쿠바 보건의료정책에 대한 고찰

정이나(Jung, I-na) 한국외국어대학교 중남미연구소 2017 중남미연구 Vol.36 No.2

본 논문의 목적은 쿠바 보건의료 시스템의 의료적 성과와 의미를 지역사회의학의 이론적 토대와 일차보건의료의 실천적 개념을 통해 살펴보는데 있다. 지역사회의학은 사회경제적 환경을 질병 발생의 주요 원인으로 파악함으로써, 국민건강보장에 대한 국가의 기능과 역할을 강조하는 사회의학의 전통을 이어 받아 발전하였다. 그리고 일차보건의료는 1978년 세계보건기구의 알마아타 선언으로 등장한 개념으로 지역사회의학과 함께 현재 쿠바 보건의료의 중심축을 이루고 있는 요소이다. 지금까지 쿠바의 보건정책은 자본주의 질서와 대립되는 사회주의적인 ‘무상’의료라는 이념적 관점에서 주로 다루어졌음을 고려할 때, 구체적인 이론과 실천을 바탕으로 의료성과의 성공요인과 사회적 의미 등을 분석하는 것은 의미가 있을 것이다. 이에 본 논문에서는 쿠바 사회에서 작동하는 보건의료의 운영체계를 단계별로 분석하고, 쿠바 사회가 구축한 보건의료시스템의 효율적 운영과 정책적 함의를 지역사회의학과 일차보건의료의 관점에서 파악하고자 한다. 그리고 마지막으로 사회의학이 신자유주의 개혁이 야기한 전 세계적인 의료불평등을 해결하는 대안적 접근으로써 시사점이 무엇인지 고찰해볼 것이다. This study aims to clarify the medical achievements and the significance of the Cuban healthcare system by theorizing its basis in local community medicine and its practical conception as a form of primary healthcare. The practice of local community medicine has been developed within the perspective of traditional social medicine, which conceptualizes the major causes of diseases as originating in the socioeconomic environment, thus placing emphasis on the functions and roles of the nation in the imperative to secure public health. Primary healthcare, the concept born from the Declaration of Alma-Ata issued by the World Health Organization, is now an element of the central axis sustaining the current Cuban healthcare system along with local community medicine. So far, the studies on Cuban healthcare have dealt with it from an ideological perspective, focusing on its socialist “free of charge” character, as opposed to the medical care available within the capitalist order. Therefore, a new perspective on the issue must offer a concrete theoretical basis in order to analyze its achievements and the reasons for the achievements and their social significance from a practical point of view; in this manner, a theoretical analysis can make a contribution to its better understanding. For this purpose, this article analyzes each step of creating the healthcare system and its operation in Cuban society, and conceptualizes the effectiveness of the healthcare system established by Cuban society, in addition to its political implications from the theoretical perspectives of local community medicine and primary healthcare. Finally, I will contemplate what this social medicine as an alternative approach can suggest us to solve the worldwide medical inequality deepened by neoliberal reform.

일차의료 중심의 통합 의료돌봄 서비스

임선미,이정찬,문성제,우봉식 대한의사협회 2023 대한의사협회지 Vol.66 No.11

Background: Each country is providing various community care services owing to the increasingly aging population. Therefore, Korea needs to develop multiple approaches to the healthcare utilization system that can reflect the complex needs of older adult patients. Current Concepts: Considering the characteristics of older adult patients, it is essential to connect the treatment at medical institutions with home or nursing facilities. Some patients need medical and long-term healthcare simultaneously. Currently, healthcare services for older adult patients in Korea are fragmented across various service areas. Therefore, healthcare service plans need to be explored to provide integrated and long-term healthcare for older adult patients. Discussion and Conclusion: We propose to establish a healthcare information linkage center to provide comprehensive information on the appropriate services needed by patients. The healthcare information linkage center would refer patients to their local community or local primary healthcare provider if they want home services. Through this process, doctors and healthcare teams would visit the patient’s residence to provide services and perform a comprehensive assessment of their condition to create a personalized care plan. The core of this proposal lies in the establishment of a single point of contact in the region to link and integrate healthcare. Consequently, information on services appropriate to the needs of the target population would be appropriately linked in one place and overlapping services would be coordinated to improve operational efficiency.

Patient value of primary care in Lean healthcare context

( Malgorzata Fialkowska-filipek ) 한국품질경영학회 2015 한국품질경영학회 학술대회 Vol.2015 No.2

Purpose - Enhancing patient value is acknowledged to be a central part of Lean healthcare. However, approaches to ascertain what patients regard as valuable are not yet established. The purpose of this study is to examine what constitute the value of the primary care from the patient□s perspective. Methodology/approach - This study employed customer value hierarchy to analyse what is the value from the patient point of view. Analytic hierarchy process (AHP) was used in in order to identify the attributes and priorities of patient value. Pairwise comparisons of the attributes were obtained by the face-to-face survey carried out among patients in primary care units in Poland. Before main data collection, questionnaire construct was tested by the pilot study. The data was analysed according to the AHP procedure and appropriate statistical tests. Findings - Patients of primary care consider the comprehensiveness of care as the most valuable attribute of primary care. This is followed by the coordination and continuity of care, accessibility of care and interpersonal relationship with medical personnel. There are differences on how young and elderly assess value of primary care. For the young people the most important is to get quick response on healthcare needs. On the other hand, for the elderly people the most important is to have good interpersonal relationship with medical personnel. Practical implications - Results from this study are of significant benefit to all healthcare managers which consider applying Lean as a medical service improvement concept and designing healthcare delivery in the way, which allows enhancing patient value. Originality/value - There are many studies presenting application of Lean in healthcare, but none of them answers the question what constitute patient value and which value attributes are the most important, which this paper provides. This paper makes also contribution by presenting how AHP can be successfully applied in customer value research.

중동호흡기증후군 사태 이후 병원감염관리를 강화하기위한 의료정책과 의료이용문화 개선

김윤 대한의사협회 2015 대한의사협회지 Vol.58 No.7

The recent outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infections in South Korea in May 2015 revealed that the Korean healthcare system and hospitals are highly vulnerable to hospital-spread infections. In a short period of time, MERS-CoV infection spread widely across Korea due to the unique characteristics of the Korean healthcare system including 1) hospitals with limited infection control capabilities, 2) a heavy dependency on private caregivers due to a nursing shortage, 3) emergency department overcrowding, and 4) healthcare-related patient behaviour such as hospital shopping. To prevent future outbreaks of emerging infectious diseases similar to MERS-CoV, the Korean healthcare system should be reformed and healthcare-related patient behaviour must change. To improve the performance of hospital infection control, the National Health Insurance service should pay more for hospital infection control services and cover private patient rooms when medically necessary, including for infectious disease patients. To reduce risks of hospital infection related to private caregiving, the nurse staffing level should be increased and hospitals should take full responsibility for inpatient nursing care. To reduce hospital shopping, the National Health Insurance service should introduce a differential fee schedule which pays more when primary care providers care for patients with common conditions and tertiary care providers care for patients with severe conditions. To incentivize patients for appropriate health care use, lower patient out-of-pocket payments should be combined with a differential provider fee schedule.

국제보건에서 한의약 공적개발원조의 현재와 지속가능한 발전전략

황예은,이승현,김형우,남효주,이승언,백유상,채한 대한한의학회 2024 대한한의학회지 Vol.45 No.1

Objectives: Korea has a unique history of being both a recipient and a donor of Official Development Assistance (ODA), and the international community expects Korea to contribute to the development of developing countries by utilizing this experience. Traditional Korean medicine (TKM) seeks to contribute to global health, however the concept of ODA has been unclear and there has been no clear strategy and sustainable initiatives. Methods: This study examines the concept of ODA and its application in global health, including business objectives, scale, evaluation principles, and development strategies. Additionally, we reviewed the current status of Traditional Korean medicine globalization projects and conducted a SWOT analysis of the internal and external environment of the TKM sector. Based on these findings, we redefined the concept of ODA for TKM and proposed suggestions for its development. Results: The current study identified key ideas for TKM ODA. It should prioritize the improvement of primary healthcare in recipient countries, aligning with the international evaluation criteria of the SDGs. Secondly, TKM's 70 years of experience can be leveraged to enhance both the competence and economic benefits of recipient countries' medical systems. Based on these concepts, a TKM ODA development model was proposed, comprising two core visions, three development strategies and goals, and six core values. Conclusion: This study systematically examined the TKM in global health and suggested sustainable development strategies for TKM ODA. Through its expansion, TKM could contribute to the advancement of global traditional medicine and its overall engagement in healthcare.

표준업무개발을 통한 일차의료기관 활성화에 관한 연구

오현종,박정식,박아련,편석원,김양균 대한의사협회 2011 대한의사협회지 Vol.54 No.2

Primary care lays the foundation of national healthcare systems, but it has been weak in playing its role correctly because of legal and environmental attributes surrounding the healthcare industry in Korea. This study is conducted to concretize the definition and scope of primary care and to deduce its standard functions to contribute to establishing the healthcare delivery system and appropriate healthcare systems embracing socio-environmental leverage. The term primary healthcare institution was adopted based on literature review to achieve the research goal. The principle diseases appropriate for the primary healthcare institution based on ambulatory care sensitive conditions were analyzed, and the standard functions were deduced by matching these diseases with current procedural terminologies using CrossCoder package. Based on the analysis,the primary healthcare institution-specific diseases were 53 specific diseases under 23 broad disease groups. The standard functions were deduced in three categories of the standard functions of the entire primary healthcare institutions with 100% frequency, common standard functions with 70% frequency, and peculiar standard functions specific to diseases or body systems. These functions included outpatient evaluation and measurement, various factor tests through blood collection, and X-ray. Establishing the standard functions for the primary healthcare institution can promote patient reliability on primary care, alleviate health demand congestion toward large-sized advanced healthcare institutions. Furthermore, it contributes to establishing and reinforcing other healthcare policies related to the healthcare reimbursement system and referral system, and fosters primary care physician education. Most importantly, it reduces the national health expenditures by realizing efficient and effective healthcare delivery.

Evolution of Healthcare Service Disparities: A Case Study of Primary Care Services in Korea, 1995-2021

김현,송예나 한국경제지리학회 2023 한국경제지리학회지 Vol.26 No.3

While South Korea's universal healthcare system has garnered attention in public health, the issue of inequality in healthcare service provision among different age groups has incessantly become a significant concern. The focus of this concern is primarily on essential healthcare services, encompassing fundamental aspects of healthcare such as internal medicine, family medicine, and pediatric and adolescent care. This inequality is not limited to differences among age groups (both junior and senior demographics) but also extends to potential disparities in healthcare services based on geographic location, particularly in urban and rural contexts. This paper aims to investigate disparities in primary healthcare service resources in South Korea's evolving economic landscape between 1995 and 2021. We utilize a set of inequality indices with a spatial perspective through geographic cluster analysis. The findings reveal that concerns about inequality have been amplified during various economic events, including the IMF crisis in 1999, the global financial crisis in 2008, and the COVID-19 pandemic in 2020. These years are identified as significant phases that have contributed to manifesting spatial disparities in primary healthcare provisions, with a particular emphasis on the senior-aged population rather than junior or all population groups. Our findings underscore the pressing need to address the unequal distribution of essential healthcare resources as part of preparedness for potential economic impacts, requiring a comprehensive consideration of the interconnected nature of demographic and spatial dimensions in healthcare services.

The Primary Care Performance of Three Types of Medical Institutions: A Public Survey using the Korean Primary Care Assessment Tool

Jung, Hye-Min,Jo, Min-Woo,Kim, Hyun-Joo,Jang, Won-Mo,Lee, Jin-Yong,Eun, Sang-Jun Korean Society for Quality in Health Care 2019 한국의료질향상학회지 Vol.25 No.2

Purpose:The healthcare system of South Korea is at the extreme of the dispersed system. Few regulations limit patients from directly visiting higher-level medical institutions for primary care sensitive conditions. As a result, similar to local clinics, general and tertiary teaching hospitals also provide diverse primary care services. Our study aimed to examine the general public's perceptions of their primary care performance. Methods: Face-to-face surveys were conducted with 1000 adults who were living in South Korea with the aid of a questionnaire that included the Korean Primary Care Assessment Tool (KPCAT). The KPCAT consists of five domains, which are the main indicators of primary care performance: first contact, comprehensiveness, coordination, personalized care, and family/community orientation. One-way analysis of variance and post hoc tests were used to compare the KPCAT scores across the three types of medical institutions. Results: Domain-wise analyses revealed two different patterns. With regard to first contact and its subdomains, the highest and lowest scores emerged for local clinics and tertiary teaching hospitals, respectively. However, the other four domain scores were significantly lower for local clinics than for the other two types of medical institutions. Conclusions: Local clinics were perceived to be medical institutions that are responsible for providing primary care. However, the general public perceived only one domain of their primary care to be superior to that of the other two types of medical institutions: first contact. National efforts should be taken to strengthen their other four domains of primary care by training their workforce and providing appropriate incentives.

Failure Demand: An evaluation of concept in UK Primary Care

( Paul Walley(dr) ),( Sharon Williams(dr) ),( Pauline Found(dr) ) 한국품질경영학회 2015 한국품질경영학회 학술대회 Vol.2015 No.2

Purpose - The purpose of this paper is to assess the characterisation of failure demand as service lean concept that assists in the analysis of waste during quality improvement activity. We assess whether the limited use of this concept is a missed opportunity to help understand improvement priorities given that a UK Government requirement for public services to report failure demand has been removed. Design/methodology/approach - The study looks at the existing literature across the public sector and then applies the concept of failure demand to the UK□s primary healthcare system. UK NHS demand data are analysed and the impact on patient care is elicited from patient interviews. Findings - The study highlighted the value of the concept, showing how the primary care system often generates failure demand partly because of existing demand and capacity management practices. This demand is deflected to other parts of the system with a considerable detrimental impact on the patient□s experience. Research implications - More research is now needed to fully understand how best to exploit the idea of failure demand as there are many barriers to its appropriate and successful application. Practical implications - The paper highlights three practical barriers: the lack of general understanding of demand within the healthcare system, the lack of understanding of systems improvement and the need to apply the concept for improvement not reporting purposes. Originality/value - The paper provides an objective and independent insight into the concept of failure demand that has not previously been seen in the academic literature.

Unmet healthcare needs among adults in Rural area, Paraguay: A cross-sectional study

김지언,이호철,남은우 연세대학교(미래캠퍼스) 빈곤문제국제개발연구원 2021 地域發展硏究 Vol.30 No.1

The Plan Nacional de Desarrollo Paraguay 2030 states “coverage must be secured in public sectors for [the] development of the country,” and efforts are currently being made to increase health coverage. However, there has been a limited number of studies on the accessibility and use of medical care by local residents in Paraguay. This study aimed to identify factors that affect the experience of unmet health care needs in adults residing in rural area, Paraguay, Community Health Survey of Limpio city. Results revealed that participants residing in rural areas had higher unmet healthcare needs than those in urban areas. It was also found that those in the higher income quartile had fewer unmet healthcare needs than those in the lower income quartile. Those with chronic diseases and no healthcare insurance were more likely to experience unmet healthcare needs than those without chronic diseases and those with health insurance, respectively. We concluded that regional features can create gaps in the use of healthcare services. Therefore public health centers should be located in areas accessible. And according to the results, the quality of healthcare services is an important factor in the selection. Thus, the function of public health centers should be improved, and healthcare human resources and infrastructure of facilities should be systematically reinforced.