USA Evidence on the Relation between Health Insurance, Outpatient Services and Inpatient Services for Children ACSC

김양균,성주호 한국보험학회 2004 保險學會誌 Vol.69 No.-

The purpose of the study is to identify influence of health insurance status on ambulatory care (outpatient) visits as primary care accessibility and on hospitalization as health outcome caused by lack of primary care accessibility, and to explore the factors affecting outpatient visits, hospitalization caused by lack of outpatient visits.One of indicators to identify the relationship between access to health care service caused by health insurance status and health service utilization is Ambulatory Care Sensitive Conditions (ACSC), which are conditions that when timely and effectively treated in the outpatient setting can help reduce the risk of hospitalizations by preventing onset of an illness. The study chooses ACSC to test the relationship the lack of primary care and hospitalization among diseases.We use the available recent health care survey data (i.e. 1996 Medical Expenditure Panel Survey; MEPS96). We find out the positive relationship between hospitalization and no health insurance, and the negative relationship between outpatient visit and no health insurance. This indicates that reducing accessibility for outpatient visit caused by no health insurance results in increasing hospitalization. Furthermore, this result strongly suggests that the uninsured children is actually not able to care in early disease stage so that they are likely to hospitalization when their disease was more sever and then they need long stay for cure. As a result, fortifying the accessibility to necessary health care in a way of sharing appropriately the role with private health insurance can lead to the efficiency of national health care delivery systems in view of total health care expenditure, in particular in a case of ACSC children. Additionally, this kind of health policy may be expected to reform gradually the population structure such as aging, aged and super-aged society. 본 연구는 미국 의료심사원에서 공표한 실제데이터(MEPS96)를 의료보험통계분석 소프트웨어인 SUDAAN에 적용하여 심각한 질병상태는 아니지만 통근치료가 필요한 질환상태 ACSC(Ambulatory Care Sensitive Conditions: 중이염, 세균감염, 피부염, 위장염 등)에 있는 18세 이하 어린이들의 외래통근치료 빈도, 입원 빈도 및 평균 입원 일수 등을 종속변수로, 이에 영향을 미치는 주요 경제적 요인(사보험가입 여부, 국영보험가입 여부, 가정의 여부, 주거지역 등), 인구통계적 요인(연령, 인종, 성별) 그리고 건강상태(건강체, 표준체, 미달체 등) 등을 독립변수로 두어, 다변량분석 및 다중회귀분석을 수행함으로써 이들간의 상호 인과 관련성을 검증하였다. 우리는 민영건강보험시장 및 국민건강보험의 발전 방향 수립에 참조가 될 수 있는 다음과 같은 주요 시사점들을 도출하였다: 첫째, 사보험가입상태, 국영보험가입상태 및 비보험상태 순으로 외래통근치료 빈도와 양의 상호관련성이 높았으며, 둘째 입원 빈도와 평균입원 일수 등은 모두 외래 통근 치료 빈도와 음의 상호관련성이 있으며, 셋째 유아기(0세-5세) 는 청소년기(6세-18세)에 비하여 공통적으로 통근치료 빈도, 입원 빈도 및 평균입원일수 모두 높음을 알 수 있다. 특히 유아기의 입원빈도 및 평균입원일수는 청소년기에 비해 약 3배 이상 높게 산출되고 있다. 이는 생명표상에 유아기 사망률이 높게 나타나고 있음과 깊은 상관관계가 있음을 시사한다. 따라서 국민건강보험 및 민영건강보험의 보험적용범위를 유아기 질병 조기진단 방향으로 확대 적용할 필요성이 있으며, 이는 궁극적으로 질병악화로 인한 고액 의료비 지출을 조기에 차단하는 재정안정화 효과와 더 나아가 인구구조의 고령화 속도를 지연하는 간접적 효과를 기대할 수 있을 것이다. 이에 대한 국내 실증적 분석은 향후 연구과제로 두고자 한다.

의료 서비스품질이 진료가치와 환자만족에 미치는 영향에 관한 연구

김양균,조철호 한국보건행정학회 2006 보건행정학회지 Vol.16 No.1

The role of medical service quality to provide patients enhances influence on the hospital performance under being severe competition among the large size hospitals and increasing the right of patients. When a large hospital perceived factors of quality that a customer expects and feels value of care and it invests its resources to improve the factors of quality, it can get successful performances. Therefore, the purpose of the study explores the factors of quality affecting the trust of care and the patient satisfaction, and tests relationship among the trust of care, patient satisfaction and revisit intention. When considering the factors, a large size hospital can increase the trust of care and the patient satisfaction, through this process the hospital can assure patients' revisit and increase its revenue. This study uses interview data on outpatients visiting clinics in about 1000 beds sized training hospital located in Seoul. This study uses casual relationship model for the analysis. This study finds that 1) the trust of care and the procedure of care significantly influence the value of care felt by patients, 2) the trust of care, quality of doctors' care, procedure of care significantly influence the patient satisfaction, 3) the trust of care increases the patient satisfaction, and 4) the value of care and the patient satisfaction increase revisit intention.

A Comprehensive Model of Factors Affecting Adoption of Clinical Practice Guidelines in Korea

김양균,이선희,서주현,김주혜,김성덕,김국기 대한의학회 2010 Journal of Korean medical science Vol.25 No.11

This study aims to investigate the factors related to the adoption of clinical practice guidelines in clinical settings in Korea; it also aims to determine how these factors differ depending on the specific situation of health care system and professional climate. The research sample comprised physicians who are board members of academic societies with experiences in development of clinical practice guidelines using a convenient sampling. We analyzed 324 physicians with pooling two-year sample of 2007 and 2008. From all the respondents, 48.8% stated that they followed Clinical Practice Guidelines, and 93.4% agreed with the content in the Clinical Practice Guidelines. With regard to the item on the self-efficacy of practicing guidelines, 90.3% of the respondents selected ‘low level’. In the regression analysis, the factors associated with implementation were level of recognition, agreement and self-efficacy and positive attitude towards practice guidelines. Although the health care system in Korea differs from those in Western countries, our results revealed that the factors related to the adoption of practice guidelines were similar to the research results of Western countries. These results suggest that professionals’attitudes towards clinical practice guidelines are universal, and implementation strategies should be developed globally.

A study on the development of an artificial neural network model for the prediction of ground subsidence over abandoned mines in Korea

김양균,손민,문현구,이승아 한국자원공학회 2017 Geosystem engineering Vol.20 No.3

The subsidence over abandoned mines has led to big problems in the local areas. Hence, many attempts have been made to predict subsidence and to check the stability of an abandoned mine. This paper focuses on the development of an artificial neural network (ANN) model to predict mine subsidence, and the verification of prediction ability, based upon the investigation of 247 subsidence areas over 27 abandoned mines in Korea. The analysis is divided into two stages. In stage 1 where the data of 229 cases are used for learning as well as prediction of ANN, it is found that the correct answer percentage of final output values to the actual values shows 99, 95, 100 and 100% for four output parameters of subsidence type, final decision, filling method, and local reinforcement respectively. In stage 2 where the information of 18 other cases is used for prediction after learning with the 229 cases, the correct answer percentage of final output values is 89, 78, 100, and 94% for the four parameters, respectively. Finally, it is thought that this ANN model can be used for the prediction of unknown situations regarding subsidence over an abandoned mine with high reliability.

표준의원의 원가분석을 통한 건강보험 수가평가 연구

김양균,오현종 대한의사협회 의료정책연구소 2009 대한의사협회 의료정책연구소 연구보고서 Vol.- No.-

총설 : Zinc Finger Nuclease Technology의 생물공학적 이용: 현황과 전망

김양균 한국생화학분자생물학회 (구 한국생화학회) 2006 생화학분자생물학회 소식 Vol.26 No.1

의원급 의료기관의 2012년 요양급여비용 계약을 위한 환산지수 및 적정수가인상률 연구

김양균,오현종,박정식 대한의사협회 의료정책연구소 2012 대한의사협회 의료정책연구소 연구보고서 Vol.- No.-

헌법재판의 입법통제와 변형결정

김양균 한국공법학회 1997 公法硏究 Vol.25 No.1

물 분무 소화설비 성능검토를 위한 수치해석 연구

김양균,유용호,박진욱,박병직,김휘성 한국자원공학회 2017 한국자원공학회지 Vol.54 No.6

본 연구에서는 대심도 복층터널 방재에 사용되는 물 분무 소화설비의 체계적인 성능검토를 위해 수치해석을 이용하였다. 선택된 수치해석 기법은 2차원 Eulerian 다상유동 모델이고 수치해석 기법의 검증을 위해 운동량 방정식 및 물 분무 실물시험값을 이용하였다. 수치해석 결과 적용된 모든 노즐 출구 압력에서 물의 체적분율은 0.5를 넘지 않 았다. 또한 물의 분사각도가 없는 경우는 노즐의 출구압력이 증가함에 따라 바닥에 퍼지는 물의 체적분율이 증가하였 지만 물의 분사각도가 올라가면 노즐의 출구압력이 증가함에 따라 바닥에 퍼지는 물의 체적분율이 감소하였다. This paper describes numerical simulation on the water jet extinction system for systematical verification of its performance applied in double deck tunnel in great depth underground space. Numerical model applied is 2D Eulerian multiphase model, and its results are validated with the equation of motion and experiment. Simulation results show that water volume fraction is not over 0.5 in whole nozzle inlet pressure applied. Also, water volume fraction on the ground of tunnel is increased according to an increase in jet discharge pressure in case of 0° of jet inclination angle, while water volume fraction on the ground of tunnel is decreased according to an increase in jet discharge pressure in case of 5° and 11° of jet inclination angle.

개방 공간에서 발생하는 수소-공기 혼합 가스 폭연에 대한 실험적/해석적 연구

김양균,박병직,Kim, Yangkyun,Park, Byoung Jik 한국안전학회 2021 한국안전학회지 Vol.36 No.1

Experimental and analytical investigations are performed to explore the explosion characteristics of a hydrogen-air mixture in open atmosphere. A hydrogen-air mixture tent of total volume of 27 m³, with 40% hydrogen volume, is used to observe overpressure at a distance from the ignition source. Vapor cloud explosion analyses are performed using the TNO multi-energy model and Baker-Strehlow-Tang model. The results of these analyses are compared with experiment done from this study and references. The experimental results with and without obstacles indicate that the overpressure values measured at a distance of 4.5-21.5 m from the ignition source are about 9.4-3.6 kPa and 6.5-2 kPa, respectively. This implies that the overpressure with obstacles is approximately 1.7 times greater than that without obstacles. Analytical observation indicates that the results obtained with the Baker-Strehlow-Tang model with M_f = 0.2-0.35 are in good agreement with those of most of the previous studies, including that obtained from this study. Moreover, the TNO multi-energy model with a volume of 27 m³ well predicts the overpressure obtained from this study. Further studies should considered explosions in semi-confined spaces, which is more suitable for hydrogen refueling stations.