모아의 환경적 건강에 대한 출산 코호트 효과: 체계적 고찰

채정미 ( Jungmi Chae ),김현경 ( Hyun Kyoung Kim ) 한국여성건강간호학회 (구 여성건강간호학회) 2021 여성건강간호학회지 Vol.27 No.1

Purpose: This study aimed to review recent findings from birth cohort studies on maternal and child environmental health. Methods: Birth cohort studies regarding environmental health outcomes for mothers and their children were investigated through a systematic review. A literature search was conducted in PubMed, CINAHL, the Cochrane Library, Embase, and RISS to identify published studies using the keywords using a combination of the following keywords: maternal exposure, environmental exposure, health, cohort, and birth cohort. Articles were searched and a quality appraisal using the Newcastle-Ottawa Scale for cohort studies was done. Results: A review of the 14 selected studies revealed that prenatal and early life exposure to environmental pollutants had negative impacts on physical, cognitive, and behavioral development among mothers and children up to 12 years later. Environmental pollutants included endocrine disruptors, air pollution (e.g., particulate matter), and heavy metals. Conclusion: This systematic review demonstrated that exposure to environmental pollutants negatively influences maternal and children’s environmental health outcomes from pregnancy to the early years of life. Therefore, maternal health care professionals should take steps to reduce mothers’ and children’s exposure to environmental pollutants.

의료기관별 간호인력 활용방안

홍지연(Hong, Ji Yeon),채정미(Chae, JungMi),송미라(Song, Mi Ra),김은미(Kim, Eun Mi) 한국산학기술학회 2017 한국산학기술학회논문지 Vol.18 No.8

본 연구는 중소병원 간호인력 현황과 관련 정책을 분석하고 인력 확보에 영향을 주는 요인을 파악하여 중소병원 간호인력 확보를 위한 정책을 입안하고 결정하는 데에 근거를 제시하고자 실시되었다. 보건복지부와 건강보험심사평가원 등에서 제시한 통계자료를 2차 분석한 후 그 결과를 다양한 내·외적 보건의료환경에 대한 이해를 기반으로 조명하였다. 연구결과 우리나라의 활동 간호사 수는 면허간호사 수의 50% 미만으로 그 수는 해마다 감소하고 있었으며, 이는 간호대학 정원 증가의 비용 대비 성과의 효율성을 재고할 필요가 있음을 의미한다. 또한 간호관리료 차등제 실시로 인해 신규간호사는 물론 간호사 인력부족이 심각한 중소병원의 경력간호사들이 상급종합병원으로 이동하게 되는 결과를 야기하였으며, 결국 중소병원 간호인력 부족 현상을 더욱 악화시키는 원인이 되었다. 따라서 입원환자 간호관리료 차등제가 중소병원 간호인력 확보정책으로 실효성이 있는지에 대한 재검토가 필요하며, 면허간호사에 대한 추적 관리 시스템을 통해 간호인력 수급의 불균형을 해소할 수 있어야 한다. This study analyzed the current situation of medium and small-sized hospital nursing staff and related policies, and identified the factors that affect staffing level to provide evidence for planning and adopting policy. By analyzing the statistical data published by public institutions such as the Ministry of Health and Welfare and Health Insurance Review and Assessment Service, the result was viewed based on the understanding of various internal and external health care environments. The number of active nurseswasless than 50% of the number of licensed nurses and has decreased every year. This means that the cost-effectiveness of increases in nursing college enrollment should be reconsidered. Inpatient nursing fees by staffing grades has caused nurses to move from medium and small-sized hospitals, where there is a severe lack of staff, to more advanced general hospitals. As a result, the lack of nursing staff in medium and small-sized hospitals has worsened. In conclusion, reexamination is needed to improveeffectiveness of inpatient nursing fees by staffing grades as a policy to secure the workforce of medium and small-sized hospitals. Furthermore, the tracking management system of licensed nurses must be able to solve the imbalance betweendemand and supply of nursing staff.

자동차보험 한방진료비 증가요인 분석

이창수(Lee ChangSoo),이현주(Lee Hyeon Ju ),채정미(Chae JungMi) 한국산학기술학회 2019 한국산학기술학회논문지 Vol.20 No.1

자동차보험 총 진료비는 2014년 대비 2015년 12% 증가하였으나 그 중 한방진료비는 36% 증가하였다. 본 연구 목적은 진료비 항등식을 이용하여 자동차보험 한방진료비의 급격한 증가 원인을 구체적으로 파악하는 것이다. 2014년~2015년 기간 중 진료하여 심사 완료된 34,351,120건의 데이터를 이용하여 분석한 결과 한방 환자수는 해당 기간 중 27%, 환자당 진료비는 7% 증가하였다. 환자당 진료비를 세분화하여 분석한 결과, 환자당 입(내)원 일수는 변하지 않았으며 일당진료비만 7% 증가하였다. 환자수 증가를 보면 한방진료만을 받은 환자는 32%, 의과와 한방을 함께 진료 받은 환자는 24% 증가한 반면 의과진료만을 받은 환자는 오히려 4% 감소하였다. 일당진료비 증가에 영향을 미치는 요인으로는 한방물리요법 등 표준화되지 않은 진료행위의 비용 상승이 있다. 그럼에도 불구하고 한방 진료비 증가에 가장 크게 영향을 미친 요인은 환자수의 증가였다. Automobile insurance medical expenses increased by 12% in year 2015 compared to year 2014. But the oriental medical service expenses in automobile insurance increased by 36% during the same period. In this paper the reason for the rapid increase of expenses for oriental medical service was analyzed using the method of decomposing medical expenses. As a result of analyzing 34,351,120 cases that were examined and completed during the period of 2014∼2015, the number of oriental medicine patients increased by 27% and the medical expense per patient increased by 7%. The result of analysis showed that there was no significant change in service period per patient but medical expense per day increased by 7%. The increase in the number of patients receiving only oriental medical services was 32%. Increase in the number of patients receiving medical treatment and oriental medical services was 24% and the number of patients receiving medical treatment only decreased by 4%. There was significant increase in non standardized cost of oriental physical therapy which was one reason of the increase of the expenses. However, the most influential factor of the increase in the expenses of oriental medical services was the increase of the number of patients.

인구구조의 변화를 반영한 건강보험 진료비 추계

이창수(Lee, ChangSoo),권혁성(Kwon, HyukSung),채정미(Chae, JungMi) 한국보건간호학회 2017 韓國保健看護學會誌 Vol.31 No.1

Purpose: This study was conducted to suggest a method for financial projection of health insurance expenditures that reflects future changes in demographic structure. Methods: Using data associated with the number of patients and health insurance cost per patient, generalized linear models (GLM) were fitted with demographic explanatory variables. Models were constructed separately for individual medical departments, types of medical service, and types of public health insurance. Goodness-of-fit of most of the applied GLM models was quite satisfactory. By combining estimates of frequency and severity from the constructed models and results of the population projection, total annual health insurance expenditures were projected through year 2060. Results: Expenditures for medical departments associated with diseases that are more frequent in elderly peoples are expected to increase steeply, leading to considerable increases in overall health insurance expenditures. The suggested method can contribute to improvement of the accuracy of financial projection. Conclusion: The overall demands for medical service, medical personnel, and relevant facilities in the future are expected to increase as the proportion of elderly people increases. Application of a more reasonable estimation method reflecting changes in demographic structure will help develop health policies relevant to above mentioned resources.

항생제 사례로 살펴본 건강보험청구자료 분석 시 고려사항

김예슬,채정미,신지혜,김유정,조가영,지승연,김동숙 건강보험심사평가원 2023 HIRA RESEARCH Vol.3 No.2

The Health Insurance Review & Assessment Service (HIRA) collects and stores medical information of all citizens and medical institutions, including pharmaceutical claims data. Claims data including consultation notes and information about the medical institution are submitted to the HIRA by medical providers. Claims data have potential to offer a high quality for research, but various factors must be strongly considered in its analysis and interpretation. This study highlights various points to be considered while utilizing claims data. First, the time period between a claims review and loading of the data onto a data warehouse (DW) must be taken into account because over 99% of claims are available on DW for extraction after 5 months, according to an analysis of claims rate for pharmaceutical expenses. Second, over 50% of pharmaceutical claims data consists of reimbursable items, of which over 99% are antimicrobial medications. Accurate determination of the precise usage of nonreimbursable pharmaceuticals is limited to estimations based on the data on pharmaceutical supply declaration, which is only partially reported on claims statements as part of the comprehensive fees system. Finally, complete data on the use of pharmaceuticals during inpatient admission is unavailable. Due to the lack of requirement to input the administration time or to differentiate prescriptions on the day of discharge, it is difficult to accurately calculate the used amounts. These factors must be considered prior to analysis and interpretation of claims data from the HIRA. Hence, to ensure a higher research quality, we recommend considering these factors when conducting a claims data-based research.

연령에 따른 근무환경 및 의료기관 특성이 간호사 이직에 미치는 영향

이요셉,김정림,김소희,채정미 건강보험심사평가원 2022 HIRA RESEARCH Vol.2 No.1