristics, health behavior, disease morbidity, and medical care and even as a comparative result after controlling socioeconomic characteristics, it was found that medical aid beneficiaries health-related quality of life was lower because of not good health behavior, disease morbidity, and medical care. Therefore, to improve health-related quality of life in medical aid beneficiaries as effectively as possible, improving mental health including managing chronic disease and stress and depression and daily living activities is above all important and our national concern with developing systematic program and policies focusing on health promotion behaviors such as moderate drinking habits and regular exercise and eating habits is required.

외국인근로자의 보건의료 현황과 문제점

이병운(Lee, ByungWoon),고준기(Ko, ZoonKi) 한양법학회 2010 漢陽法學 Vol.31 No.-

The physical and psychological right to health in the Korean Constitution is Fundamental human right. However, there are still the underprivileged people like foreign workers who have financial difficulties and little medical benefits in Korea, which does not meet the social demands of heal and medical care. International law asks every country to care for the health of foreign workers who reside within its own domain. Korean medical laws require medical institutions like hospitals or clinics and doctors in the maternity and dental clinics not to refuse medical treatment with no probable cause. They provide that the institutions and doctors should take the best measures for emergency patients. This study proposes health and medical strategies based on earlier studies of the health and medical aid service for foreign workers and the present conditions and problems of it as follows. First, It is necessary that various health and medical strategies for foreign workers or immigrant laborers should be designed from the standpoint of the long-term and integrated situation. Second, we need to prepare measures for uninsured people and rationalize insurance premiums or fees of medical insurance subscribers. Third, we need to improve the quality of medical service through physical examination not as group practice but as precautions. Fourth, it requires to keep a close relationship and persistent supporting between medical institutions and private organizations. Fifth, to prevent industrial accidents of foreign workers, we need to set an institutional apparatus and the safety and health management practices, unlike the ones for Korean workers, which are commensurate with various labor and environment. Sixth, workers infected by contagious disease are rather deprived of all their rights than benefited by Korean medical laws, so we need to take the necessary measures to prevent violation of human rights and deprivation of the right to health. Seventh, from a long-term perspective, we need to found the hospitals for foreign workers in certain districts and provide translators of various languages for them.