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박웅섭,김한중,손명세,박은철,Park, Woong-Sub,Kim, Han-Joong,Sohn, Myong-Sei,Park, Eun-Cheol 대한예방의학회 1998 Journal of Preventive Medicine and Public Health Vol.31 No.4
This study describes the relation of physician's income and price of medical service and social welfare through microeconomic view, reviews the literature of influencing factor on physician's income, and it describes general distribution of physician's income, and analyzes influencing factor of physician's income. A total of 844 persons responded to the mail survey, through stratified sampling by 23 branches of medical society in Korean RBRVS study. The design of the study is cross sectional study, and the unit of analysis is a physician. To examine the change of average income per month, multiple regression was used to test the change according to physician's characteristics, demographic characteristics, scale of clinic, average intensity of ordinary work, and specialty. The major findings of this study are as follows; 1. As for self-employed physicians, the difference of average income per month among specialties was mcreased \4,850,000, but the difference was \6,020,000 under the control of control variables. 2. The number of average out-patients per month and number of nurses and nursing aides significantly positively associated, and average income per month was significantly higher for physicians who had sick-beds than physicians who had no sick-beds. In conclusion, the number of out-patient and number of nurses and nursing aides is the major influencing factor, and the difference of average income per month among specialties existed in self-employed physicians. So this study suggests basic hypothesis that the price of medical service and supply of physician by specialties are not pertinent. Being a cross-sectional study, this study can not suggest causal explanations. In the future, further study is needed for causal explanations.
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김춘배,이도성,김한중,손명세,Kim, Chun-Bae,Lee, Do-Sung,Kim, Han-Joong,Sohn, Myong-Sei 대한예방의학회 1995 예방의학회지 Vol.28 No.2
This paper tested by using Micro TSP, an empirical econometric analysis to approve officially a hypothesis of price elasticity of the demand for medical care services in Korean national medical insurance and the economic effect of health care delivery system with time-series datas of Medical Insurance Statistical Yearbook$(1981\sim1993)$. The results suggest that the Korean medical insurance system shows moral hazard due to the change of coinsurance and the economic effect according to intervention of the health care delivery system, but it is different by insurers regardless of the same structure of the medical insurance scheme.
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박형욱,손명세,김한중,박은철,유승흠,Park, Hyoung-Wook,Sohn, Myong-Sei,Kim, Han-Joong,Park, Eun-Cheol,Yu, Seung-Hum 대한예방의학회 1996 Journal of Preventive Medicine and Public Health Vol.29 No.4
In recent years, the Korean Medical Association has undertaken the feat of establishing the Korean Standard Terminology of Medical Procedures with the dedicated help of 32 medical academic societies. However, because the project is being conducted by several different circles, it has yet to see a clear system of classification. This thesis, therefore, proposes the three principles of scientific properties, usefulness and ideology as the basis for classification system and has developed the Classification System of Medical Procedures in Korea upon their foundation. The methodology and organization of this thesis as follows. First, by adopting scientific classification system of Feinstein(1988), an analysis of the classification systems of the medical procedures in the United States, Japan, Taiwan, WHO was carried out to reveal the framework and the basic principles in each system. Second, the direction of classification system has been constructed by applying the normative principle of medical field in order to show the future direction of the medical field and realize its ideology. Third, a finalized framework for the classification system will be presented as based on the direction of classification system. Of the three basis principles mentioned above, the analysis on the principles of usefulness was left out of this thesis due to the difficulty of establishing specific standards of analysis. The results of the study are as follows. The overall structure of the thesis is aimed at showing the 'Prevention-Therapy-Rehabilitation' quality of comprehensive health care and consists of six chapters; I. Prevention and Health Promotion II. Evaluation and Management III. Diagnostic Procedures IV. Endoscopy V. Therapeutic Procedures VI. Rehabilitation Chapter three Diagnostic Procedures is divided into four parts : Functional Diagnosis, Visual Diagnosis, Pathological Diagnosis, Biopsy and Sampling. Chapter five Therapeutic Procedures is divided into Psychiatry, Non-Invasive Therapy, Invasive Therapy, Anaesthesia and Radiation Oncology. Of these sub-divisions, Functional Diagnosis, Biopsy and Sampling, Endoscopy and Invasive Therapy employs the anatomical system of classification. On the other hand, Visual Diagnosis, Pathological Diagnosis, Anesthesia and Diagnostic Radiology, namely those divisions in which there is little or no overlapping in services with other divisions, used the classification system of its own division. The classification system introduced in this thesis can be further supplemented through the use of the cluster analysis by incorporating the advice and assistance of other specialists.
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환자와 의사의 의료에 대한 태도 차이 -한 중소도시의 대학병원과 한의과대학 부속 한방병원을 중심으로-
강명근,박종구,김한중,손명세,김달래,Kang, Myung-Guen,Park, Jong-Ku,Kim, Han-Joong,Sohn, Myong-Sei,Kim, Dal-Rae 대한예방의학회 1998 예방의학회지 Vol.31 No.3
The objective of this study is to identify the difference in attitude toward medical care between patients who visited a university hospital or an oriental medical hospital of oriental medical college, and physicians who engaged in the same hospitals. The subjects of this study were 397 cases who agreed to respond the prepared questionnaire, including 288 patients(146 university hospital utilizers and 142 utilzers for an oriental medical hospital) and 109 physicians(76 physicians and 33 oriental medical doctors). The attitude toward medical care was measured by the structured questionnaire developed for this study, which had high validity and reliability according to factor analysis, item discriminant validity, and Cronbach's $\alpha$ coefficients. On the criteria of mean value of care and cure score, the attitude toward medical care was classified into 4 groups encompassing a group with dependent attitude on medical care, a group with skeptical attitude toward it, a group with cure-oriented attitude, and a group with care-preferred attitude. The results of chi-square test, discriminant analysis, and logistic regression analysis were as follows; patients who visited a univisity hospital, patients who visited an oriental hospital, physicians, and oriental medical doctors included in the group with dependent attitude, the group with cure-oriented attitude, the group with skeptical attitude, and the group with care-preferred attitude, retrospectively. Among the subdomains of care and cure domains, which classified in reference to the result of factor analysis on pilot study, those that patients ranked more importantly than physicians were 'the importance of medical equipment for diagnosis and treatment', 'authority of physician, 'aggressiveness of treatment', 'information giving', 'personal interest' in the case of western medicine. In the case of oriental medicine, those were 'the importance of equipment for diagnosis and treatment', 'aggressiveness of treatment', 'amenities and accessibility', 'coordination of medical staff'. Both physicans and patients put the subdomain, 'physicians' medical knowledge and skillfulness' on the highest rank. The differences in ranking the important attributes of medical care between patients and physicians were apparent in the area of an 'importance of medical equipment for diagnosis and treatment' and so on. It meant that patient had over-expectation on medical care and suggested that the policy on demanad side such as the developement and dissemination of an evidence-based recommendation protocol for health care consumers might be important in Korea. In addition, regarding the attitude of physicians, during the medical education and training it may be neccessary to emphasize the aspect of 'care' of medical care rather than 'cure'. In planning on heath care delivery system, it should be considered that there is a difference in the attitude toward medical care between western medicine and oriental medicine as well as between health care providers and consumers. We expect that more valid measurement tool be developed in this area, which may be major limitation of this study and that this kind of research be expanded into the non-academic settings.
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김석일,강형곤,김한중,채영문,손명세,이명근,Kim, Suk-Il,Kang, Hyung-Gon,Kim, Han-Joong,Chae, Young-Moon,Sohn, Myong-Sei,Lee, Myung-Keun 대한예방의학회 1995 Journal of Preventive Medicine and Public Health Vol.28 No.3
After the introduction of National Medical Insurance in 1989, the medical demand has rapidly increased. The impact of increased medical demand was followed by an increase in the number of claims in need of review. We studied a new, fair method for reducing the number of claims reviewed. We analysed 90,583 outpatient claims submitted between September and October; claims were made for services given August of 1994. We finally suggested a screening system for claims review using a statistical method of discriminant analysis of the medical costs. The results were as follows. 1. In the cut-off group, age, days of medication, number of hospital or clinic visits, and total charge were significantly high. The cut-off rates according to the hospital-type and existence of accompanied disease were significantly different 2. According to ICD, the cut-off rate was highest in peripheral enthesopathies and allied syndromes(20.76%), lowest in acute sinusitis(0.93%). The mean charges were significantly different according to ICD and existence of cut-off. 3. We build discriminant functions by ICD with such discriminant variables as patient age, sex, existence of accompanied disease, number of hospital or clinic visits, and 9 detailed hospital or clinic charges included in claim. 4. We applied the discriminant function for screening those claims that were expected to be cut-off. The sensitivities comprised from 40% to 70%, and specificities from 70% to 95% by ICD. Acute rhinitis had highest sensitivity(100.00%) and other local infections of skin and subcutaneous tissue had highest specificity(98.45%). The expected number of cut-off was 17,762(19.61%). The total sensitivity was 49.62%, the total specificity was 82.57% and the error rate was 19.66%. We lacked economic analysis such as cost-benefit analysis. But, if the new method of screening claims using discriminant analysis were applied, the number of claims in need of review will reduce considerably.
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비만아동 및 청소년의 체중조절 경험과 비만관리 의도에 영향을 미치는 요인
강윤주,손명세,진기남,김한중,오희철,서성제,Kang, Yun-Ju,Sohn, Myong-Sei,Jin, Ki-Nam,Kim, Han-Joong,Oh, Hee-Choul,Suh, Sung-Jae 대한예방의학회 1998 예방의학회지 Vol.31 No.2
This study was undertaken to explain weight control behavior and intention of obese children and adolescents as measured by the elements of the health belief model. A total of 732 obese students from 28 schools in Seoul metropolitan area and their mothers were assessed with a self-administered questionnaire. The analyzed results are as follows; 1. Among obese students, 45.3% of male students and 57.2% of female students, a significantly higher portion than male students, reported that they had tried to lose weight within the recent year. Exercise was the most frequently used method to lose weight followed by diet control, drug use, and specialized clinic visits, in descending order. 2. Male students were more likely to try to lose weight if they perceived a low threat level and their mother had a job, and female students were more likely to try to lose weight if they were younger in age, perceived a low threat level and had strong external motivating factors. 3. Female students showed a significantly higher level of intention to obesity control than male students, and the intention level of their mothers also showed the same trend. 4. In male students, the degree of weight dissatisfaction, weight control experience, the level of obesity related beliefs of students, the educational level of the mother and economic status of the family were significant predictors of intention to obesity control, and in females, age, the level of obesity related beliefs of students and intention of their mothers were significant. In the mothers of male students, obesity index of students, age of the mother and the level of obesity related beliefs of the mother were significant predictors of intention of the mother, and in the mothers of female students, obesity index of students, occupational status of the mother and obesity related beliefs of the mother were significant. 5. According to the path model of intention to obesity control, the degree of weight dissatisfaction had the most powerful effect in male students, and perceived net benefit level was the most important variable in female students. Since the weight control behavior and intention of obese students were more predictable by the degree of weight dissatisfaction than the obesity index, we can conclude that only the students dissatisfied with their weight are well motivated for obesity control. There can be a discrepancy between the mother and her child's beliefs and intention status(especially in male students), so the therapists should also assess the student's opinion as well as the mother's. In female students, the perceived net benefit level wag the most important predictor of intention to obesity control, therefore the intervention program should pay particular attention to the positive benefits of weight control rather than negative aspects(threats) of obesity.
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