고속철도 도중 건넘선의 합리적인 설치간격에 관한 연구

안용익(Yong-Ik Ahn),오석문(Suk-Mun Oh),이경철(Kyung-Chul Lee),김경민(Kyung-Min Kim),장윤호(Yoon-Ho Jang) 한국철도학회 2015 한국철도학회 학술발표대회논문집 Vol.2015 No.10

이 논문은 현재 국내에 명확하게 제시되어 있지 않은 고속철도 도중 건넘선의 적정 설치간격을 검토한다. 이 논문에서 제시하는 도중 건넘선의 적정 설치간격은 설치에 따른 비용 및 유지보수비와 이를 이용하는 고속열차 및 유지보수차량의 편익을 비교하는 방법으로 구성된다. 도중 건넘선의 설치비용은 호남고속철도 도중 건넘선 설치비용을 참고로 하였다. 도중 건넘선을 설치함으로써 발생할 수 있는 편익으로는 유지보수차량의 연료비 및 인건비 절감편익과 고속열차 차량의 추가 운영을 통한 승객 수송인원을 자동차를 이용하였을 경우와 비교하여 산정하였다. 마지막으로 도중 건넘선 설치에 따른 공사비 및 유지보수비와 편익을 비교하여 B/C 1.0 이상이 되는 최소 설치간격을 검토하였다. This paper examines the proper spacing can be applied line crossing during high-speed railroad. Proper spacing of the line crossing presented in this paper is configurations to compare that the cost of installation a line crossing and the benefit of using a line crossing by high-speed rail vehicles and maintenance vehicles. Cost of installation a line crossing was referenced Honam high-speed railway. Benefits were estimated to reduce fuel costs and labor costs of maintenance vehicle and passenger’s destination arrival time between high-speed train and car. Compare to costs and benefits, than examined a minimum spacing to installation line crossing that is more than B/C 1.0.

입원과 수술시행의 적정성 평가

김창엽,안형식,이영성,권영대,김용익,신영수,Kim, Chang-Yup,Ahn, Hyeong-Sik,Lee, Young-Seong,Kwon, Young-Dae,Kim, Yong-Ik,Shin, Young-Soo 대한예방의학회 1992 예방의학회지 Vol.25 No.4

The aim of this study was to evaluate the appropriateness of some kinds of surgery and admission, such as cesarean section (C/S), cholecystectomy, and pediatric pneumonia. For appropriateness evaluation, we ourselves developed some criteria, which were included in the category of explicit and linear criteria, with the assistance of specialists of relevant clinical field. The evaluation of appropriateness was performed by two family physicians. The major findings were as follows: 1. For cesarean section, 77.6% of deliveries were determined to be 'appropriate', but the level of appropriateness was not significantly different among hospitals and between hospital groups by size. The most freqeunt indication of C/S was repeated operation, followed by cephalopelvic disproportion (CPD). The labor trials for vaginal delivery among repeated C/S and CPD cases were performed in 24.5% of pertinent deliveries. 2. About 73.8% of cholecystectomy cases was appropriate to one of the surgical indications, without significant differences among hospitals. Of surgical indications, 'sufficiently frequent and intense symptom recurrence' was the most frequent, and 'confirmed acute cholecystitis' was the second. 3. Of children admitted due to pneumonia, only 57.4% of cases satisfied admission criteria, and the level of appropriateness of admission was different among hospitals. The common reasons fur admission were 'failure to initial treatment', 'suspected bacterial pneumonia', 'young infant', etc. We could find that there were differences of quality among hospitals in some procedures, especially in the pediatric pneumonia and labor trial before C/S, which suggested that the implementation of quality assurance activiteis would be necessary in this country. In this study, we used some simple and primitive research tools and the numbers of subjects and tracer procedures were limited. So advanced studios with plentiful subjects and more representative diseases or procedures should be tried.

1개 군지역 의료보험제도에서의 보험료 부담수준별 병.의원 의료이용에 관한 연구

이상일,최현림,안형식,김용익,신영수,Lee, Sang-Il,Choi, Hyun-Rim,Ahn, Hyeong-Sik,Kim, Yong-Ik,Shin, Young-Soo 대한예방의학회 1989 Journal of Preventive Medicine and Public Health Vol.22 No.4

1988년부터 전국적으로 실시된 농어촌 지역의료보험제도의 형평성을 검토하기 위하여 1개군 지역의료보험 대상자 중 1년간 계속하여 자격을 보유하고 있었던 피보험자를 대상으로 세대당 총보험료와 능력비례 보험료에 따라 10등급으로 구분하여 1) 등급별 보험료 구성, 2) 등급별 의료이용도, 3) 등급별 보험급여액, 4) 등급별 의료이용의 진료권별 분포를 분석하여 다음과 같은 결과를 얻었다. 총보험료중 능력비례 보험료가 차지하는 비율은 39.2%이었으며 등급이 증가할수록 총보험료중 능력비례 보험료가 차지하는 비율이 증가하고 있었다. 보험료 부담수준이 증가할수록 병의원 외래, 입원 및 치과 의료이용율이 증가하여 소득이 낮은 계층에서 상대적으로 큰 미충족 의료필요가 존재함을 시사하고 있었다. 총보험료 및 능력비례 보험료 등급이 증가할수록 보험료의 누적백분율이 보험급여액의 누적백분율보다 커서 상위 등급에서 하위 등급으로 보험료의 이전이 발생하고 있으나, 보험료 등급에 따른 피보험자수의 누적백분율이 보험급여액의 누적백분율보다 크게 나타나고 있어 의료보험제도 내에서도 소득수준에 따른 의료이용의 차이가 있어 매우 제한된 범위내에서 소득재분배 효과가 있는 것으로 생각되었다. 총보험료 및 능력비례 보험료 등급별 의료이용 중 군내 및 군외 1차기관이 차지하는 비율은 등급의 상승에 따라 감소하고 2차기관의 이용 비율은 증가하는 경향을 보이고 있어 의료전달체계의 실시가 병의원 이용에 있어 보험료 부담수준 또는 의료비 지불 능력에 따라 차별적인 영향을 미치는 것으로 나타났으며 이는 주로 간접의료비에 기인한 것으로 생각되었다.자에게 1-2종의 항생제를 평균 1주일 정도 투여하였다. 또 어떤 의원에서는 제왕절개 분만시 모든 환자에게 전혈을 수혈하는 곳도 있었다. 이 외에도 의료기관에 따라 비타민제제, 지혈제, 자궁수축제, 진통제, 해열제, 소염제, 진정진경제, 소화제, 변비완화제, 항히스타민제, 이뇨제 등을 투여하는 빈도와 약품종류가 다양하였다. 입원기간에 있어서는 정상분만의 경우 평균 입원기간이 초산은 2.6일, 경산은 2.4일로 초산이 경산보다 약간 길었으며 어떤 병원에서는 3.5일로서 약간 긴 경우도 있었으나 대체로 비슷한 양상이었다. 제왕절개 분만에 있어서는 평균 입원기간이 초산 7.5일, 경산 7.6일로 별다른 차이는 없었다. 그러나 의료기관에 따라 가장 짧은 것은 6.5일에서 가장 긴 것이 9.4일로 차이가 났다. 평균 입원비는 일반환자인 경우 정상분만의 초산 비용은 182,100원이었고, 경산은 167,300원이었다. 의료보험인 경우 본인 부담액이 초산은 82,400원, 경산은 75,600원이었으며 제왕절개분만은 일반환자 초산인 경우 946,500원, 경산은 753,800원이었고, 의료보험인 경우 초산은 256,200원, 경산은 253,700원이었다. 대학병원간에도 정상분만 비용이 268,000원과 350,000원으로 큰 차이를 보이며 제왕절개 분만의 경우에도 각 의료기관별로 차이를 나타내고 있다. 이와 같이 의료기관에 따라 정상분만과 제왕절개분만시 임상병리검사, 투약 등에 큰 차이를 나타내고 입원기간에도 차이가 있어 결과적으로 의료비에도 큰 차이를 나타내고 있으며 어떤 기관에서는 포괄수가제를 적용하고 있는 곳도 있었다. This study was conducted to assess the equity in the regional insurance scheme through analysis of the computerized data from one regional insurance society and National Federation of Medical Insurance. We analysed the insurance contribution and benefit by the classes based on total and income-related contribution per household. The major findings of this study are as follows : 1. The average proportion of income-related contribution among the total was 39.2% and the upper classes show higher proportion of the income-related contribution. 2. The upper classes show higher health care utilization rate than the lower classes. It suggests that the lower classes have relatively large unmet medical needs. 3. The analysis through the Lorenz curve reveals that there exists transference of contributions from the upper to lower classes. But the cumulative percentage of insurance benefit is smaller than that of the number of the insured. It implies that regional medical insurance scheme in Korea has still some inequity in the context of social security principles.

일부 다빈도 입원 및 수술례의 진단과 치료과정에 대한 연구

김창엽,김윤,권영대,김용익,신영수,안형식,Kim, Chang-Yup,Kim, Yoon,Kwon, Young-Dae,Kim, Yong-Ik,Shin, Young-Soo,Ahn, Hyeong-Sik 대한예방의학회 1993 예방의학회지 Vol.26 No.3

The aim of this study is to analyze the variations among hospitals and hospital groups in resource use and procedures of diagnostic and therapeutic process, such as laboratory tests, radiologic examinations, tissue diagnosis, timing of surgery after admission, the time required for operation. The study was performed for five procedures including cesarean section (C/S), appendectomy, cholecystectomy, cataract extraction, and pediatric pneumonia. The 2,316 subjects were selected from medical insurance claims list, and from this list 413 cases were sampled for medical record review. The patterns of resource utilization and process of treatment were described according to hospitals and characteristics of hospital groups. The major results were as follows : 1. The numbers of laboratory and radiologic tests showed significant difference among hospitals and hospital groups. In case of hospital groups, we could find tendencies of more tests with increasing hospital bed size. 2. In general, the proportion of operative cases evaluated by tissue diagnosis postoperatively among all operations ranged from 28.3% to 100%. The proportion varied among hospital groups, of which general hospital A group(more than 15 specialty) showed the highest proportion. 3. Post-admission delay until operation and the time required for operative procedure were not invariable among hospitals and hospital groups. The duration of operation in tertiary hospitals was slightly shorter than general hospitals, with varying statistical significance. We could find that probably there were differences of quality among hospitals in some components of procedures, which suggested that the implementation of quality assurance activities would be mandatory. In this study, we simply described the patterns of resource utilization and some features of clinical process, with institution of the need for advanced studies with in-depth analyses for each component of diagnosis and treatment procedures.

개원의의 소아 급성호흡기질환에 대한 항생제 처방양상에 관한 연구

이영성,김명기,김용익,신영수,이환종,안형식 대한보건협회 1991 대한보건연구 Vol.17 No.2

The purpose of this study is to evaluate the patterns of antibiotic prescriptions for acute respiratory infections (ARI) in children: such as prescription rate and appropriateness of antibiotics prescribed by clinical practitioners in Korea. Clinical cases selected for this study include common cold, viral croup, bacterial pneumonia, pharyngitis and two others. For this study, a sampling was made, which encompasses all of the private practitioners in one district of Seoul city. It also includes some pediatric professors in medical colleges as a control group. And then the self-administrative questionnaires were handed out to the selected samples(178 practitioners). 174(97.7%) practitioners responded and among them 68(39.1%) who were practicing pediatric cases were validly analyzed. The study results are as follow: 1. The antimicrobial prescription rate of private practitioner group was in general higher than that of professor group, while difference among the specialties did not exist. 2. The appropriateness of antibiotic prescription was 88.9% and 25.0% respectively in professor and private practitioner group in case of common cold, for which the antibiotic prescription is not approved by WHO prescription protocol. 3. Both the private practitioner and the professor groups prescribed most frequently broad spectrum penicillin derivatives (usually ampicillin). The former group quite frequently prescribed aminoglycoside(28.4%. and 27.6% respectively in case of viral croup and bacterial pneumonia), while the latter group did not. Also the study results showed that the private practitioners, relative to the professor group, tend to prefer the antibiotics for injection, such as the aminoglycoside. 4. The non-pediatrician and the general practitioner groups prescribed expensive reserved antibiotics(3.8% and 5.8% respectively in case of common cold), while the pediatricians did not at all. 5. The prescription patterns of combined antibiotics were similar to the patterns of antibiotics for injection. The study results provides many aspects of understanding about medical care behaviour in private practice settings, which are of major domain for primary health care. In order to overcome some design limitations in sampling and case selection of this study, further researches on this topic may be followed, including analysis of behavioural factors affecting drug prescription on both providers' and consumers' parts.