건강보험 지불제도 개편과 신포괄수가제도 발전방향

공인식 건강보험심사평가원 심사평가연구소 2011 HIRA 정책동향 Vol.5 No.5

비급여 관리 정책현황 및 발전 방안

공인식 건강보험심사평가원 2020 HIRA 정책동향 Vol.14 No.6

호스피스완화의료 제도 현황 및 발전방안

공인식 건강보험심사평가원 심사평가연구소 2015 HIRA 정책동향 Vol.9 No.6

응급의료 정책의 발전방향

공인식 대한의사협회 2010 대한의사협회지 Vol.53 No.10

Emergency Medical Services, more commonly known as Emergency Medical Services (EMS), is a system that provides emergency medical care and public safety. EMS is infamous as a market failure, which cannot reach the break-even point financially due to operation of 24 hours and 365 days, and maintenance personnel. Thus, government’s intervention is inevitable to balance the allocation of medical resources. Vulnerable area still exists for transport and patient care, and quality of EMS is behind the advanced countries. Furthermore,professionalism of 119 ambulance service is below par, also survival rate of cardiac arrest patient is low in Korea. To solve these problems, the Ministry of Health and Welfare plans to provide EMS within 30minutes by resolving of emergency vulnerable area for EMS. To improve quality of emergency medical centers, criteria of evaluation will be changed from structure to process and outcome. According to the result, differential financial support will be applied. To lower the preventable death rate as of advanced countries, 6 regional trauma centers will be run 24-hours operation for severe trauma patients. Professional education programs for emergency medical technician such as 119 providers will be reinforced. The quality management of medical consulting will be improved by appointment of medical consultants in 119 situation rooms. Also, medical safety for individuals suffering from sudden cardiac arrest will be provided in the place where large numbers of people gather by installing 1,000 Automatic External Defibrillator equipment every year.

최대보장(Maximal Step Length, MSL)검사의 임상적 유용성

이승주,이정운,조비룡,신재원,공인식,유상호 대한가정의학회 2007 Korean Journal of Family Medicine Vol.28 No.4

연구배경: 노인의 낙상 위험도 측정을 위해 많은 임상적 도구들이 이용되고 있다. 이 중 보호전략으로서 최대 보장(maximal step length, MSL)검사와 낙상 위험 인자들과의 상관성에 대해 알아 보고자 하였다. 방법: 일개 노인 대학을 다니는 60세 이상 노인 149명을 대상으로 사회 인구학적 변수 및 우울 정도, 피로도를 평가하고, 한국판 간이정신상태검사(K-MMSE) 및 MSL, US (unipedal stance), TUG (Time Up and Go test)를 면담 시 시행하였다. 기록이 누락된 13명을 제외한 136명을 연구 대상으로 MSL의 방향별 상관성 및 기타 기능 수행검사와의 상관성을 분석하고, 낙상 위험 인자들과의 관련성을 평균비교(t-test, ANOVA) 및 다중회귀분석을 통해 분석하였다. 결과: 각 방향별 MSL 및 MSL평균(MSLmean) 사이에는 강한 양적 상관관계를(r=0.771~0.941, P<0.01), MSLmean과 US는 뚜렷한 양적 상관관계를(r=0.392, P<0.01), MSLmean과 TUG는 뚜렷한 음적 상관관계를 보였다(r=-0.608, P<0.01). MSLmean은 하지 길이를 보정했을 때도 낙상과 유의한 관계를 보였고, 그중 하지 길이를 보정한 MSLmean/L이 가장 유의 하였다(P=0.005). 또한 연령, 성별, 규칙적 운동, 결혼, 당뇨, 뇌졸중, 치매 의심, 우울 성향, 관절염, 잦은 낙상(frequent fall), 피로도 등이 MSLmean/L과 유의한 관계를 보였다. 이에 대해 다중회귀분석을 시행하였을 때, 연령(P<.001), 성별(P=0.001), 당뇨(P<.001), 잦은 낙상(P=0.017), 치매 의심(P=0.016), 관절염(P=0.024)만이 MSLmean/L과 관련된 변수였다. 결론: MSL은 US, TUG와 높은 상관관계를 보였고, 연령, 성별, 당뇨, 잦은 낙상, 치매의심, 관절염 등의 낙상 위험인자와 관련성이 있었다. Clinical Availability of Maximal Step LengthSeung Joo Lee, M.D., Jae Won Shin, M.D., In Sik Kong, M.D., Sang Hoo Yoo, M.D., Jung Un Lee, M.D.*, BeLong Cho, M.D., Ph.D.†

Surveillance and compensation claims for adverse events following immunization from 2011 to 2016 in the Republic of Korea

김민경,이연경,김태은,공인식,양현종,서은숙 대한백신학회 2017 Clinical and Experimental Vaccine Research Vol.6 No.2

Purpose: In recent years, research on reported adverse events following immunization (AEFI) and claims filed for compensation has been lacking. We reviewed reported AEFIs and compensation claims in Korea from 2011 to 2016. Materials and Methods: We listed all of the AEFI registered in the Integrated Management System of Disease and Public Health and reviewed the list of claims filed and serious AEFIs reported from 2011 to 2016. Results: An average of 278 AEFI cases was reported annually from 2011 to 2016. Of these, 31 deaths were reported. However, there was no association found between these deaths and vaccinations when evaluating vaccine lot, reviewing autopsies, and considering underlying diseases. AEFI reporting rate was as high as 20.8 cases for bacillus Calmette–Guérin (BCG) vaccine, 7.3 cases for 23-valent pneumococcal polysaccharide vaccine (PPV23), and 5.4 cases for human papillomavirus vaccine per 100,000 vaccination doses in 2016. Of the 469 total cases that claimed vaccine injury compensation from 2011 to 2016, the BCG vaccine was most commonly involved, with 235 cases (50%), followed by influenza vaccine and PPV23, with 90 and 55 cases, respectively. Of these cases, 96% of BCG-related AEFI were compensated, while only 31% and 49% of AEFI following influenza and PPV23 vaccination, respectively, were compensated. Common characteristics of uncompensated cases included the elderly subjects, receiving influenza vaccine, having underlying disease, or a very short time interval between vaccination and symptoms. Conclusion: We have maintained vaccine safety management system through both rapid response to serious AEFI and vaccine injury compensation in order to sustain public trust in the National Immunization Program.

자유연제발표 : 세션2 ; 인터넷상의 보완대체요법 관련 국내 정보제공 사이트의 평가분석

김춘배,엄기봉,이지은,김기경,유준상,공인식 한국보건행정학회 2008 한국보건행정학회 학술대회 논문집 Vol.2008 No.2

Nationwide Cancer Incidence in Korea, 2003~2005

원영주,성주헌,박소희,황인경,이덕희,최진수,김우철,김태용,김옥남,정우진,공인식,이덕형,이진수,정규원,공현주,박은철,안윤옥,유철인,배종면 대한암학회 2009 Cancer Research and Treatment Vol.41 No.3

Purpose: To estimate the current cancer burden in Korea, newly diagnosed cancer cases and cancer incidence rates were calculated for the years 2003~2005. Materials and Methods: The cancer incidence cases and rates were calculated from the Korea National Cancer Incidence Database. Crude and age-standardized incidence rates were calculated by gender for specified cancer sites in 5-year age groups. Results: From 2003 to 2005, 398,824 cases of cancer were newly diagnosed in Korea (218,856 in men and 179,968 in women). For all sites combined, the crude incidence rate (CR) was 300.0 and 248.2 for men and women and the age-standardized incidence rate (ASR) was 297.0 and 191.2 per 100,000, respectively. Among men, five leading cancers were stomach (CR 66.0, ASR 64.2), lung (CR 48.5, ASR 50.3), liver (CR 44.9, ASR 42.1), colon and rectum (CR 37.9, ASR 37.2), and prostate cancer (CR 12.7, ASR 13.8). Among women, five leading cancers were breast (CR 37.3, ASR 29.0), thyroid (CR 36.2, ASR 28.8), stomach (CR 34.1, ASR 25.4), colon and rectum (CR 28.0, ASR 21.1), and lung cancer (CR 17.9, ASR 12.8). In the 0~14-year-old group, leukemia was the most common in both sexes; in the 15~34 group, the most common cancer was stomach cancer for men and thyroid cancer for women; in the 35~64 group, stomach cancer for men and breast cancer for women; among those 65 and over, lung cancer for men and stomach cancer, for women, respectively. Conclusion : The cancer incidence rates have increased in recent years, and more cancers are expected to develop as Korea is quickly becoming an aged society. The cancer incidence statistics in this report can be used as an important source to effectively plan and evaluate the cancer control program in Korea.

우리나라 암환자의 의료기관 접근성의 지역간 불균형

문연옥(Yeon Ok Moon),박은철(Eun Cheol Park),신해림(Hai Rim Shin),원영주(Young Joo Won),정규원(Kyu Won Jung),황순영(Soon Young Hwang),이진희(Jin Hee Lee),공현주(Hyun Joo Kong),황승식(Seung Sik Hwang),이종구(Jong Koo Lee),공인식(In Sik 한국역학회 2006 Epidemiology and Health Vol.28 No.2

  Objectives: To investigate the differences in accessing regional hospitals and the utilization rate of hospitals located in other regions for cancer patients by regions.   Methods: Data for the utilization of regional hospitals for cancer patients were obtained from the Korean National Cancer Incidence Databases in 1999 and 2002. We divided the regions into 16 provinces by administrative districts. We using the SAS 9.1.3 to analyze difference of regional self-sufficiency and the Arcview 3.2 to show in a schematize for regional variation of the regional self-sufficiency.   Results: There were regional variations in the regional self-sufficiency of cancer patients. Especially, Jeollanamdo(1999 13.6%, 2002 12.8%), Gyeongsangbuk-do(1999 22.0%, 2002 20.7%), and Chungcheongnam-do(1999 27.8%, 2002 27.1%) had low regional self-sufficiency. The regional self-sufficiency in Gyeonggi-do and utilization rate of cancer patients who lived in other regions were increased between 1999 and 2002(regional self-sufficiency: 1999 37.2%, 2002 48.2%).   Conclusion: The results of this study showed that there were regional variation in utilization of regional hospitals for cancer patients. Accessibility of cancer patients in metropolitan areas was higher than in small size cities, medium size cities, and rural county areas. These results suggested that it should be considered support medical facilities for cancer patients in rural areas where have lower relevance rate.