專門保健人力 養成의 現況과 展望

宋建鏞(Kun Yong Song) 고려대학교 보건과학연구소 1993 보건과학논집 Vol.2 No.1

出生間隔의 分析과 家族計劃事業의 效果推定

宋建鏞(Song, Kun Yong) 인구문제연구소 1966 人口問題論集 Vol.- No.2

서울市 婦人의 出産調節과 不姙이 出生抑制에 미친 效果測定

宋建鏞(Song, Kun-Yong) 인구문제연구소 1967 人口問題論集 Vol.- No.4

家族計劃事業이 出生抑制에 미친 效果

宋建鏞(Song, Kun-Yong) 인구문제연구소 1965 人口問題論集 Vol.- No.1

公衆保健과 人口政策

宋建鏞(Song, Kun-Yong) 인구문제연구소 1968 人口問題論集 Vol.- No.6

家族計劃 啓蒙·敎育事業의 效果分析

宋建鏞(Song, Kun-Yong) 인구문제연구소 1967 人口問題論集 Vol.- No.5

벽지(僻地) 보건의료(保健醫療)에 관한 조사연구(調査硏究)

송건용 ( Kun-yong Song ),김홍숙 ( Hong-sook Kim ) 한국보건사회연구원 1982 保健社會硏究 Vol.2 No.1

政府는 農漁村 중 保健醫療 脆弱地域의 保健醫療 擴大를 위하여 1981년부터 保健診療員을 訓練ㆍ配置하엿다. 本 調査硏究는 이들 保健診療員의 活動成果를 종합평가하기 위하여 이들이 配置되기 以前의 保健診療狀態를 現況分析하는데 目的을 두었다. 本 稿는 이 調査의 주요결과를 要約하고 있다. 資料는 1981년 10-11월의 30일간 僻地 標本家口 4,083 家口에 대한 家口面接調査에 의하여 수집되었다. ① 15日間 認識된 醫療要求水準은 人口 100人當 21이었고, 이에 대한 醫療充足率은 59%였다. 利用된 治療源중 藥局(房)이 72%였고, 病醫院은 13%, 保健(支)所는 5%에 불과하였다. 年間 人口 1人當 각종 醫療施設訪問數는 4.41回이며, 이중 藥局(房)이 3.18回였고, 病ㆍ醫院은 73回에 불과하였다. 未治療者의 69%가 經濟的 理由로 治療源에 접근하지 못하였다. ② 姙娠婦의 34%가 産前管理를 1回이상 받았고, 分娩의 17%가 醫師, 助産員, 保健要員의 直接介助를 받았다. 醫師의 分娩介助를 원했던 姙娠婦는 33%였으나 실제 醫師에 의한 分娩介助는 12%로서 20% 포인트의 差가 났다. 全體 分娩중 家庭分娩이 87%였고, 臍帶切斷에 사용한 器具의 消毒은 28%의 分娩에서만 이루어졌다. 姙娠婦가 원하였던 分娩介助중 醫師, 助産員, 保健要員등이 차지한 比率은 35%에 불과하였고, 대다수 姙娠婦는 어머니, 男便, 其他 家族 또는 이웃을 分娩介助者로 원하였다. ③ 0~2歲 ?幼兒의 어머니 중 5%는 이들의 아기가 "건강하지 못하다"고 인식하고 있다. ?幼兒중 최소 1회 預防接種을 맞은 比率은 61%였고, 포리오 1회이상 接種率은 53%, BCG 接種率은 30%였다. ?幼兒의 78%가 補充食을 하고 있으며, 補充食을 6月以內에 실시한 比率은 62%였다. 補充食의 49%는 牛乳로 시작하였고 미움, 밥의 比率은 40%였다. ④15-44歲 有配偶婦人 중 家族計劃을 원하는 家族計劃써비스 요구 100人當 現實踐 또는 充足率은 92%로서 거의 飽和狀態에 있다. The Government has trained and deployed a new-type middle-level health worker,so called Community Health Practitioner (hereafter referred to as CHP), for attaining the ultimate goal of equity in the provision of health services in remote rural areas since 1981. This study aimed to assess current situations of need for and utilization of health services before deployment of the Government-supported CHPs in remote rural areas. The data utilized in this paper are drawn from the 1981 Baseline Household Interview Survey for evaluation of the Government-supported CHP program. The data was collected by a household interview survey during 30 days of October-November, 1981. An interview was completed with a total of 4,083 households sampled. This paper summarizes major findings from the survey. 1) Perceived or subjectively assessed need for medical treatment was 21 per 100 persons during a 15 day period; the met rate per 100 persons wanting to obtain medical treatment was only 59. There is a big gap between the need for and utilization of medical treatment. Major source of medical treatment employed was druggist or pharmacist: 72 percent of medical treatment was rendered by druggist or pharmacist, 13 percent by private practitioner, and only 5 percent by health sub-center`s physician. Annual visits to various type of medical facilities per capita were 4.41:3.18 visits to druggist or pharmacist and .73 visits to private practitioner. About 70 percent of non-users expressed economic reason as a major barrier against access to one of various medical facilities. 2)A third of pregnant women received at least once prenatal care and 17 percent of the women were attented by professionals for delivery. A majority of births (87 percent) took place in home and only 28 percent of the home deliveries used sterilized scissors, sickle, or knife for cutting umbilical cord. A majority of the pregnant women (65 percent) wanted their mother, husband, or neighbour as a birth attendent (wanted help from physician was only 35 percent). There is still a great need for traditional attendant such as her mother, husband or neighbour. 3)About ten percent of mothers self-assessed their infant or child aged 0-2 is unhealthy. Immunization coverage was high; one or more shots or doses were given to 61 percent; polio vaccines given to 53 percent; and BCG given to 30 percent. 4)Currently practicing rate of family planning was 52 percent of presently married women aged 15-44. Female sterilization was most prevalent (30 percent) for the users. The use rate of family planning was approaching to saturation status of family planning; the met rate over the need for practice of family planning among fecund married women was 92 percent.

의료보험(醫療保險)이 의료이용양상(醫療利用樣相)과 의료균점(醫療均霑)에 준 효과분석(效果分析)

송건용 ( Kun-yong Song ),박연우 ( Yeon-woo Park ) 한국보건사회연구원 1988 保健社會硏究 Vol.8 No.1

Demand for health services increases as expanded coverage of health insurance programs, Accordingly, the equality in access to and fairness of medical care are the current major issues of health policy in Korea. With this point of view, this paper seeks to provide the answers for the following key questions: Question 1 : Could an innovative approach such as expanding the service points and ntroducing a financing mechanism similar to the community health insurance program tried in Ok-gu area significantly imporve utilization of medical care? Question 2 : Did the community health insurance program have a substantial effect on the utilization patterns of medical care? Question 3 : Did the community health insurance program contribute to the realization of equality in access to medical care for the residents in the area of its implementation? Question 4 : Is there any significant difference in the utilization of medical care among the be-neficiaries of different insurance program between for the employed and by the community health insurance program in rural area? This study focuses on the above questions and uses the empirical data from household interview surveys. 1. Results (1) The effect of an innovative approach on medical care utilization. a. Compared with control areas, input of additional medical resources such as community health practitioners and other, professionals contributed to an increases of 108.5 % in the total number of OPD visits to physician or CHP per capita in the Ok-gu de-monstration area during the period 1976 to 1979. b. In 1987, residents in Ok-gu area who were covered by community health insurance program visited physician more frequently (50.1%) than those who were not covered by such a kind of insurance program. c. Introduction of additional service points or community health insurance programs in the defined rural areas effected a substantial increase in the utilization of medical care during the period 1976 to 1987. (2) Effect of community health insurance program on changes in utilization patterns of medical care. a. Introduction of health insurance programs of financing mechanism has a significant effect on change in utilization patterns of medical care, replacing self-cure at home by medical care service provided at clinic or hospital. b. Depolyment of community health practitioners and public health physicians also sig-nificantly contributed to replacing self-cure at home by visits to health center or sub-center or CHP`s services in rural areas. (3) Contribution of community health insurance programs 10 realize the equality in access to medical care. a. It is the results from multivariate regression analysis through using Andersen model and the household interview survey data in 1987 that rural community health insurance program significantly contributed to realizing the equality in access to medical care in Ok-gu area, where the mechanism was adopted in 1981. b. The most Significant variable affecting the number of physician visits in past 15 daysis need factor considered to be immutable by health policy. c. However, above and beyond this factor, enabling and predisposing factors significantly affect the number of physician visits in control areas where the mechanism is not introduced. As a result, it means that the equality in access to medical care is not achieved there. (4) Effect on utilization of physician`s care by the type of health insurance programs. a. Significant difference in percent of seeing or not a physician in specific time period of 15 days was shown in beneficiaries of each health insurance program for the empolyed and for the rural community residents. But both of insurance types did not have significantly discriminant function about experience of seeing a physician. Therefore it has come out through the analysis(X²-test and discriminant analysis) that seeing or not a physician is significantly affected by predisposing and need factors. b. There is a singificant difference in number of physician visits per capita for 15 days between beneficiaries of health insurance programs for the employed and those of it for the community residents. 2. Conclusions (1) This empirical study shows that major health policy including expansion of service points such as the deployment of CHPs or public health doctors and the adoption of health insurance programs significantly contributes to great increase in the utilization of physician`s care and subsequently to the equality in access to medical care in rural areas. (2) It is proved that some limitation of choice of primary care facility does not significantly affect the utilization of outpatient care. (3) Major innovative alternatives affect changes in the utilization patterns of medical care. So the change contributes to prevent from misuse or abuse of drugs, whereas it can be a factor raising unit cost per medical service.

우리나라의 의료자원(醫療資源)과 관리체계(管理體系) - 역사적(歷史的) 발전(發展), 현안문제(懸案問題), 장래전망(將來展望) -

송건용 ( Kun-yong Song ) 한국보건사회연구원 1988 保健社會硏究 Vol.8 No.1

本 論文은 1989년 全國民 醫療保險의 실시를 전제로 하여 예견되는 醫療서비스 供給上 問題를 醫療資源을 중심으로 記述하고 있다. 醫療資源은 의료서비스의 공급면에서 전국민 의료보험의 성공을 결정짓는 중요한 要素이다. 따라서 우리나라의 醫療資源 및 그 管理의 歷史的 發展을 검토하고, 현재의 주요한 현안문제를 도출 및 定義하고, 이에 기초를 둔 장래 展望이 필요하게 된다. 이러한 구상에 따라 本 論文은 1948년 정부 수립이후 현재까지의 社會ㆍ經濟, 人口의 變化를 분석하고, 장래 人口推計, 및 人口構造上의 문제를 제시하고, 保健政策의 변화와 국민의 保健狀態를 기술하고 있다. 한면 醫療資源과 管理는 人的資源(의사, 간호사, 약사 등), 物的資源(病院, 醫院, 公共保健機關 등), 國民醫療費, 그리고 醫療保障制度와 醫療費支拂報償制度 등으로 구분하며 과거의 문제, 등을 분석ㆍ기술하고 있다. 이와 같은 分析ㆍ記述에 기초를 두어, 전국민의료보험하에서 모든 국민에게 기본적 의료서비스를 效果, 技術的, 效率, 均霑 등의 실현이란 관점에서 예견되는 주요한 정책과제로서 ① 의료자원의 적정공급과 관리, ② 의료수요증가에 대응하는 의료공급, ③ 의료비의 증가억제, ④건강증진대책 등이 제시되고 있다.

중소병원(中小病院)의 재정안정도(財政安定度) 분석(分析)

송건용 ( Kun-yong Song ),김경숙 ( Kyoung-sook Kim ) 한국보건사회연구원 1987 保健社會硏究 Vol.7 No.1

The purposes of this study are to: 1) Examine differential levels of hospital financial viability by using a simple financial viability index (βindex) developed by Pegels. 2) Determine important variables affecting hospital financial viability by employing a multivariate analysis. 3) Explain the results from this analysis as a policy issue, and suggest further study on medical fee schedule and financial condition of hospitals. The data used in this analysis are from the 1986 Hospital Management Study which was conducted by the Korea Institute for Population and Health. The sample selected was nine hospitals with five-year financial data set from 1981 to 1985. Major results from this analysis are as follows: 1) The model used in this analysis presents significantly causal relationships between variables and determines important variables affecting hospitat financial viability. 2) This analysis reveals that of the five variables used, the occupancy rate of insurance patients is the single most important factor in determing hospital financial viability. The second most important variable explaining the differences in hospital financial viability is number of hospital beds. These two variables have a positive effect on the hospital`s financial viability. 3) It is difficult to generalize the results from this analysis because of limitation of sample size and variables and poor quality of data. However, the results reveal the current realities of the insurance medical fees system (based on fee for service) set by government and its effect on the financial codition of hospitals and suggest further study areas of possible alternatives to reform the current payment scheme for reduction of medical costs.