재미 한국인과 한국인의 건강수준 및 건강행태에 관한 비교

이윤현(Yoon Hyeon Lee) 한국보건교육건강증진학회 2010 보건교육건강증진학회지 Vol.27 No.4

3차진료기관(3次診療機關)의 지역화(地域化) 및 기능분화(機能分化)에 관(關)한 분석(分析)

이윤현 ( Lee Yoon Hyeon ) 한국보건사회연구원 1992 保健社會硏究 Vol.12 No.1

醫療傳達體系의 주요 골자는 醫療의 地域化와 階層的 機能分化를 통하여 의료자원의 효율성을 높이고 의료이용의 편의를 추구함에 있다. 본 연구에서는 이상과 같은 두 가지의 목표가 얼마만큼 달성되고 있는지를 3차진료기관의 진료실적을 중심으로 분석하였다. 우선 지역화의 정도를 알아보기 위해서 각 대진료권 단위별 診療實績을 분석하였으며, 의료의 공급과 수요의 지역적 균형분포를 보기위해 地域化 指數 및 Gini系數를 이용하였다. 여기서 地域化 정도가 높음에도 불구하고 3차진료기관에 환자집중이 심화되는 것은 대진료권내의 의료기관간의 계층적 기능분화가 이루어지지 못함이라는 反射的 結論 을 도출하였으며 이를 부연하기 위해서 각급 의료기관의 진료실적과 질병의 危重度에 따르는 3차진료기관의 기능분화에 대하여 검토하였다. The Government decided to adopt a regulated system of hea1th care delivery as a national health insurance policy in July 1986. Concomitantly, the whole nation was divided into eight health service regions, and each region was further divided into a number of hea1th service districts. The insured are expected to use all health and medical facilities in the health service district without restrictions expect on tertairy hospitals located within the district, but this new system prohibited the insured from random use of health facilities. They were not allowed to use tertiary medical facilities without the approval of primary care physicians. If patients want to see a specialist in another health service region, they should get a permit from their insurance society as well as a primary care physician`s referral request. The new system of health care delivery was designed to change health service utilization patterns and to promote equitable redistribution of health resources among regions. The main aim of the present study is to review the current status of the hea1th care delivery system, analyze the problems, and make recommendations based on the evaluation of tertiary care hospital utilization patterns in eight health care regions. Several findings underscore the impartial distribution of hea1th resources among the regions and the concentration of patients using tertiary care hospitals in particular regions. This raised a serious problem of equity between the metropolital areas and others. First, interestingly, the concentration of health resources in the Gyongin Medical Zone would be an obstacle to sustaining the hierachical structure of the hea1th care delivery system. For example, 52.86 percent of health care manpower in the nation worked in the Gyongin Health Service region in 1992 and 60.3 percent of the beds were in use in that region. Second, the level of in-patient days per c1aim increased from 13.4 days in 1990 to 13.8 days in 1991 for medical treatment in tertiary care hospitals, and from 1.6 to 1.7 days in out-patient volume. The indicators of regionalization in health service regions shows the distribution of health resources and utilization pattern of tertiary care hospitals were moving in the direction of the ne policy`s original intentions. For example, the Gyongin regional indicator decreased from 1,253 in 1990 to 1,246 in 1991. lt was noted that the major barrier to equitable access to the health care system is the lack of a regular health resources in eight health service -66 regions. The success or failure of the present health care delivery system depends on the extent to which patients use medical resources rationally. This requires strengthening the current referral system between primary and secondary care facilities and tertiary care hospitals.

법정전염병 신고행태 및 관련특성 연구

이윤현 ( Yoon Hyeon Lee ),맹광호 ( Kwang Ho Meng ) 한국보건행정학회 1999 보건행정학회지 Vol.9 No.4

코로나-19에 따른 남북한 검역 협력의 법제화

이윤현(Lee Yoon Hyeon) 한국보건사회학회 2021 보건과 사회과학 Vol.- No.57

본 연구의 목적은 코로나-19의 범유행에 따른 남북한 보건협력의 일환으로 남북 검역 협력 법제화를 수립하고자 수행되었으며, 검역 합의서 도출을 위하여 남북의 검역 관련 법제를 검토하여 비교· 분석하였다. 그동안 남북한 간에 오가는 사람과 물건 등에 대한 검역은 개성공단 운영과정에서 남북검역협력이 이루어져 온 경험 있다. 전 세계적으로 코로나-19가 유행을 하면서 감염병 확산을 방지하기 위한 검역의 중요성이 강조되고 있는 시점에서 향후 남북한 간의 교류협력이 이루어진다면 항만, 공항 및 육로검역에 대한 실효적 법제화가 마련되어야 할 것이다. 본 연구에서 남북한 검역 협력 법제화에서 제시한 합의서(안)은 기존의 개성공업지구 검역에 관한합의서를 기반으로 코로나-19와 같은 신종감염병에 신속하게 대응할 수 있도록 수정 제안을 하였다. 제시한 검역협력 합의서에서 검역대상과 기준·방법은 남북한의 쌍방으로 들어오거나 나가는 사람과 운송수단 및 화물 즉 운송수단 내의 컨테이너, 운송수단 내 비치용품, 소모용품 및 개인 소지물품에 대해서 검역조사를 받도록 하는 것이다. 또한 검역원칙은 쌍방 간의 검역 절차를 신속하게 하면서도 상호협력 검역으로 검역감염병을 철저하게 예방하고, 감염병이 상대국으로 확산하는 것을 차단함으로써 남북한 교류를 촉진하고 동시에 양측 주민의 건강을 유지·보호하기 위한 조치가 필요할 것이다. 감염병 관리에서 가장 중요한 정보제공은 남북한에서 발생하여 유행 중인 감염병에 대한 정확한 정보를 검역당국 간의 실시간으로 교류하는 것으로 상대측의 감염병 및 방역 관련 자료협조 요청에 대하여 특별한 사정이 없으면 지체없이 응하도록 해야 한다. 신고의무 및 검역조치는 남북한 사람이 대면할 때, 검역감염병이 발생한 지역에 체류하거나 그 지역을 경유하여 들어오는 사람 중 검역감염병을 의심할 수 있는 증상이 있는 사람은 대면 전에 쌍방의 검역 당국에 건강상태 등을 신고하도록 해야 한다. 선박위생 증명서의 발급 등과 같은 검역 관련 증명서 발급은 WHO의 보건규칙(International Health Regulation, IHR)에 따르는 규정을 남북이 모두 준수하도록 한다. 출입국의금지 또는 정지 요청은 쌍방의 검역 당국이 공중보건상 큰 위해를 끼칠 염려가 있다고 인정되는 사람, 동물과 식물에 대하여는 출국 또는 입국의 금지 또는 정지를 요청할 수 있도록 할 필요가 있다. 남북한 경색국면이 지속되는 가운데 코로나-19의 범유행에 따른 남북한 교류협력의 물꼬를 트기위한 보건협력 방안이 제시되고 있다. 보건협력이 논의되는 과정에서 필요한 ｢검역협력합의서(안)｣를마련함으로써 향후 관련 법안의 개정이나 남북 간의 실효적 검역협력하는데 크게 기여할 것이다. The purpose of this study was to establish an inter-Korean cooperation quarantine law system, and to draw up a quarantine agreement (draft), the quarantine-related laws of the two Koreas were reviewed, compared, and analyzed. Accordingly, an agreement (draft) on inter-Korean quarantine was derived as follows. The subject of quarantine, standards and methods of quarantine were to undergo quarantine investigations on people entering or leaving both sides of the South and North Korea, transportation means and cargo, such as containers in transportation means, beach supplies in transportation means, consumables and personal belongings. The quarantine principle was suggested to keep and protect the health of the residents of both sides by speeding up the quarantine procedure between the two sides, thorough prevention of quarantine infectious diseases through mutual cooperation quarantine, and blocking the spread of infectious diseases to other countries. The provision of information is to exchange accurate information on infectious diseases occurring in North and South Korea in real time between the quarantine authorities, and respond to the request of the other party for cooperation with infectious diseases and quarantine-related data without special circumstances. Quarantine notification and reporting shall be made to the head of the means of transport subject to the quarantine investigation, or the name of the means of transport to the quarantine authorities in charge of the relevant means of transport or hikers prior to departure of the means of transport or hikers. And nationality, number of crew members, hygiene status, name and quantity of cargo loaded, name of country of departure, presence of quarantine infectious disease patients, and hygiene status, etc. Reporting obligations and quarantine measures are required when a person from South and North Korea faces a face-to-face, if a person who stays in an area where a quarantine infectious disease has occurred or who enters through the area has symptoms that may be suspected of a quarantine infectious disease, contact the quarantine authorities of both sides before meeting. I had to report back. In the case of an infectious disease patient or a dead person whose cause is unknown in the transportation means passing through both sides, the person in charge of the transportation means immediately informs both quarantine agencies, and the quarantine of both parties who received notification of the infectious disease patient or the deceased The authorities immediately rectified the site and took appropriate measures. For the issuance of quarantine certificates and ship hygiene certificates, both South and North Korea comply with the regulations in accordance with the International Health Regulation (IHR) of the WHO on quarantine. The request for prohibition or suspension of entry and exit allowed the quarantine authorities of both sides to request prohibition or suspension of exit or entry to persons, animals and plants deemed to be likely to cause serious harm to public health. While drawing an agreement (draft) on inter-Korean quarantine, there was a practical limit to accurately grasp North Korea s health care and quarantine system. However, by examining the quarantine legislation between the two Koreas and preparing an agreement (draft), future revisions to related laws, quarantine and It is expected to be an important supporting data for health and medical cooperation. The agreement on inter-Korean quarantine (draft) prepares a plan to overcome the problems of the ｢Agreement on Quarantine of the Gaeseong Industrial District｣, and includes the quarantine location and quarantine time as well as the obligation to report, notification of quarantine, and quarantine investigations in more detail. It was intended to increase the effectiveness of the cooperative quarantine legislation.

효과적 검역체계를 위한 검역법 개선방안

이윤현 ( Yoon Hyeon Lee ),김명성 ( Myeong Seong Kim ),이진홍 ( Jinhong Lee ) 한국보건행정학회 2018 보건행정학회지 Vol.28 No.3

The development of transport is being easily shared with people all over the world. It is necessary to appropriately and effectively revise the domestic quarantine law because the fatal infectious diseases are at risk of being easily shared. Today, Korea has an advanced quarantine system approved by World Health Organization, but it maintains partnerships with related ministries (Ministry of Foreign Affairs, Ministry of Justice, local medical institutions) and to introduce new medical technology (electronic quarantine) is important. And since the prevention of quarantine infectious diseases and prevention of the spread, in order to maintain international cooperation with the International Health Regulations, the quarantine law and the system should be amended and improved effectively and it is also a way to prepare for the outbreak of new quarantine infectious diseases. In the past, Korea has experienced great confusion during the past outbreak of swine flu and Middle East respiratory syndrome coronavirus. To prevent similar cases from recurring in the past, the revision of the quarantine law and the improvement of the system should be done to cope with the changing environment (new infections, increased number of overseas travelers, etc.).

입원의료(入院醫療)의 타중진료권(他中診療圈) 이용에 관한 연구

황성철 ( Sung-chul Hwang ),이윤현 ( Yoon-hyeon Lee ) 한국보건사회연구원 1993 保健社會硏究 Vol.13 No.1

의료전달체계를 실시한 근본적인 목적의 하나가 지역화이다. 이러한 지역화의 일탈된 형태로 나타나는 일부지역 주민들의 타중진료권 입원의료시설 이용의 이유를 밝히고, 중진료권간의 환자이동의 양태를 분석하여 지역별 의료수요에 부응하는 의료공급의 규모를 밝히고자 하였다. 입원의료의 타중진료권 이용률에 대한 다중회귀분석의 결과 해당지역의 입원의료기관의 존재가 중요한 요인으로 부각되었다. 타중진료권의 이용률이 높은 지역은 소규모 도시 또는 농촌지역으로 인구수가 적고 사회경제적으로 열악한 상태에 있으며, 인접 대도시의 유인요인이 강할수록 환자유출이 심하게 나타났다. 이러한 결과를 기초로 친화지역으로의 환자 이동경로를 분석하여 현행 의료전달체계의 문제점을 밝히고 그 대안을 제시하였다. The utilization pattern of medical care services has changed greatly since the implementation of the health care delivery system in 1989. Under the current system, the whole country is divided into eight health service regions and each of them is further divided into 10-20 health service districts in accordance with administrative boundaries. The insured are expected to use all health and medical facilities in their health service distrcits without any restriction except for tertiary hospitals, but visiting a tertiary hospital or using medical facilities in other health service districts requires a referral request from a primary care physician. Central to the system in rationalizing the utilization pattern of medical care services on the part of the consumers and regionalizing the distribution of medical resources on the basis of comsumers` needs. The unequal distribution of medical resources in each Health Service District causes serious problems, for the insured in bypassing medical facilities in their districts. This study investigates factors influencing bypassing medical facilities for the use of in-patient care services in other health service districts and determines the amount of medical resources in each one to meet in-patient care service needs. The findings of this study reveal that the absence of general hospitals largely determines the rate of bypassing and consumers residing in small cities or counties that are often considered to be inferior to large medical facilities show a high rate of bypassing. Implications of these findings have been discussed in conjunction with the way in which regional self-sufficiency of in-patient medical services could be accomplished in the near future. Possible rearrangement of current health service districts has also been addressed in this paper.

교육현장에서 요청되는 리더십에 관한 고찰

이윤현 남서울대학교 2005 남서울대학교 논문집 Vol.11 No.1

This study is aimed to research the types of leadership in school system, especially middle & high school. Today all of our school has many problems in the education system, leadership absence, school violence, dehumanized education and etc. The image against the public education which the citizens see the negation side is less positive convenience than we expected. We disbelieve the school because it is in order for the school not to be able a role in Korea. Now the school must be changed rightly in time and confront to changes of the global standard. It is necessary for us to make a competent leadership which can change our education system. That is servant leadership which will be able to integrate the school system which breaks up. Fist of all, the servant leader must have a love, respect, service and sacrifice spirit. So the school system will develop newly and become the core of the change in Korea.

인터넷 금연컨텐츠 개발에 관한 연구

이윤현 남서울대학교 2003 남서울대학교 논문집 Vol.9 No.-

These days, we are highly interested in our health and the government actively proceeds it0 the programs of national health promotion. For this, it continuously puts budgets and human resources into development of various programs and education of health for prevention of diseases. Among the businesses of national health promotion that are proceeded by the government, smoking prevention programs is noteworthy because ill effects of smoking on health are very serious and wide. According to the 1997 report made by WHO, 68.2% of Korean males who are over 15 years old smoke, which is the highest in the world. The smoking population m Korea is currently expanded to juveniles and females. In 2001, about 500,000 middle and high school students in Korea were estimated to smoke, which means that 7.4% of middle school male students, 3.2% of middle school female students, 27.6% of high school male students, and 10.7% of high school female students smoke. Juveniles' high smoking rate causes a serious problem with health because health in the adolescent period decides one's health in life. The sooner one smokes, the more one gets poisoned to nicotine so one gets to smoke more than others who start to smoke after grown up. The purpose of this study is "Development of the Internet Contents for Cyber Smoking Cessation Program" to promote smoking cessation in adolescents and young women by using on the internet contents. As a r a t of this project, we developed the Internet contents for cyber smoking cessation program, namely, "Dr. smoking" that contained various menu and database regarding anti-smoking designed by resulting this evaluation. The domain address of Dr. smoking is http://www.dmosmoking.com and our homepage has the various kinds of news, informations, self-diagnosis, prescription, consulting, no-smoking mall and so on. Second, 20 students of Nam Seoul University who want to stop smoking have participated in this study - 11 people for the control group and 9 for the comparison(uncontrolled) group. The control group has received both on-line education available on the homepage and off-line education available in the antismoking class opened in Department of Health and Management of Nam Seoul University for comparison. The comparison group has used the existing ways to stop smoking. The controlled group has shown more effects - 1.8 times higher in terms of the rate of practicing no smoking for a month, 2.4 times higher in quantity of smoking cigarettes, and 1.5 times higher in attitudes toward smoking. The above results say that if the existing ways to stop smoking and the cyber programs are combined for juveniles and females, it will get higher effects. Finally, this contents, "Dr. No Smoking" developed by this research will make a big contribution to lowering the rate of smoking in Korea, together with the existing antismoking contents.

대형 종합병원(3차기관)의 진료실적 및 환자의 지역분포에 관한 연구

이윤현 中央醫學社 1992 中央醫學 Vol.57 No.6

Virtually the whole population is covered by medical care under social security in Korea as of July 1, 1989. The health care system has been undergoing rapid change, and face rising costs through the problems posed by rising expectations on the part of consumers and providers and increasing demands for the quality care. In particular, to cope with the expansion in the volume of claims in tertiary care hospital, government has introduced Health Care Delivery System. This new system pohibited insured persons from random use of health facilities. They were not allowed to use secondary or tertiary medical facilities without the approval of primary care physicans. The main aim of the present study is to review status quo of the current health care delivery system, analyze the problems and the recommendations base on efficiency and equity concept through eight health care regions. First, the level of inpatients days per claim increased 13.4 days in 1990 to 13.8 days in 1991 in the medical treatment of tertiary care hospital, and from 1.6 days to 1.7 days in the outpatient volume. Second, the whole nation was regionalized into the Eight Health Service Regions. If patients want to see a specialist in the other Health Service Regions, they should get a permit from their insurance society as well as a primary care physician's referal request. This, however, raised a serious problem of equity between the Metropolitan Erea and the others. The problem of inequity has been caused by the ubiquity of health resources among health services regions. Third, the major barrier to equiable access to the health care system is the lack of a regular health resources in each health service regions. The government should make a decision to adopt the regulated system of health care delivery as the impartial sharing of health resources.

3次診療機關의 地域化 및 機能分化에 關한 分析

李允鉉 한국인구보건연구원 1992 保健社會論集 Vol.12 No.1