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        • KCI등재

          DRG 지불제도가 재원일수와 퇴원 후 외래방문일수에 미치는 영향: 2004-2007년도 제왕절개술을 중심으로

          손창우,정설희,이선주,권순만,Shon, Chang-Woo,Chung, Seol-Hee,Yi, Seon-Ju,Kwon, Soon-Man 대한예방의학회 2011 Journal of Preventive Medicine and Public Health Vol.44 No.1

          Objectives: The purpose of this study was to examine the impact of Diagnosis-Related Group (DRG)-based payment on the length of stay and the number of outpatient visits after discharge in for patients who had undergone caesarean section. Methods: This study used the health insurance data of the patients in health care facilities that were paid by the Fee-For-Service (FFS) in 2001-2004, but they participated in the DRG payment system in 2005-2007. In order to examine the net effects of DRG payment, the Difference-In-Differences (DID) method was adopted to observe the difference in health care utilization before and after the participation in the DRG payment system. The dependent variables of the regression model were the length of stay and number of outpatient visits after discharge, and the explanatory variables included the characteristics of the patients and the health care facilities. Results: The length of stay in DRG-paid health care facilities was greater than that in the FFS-paid ones. Yet, DRG payment has no statistically significant effect on the number of outpatient visits after discharge. Conclusions: The results of this study that DRG payment was not effective in reducing the length of stay can be related to the nature of voluntary participation in the DRG system. Only those health care facilities that are already efficient in terms of the length of stay or that can benefit from the DRG payment may decide to participate in the program.

        • KCI등재
        • 서울시 치매관리 실태와 개선방안

          손창우(Chang-Woo Shon),김정아(Jung-Ah Kim) 서울연구원 2018 서울연구원 정책과제연구보고서 Vol.- No.-

          The prevalence of dementia and mild cognitive impairment among seniors over 65 has increased 24% for 5 years and an explosion of dementia patients is expected after 2026 when old population would exceed 20% of total population in Seoul. At this point, in September, 2017, the government announced ‘National Responsibility Policy for Dementia Care’ which set up District Dementia Support Center in public health center through cities and towns throughout the country. However, this plan just expands dementia management projects of Seoul, running District Dementia Support Center in each 25 district. Against a backdrop of this situation, this study grasps the needs of healthcare and convalescence services of dementia patients, information unmet needs of guardians, the need of education and training program dementia managing workers to suggest future directions for existing dementia management in Seoul. We conducted surveys and in-depth interviews to dementia patients and their guardians, dementia managing workers in District Dementia Support Centers, Day Care Centers certified by Seoul City, Aged Care Facilities, and dementia beds in healthcare facilities. Given stigma of dementia, unmet needs of dementia patients and their guardians, and the needs of education program among dementia managing workers, policies are needed to improve dementia awareness in community, systemize educational programs for workers, set dementia consultation call center and information sharing system among institutions.

        • KCI등재

          홍콩 이주 한인의 미충족 의료에 영향을 미치는 요인

          손창우 ( Chang Woo Shon ),이선주 ( Seon Ju Yi ),황종남 ( Jong Nam Hwang ) 대한보건협회 2015 대한보건연구 Vol.41 No.1

          연구목적 : 본 연구는 홍콩 현지 이주 한인을 대상으로 미충족 의료 경험 여부 및 원인을 파악하고, 도출된 결론을 바탕으로 향후 해외 이주 한인, 또는 국내 거주 해외 이민자를 위한 정책적 제안을 하고자 하였다. 연구방법 : 구조화된 설문지를 이용하여 홍콩 현지 이주 한인들을 대상으로 설문을 진행하였으며, 만 19세 이상 조사 대상자112명 중 신뢰성이 떨어지는 15명의 설문지를 제외한 97명을 분석에 활용하였다. 미충족 의료 경험에 영향을 미치는 요인을 확인하기 위해 STATA 11을 활용하여, 로지스틱 회귀분석을 실시하였다. 연구결과 : 홍콩 이주 한인의 미충족 의료 경험률을 약 51.5%로 나타났다. 분석 결과 여성일수록(남자에 비해), 홍콩의사를 신뢰하지 않을수록, 한국 의사를 신뢰할수록 홍콩 현지에서의 미충족 의료 경험 확률이 높았으며, 특히 영어를 잘한다고 느끼는 이주민의 경우 미충족 의료를 경험할 가능성이 그렇지 않은 경우에 비해 통계적으로 유의하게 낮았다. 마지막으로 이주후 거주기간의 경우, 이민 1년 미만에 비해 1-5년 사이의 사람들이 미충족 의료를 경험할 확률이 높았고, 그 이후에는 이러한 영향이 사라졌다. 결론 : 이러한 연구결과는 그동안 관심을 기울이지 못한 아시아 지역에 거주하고 있는 한인들의 의료서비스 이용 양상을 다룬 실증적 연구라는 점에서 기여하는 바가 있다. 또한 한국 이주 외국인을 대상으로 한 의료정책의 수립 시, 경제적 접근성향상 뿐 아니라, 의료에 대한 신뢰도 및 의사-환자 사이의 언어적 장벽을 낮추려는 노력을 동시에 기울일 필요성이 있음을 보여주었다. Objective: Despite numerous studies addressed health and health care issues among migrant populations, a majority of studies focused on migrants with lower socioeconomic status living in North America or Europe. The purpose of this study was to examine factors associated with unmet healthcare needs among Korean migrants in Hong Kong, Asia``s popular destination of immigration. Methods: The information on unmet healthcare needs among Korean immigrants were collected using a structured questionnaire. A total of 112 individuals responded the survey and 97 respondents were included in our analysis after excluding missing values. Results: Our results indicated that approximately 50% of Korean migrants have experienced unmet healthcare needs and the proportion of unmet healthcare needs was evenly spilt between male and female. In light of thefactors associated with unmet healthcare needs, we found that individuals who expressed trust in Korean physicians and those who do not have trust in Hong Kong-Chinese physicians were more likely to report unmet healthcare needs. In addition, English language proficiency, duration of immigration and total number of inmates were associated with unmet healthcare needs. Conclusion: Our findings provide empirical evidence regarding unmet healthcare needs among Korean migrant populations in Hong Kong. Thus, our study also suggests that the identified factors need to be considered for new comers to Korea in order to provide appropriate health care services.

        • 서울시 치과주치의 제도 정책평가와 개선방안

          손창우(Chang-Woo Shon),김정아(Jung-Ah Kim) 서울연구원 2016 서울연구원 정책과제연구보고서 Vol.- No.-

          The amount of personal and public expenditure for oral health in Seoul has increased significantly over the years. Especially for students and children, the number of cavities of them was much more than OECD. Also there emerges the view that oral health of children is related with their parents’ socioeconomic status which brings about disparities in use of dental services. Against the backdrop of the situation, this study evaluates the policy “Family dentist system for students and children of low-income households” which has started since 2012 as a demonstration project(including 6 out of 25 autonomous districts) of Seoul. Drawing the results and lessons from evaluations, the study provides some policy suggestions to improve this policy as a sustainable program to all autonomous districts in Seoul. It is found that the policy needs to increase its enrollees and budget to cover increased students. For payment system, this study recommends that it needs to be changed from a mixed payment system, both for per diem payment and fee for service payment, to a capitation which can cover all grades of elementary school. There is a limitation in data for analysis due to a short observation period, this study could not find out the clinical effectiveness of the policy. However, this study finds out the improved recognition of students and parents, positive recognition of participating dentists for the policy. Also this study confirms that limits in governance where all stake holders can not participate in the policy and supervision and regulation are insufficient in operating this policy.

        • KCI우수등재

          연구논문(硏究論文) : 의료서비스 해외진출을 위한 의료관광객의 의료이용 요인 분석 -홍콩 현지 건강검진센터를 중심으로-

          손창우 ( Chang Woo Shon ),이선주 ( Seon Ju Yi ) 한국관광학회 2014 관광학연구 Vol.38 No.2

          The objective of this study was to investigate the expansion overseas of Korean healthcare service. A field survey was conducted using structured interview questions with residents in Hong Kong, considered an international location, and rich by purchasing power parity and thought to be a ``healthy`` city. The Anderson model is applied for the analysis of health examination service utilization. Results concluded that age, sex, nationality, marriage status as predisposing factors; and obesity, smoking, having breakfast regularly, perceived health status in need factors have a significant effect on preference for service utilization. Futhermore, adjusting predisposing, enabling and need factors, people who have willingness to use Korean health examination center, were inclined to visit Korea as medical tourism. Further research should be conducted to consider institutional factors influencing health examination service use.

        • 신종 대형 도시재난 전망과 정책방향

          신상영(Sang-Young Shin),조권중(Kwonjoong Choh),조항문(Hang-Moon Cho),원종석(Jong-Seok Won),변미리(Miree Byun),손창우(Chang-Woo Shon),김상균(Sang-Gyoon Kim),이윤상(Youn-Sang Lee) 서울연구원 2016 서울연구원 정책과제연구보고서 Vol.- No.-

          Recently, Seoul and Korea have experienced large-scale or newly emerging disasters frequently such as land slides, infectious diseases, earthquakes, and ferry sinks. Emerging high-impact urban disasters are difficult to prepare and respond because they are difficult to predict due to high levels of uncertainty and large-scale consequences once taking place. They are typically beyond usual public concerns and capacity. This study identifies emerging high-impact urban disasters in Seoul in the future and proposes policy directions to cope with such disasters. First, the study discusses concepts of emerging high-impact urban disasters and various associated concepts. Criteria of high-impact disasters are also reviewed with existing institutions and policies. Second, through past cases of urban disasters of Seoul and other metropolitan cities, the study analyses characteristics and trends of high-impact urban disasters. Also, the study looks through changes of urban conditions and the impacts on disaster risks in terms of urban spaces, socioeconomic changes, climate change, newly emerging technologies, and international situations. Third, based on questionnaire survey data, the study analyzes perceptions of citizen and experts on emerging high-impact urban disasters. Fourth, the study identifies possible emerging high-impact urban disasters in Seoul in the future. Such disasters are classified into two types: traditional high-impact disasters that have persistently taken place and are predicted to increase in future, and emerging urban disasters that are anticipated to take place in future in terms of changes of urban conditions and experiences of other metropolitan cities. Fifth, the study proposes policy directions to cope with emerging high-impact urban disasters in Seoul. As a basic directive concept, the study emphasizes to secure urban disaster resilience since the disasters are beyond usual capacity and resources due to unpredictability and uncertainty. Under the umbrella of urban resilience, the study propose policy and institutional changes in terms of comprehensive disaster reduction capacities of urban spaces, crisis management systems, and information sharing and knowledge building. Finally, the appendix shows evacuation simulations with the case study of large-scale disasters in a downtown subway station in Seoul and evaluates evacuation sufficiency.

        • 시민 건강증진 위한 도시공원 활용도의 향상방안

          김원주(Won-Ju Kim),손창우(Chang-Woo Shon),진정규(Jung-Kyu Jin),채진해(Jin-Hae Chae) 서울연구원 2017 서울연구원 정책과제연구보고서 Vol.- No.-

          Rapid industrialisation and urbanisation have increased the incidence of disease and ageing. Therefore, citizens are interested in health promotion. Park operation to improve health will be the theme for the development of an advanced model in the future. Urban parks have a significant effect on physical health, both directly and indirectly. Health can be enhanced through activities, including walking inside the park. The purpose of this study is to identify the role of urban parks in health promotion, and propose measures for revitalisation through demand analysis of Seoul residents and field survey. The survey involved seven independent parks. The main user group was not considered due to uniform facilities. Approaches require maintenance and additional information facilities. In many cases, exercise facilities are tailored to adult males, and improvement in facilities based on the use of each age group should also be considered. Improvement and maintenance of drinking water facilities are urgently needed. Street lamps are essential during night-time movements, and the maintenance of street lamps should be monitored frequently. The focus is on improvements in physical accessibility and external links. Based on information facilities, access to the outside of the park and the use of traffic lines inside should be promoted. Often, sports centres or libraries exist around the park. Programmes associated with park activities are designed to benefit citizens engaged in outdoor health activities. Integrated guidelines suggest strategies for improved health of existing and new parks.

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