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일차의료기관의 이동 현황과 이에 영향을 미치는 요인에 대한 연구
신순애,이진석,김창엽,김용익,하범만,Shin, Soon-Ae,Lee, Jin-Seok,Kim, Chang-Yup,Kim, Yong-Ik,Ha, Beom-Man 대한예방의학회 2001 예방의학회지 Vol.34 No.3
Objectives : To understand the current status of the opening, closing and relocation of primary medical institutes in Korea and identify the underlying decision factors. Methods : Sources of analyzed data included the medical institutional master file at the National Health Insurance Corporation(1998, 2000) and Regional Statistic Annual Bulletins. To investigate changes including the opening, closing and relocation, a total of primary medicalinstitutions(16,757 in 1998, 19,267 in 2000) were analysed. Results : Between 1998 and 2000, there was a 15.0%(2,510) increase in the number of primary medical institutions and the rate of increase in the rural area was higher than the urban area, and higher for specialty clinics than primary practice. However, these findings did not suggestany improvement in the maldistribution of primary medical institutions. During the time period studied, newly opened and closed primary medical institutions numbered 4,085 and 1,573, respectively. Additionally, institutions thatrelocated numbered 2,729, or 16.3% of all primary medical institutions in operation in 1998. These openings and closings were more frequent among young doctors. As a result of our analysis on the underlying regional factors forrelocation, the factors that were statistically significant were local per capita tax burden and the number of schools per ten thousand persons. !n, the case of institutional factors, movements were significantly associated with gender and the location of primary medical institutions. Conclusions : In order to establish effective long-term intervention for primary medical institutions, further study and monitoring of primary medical institutions and the identification of factors influencing opening location and relocation is necessary.
신순애,김형수,이건세,Vivian Lin,George Liu,신은영 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.1
Purpose: This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design. Materials and Methods: The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007. Results: The case management program significantly improved the study population’s knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This programalso significantly changed the study population’s health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations(mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup,there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention. Conclusion: This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors,and utilization of health care. It is necessary in future studies to evaluate the appropriatenessof healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program.
고수경,신순애,김기영,김창엽 한국보건행정학회 2001 보건행정학회지 Vol.11 No.3
This study was conducted to investigate provider's behavior change after releasing the information on the Cesarean section rate. Claims data filed at the National Health Insurance Corporation was used for this analysis and the focus of this study was the change of cesarean rate after the public disclosure of information. Average rates of the year 1999 and 2000 were compared, on the institutional basis, and range and coefficient of variation were estimated. For the last decade, Cesarean section rate has been increased dramatically. Clinical or demographic factors could not adequately explain the increase. Instead, nonclinical factors, such as financial incentive, physician's convenience, practice characteristics, etc., were more significant in explaining the increasing rate. Providers' behavior was significantly affected by the public release of information: after the release, average rate was decreased by 10.2%, and variations were also decreased. In particular, the extent of decrease was explained mainly by nonclinical factor rather than clinical ones. The results suggest that disseminating practice information to providers and consumers could contribute to reducing unnecessary medical service.