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RISS 인기검색어
- 검색키워드
- 저자 : 韓達鮮(Dal Sun Han) (검색결과 39 건)
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한달선,김병익,이영조,배상수,권순호,Han, Dal-Sun,Kim, Byungy-Ik,Lee, Young-Jo,Bae, Sang-Soo,Kwon, Soon-Ho 대한예방의학회 1991 Journal of Preventive Medicine and Public Health Vol.24 No.4
This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discouraging the use of tertiary care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131 (3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care utilization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.
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Origins and Evolution of Social Medicine and Contemporary Social Medicine in Korea
한달선,배상수,김동현,최용준,Han, Dal Sun,Bae, Sang-Soo,Kim, Dong-Hyun,Choi, Yong-jun The Korean Society for Preventive Medicine 2017 예방의학회지 Vol.50 No.3
유럽의 많은 의과대학들은 사회의학을 교과목으로 개설하고 있으며, 미국에서는 일부 의과대학들이 사회의학을 department의 명칭에 사용하고 있다. 그러나 한국에서는 사회의학의 도입이 제대로 진행되지 못했다. 이는 한국 의학에 지대한 영향을 미친 미국 의학계가 한동안 그 용어와 원리를 수용하지 않았었기 때문일 것이다. 이러한 상황 인식을 바탕으로 1) 사회의학의 기원과 진화에 관하여 기술하고, 이어서 2) 한국 사회의학의 실상에 대하여 간략히 논의할 것이다. 사회의학은 1848년 프랑스와 독일에서 창시되어, 국제적으로 다양한 발전 과정을 거쳤다. 사회적, 경제적 여건이 건강, 질병 및 의료서비스에 미치는 영향이 심대하며, 따라서 그에 대한 과학적 연구가 필요하다는 것이 사회의학의 핵심적 개념에 속한다. 한국에서는 사회의학이 거의 사용되지 않는 용어지만, 그 내용은 의과대학 예방의학 교과과정에 도입된 상태이다. 그러나 이러한 내용적 수용은 사회의학에 대한 논의와 이해에 근거해서 이루어진 것이 아니므로 그 의의와 가치의 전달에 한계가 있다. 따라서 예방의학과 사회의학의 연계관계를 분명히 밝히고, 체계화하는 노력이 필요하다. 구체적으로는 의과대학 예방의학 과목의 명칭을 많은 나라에서처럼 예방사회의학으로 변경하고, 명칭에 부합하도록 내용을 조정 보완하는 방안을 검토할 필요가 있다. Social medicine is recognized as one of medical specialties in many countries. However, social medicine has never been formally introduced to Korea, presumably because the term and its principles were not accepted for some years in the past in American medicine, which has strongly influenced Korean medicine. This paper describes the origins and evolution of social medicine and briefly discusses contemporary social medicine in Korea. Social medicine was initiated in France and Germany in 1848. Since then, it has expanded globally and developed in diverse ways. Included in core principles of social medicine is that social and economic conditions have important effects on health and disease, and that these relationships must be subjected to scientific investigation. The term 'social medicine' is rarely used in Korea, but many of its subject matters are incorporated into preventive medicine which, besides prevention, deals with population health that is inescapably social. However, the Korean preventive medicine directs little attention to the basic concepts and principles of social medicine, upon which systematic development of social medicine can be based. Thus, it is necessary to supplement the social medicine contents of preventive medicine through formalizing the linkages between the two fields. One way of doing so would be to change the title of 'preventive medicine' course in medical colleges to 'preventive and social medicine,' as in many other countries, and to adjust the course contents accordingly.
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한달선,조병희,배상수,김창엽,이상일,이영조,Han, Dal-Sun,Cho, Byung-Hee,Bae, Sang-Soo,Kim, Chang-Yup,Lee, Sang-Il,Lee, Young-Jo 대한예방의학회 1996 예방의학회지 Vol.29 No.2
This paper concerns professional socialization of medical students. Professional socialization, in the context of this paper, means the process through which a layperson becomes a doctor equipped with professional identity and values. While medical education does not include such process in the curriculum, medical students obtain certain values and identity informally. The dependent variables were professional values and professionalism. The former means the desirable attributes required to conducting professional works such as humane attitudes, science-oriented mind, capability for organizational management. The latter means socio-political reasoning with which doctors can rationalize their privileges such as autonomy. A specially designed questionnaire was developed. The data were collected from five medical schools for 1,318 students in 1994. A total of 1,070 cases were finally included in the statistical analysis. The students emphasized the human factor in the professional values. Their attitude did not change with the grade. Other independent variables such as motives for entering a medical school, socioeconomic status, satisfaction with medical education, etc. also did not influence professinal values. It implies that professional values were not consolidated among the students. However, the factors of professionalism change significantly with the grade. It implies that the students paid more attention to socio-political issues related to doctor's interests as the grade went up. And the factor scores for professionalism were higher for those students who had more positive attitude towards doing medical practice for profit, expected higher income, and were more conservative about social reform. Other independent variables did not influence professionalism. It seems that the students also give emphasis on professionalism, like current medical doctors, mainly because of their concern with recent unfavorable changes in economic conditions of medical care providers.
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한달선,권순호,Han, Dal-Sun,Kwon, Soon-Ho 대한예방의학회 1990 예방의학회지 Vol.23 No.3
The utilization of medical care services has been partly regionalized with the implementation of referral requirement by the government since July 1, 1989 when the health insurance coverage was extended to all the people. For the purpose of regionalization, the whole country has been primarily divided into tertiary care regions, and each of them again into secondary care regions. This study investigates the self-sufficiency for in-patient care services of secondary care regions focusing on why it varies among the regions. In doing so, analysis is performed to examine a model which embodies three sets of hypotheses as follows : 1) The regional self-sufficiency for medical care services would be subject to direct influences of regional characteristics, amount of available services and structural properties of regional medical care system ; 2) The regional characteristics would have indirect effects on the self-sufficiency which are mediated by medical care services ; and 3) The amount of available services would indirectly affect the self-sufficiency by influencing the structure of regional medical care system. The results of analysis were generally consistent with the model. The findings have some practical implications. The regional self-sufficiency for medical care services partly depends upon basic properties of each region which cannot be changed in a short period of time. Thus the self-sufficiency for medical care services can be improved mainly by health policy measures. In some of the regions the self-sufficiency for in-patient care services was much higher or lower than can be predicted from the bed-population ratio. Indication is that the allocation of health resources should be made considering a variety of factors bearing upon the supply of and demand for health care ; not on the basis of just a single criterion like the availability. The self-sufficiency of a certain region is related to not only its own characterstics but also the characteristics of neighboring regions. Therefore, attention should be also directed to the inter-regional relationships in health care when the needs for investment of health resources in a region are assessed. However, it should be noted that this study used the data collected before the referral requirement was imposed. A replication of this analysis using recent data would provide an evaluation of the impact on the self-sufficiency of the referral requirement as well as a confirmation of the findings of this study.
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21세기 초 한국의 보건의료체계 - 공급체제를 중심으로 -
한달선,Han, Dal-Sun 대한예방의학회 1994 Journal of Preventive Medicine and Public Health Vol.27 No.2
This paper is an attempt to identify major challenges to be faced by the Korean health care delivery system for about 30 years in the future and to deliberate over possible policy responses to them. It is not intended to make a precise prediction of the future profile of the system, but the focus is given to understanding what we have to do from now on in order to develop health care in Korea toward a desirable direction. Although the discussion has been made in a rather fragmented manner, it would hopefully provide stepping stones for a systematic study of the Korean health care system from a long range perspective.
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한달선 ( Dal Sun Han ) 한국보건행정학회 2004 보건행정학회지 Vol.14 No.4
There is general agreement that the Korean health care delivery system has two basic structural problems. One is the limited capacity and role of public hospitals, and the other is the absence of functional differentiation and referral arrangement between the clinics and hospitals of various technological sophistication levels. This study is intended to make an empirical observation of the system`s growth process from the viewpoint of the population ecology model of organizations so as to understand the background of these problems and to find out ways of approaching them. As predicted from the population ecology model of organizations, all the types of medical care facilities have expanded in response to the environmental changes for the past three decades or so, and the differences in the extent and pattern of expansion among the types are related to what have taken place in the environment. These findings suggest that the efforts for reforming the health care delivery system should be directed not only to medical care institutions but also to the environmental context under which they function. It is believed that the usefulness of the population ecology perspective on organizations for studying the health care delivery system has been demonstrated. Thus further studies along this line based upon more strict design would improve systematic understanding of the system that is needed for developing policy approaches needed to increase its effectiveness.
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