외국에서의 건강불평등 개선을 위한 노력: 건강영향평가, 건강도시

유원섭,고광욱,김건엽,Yoo, Weon-Seob,Koh, Kwang-Wook,Kim, Keon-Yeop 대한예방의학회 2007 예방의학회지 Vol.40 No.6

In order to reduce the health inequalities within a society changes need to be made in broad health determinants and their distribution in the population. It has been expected that the Health impact assessment(HIA) and Healthy Cities can provide opportunities and useful means for changing social policy and environment related with the broad health determinants in developed countries. HIA is any combination of procedures or methods by which a proposed 4P(policy, plan, program, project) may be judged as to the effects it may have on the health of a population. Healthy city is one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential. In Korea, social and academic interest regarding the HIA and Healthy Cities has been growing recently but the need of HIA and Healthy Cities in the perspective of reducing health inequality was not introduced adequately. So we reviewed the basic concepts and methods of the HIA and Healthy Cities, and its possible contribution to reducing health inequalities. We concluded that though the concepts and methods of the HIA and Healthy Cities are relatively new and still in need of improvement, they will be useful in approaching the issue of health inequality in Korea.

지역사회정신보건서비스 이용자의 만족도 측정을 위한 한국어판 Verona Service Satisfaction Scale-82 (VSSS-82)의 개발 및 신뢰도와 타당도 평가

유원섭,문옥륜,남정현,신영전,Yoo, Weon-Seob,Moon, Ok-Ryun,Nam, Jung-Hyun,Shin, Young-Jeon 대한예방의학회 2001 Journal of Preventive Medicine and Public Health Vol.34 No.3

Objectives : To develop a Korean version of VSSS-82 for measuring the multi-dimensional satisfaction with community-based mental health services in psychiatric patients and to investigate both the reliability and validity of the Korean version. Methods : The VSSS-82 English version was translated and back-translated with some modification. Data from 68 psychosis patients using community-based mental health services in three Community Mental Health Centers (CMHCs) was collected through a personal interview survey regarding the satisfaction and suitability of service. Variability of satisfaction and internal consistency, discriminant validity, and concurrent validity of the VSSS-82 Korean version were evaluated. Results : A higher number of dissatisfied subjects and significant pairwise differences for the dimensions were found. The Crohnbach's alpha coefficient, a measure of internal consistency, ranged from 0.56(overall satisfaction) to 0.90(skills and behavior) and significant differences in satisfaction was found in patients by the self-rated suitability of service. Conclusions : The VSSS-82 Korean version is a reliable and valid instrument for measuring multi-dimensional satisfaction with community-based mental health service.

만성질환자의 한방의료서비스 이용 결정요인 : 2005년도 국민건강영양조사

이현주,유원섭,정수경,Lee, Hyun-Joo,Yoo, Weon-Seob,Chung, Su-Kyoung 대한예방한의학회 2011 대한예방한의학회지 Vol.15 No.3

Objectives : The aim of this study is to investigate the relevant factors which determine the use of oriental healthcare services among subjects with chronic illnesses. Method : This study utilized the data from the Korean National Health and Nutrition Examination Survey in 2005. Out of all the participants of the survey, 11,665 individuals who are older than 19 years old and have one or more chronic diseases were included in this study. Results : The factors that affect utilization of oriental healthcare services were significantly associated with gender, educational level, job, personal income, the number of chronic illnesses, experiences of nontreatment or delayed treatment and admission experiences for the last one year(p<.001). Although some of these factors need further studies, the determining factors for the use of oriental healthcare services are the presence of chronic illness and the number of chronic disease. That is, the chronically ill are more likely to seek oriental healthcare services. And the more chronic diseases the clients have the higher probability of seeking oriental healthcare services was found. Conclusions : The results suggest that the national integrated care services should be established for diverse development of policy regarding the quality of care of chronic illness and cost-effectiveness.

일부 도시 저소득층 주민의 사회적 지지와 자가평가 건강수준

임민경,신영전,유원섭,양봉민,김명희,Lim, Min-Kyoung,Shin, Young-Jeon,Yoo, Weon-Seob,Yang, Bong-Min,Kim, Myoung-Hee 대한예방의학회 2003 예방의학회지 Vol.36 No.1

Objectives : To assess the distribution of social support, and explore its effects on self-rated health status in a low income neighborhood of Seoul, Korea. Methods : In September 2001 we conducted a survey in a low income neighborhood of Seoul, Korea, in which 862 residents, aged 18 years or over, participated. We measured the general sociodemographic characteristics, self-rated health status and social support with the instrument developed from Korean translation of the Medical Outcomes Study Social Support survey (MOS-SSS) scale of the US. Logistic regression was used to identify the determinants of social support, and explore its effects on self-rated health status. Results : Lower social class, women or divorced people had much less social support compared to higher social class, men or those never married, respectively. Those families on much lower income also received less social support. Social support has a positive impact on the self-rated health status, which remains statistically significant even when other relevant variables are adjusted. Conclusions : This study suggests that social support has an important role in health, and the socially disadvantaged have lower social support. Therefore, to improve the health status of the poor, it is necessary to encourage community participation, and develop strategies that could strengthen their provision of social support.

권역 심뇌혈관질환센터 예방관리사업 전문인력 역량기반 교육프로그램 개발

이승진(Seung Jin Lee),유원섭(Weon Seob Yoo),정서영(Seo Yeong Jeong),김미영(Mi Young Kim) 한국보건교육건강증진학회 2021 보건교육건강증진학회지 Vol.38 No.3

복합만성질환자의 다빈도 만성질환조합 유형과 질병부담

김창훈 ( Chang Hoon Kim ),이미리 ( Mi Ri Lee ),유원섭 ( Weon Seob Yoo ) 한국보건경제정책학회(구 한국보건경제학회) 2014 보건경제와 정책연구 Vol.20 No.4

복합만성질환은 흔하게 나타나는 건강문제이며, 의료이용과 비용을 향상시키고, 건강결과를 악화시키는 것으로 알려져 있으나, 본격적인 연구가 시행되지 않고 있다. 이 연구는 복합만성질환자의 다빈도 만성질환조합의 유병양상과 그 비용을 산출하고 복합만성질환에 대한 중재전략을 모색 시 질병부담 측면에서 우선순위가 높은 다빈도 질병조합군을 확인하고자 하였다. 2011년 한국의료패널 자료를 활용하여 시설에 거주하지 않는 20세 이상 성인을 대상으로 다빈도 질환조합을 확인하고 노인층과 청장년층으로 구분하여 1인당 평균의료비와 질병조합군별 총 의료비용을 추정하였다. 청장년층에서 유병율 기준으로 가장 빈도 높은 2개 질환조합과 3개 질환조합은 각각 고혈압-당뇨(3.6%)와 고혈압-관절염-골다공증(0.9%)이었고, 노인층에서는 고혈압-관절염(8.6%), 고혈압-고지혈증-관절염(3.1%)이었다. 복합만성질환 중 가장 많은 비용이 지출되는 질환조합은 청장층의 경우 천식-만성폐쇄성폐질환(2개 질환조합)과 고혈압-관절염-당뇨(3개 질환조합)이고, 노인층의 경우 고혈압-관절염(2개 질환조합), 고혈압-고지혈증-관절염(3개 질환조합)이었다. 이 연구를 통해 확인된 복합만성질환을 구성하는 주요 질환들과 다빈도 질환조합군들은 복합만성질환자들의 의료이용을 적정화하고, 건강결과를 향상시키며, 보건의료비용을 감소시키기 위한 전략과 중재를 모색할 때 우선순위 높은 표적집단으로 활용할 수 있을 것이다. Background: Multimorbidity is common health condition especially in the older population and associated with high levels of healthcare utilization and costs. But little is known about its frequent patterns and association with healthcare utilization or cost in Korea. The purpose of this paper is to investigate the prevalent combinations of common chronic conditions and their effect on healthcare cost and to find out target groups for an intervention to relieve disease burden. Methods: We analyzed the Korea Health Panel Data representing non-institutionalized Korean adult populations aged 20 and over with chronic conditions. Also we identified the most prevalent combinations of common chronic conditions and estimated their mean and total healthcare cost for the elderly and nonelderly patients. Results: The most common dyad and triad of chronic conditions for the nonelderly patients are hypertension-diabetes(3.6%), hypertension-arthritis-osteoporosis(0.9%) and for the elderly are hypertension-arthritis(8.6%), hypertension-hyperlipidemia-arthritis(3.1%). The most burdensome combinations for the nonelderly are asthma-COPD, hypertension-arthritis-diabetes and for the elderly are hypertension-arthritis, hypertension-hyperlipidemia-arthritis(dyad and triad, respectively) Conclusion: Our findings suggest that national strategy and intervention for chronic diseases should place the priority to the multimorbid population causing the highest medical cost.

복합만성질환의 흔한 유형과 의료비에 미치는 영향

김창훈 ( Chang Hoon Kim ),황인경 ( In Kyung Hwang ),유원섭 ( Weon Seob Yoo ) 한국보건행정학회 2014 보건행정학회지 Vol.24 No.3

Background: Current trends in Korea population aging with advances in public health and clinical medicine foretell rises in the prevalence of not only chronic diseases but also patients with multimorbidity. One important aspect in analyzing multimorbidity is to define the list of chronic diseases included when calculating multimorbidity index. The objective of this study is to describing the effect of multimorbidity on healthcare cost in Korea using US Office of the Assistant Secretary of Health (OASH) list. Methods: We analyzed the Korea Health Panel Data representing non-institutionalized Korean adult populations aged 20 and more. We calculated multimorbidity index based on OASH list and estimated the prevalence and healthcare cost for each OASH chronic disease. Results: In 2011, 15.2 million (39.6%) Koreans aged 20 and more were living with chronic condition. The health care cost due to chronic diseases, accounted for 80.2% of the overall healthcare costs and the prevalence of chronic conditions, the prevalence of multimorbidity and healthcare cost increased with ages. In the analysis using OASH list, 40% of the adult population over the age of 20 and 66.7% of the population over the age of 65 was affected with multimorbidity. In most of diseases in OASH list, prevalence of mulitmorbidity was high and healthcare cost increased with multimorbidity. Conclusion: OASH chronic disease list that accounts for 72.4% of prevalence and 86.7% of healthcare cost of persons with chronic conditions in Korea. OASH chronic disease list would be a useful and representative indicator for studying multimorbidity.

우리나라 고혈압 · 당뇨병 예방관리사업 정책 동향과 분석 그리고 한국형 만성질환 예방관리 모형

이무식(Moo-Sik Lee),이경수(Kyeong-Soo Lee),이중정(Jung-Jeung Lee),황태윤(Tae-Yoon Hwang),이진용(Jin-Yong Lee),유원섭(Weon-Seob Yoo),김건엽(Keon-Yeop Kim),김상규(Sang-Kyu Kim),김종연(Jong-Yeon Kim),박기수(Ki-Soo Park),황보영(Bo-Young 한국농촌의학 지역보건학회 2020 농촌의학·지역보건 Vol.45 No.1

Objectives: The purpose of this manuscript was to propose the policy and perspectives of prevention and management for hypertension and diabetes in Korea. Methods: Authors reviewed the chronic disease prevention and management projects and models were executed in Korea until now, and analyzed and evaluated their performances. Results: In the circumstances of Korea, the following several requisites should be improved ; Specific Korean strategy for development and pursuing of national level policy agenda for chronic disease management must be established. There are a need to establish several means of supplementing the weaknesses of the current chronic disease management policies and programs. Firstly, development and distribution of contents of guidelines on the systematic project execution regime (regarding systematization of local community, subjects and contents of the projects) with guarantee for the quality of chronic disease prevention and management are necessary. Secondly, there is a need for development of information system that can lead the chronic disease management programs currently being implemented. Thirdly, there is urgent need to develop resources such as cultivation of manpower and facilities for provision of education and consultation for the patients and holders of risk factors of chronic disease. Fourthly, there is a need for means of securing management system and financial resources for operation of policies and programs. Conclusions: The results can be able to use as a road map, models, and direction and strategies of policies for chronic disease prevention and management of Korea.

일부 병원에서의 입원비 본인부담양상

신영전,유원섭,하헌영,정설희 한양대학교 의과대학 2000 한양의대 학술지 Vol.20 No.1

The purpose of this study was to estimate the proportion of user charges out of total treatment costs and to investigate the occuring status of the charge of non-benefit service. The data were collected from 6 hospitals in 3 cities (Seoul 2, Incheon 3, Shihung 1), which containing 1,752 discharge-bills of discharged patients insured by health insurance. The data were analyzed after standardization of the items of non-benefit services. The result are as follows; 1. the average percent of the cost-sharing of discharged patients was 38.1%(benefit : 15.5%, non-benefit : 22.6%) and the proportion of the cost-sharing due to non-benefit services was greater than that due to benefit services. 2. The occurrence rate and the occurred number of non-benefit services were different among hospitals and showed characteristic occurrence rate in individual hospitals. 3. In acute appendicitis, the characteristics of the occurrence rate and the occurred number of non-benefit services by individual hospitals was similar to those of hospitals. It suggest that the hospitals intentionally applied non-benefit item to patients in order to increase their profit. These findings suggest that the burden of cost-sharing is still high especially due to non-benefit services, so it is necessary to extend the coverage of insurance benefits and to develop management system for the appliance of non-benefit services. Regarding the discharge-bill, all service charges should be included in the bill.

국가정신보건정책안의 우선 순위에 관한 전문가 설문조사

신영전,남정현,유원섭,이선영,유주영 漢陽大學校 精神健康硏究 2000 精神健康硏究 Vol.19 No.-