산업재해보상보험의 청구 절차 미비로 인한 건강보험의 재정 손실 규모와 개선 방안

좌혜경(Jwa, Hey-Kyoung),임준(Yim Jun),정원(Cheong Won) 비판과 대안을 위한 사회복지학회 2013 비판사회정책 Vol.- No.39

산업재해보상보험(이하 산재보험)으로 치료를 받지 못하고 건강보험을 이용하여 치료를 받는 직업성 손상 및 질병에 이환된 환자가 많은 것으로 알려져 있다. 본 연구는 산재보험으로 치료를 받지 못하여 발생하는 건강보험의 재정손실 규모를 추정하고 그 이유를 분석하여 개선 방안을 도출하고자 수행되었다. 손상 및 근골격계질환에 국한하여 직업 기여율을 먼저 구하고 직장가입자중 손상 및 근골격계질환으로 치료를 받은 환자의 공단부담금을 구한 후 직업 기여율을 곱하여 산재보험으로 치료를 받지 못하고 건강보험으로 치료를 받아 발생한 건강보험 재정손실 규모를 추정하였다. 또한 임금노동자 전체로 확대할 경우 산재를 산재보험에서 처리하는 방향으로 제도 변화를 가정했을때의 건강보험 재정 절감액을 추계하였다. 직업성 손상만을 모두 산재보험으로 처리한다고 가정할 때에 2014년부터 2018년까지의 5년 간 누적 재정 절감액은 최소 8,312억 원이고, 최대 1조 7,463억 원인 것으로 나타났다. 직업성 손상과 직업성 근골격계 질환자를 합쳐서 모두 산재보험으로 처리한다고 가정할 때에 5년 간 누적 재정 절감액은 최소 1조 6,812억 원이고, 최대 3조 5,746억 원인 것으로 나타났다. 현재의 산재보험은 직업성 손상 및 질병에 이환된 환자에게 직업관련성의 입증을 요구하고, 근로복지공단에 의한 사전승인 절차를 거치도록 하며, 그 기준마저 엄격하게 제한하고 있다는 점에서 노동자의 권리를 보장해주지 못하는 제도라고 할 수 있다. 산재 요양을 위해 직업성 손상 및 질병에 이환된 환자가 근로복지공단에 청구하고 사전을 받아야 하는 사전승인제도를 없애고 요양 시점부터 의료기관의 분류에 의하여 치료를 받을 수 있도록 청구절차를 개선하고 사후 평가 방식으로 제도운영을 보완한다면 보다 근본적인 제도 개선이 가능할 것이다. In Korea, many people suffering from occupational injuries or diseases are compensated by the national health insurance (NHI) instead of the national workers" compensation insurance (NWCI). We identified the occupational contribution for injuries and musculoskeletal disorders compensated by NHI and analyzed the total benefit amount for those and then estimated the financial losses to the NHI due to substitution for the NWCI. Finally, we estimated the financial savings of the NHI supposing that the NWCI would be reformed and all occupational injuries and musculoskeletal disorders were compensated by the NWCI. If it could be assumed that all occupational injuries were compensated by the NWCI, the cumulative financial savings for 5 years (2014~2018) ranged from 831.2 billion won to 1.746 trillion won. If it could be assumed that all occupational injuries and musculoskeletal disorders were compensated by the NWCI, the cumulative financial savings for 5 years(2014~2018) ranged from 1.684 trillion won to 3.575 trillion won. Nowadays, those people who want to be compensated by the NWCI, have to demonstrate the causality between work and disease, and then be approved before getting the medical care benefits. As a result, the NWCI has not protected the workers" rights but in fact has infringed the worker"s rights. In order to solve these problems, it needs to improve claims procedures for classifying occupational injuries and diseases at the point of medical care.

실태조사에 의한 장난감과 부모의 심리적 요인에 관한 연구

任元明 德成女子大學校 1974 德成女大論文集 Vol.3 No.-

幼兒의 社會的敎育에 對한 主婦의 關心度 調査

任元明 德成女子大學校 1977 德成女大論文集 Vol.5-6 No.-

羅隱의 詠史懷古詩

임원빈 한국외국어대학교 외국문학연구소 2003 외국문학연구 Vol.- No.14

LuoYin was a celebrated poet of the last period Tang Dynasty. It was disordered at those days, and he come under the influence of Confucian theory, and he cared greatly for his nation and society. His Poem on history and Poem recalling antiquity were also related to social issues. Both of them are based on historical facts. They mainly aim at satirizing the present with the past. We will see the satiric meaning and writer's mentality in this paper. This paper has four chapters : The first chapter, introduction which contains the background characteristic of times, characteristic of LuoYin's poems and motives & object of this study. The second chapter tells about the satiric meaning of Poem on history and Poem recalling antiquity. We can see the fact that he had satirized the last period of Tang Dynasty in his poems with the dissipated and unashamed former emperors. In addition, we can also see the writer's care for his nation and people through his satiric view from Poem on history and Poem recalling antiquity. The third chapter mainly shows the writer's mentality from his Poem on history and Poem recalling antiquity by the division into 'sentimentality', 'resentment' and 'ridicule'. Sentimentality and resentment are the general factors of Poem on history and Poem recalling antiquity, but ridicule is the unique feature of LuoYin's poems. The last chapter is the conclusion. We can see the importance of LuoYin's poems through the study on satiric feature and writer's view & mentality from his Poem on history and Poem recalling antiquity.

톨루엔 노출 근로자에서 유전자적 요인, 생활습관 및 식이가 요중 마뇨산 배설에 미치는 영향

임현우,박정일,노영만,이강숙,이정민,이원철,이세훈,정치경 大韓産業醫學會 2000 대한직업환경의학회지 Vol.12 No.3

목 적 : 본 연구는 생물학적 지표 특성 연구를 위한 단면조사 연구로서 톨루엔 노출과 톨루엔의 생물학적 모니터링으로 이용되는 요중 마뇨산 농도간의 양-반응 관계에서 효과 변경인자로서 작용하는 유전자 ALDH2, CYPIAI, CYP2El의 다양성 분포를 조사하고, 이들 유전자가 요중 마뇨산 배설 농도에 미치는 영향을 알아보고자 하였다. 방 법 : 연구대상자는 경인지역에 위치한 22개의 사업체에서 페인트 제조 72명, 제조업에서 도장작업 50명, 인쇄업 12명, 접착작업 12명, 벽지의 코팅작업 14명등 160명의 근로자이었다. 성, 연령, 유기용제 작업장 근무경력, 흡연습관, 음주습관, 검사일 이전 밤에 음주 여부, 시료 채취전 6시간 이내에 섭취한 식품조사, 측정일 개인보호구의 착용 여부에 대하여 설문조사를 시행하였다. 톨루엔에 대한 개인노출량은 passive air sampler로 측정하였고, 요중 마뇨산은 요중 크레아틴으로 보정하여 측정하였다. 또한 aldehyde dehydrogenase 2 (ALDH2) , cytochrome P45O IAI(CYPIAI), 그리고 cytochrome P45O 2El(CYPfEl)의 유전적 다양성은 혈액으로부터 백혈구의 DNA를 추출하여 제한 효소 절단 길이 다양성 (restiction fragment length polymorphism, RFLP)법으로 검사하여 다음의 결과를 얻었다. 결 과 : 연구대상자의 요중 마뇨산 농도의 기하평균은 0.44g/g creatinine, 기하표준편차 2.80이었다. 톨루엔 노출 농도, 개인 보호구 착용여부, 안식향산이 함유된 식품의 섭취여부중 요중 마뇨산 배설농도에 영향을 미치는 인자는 톨루엔 노출 농도뿐이었다. ALDH2, CYPIAI, CYPfEl, 연령, 흡연, 근무기간에서 회귀계수간에 차이를 보이는 경향이 있었다. 요중 마뇨산 농도에 대한 다중회귀분석에서 톨루엔, ALDH2, CYPIAI, CYP2El유전자형의 회귀계수가 통계적으로 유의하였다. 결 론 : 톨루엔 노출로 인한 요중 마뇨산 배설 농도는 ALDH2, CYPIAI, CYP2El유전자 다양성에 의해 영향을 받기 때문에, 유전자형의 대사능의 차이를 고려하여 마뇨산 기준 농도를 찾는 연구가 이루어져야 하겠다. Objectives The purpose was to investigate the distributions and the effects of genetic polymorphism of aldehyde dehydrogenase 2(ALDH2), cytochrome P45O IAI (CYPIAI), and cytochrome P45O 2El (CYPfEl) on the toluene metabolism. Methods : The subacts consisted of 160 workers who were exposed to toluene in different industries such as paint manufacturing, painting on steel and wood products, printing, bonding, and coating. The exposed toluene level was monitored by passive air sam paler, and the questionnaire variables were age, sex, smoking, drinking, previous night's drinking, use of personal protectlve equipment, work duration, and taking benzoic acid containing food. The urinary hippurric acid collected in the end of shift was corrected by urinary creatinine concentration. The genotypes of ALDH2, CYPIAI, and CYP2El were investigated using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods with DNA extracted from venous blood. Results'The geometric mean and the geometric standard deviation of urinary hippuric acid concentration were 0.44 g/g creatinine and 2.80. The urinary hippuric acid concentration was significantly related to personal exposed toluene level among personal exposed toluene level, use of personal protective equipment, and benzoic acid containing food diet. The slope differences of the regression for ALDH2, CYPIAI, and CYP2E1 genetic polymorphism, age, smoking, and work duration tended to be significant. In multiple regression analysis, the regression coefficient of toluene, ALDH2, 7YPIAl, CYP2E1 genetic polymorphism were significant. Conclusions : From the above results, urinary hippuric acid level after toluene exposure was significantly affected by the genetic polymorphism of ALDH2, CYPIAI, CYPfEl. It is needed further investigation of the urinary hippuric acid level considering the effect of genetic polymorphism.

李商隱 詩歌와 道敎文化

임원빈 韓國外國語大學校 外國學綜合硏究센터 中國硏究所 2004 中國硏究 Vol.34 No.-

Li shang yin's poetry express extensive Taoism culture. His poem affected by Taoism culture. The reason because of live in Taoism holy place and Taoism are prevalent habits. This paper has five chapters : The first chapter, introduction, contains background characteristic of times, characteristic of Li shang yin's poems and motives & object of this study. The second chapter tells about the relation between Li shang yin and Taoism culture. The third chapter mainly shows Taoism culture. Taoism culture include a Taoist hermit with super-natural powers, the world of a Taoist hermit with super-natural powers, make pills of immortality and a method of moral culture. The fourth chapter shows reflect of Taoism culture. Li shang yin's poems turn Taoism culture to account make subject matter for a satire and deposit sentimentalism. The fifth chapter is conclusion. Under the influence of Taoism culture, Li shang yin's poems enrich poetry subject matter and contents, on the other hand composed new mood of a literary.

실태조사에 의한 장난감의 가정적 요인에 관한 연구

임원명 德成女子大學校 1973 德成女大論文集 Vol.2 No.-

The aim of this study is to know the actual conditions of a toy in connection with all the various domestic environments. Todays, our society is a mode of life that we have to live soundly through a play with a toy in children and a productive actibity in adults. Although the real value of a toy in childhood has a important meaning, many adults, especially the parents who are in directive relation with the growth and the mature of children, have not to mind and lose sight of it, they seem to have a tendency that takes granted for it as a trifle. Therefore, I am to report about the value of a toy within a family and the various aspects that it has in connection with the domestic conditions.

李商隱 詠物詩의 抒情詩

임원빈 韓國外國語大學校 外國學綜合硏究센터 中國硏究所 2005 中國硏究 Vol.35 No.-

만성 폐쇄성 폐질환 환자에서 장기간의 스테로이드 복용 중 발생한 중증 분선충 감염 1예

하원철,이영현,하경임,안명희 대한감염학회 2008 감염과 화학요법 Vol.40 No.5

Strongyloides stercoralis is a soil-transmitted intestinal nematode that may cause long-lived auto-infection in the host. It is distributed worldwide, especially in the tropical and subtropical regions, but has been rarely reported in Korea. Chronic infections by S. stercoralis are mostly inapparent infections that carry nonspecific gastrointestinal and pulmonary symptoms. However, In immunocompromised patients such as those receiving long-term steroid therapy and patients with AIDS or malignant tumors, S. stercoralis can induce hyperinfection by autoinfection. This may lead to increased rate of complications such as resistance to chemotherapy and sepsis, In such cases mortality rate of up to 87% has been reported. We report a case of severe strongyloidiasis in a patient with chronic obstructive pulmonary disease who was receiving long-term steroid therapy. The chief complaint was repeated dyspnea and hematochezia, and strongyloidiasis was diagnosed by the presence of rhabditiform larvae of S. stercoralis in the fecal smear and isolation of filari-form larvae from the stool culture. The patient developed septic shock during treatment with albendazole and showed clinical signs of hyperinfection of S. stercoralis. He eventually died despite aggressive treatment.

근로자 건강증진전략을 위한 행동변화에 대한 요구도 평가

이강숙,임현우,구정완,홍현숙,이정민,이원철,박정일,맹광호,M, O'Donnel 大韓産業醫學會 1999 대한직업환경의학회지 Vol.11 No.4

Objectives : In order to evaluate the stage of behavior change for health promotion strategy in workplace Methods : Questionnaire survey was carried out for 309 workers who employed in H Electronics company in Kyong-in area from September to October 1998. Results : According to need assessment of four step such as precontemplation stage, contemplation stage, action stage, maintenance stage which were to change of behavior for health promotion, the percent for quitting smoking were observed 48.8%, 43.1%, 8.1%, 0%, and for the restriction of drinking were 29.8%, 10.6%, 9.3%, 5.3%; for fitness 11.1%, 31.0%, 37.3%, 20.6% in male 26.6%, 27.8%, 26.6%, 19.0% in female, for regular diet 26.1%, 19.8%, 38.7%, 15.3% in male, 27.8%, 22.2%, 40.0%, 10.0% in female and for stress management 5.8%, 10.6%, 8.7%, 75.0% in male, 13.6%, 22.7%, 19.7%, 44.0% in female. In heavy smoker(p=0.017) and heavy drinker,(p=0.021) the percent of precontemplation stage was significantly higher than in lower drinker and light smoker. Conclusions : This study suggested that company support for health promotion in workplace was and workers of high risk group for smoking and drinking were in precontemplation stage. So before conducting the health promotion program, health risk appraisal and need assessment for stage of behavior change should be taken for the efficient health promotion strategy.