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농어촌의료(農漁村醫療)서비스 개선사업(改善事業)에 대한 보건소(保健所) 공무원(公務員)의 인식도(認識度)
김영길,박재용,감신,한창현,차병준,Kim, Young-Gil,Park, Jae-Yong,Kam, Sin,Han, Chang-Hyun,Cha, Byung-Jun 한국농촌의학지역보건학회 1998 농촌의학·지역보건 Vol.23 No.2
This study was performed investigate the opinion of civil servants in Health center about Rural Health Service Improvement Project The survey by mail was carried out for 447 servants of 25 health centers in Kyungsangbuk-do and the data were collected through self-administered questionnaires to servants about need, participation, concern, and comprehension for the project and satisfied with current facility and equipment of health center. The results were as follows. Generally considered, 48.2% of the improved health center servants was satisfied with health center building and 14.0% or 24.1% of the improving or unimproved center was. About the location of health center, 37.7% of the improved health center servants was satisfied, 25.9% of the unimproved center was. Of the improved health center servants, 43% was satisfied with the medical equipment but in unimproved place, the dissatisfaction was appeared higher than any other place. 49.7% of respondents was participated in making out the Rural Health Service Improvement Project. 50.6% was interested in this project. In the improved area. 65.5% of health center servants replied that the mayor's or county executive's concern about this project was high and 46.5% in councilors but in the unimproved area. their concern was low. About the contents of the project. 24,6% of the servants in the improved center, only 15.2% in unimproved center replied that they had known well. After making out the plan, 13.6% of respondents was unsatisfied with this plan and 17.1% replied that the estimating method of selecting the project area was not good. After the improvement of institution and equipment, 86.1% of health center servants answered that the medical service provided by health center would increase but 59.2% replied that the residents' utilization rate of private medical facility would decrease. The servants of the improved health center replied that the recognition about the developing will of health service(91.2%), the efficiency(91.2%), the quality of health and medical service(93.0%), the amount of health project(91.2%) were improved. In health center which had already improved the institution and equipment, 88.5% of servants replied that the residents' utilization for health center was increased. So, this project should be continuously carried out for health center and health center must develope new project to fit region condition.
문병욱,박재용,Moon, Byung-Wook,Park, Jae-Yong 대한예방의학회 1987 Journal of Preventive Medicine and Public Health Vol.20 No.2
의사들의 지역간 분포양상 및 불균형 정도를 체계적으로 측정하여, 장기적이고 합리적인 의사인력의 배분정책 수립을 위한 기초자료로 제시하고자 1980년과 1985년의 인구센서스 통계자료와 정기의사 신고자료를 이용하여 의사, 일반의, 전문의의 지역간 불균형정도를 분석한 결과는 다음과 같다. 1980년에는 전체의사의 10.4%가 군지역에 위치하고 있었으나 1985년에는 9.6%로 군지역 분포율이 낮아졌고, 인구 100,000명당 의사수는 1980년에는 군지역에 9.18명이던 것이 1985년에는 12.95명으로 증가했다. 일반의는 1980년에 군지역에 14.7% 분포되어 있었으나 1985년에는 12.7%로 낮아졌고, 인구 100,000명당 의사수는 7.13에서 7.29명으로 증가했다. 전문의의 경우 1980년에는 5.1%가 군지역에 위치하고 있었으나 1985년에는 7.3% 증가되었고, 인구 100,000명당 의사수도 2.05명에서 5.66명으로 증가했다. 군지역에의 분포비율이 10%를 초과한 전문과목별 전문의는 일반외과와 예방의학과 뿐이었으며, 1980년에 비해 1985년에 군지역 분포비율이 흉부외과 전문의를 제외하고는 모든 전문과목에서 높아졌다. Gini계수의 1980년$\sim$1985년간 변화율은 의사 -15.40%, 일반의 18.01%, 전문의 -10.43%로서 일반의의 불균형 정도가 심화되었고, 구지역간과 군지역간에는 모든 의사의 분포가, 시지역간에는 일반의의 분포만 더 불균형하게 된 것으로 나타났다. 전문의 중에서는 소아과 전문의의 변화율이 -12.24%로 가장 높았으며, 신경외과, 흉부외과, 성형외과, 안과, 결핵과, 예방의학과, 해부병리과 전문의는 1980년보다 1985년에 Gini계수가 더 높아졌다. 그리고 1985년 기준으로 일반외과 전문의의 Gini계수만 0.4369로 0.5이하였고, 0.8이상인 전문과목은 성형외과, 결핵과, 임상병리과, 해부병리과, 재활의학과 등이었다. 의사의 지역간 균형분포를 위해서는 의사의 지역간 분포요인 분석 연구를 통해, 이를 기초로 적절한 배분정책을 수립해야 할 것이며, 공공의료인력의 효과적인 활용이 필요할 것으로 보인다. The purpose of this study is to analyze degree of geographic maldistribution of physicians and changes in the distributional pattern in Korea over the years 1980-1985. In assessing the degree of disparity in physician distribution and in identifying changes in the distributional pattern, the Gini index of concentration was used. The geographical units selected for computation of the Gini index in this analysis are districts (Gu), cities (Si), and counties (Gun). Locational data for 1980 and 1985 were obtained from the population census data in the Economic Planning Board and regular reports of physicians in the Korean Medical Association. The rates of physicians located counties to whole physicaians were 10.4% in 1980 and 9.6% in 1985. In term of the ratio of physicians per 100,000 population, rural area had 9.18 physicians in 1980 and 12.95 in 1985, 7.13 general practitioner in 1980 and 7.29 in 1955, and 2.05 specialists in 1980 and 5.66 in 1985. Only specialists of genral surgery and preventive medicine were distributed over 10% in county and distribution of every specialists except chest surgery in county increased in 1955, comparing with that rates of 1980. The Gini index computed to measure inequality of physician distribution in 1985 indicate as follows; physicians 0.3466, general practitioners 0.5479, and specialists 0.5092. But the Gini index for physicians and specialists fell -15.40% and -10.42% from 1980 to 1985, indication more even distribution. The changes in the Gini index over the period for specialists from 0.3639 to 0.4542 for districts, from 0.2510 to 0.1949 for cities, and 0.5303 to 0.5868 for counties indicate distributional change of 24.81%, -22.35%, and 10.65% respectively. The Gini indices for specialists of neuro-surgery, chest surgery, plastic surgery, ophthalmology, tuberculosis, preventive medicine, and anatomical pathology in 1985 were higher than Gini indices in 1980.
소득계층과 주관적 계층인식에 따른 의료이용: 『한국의료패널』자료를 중심으로
최령(Ryoung Choi),박재용(Jae Yong Park),황병덕(Byung Deog Hwang) 한국보건사회학회 2013 보건과 사회과학 Vol.0 No.33
이 연구는 한국보건사회연구원과 국민건강보험공단에서 수집한 한국의료패널(Korea Health Panel) 의 원자료 중 2009년 연간통합데이터를 분석자료로 이용하였다. 의료이용에 영향을 미치는 요인을 파악하기 위하여 다중 회귀분석을 실시하였고, 계층요인과 건강상태요인에 따른 영향을 좀 더 명확하게 분석하기 위하여 Model 1,2,3을 개발하였다. 외래의료비의 경우 소득계층과 주관적 계층인식이 낮을수록, 연령이 낮을수록, 외래와 입원상병진단을 받을수록 의료비지출이 높았으며, 입원의료비의 경우 배우자가 있는 경우, 사업주 및 자영업자, 임금근로자에 해당하지 않는 경우, 경제적인 어려움으로 인한 스트레스를 받는 경우, 입원진단상병을 받은 경우 의료비 지출이 높은 것으로 분석되었다. 이러한 결과는 상위계층에 비해 하위계층의 의료이용과 의료비 지출이 상대적으로 증가하고 있다는 것으로 의료보장의 목적에 바람직한 일이라고 할 수 있지만, 한편으로는 하위계층일수록 주관적 건강상태가 나빠지고, 급여 및 비급여 의료비부담률 등이 증가하고 있는 것으로 판단된다. 객관적 지위가 되는 소득계층뿐만 아니라 일상적인 삶에서 생활양식과 나와 남을 처지를 구분하는 주관적 계층인식에 따른 범주형 분석을 시행하고 의료이용에 미치는 영향을 비교 분석함으로써 소득계층뿐만 아니라 주관적 계층인식에 따른 건강보험의 보장성 강화, 의료보장정책 및 전달체계, 서비스, surveillance 등 보건의료서비스 체계개발이 필요할 것이다. The study used the ‘2009 annual total data as an analysis material among other raw data of Korea Health Panel collected by Korea Institute for Health and Social Affairs and National Health Insurance Corporation. In order to understand causing factors to the medical use, the multiple regression analysis was conducted with Model 1, 2 and 3 designed to get social stratification factors and health condition factors analyzed even more thoroughly. In terms of the outpatient medical expenses, more money would be spent on the medical service as the perceptions of income class and subjective income class are low, as the age is low, and as the outpatient care and inpatient diagnosis are frequent. Regarding the inpatient medical expenses, more money would be spent as a patient has a spouse, as the patient is not regarded as a business owner, an owner-operator and a paid worker, as the patients get stressed by financial difficulties and lastly as the patient gets diagnosed while in hospital. As the results confirmed, it is good to see how the purposes of the medical security are being satisfied here while more medical uses and more medical expenses spending are conducted by the lower class than the upper class. However, at the same time, the results also argued that subjective health conditions of the lower class are getting worse constantly and that such phenomenon would, in return, increase the paid and unpaid medical benefit rates and others. In order to deal with such problems, a categorical analysis should be conducted not only on the income class, the objective position, but also on the regular life styles and the subjective income class perception that would distinguish one’s own situations from others. Not only that, with results from the categorical analysis, health and medical care system such as health insurance guarantee, medical social security and information delivery system, service and surveillance shall be developed.