도시지역 한 보건소 기능 강화 방안에 대한 의견 비교 분석

이원영,신영전,권영준,최보율,문옥륜,전혜정,Lee, Weon-Young,Shin, Young-Jeon,Kwon, Young-Jun,Choi, Bo-Youl,Moon, Ok-Ryun,Jeon, Hye-Jeong 대한예방의학회 1998 예방의학회지 Vol.31 No.4

The objective of this study is to collect the opinions on the present condition and the improvement directions of urban health centers from and to make a comparison. Samples were drawn from the various sources of a district in seoul. 53 persons involved in district health's administration(the Members of a District Parliament, the senior officials of a District office, village chief) and 84 health center workers were surveyed with anonymous postal questionaires and 427 district private medical personnels with postal questionaires and 625 users of a health center with direct questionaires, from November 18 to 25, 1996. Additionally, 12,151 households were surveyed with self-reported questionaires including priorities on special district health services of health center, from September 1 to 7, 1996. The major findings were as follows : 1) Although the persons involved in district health administration tend to put lower priority on health service over other community activities, they well acknowledged the importance of health center. But health center workers strongly acknowledged the importance of both health service and heath center. 2) As to the level of human resoureces, equipments and ammenities of Health Center commpared with private medical institute, the persons involved in district health's administration and health center workers responded that health center was higher in following order : 54.9%, 41.6%, 36.5% and 88.0%, 80.7%, 44.1%. 3) Concerning the priorities of health center's improvement, the persons involved in district health's administration replied in the order of reinforcement of proffesional health workers (43.3%), improvement of equipments and ammenities(28.3%), and the health center workers replied in the order of reconstruction of organization(24.1%), public health education and promotion(22.8%), reinforcement of proffesional health workers(21.0%). 4) Both the persons involved in district health's administration and health center workers replied that Ministry Health and Welfare, District office, health center were essential as the most critical organizations in the activation of Health Center's Function. 5) Persons involved in district health's administration and health center workers chose, as the most important health center's Function, medical treatment and prevention of infectious disease, and prevention of acute and chrone disease control and special district health service, respectively. Both Groups replied that fammily planning and parasite control are no longer in need. 6) As the future health service requiring reinforcement, every human resources parties considered health conselling, health line, sex education as the most imortant elements in public health education. Concerning the reinforement of other health services such as medical checkup and visiting nurses, every human resources parties showed more than 80% approval rate, but for oriental medical care service, the private medical personels showed relatively low approval rate(52.9%). Therefore the planning for reinforcement of health center's function requires the reflection of human resources party's opinion and the implication of system which can control and combine the differences in party's opinions.

농촌지역 정신질환자 가족 부담

이원영,김정회,남정현,문옥륜,신영전,Lee, Weon-Young,Kim, Jung-Hoe,Nam, Chung-Hyun,Moon, Ok-Ryun,Shin, Young-Jeon 대한예방의학회 1999 예방의학회지 Vol.32 No.3

Objectives: This is a descriptive study which was carried out to identify characteristics of the chronic mentally ill and their families in a rural area and the influencing factors on family burden. Methods : Data was collected for seven months beginning April 1, 1998 by questionnaire from chronic mentally ill patients and their families in two towns and seven townships of the rural areas of Kyonggi Province. In additional to the mental diagnosis of the mentally ill patients, family burden was measured by interviewing the other family members using the questionnaire developed by Pai & Kapur (1981). Of those interviewed, 103 patients were selected for final analysis. Results : Of 103 mentally ill patients, 36.1% of the subjects were not under treatment. In particular, of 29 patients with schizophrenia, 48.3% of the subjects had stopped taking medication and 6.9% of the subjects had never been treated. According to the results of a specialized examination by a psychologist, 81% of patients were in need of Hospitalization. Most primary caregivers were parents. Of the 101 primary caregivers in the study, 39.6% were over 65 years old. In case of death of the primary caregiver, 50.5% of these 101 mentally ill patients would not have anyone to care for them. Of the various kinds of family burden, primary caregivers most often reported psychological stress. Overall, the families of dementia and schizophrenia patients complained of the most family burden. Through univariative analysis, the variables of sex, education and current treatment type of the patients, the relationship with the patient and marital status of the primary caregiver and the number of people living together in the household showed significant correlation with the family burden of schizophrenia patients. Univariative analysis also showed that there were a number of variables which were correlated to the family burden in mentally retarded patients. Concerning the need for mental health services, the most common requests were for entitlement to disability benefits and housing programs. Conclusions: Community mental health services in rural areas must be developed, planned and executed in consideration of the local situation. In particular, the development of various family support programs is needed in order to mitigate emotional, mental and economic burdens and carry out a positive role to care for and rehabilitate patients.

농촌지역 정신보건관리실태

이원영(Weon-Young Lee),김동문(Dong-Moon Kim) 한국농촌의학 지역보건학회 2003 농촌의학·지역보건 Vol.28 No.2

건강투자론에 대한 비판적 고찰

이원영(Lee Weon Young) 비판과 대안을 위한 사회복지학회 2009 비판사회정책 Vol.- No.27

건강향상이 개인 혹은 가구 혹은 국가의 부를 축적하는데 기여한다는 건강투자론은 경제성장론이 제 사회부문에 여전히 위력을 갖고 있는 한국사회에서 설득력을 갖는 패러다임이 될 수 있다. 최근에 건강투자론이 등장한 배경은 세계보건기구의 거시경제 및 건강위원회(Commission on Macroeconomic Health, CMH) 가 저개발국가의 경제성장을 돕기 위해 그들 나라의 국민건강을 향상시키는 것이 매우 실효성이 있는 접근전략임을 제시한 데서 연유한다. 건강향상이 경제적 번영으로 이어지는 이론적인 경로는 노동생산성 향상, 저축의 증가, 교육수준 향상, 경제활동인구의 증가를 통해서이다. 저개발국가들을 대상으로 한 경험적 연구들에서 그 연관성이 입증된 연구들이 상당수 있었으나 선진국들을 대상으로 한 관련 연구들은 양적으로 부족하며 연구결과의 일관성을 보이지 않았다. 한편 선진국 에서도 건강부문에 대한 정부의 예산투자를 유도하거나 취약 지역이나 계층의 빈곤화를 예방하기 위한 정책적 개입에 건강투자론이 동원되기도 하였다. 그러나 투자재로서의 건강의 관점은-한 사회에서 불건강의 사회구조적 원인이나 권리로서의 건강이 갖는 내재적 가치를 도외시할 수 있다는 비판적 지적도 일고 있다. 건강투자론의 비판적 수용 혹은 검토는 건강권 보장이라는 관점에서 건강에 대한 정부역할 확대를 주장해 온 기존-진보적 논의의 지평을 더 확장하는 데 기여할 수 있을 것이다. The purpose of this paper is to have a critical review of investment in health for economic development. The Commission on Macroeconomic and Health report of 2001 argued that global effort should be made on increasing investment in health for economic development, especially among developing countries. The report is being adopted as the blueprint for global health policy making. Theoretically, the effect of investment in health on accumulation of nation's wealth are made through four pathways ?production, education, investment in physicalcapital, demographic dividend. There have been somewhat scientific evidences demonstrating the correlation, especiallyamong developing countries. But the correlation may not be clear in micro- and macro-economic studies among developed countries. Some authors concerned or criticized about the CMH report. It ignores macroeconomic determinants and other causes of both poor health and poverty and recommends greater amounts of charity while preserving the status quo of a deeply unjust and irrational international economic order. But, considering that economic growth have been embedded through entire Korean society and both investment in health and health as a right need a active involvement in health sector of government, the development of health policy in different levels of government, based on integratingtwo perspectives, may be progressive and practical in Korea.

2000년 홍역 유행 시 합병증 발생률과 질병비용

이원영(Weon Young Lee),기모란(Moran Ki),오진경(Jin Kyoung Oh),이종구(Jong Koo Lee),김명빈(Myung Bin Kim),최보율(Bo Youl Choi) 한국역학회 2004 Epidemiology and Health Vol.26 No.2

Objectives: To estimate the complication rate and the societal cost of measles, a survey was conducted in Seoul, Jeonju city, and Kyonggi province in 2001. Methods: A telephone survey was conducted in Jeonju city (175/307) and four local areas of Kyonggi province (793/1,238) to gather information on the complications of measles. To estimate societal cost, the telephone survey was conducted for the sampled subject by complication type and the age group. The response rate was 78% (180/230). Paid bills were examined for direct cost estimation, and the time cost and the transportation expense were analyzed for indirect cost estimation. Results: The incidence of a complication of measles was 3.1% which found to be higher in younger age group. The incidence of pneumonia, otitis media, and encephalitis were 2.1%, 0.8%, and 0.2% respectively. Direct and indirect costs of in-patients without a complication were $417.00 (US $1.00 = 1,000 won) and $256.00 per case, respectively, and the out-patients who have no complication were $54.00 and $65.00, respectively. The average cost for a patient with measles without complication was $119.00 as the result. The societal cost of encephalitis was high as $6,660. Estimated total societal cost of measles ranges from $14 million to $69 million in the year 2000. Conclusion: Complication rate of measles was fairly low compared to foreign countries. The lower rate could result from the difference in vaccination rate and the age distribution of the measles patients. The cost of measles without complication was not high. However, the cost for the complication and the total disease burden caused by measles shown to be high in the year 2000.

영국 NICE 의료기술평가의 환자 및 시민참여 경험에 대한 고찰

이원영(Lee Weon Young) 비판과 대안을 위한 사회복지학회 2012 비판사회정책 Vol.- No.34

우리나라 신의료기술평가제도는 환자 및 시민이 적극 참여할 수 있는 구조적 장치가 매우 미비하다. 이 연구의 목적은 영국 National Institute for Health and Clinical Excellence(NICE)의 의료기술평가에서 환자 및 시민참여의 실태, 도입 배경, 평가를 통해 우리나라 신의료기술평가제도에 주는 시사점을 도출하였다. 이 연구는 NICE 홈페이지에 게재된 자료와 기존 문헌에 대한 고찰을 통해 이루어졌다. 주요 문헌은 NICE의 활동을 환자 및 시민참여의 관점에서 다룬 단행본, 영국 하원의 보건위원회가 작성한 NICE 평가보고서이며, 추가로 Google Scholar 웹페이지에서 검색한 관련 학술논문과 보고서들을 참조하였다. NICE의 특정의료기술 평가과정에 이해관계자로 등록한 관련 환자단체는 의료기술평가위원회가 검토해야 할 근거자료 제출부터 최종지침에 대한 항소에 이르기까지 의료기술평가의 모든 단계에 개입할 수 있다. 또한 일반 시민 30명으로 구성된 시민위원회는 충분한 학습과 깊이 있는 토론을 통해 최종적인 의사결정 시 수반되는 사회적, 윤리적 쟁점과 관련한 사회적 가치에 대한 보고서를 작성한다. NICE가 환자 및 시민의 참여프로그램을 적극적으로 도입한 이유는 다양하고 민감한 이해관계가 얽혀 절차적 정당성이 강조되는 의료기술평가의 특성이 결정적인 영향을 미쳤다. 참여했던 환자 및 시민들은 전문적인 지식을 요하고 난해한 일임에도 불구하고 적극적이었으며, 환자나 일반인의 관점에서 문제가 되거나 도움이 되는 것들을 중심으로 자문을 하였다. 이러한 능동적인 참여는 최종적인 의사결정에 실질적인 영향을 미칠 수 있는 잠재력을 보여 주었다. 또한 NICE의 최고경영진의 정치적 지지와 행정적 지원은 환자 및 시민의 적극적 참여를 가능하게 하였다. 의료기술평가를 전문가의 영역으로만 여겨왔던 우리나라 의료정책 관계자들에게 NICE의 경험은 환자 및 시민참여를 의료기술평가제도의 발전전략으로 인식할 수 있는 계기가 될 것이다. The patient and public engagement in health technology assessment has increasingly become important for healthcare service to be patientcentered care. For patients and public in Korea, however, there are few chances to be involved in health technology assessment. This study describes the state and background of the patient and public involvement in health technology appraisals at the National Institute for Health and Clinical Excellence(NICE) in UK. In addition, the process evaluation of their participating level and ability to engage in the process, and the outcome evaluation of whether it influenced making a decision over health technology assessment in practice were conducted. To do this, the website of NICE, a book edited by senior staff at NICE on the patient and public involvement in its work, reports evaluating the patient and public involvement in NHS organizations by the House of Commons Health Committee under New Labor Government were used. Additionally, we referred to articles and reports were retrieved from Google Scholar. At NICE in UK, patients, lay people, and organizations standing up for their interest are able to suggest the topic for a formal health technology assessment process, consult on a draft guidance, and appeal to a final guidance. Patient experts as witnesses attend the first meeting of technology appraisals committee where they are expected to provide the evidence of their experiences and preferences. The Citizens Council, comprising of 30 ordinary people from England and Wales, has produced reports containing public views of social and ethical issues followed by making a decision over health technology assessment. They have contributed to establishing the principles of social judgment which were referred to by all advisory bodies of NICE. The main reason why NICE introduced patient and public involvement programs very actively at the outset is that health technology assessment essentially needs the procedural legitimacy for persuading stakeholders to be involved in to comply with a final decision. Although health technology assessment was very sophisticated and demanded advanced knowledge, the patient and the public participated in that process rigourously and mainly consulted on things could be problematic or beneficial to themselves. Their engagement proved a potential to have a practical influence to making a decision over health technology assessment. The support of senior managers and administrational team for their engagement at NICE would lead to such an active participation. These experiences of NICE may make those involved in health technology assessment policy in Korea modify their prejudice that it should be the remit of professionals.

전화판매 민간의료보험의 정보제공 실태

이원영 ( Weon Young Lee ),홍지영 ( Ji Young Hong ) 보험연구원 2008 보험금융연구 Vol.19 No.1

이 연구는 19개 생명보험회사의 전화판매가 가능한 민간의료보험상품을 대상으로 모의상담을 통하여 전화상담원들의 안내충실성을 조사하였다. 전화상담원들은 보험면책조건 등 판매에 불리한 정보 안내에 대해 소극적이었고 타회사보험상품과 비교하여 유리점이나 특별한 혜택을 주겠다는 상담사례가 많았다. 또한 과거병력 확인 여부, 계약 후 철회가능기간, 계약자 서명 없이 전화상으로 가입 가능한 사실을 미리 안내하는 경우가 적어 소비자 민원발생의 소지가 큰 것으로 나타났다. 상담원의 이름이나 연락처, 상세한 정보제공에도 소극적이었다. 한편 피상담자가 상품정보와 관련하여 질문할 경우 대체로 상세한 정보제공을 받을 수 있었다. 소비자 교육이 필요하며 소비자 관련 단체나 보험협회 차원에서 전화상담에 대한 모니터링을 실시하는 것도 고려할 필요가 있다. The purpose of this study was to examine to what extent insurance telemarketers observed their obligation of informing the insured of necessary information for the direct call insurance products of 19 insurance companies through simulated consultation. The telemarketers who answered the consultation call for our study provided the unfavorable information to the consumers passively, but advertised only superiority to other`s products actively. They seldom questioned the callers on theirs medical history and noticed that telephone subscription needed no contract signature, and explained the withdrawal system of subscription. They informed the callers of their name and contact information passively and were reluctant to send the brochure containing more useful information. By the way, the callers got more detailed information when they asked more information. Results in this paper imply the need for consumer education and may suggest that the third party such as consumer group should moniter providing for telemarketers necessary information of direct call insurance products to consumers.

서울특별시 기초의회 의원들의 흡연규제정책 지지도 및 관련 요인

이원영(Weon Young Lee) 한국보건교육건강증진학회 2005 보건교육건강증진학회지 Vol.22 No.2

보건의료 정책결정과정에서 환자 및 시민참여 연구

이원영(Weon Young Lee) 한국사회정책학회 2012 한국사회정책 Vol.19 No.4

이 연구는 1998년부터 2009년까지 영국 노동당 집권기간동안 국영의료체계(NHS)의 환자 및 시민참여 정책의 경험을 분석하였다. 노동당 집권초기부터 환자 및 시민참여 프로그램들이 국영의료체계에 적극 도입되었으며 집권 중반 2004년 이후 시장주의적 의료개혁의 강화로 다소 후퇴하였으나 지속적으로 운영되었다. 환자 및 시민참여 프로그램들을 대상으로 실질적이고 효과적인 참여기준을 충족했는지와 최종의사결정에 참여가 영향력을 미쳤는지를 평가하였다. 지역주민참여네트워크(Local Involvement Network)는 지역단위별로 의료 및 사회서비스 중개를 책임지는 지역의료트러스트와 지방정부를 대상으로 지역주민이나 환자의 의견을 반영하기 위한 조직으로 참여자들의 대표성은 떨어졌지만 정보접근성, 참여자의 의견이 의사결정에 반영될 수 있는 공식적인 기전이 있었으며, 참여자를 위한 교육 및 기술 지원 조직을 운영하였다. 참여가 해당기관의 의사결정에 영향력을 미쳤는지에 대해서는 명확하지 않았다. 운영위원회(Board of Governors)는 파운데이션트러스트의 이사회의 비상임이사를 임명하고 이사회에 환자 및 시민들의 의견을 반영시키기 위한 조직으로 회원들에 의해선출된다는 점에서 어느정도 대표성이 띠었으나 정보접근성, 의사결정단위에 의견을 전달하는 공식적인 기전, 상시적인 교육 및 기술지원이 불충분하였으며 이사회에 대한 실질적인영향력이 없다는 평가가 지배적이었다. 임상진료지침개발 과정에서 환자 및 보호자 2인의 직접적인 참여와 환자단체의 이해관계자로서의 참여는 대체로 실질적이고 효과적인 참여 기준들을 모두 충족시켰으며, 임상진료지침 작성에 실질적인 도움을 준 것으로 평가되었다. 이와 같은 영국의 경험은 환자 및 시민참여 제도 도입 여부를 판단하고 구체적인 제도를 설계하고 정책의 효과를 추정하는데 있어서 유용한 자료가 될 것이다. This study explored the experiences of the public and patient involvement(PPI) in the NHS under the Labor government(1998-2009). From the outset, the Labor government had applied actively the PPI policy to all NHS organizations. Though there was a little backdrop due to the reinforcement of the marketization of the NHS after the midpoint of the lifetime of the labor government, these policy has maintained continuously without a break. Three PPI programs were analyzed on the points that their process met four criteria for effective participation process and influenced the outcome of a decision-making. Local Involve Networks was built up to reflect patient and public views on a decision making process of Primary Care Trust and Local Authority. It had access to information, official route for delivering public view to decision maker, educational and technical support for participants despite of there being a lack of representation. Citizen and patient governors, who are members of the board of governors for NHS foundation trust, had somewhat representation due to being elected by members, while they had little influence on the board of directors as well as insufficiency of the other three criteria for effective participation process. Two lay people among patients or carers concerned with target disease of clinical guidelines were involved in the guildeline development and also patient organization related to the disease could work as a stakeholder in the condition that the patient organziation had members nationally. These program met sufficiently four criteria for the effective participation process and also showed a visible impact on clinical guideline even though it was concentrated on non medical part such as family education. These experiences in the NHS may be very available for making judgement over introuducing PPI policy, designing a effective participation process, and predicting what that policy will bring to us.

성인 구강건강수준의 사회경제적 불평등에서 일부 구강건강관련 행태 요인의 역할

이원영(Weon Young Lee) 한국보건교육건강증진학회 2009 보건교육건강증진학회지 Vol.26 No.1