민간의료보험 가입의 영향요인 -신규가입과 추가가입을 중심으로-

현숙정 ( Sook Jung Hyun ) 경희대학교 경영연구원 2015 의료경영학연구 Vol.9 No.4

Inequality in health care utilization caused by unequal access to health insurance, specially increased purchase of private health insurance (PHI). In order to overcome such limitations, this study analyzed whether the person with PHI, new PHI purchase and additional PHI purchase have or have been selected by insurance companies’ customer selections bias. Used data comes from Korea Health Panel Survey (KHPS) from 2008 to 2011. As a result, the second, the third, and the highest quartile group in household income have 1.73 times, 2.96 times, and 3.73 times more PHI, respectively, than the lowest quartile group. It means that there was inequality in PHI purchase according to income. And less chronic disease patients purchased more new PHI, additional PHI than more chronic disease patients. It indicate that there are limitations in PHI purchase due to chronic diseases. By analyzing the influence factors of new PHI and additional PHI, which were not studied previously, the study was able to prove the existence of customer selection process in PHI purchases. Inequality in PHI purchase by chronic disease patients may have inequality in health care utilization. So it need to be political approach to purchase PHI with equality. Also, It need to recognize that fixed-benefit plans and indemnity plans should be approached in a different manner.

지방의료원의 의료서비스 품질과 가치, 명성, 고객만족 및 병원애호도 사이의 상호관련성 연구

강현수 ( Hyun Soo Kang ),이문성 ( Munsung Rhee ),현숙정 ( Sook Jung Hyun ) 한국병원경영학회 2015 병원경영학회지 Vol.20 No.4

This study attempts to investigate how healthcare service quality impacts upon hospital reputation, service value, and customer satisfaction. Additionally, the association of customer satisfaction with hospital loyalty and the mediation role of service value and reputation are examined. Analysis results can be summarized as followings: First, the procedural convenience and efficiency have significant impact upon customer satisfaction but personnel service and service scape do not significantly affect customer satisfaction. Second, the personnel service and service scape have significant impacts upon both the service value and hospitals? reputation. Third, service value and hospital reputation contribute significantly to the customer satisfaction. Fourth, customer satisfaction enhances significantly customer`s satisfaction and intention to recommend. We conclude that a regional medical center should be able to offer high quality medical services to its customers to satisfy or delight them. Only the satisfied customers will have intention to revisit the medical center or to recommend it to their friends.

농촌지역 보건소 중심의 노인 통합보건의료서비스 필요도

원은숙(Eun-Sook Won),김춘배(Chun-Bae Kim),장세진(Sei-Jin Chang),박종구(Jong-Ku Park),현숙정(Sook-Jung Hyun) 한국농촌의학 지역보건학회 2007 농촌의학·지역보건 Vol.32 No.1

한 농촌지역의 일부 노인인구를 대상으로 통합보건의료서비스의 필요도와 그 관련 요인을 파악하고자 시행한 이 연구대상은 2005년 11월부터 2개월여동안 강원도 ‘H’군보건소를 내원한 60세 이상 노인으로 진료담당 의사와 보건요원(2명)에 의해 설문조사가 실시되었는데, 총 110명이 참여하였다. 연구도구인 설문지는 노인 통합보건의료서비스에 대한 국내외선행연구의 문헌고찰을 토대로 개발한 후 예비조사를 거쳐 5개 영역의 68개 문항으로 수정, 보완하였다. 수집된 자료는 SPSS PC?(Version 12.0)를 이용하여 데이터베이스를 구축하여 대상자의 인구사회학적 특성, 만성질환의 이환상태 등을 파악하였고, 영향요인 구명을 위해 위계적 다중회귀분석을 시행하였으며, 그 결과는 다음과 같다. 첫째, 만성질환 이환율로는 고혈압이 76.4%(8명)로 가장 높았으며, 대상자 중 84명은 2개 이상의 만성질환에 동반 이환되어 있었다. 둘째, 보건소내 기존 서비스의 만족도조사에서는 진료서비스와 물리치료에 84명(78.5%)과 16명(66.7%)이 각각 ‘만족한다’고 하였다. 노인 통합보건의료서비스에 대한 필요도는 전체 평균이 3.67점이었고, 보건의료 영역의 방문간호서비스(평균 4.08), 만성질환관리(평균 4.06) 및 복지 영역의 운송서비스(평균 4.05) 순으로 그 필요도가 높았다. 셋째, 영역별 서비스 필요도의 영향 요인을 파악하기 위해 위계적 다중회귀분석을 실시한 결과, 모형Ⅰ(인구사회학적 특성)에서 복지 영역 서비스의 필요도(수정 R²=7.2%)와 전체(보건의료+복지) 영역 서비스의 필요도(수정 R²=6.5%)에 소득 변수만이 통계적으로 유의하였다. 모형Ⅱ(인구사회학적 특성에 건강관심도, 신체기능상태와 건강행태 포함)에서도 복지 영역 서비스의 필요도(수정 R²=10.9%)가 적합하였고, 소득이 많을수록, 건강관섬도가 높을수록 통계적으로 유의하였다. 진료만족도가 추가된 모형Ⅲ에서는 보건의료 영역 서비스(수정 R²=5.3%), 복지 영역 서비스(수정 R²=15.2%) 및 전체 영역 서비스(수정 R²=12.4%)의 필요도가 모두 적합하되 소득 변수만이 각각 통계적으로 유의하였다. 따라서 보건의료의 측면에서 노인들에 대한 효과적이고 다양한 보건의료서비스의 제공이 시급하게 요구되고 있으며, 이를 충족시킬 수 있는 통합적인 공급체계를 확립해야 할 것이다. 더욱이 고령화가 더욱 심화될 농촌지역은 노인 개개인의 필요도 중심에서 출발하되 이들이 거주하는 가족환경 및 사회환경을 포괄하는 차원에서의 지역보건, 만성질환의 치료와 신체 기능의 회복을 위한 의료, 경제적 지원과 가용자원의 활용을 도와주는 복지 개념이 연계된 통합보건의료서비스를 다학제적 팀접근에 의해 지속적으로 제공할 필요가 있다. 특히, 우리나라의 경우 예방보다 치료 중심의 의료 전달체계로 되어 있어 다발성의 만성퇴행성 질환에 이환된 노인들에게 종합적으로 수용할 수 있는 장기간의 간호나 재활서비스를 제공할 수 있는 프로그램이 우선적으로 제공되어야 한다고 본다. Objectives: The challenge of an increasing elderly population has coupled with everpresent social concerns in Korea. A major problem in health center for the frail older people is that medical, healthcare, and welfare services are often fragmented in terms of providers and settings without appropriate coordination. The purpose of this study was to investigate the need of health center-based integrated healthcare services and its related factors for the elderly. Methods: A total of 110 elderly people who had visited at a county Health Center were interviewed using a self-administered questionnaire from November to December, 2005. The questionnaire consists of five domains according to the Program of All-inclusive Care for the Elderly. Results: Respondents had high need (total mean score with the 5-point Likert-type sacle: 3.67) of health center-based integrated healthcare services including home visiting service (mean: 4.08), chronic disease care service (mean: 4.06), and transportation service (mean 4.05). According to the results of hierarchical multiple regression analysis, among three regression models the magnititude of the variance of full model that is explained by the need of welfare-domain service was significantly larger than two reduced model. Income was a significant variable in increasing the need of health care and welfare services. Conclusions: This study suggests that the health center-based integrated healthcare services for the elderly must be continuously developed and provided for the health promotion and improved the quality of life of the elderly who live in rural area in Korea.

우리나라 직장인 피로의 역학적 특성

장세진,강명근,현숙정,차봉석,박종구,박준호,김성아,강동묵,장성실,이경재,하은희,하미나,고상백,Chang, Sei-Jin,Kang, Myung-Gun,Hyun, Sook-Jung,Cha, Bong-Suk,Park, Jong-Ku,Park, Jun-Ho,Kim, Seong-Ah,Kang, Dong-Mug,Chang, Seong-Sil,Lee, Kyung-Jae 대한예방의학회 2005 예방의학회지 Vol.38 No.1

Objective : To elucidate the correlates of self-rated fatigue in Korean employees. Methods : The data for 10,176 (men, 7,984; women, 2,192; mean age, 34.2; SD: 8.8) employees recruited from a nationwide sample were examined. A structured questionnaire was used to measure the participants' fatigue, sociodemographics (sex, age, education, and marital status), job-related characteristics (work duration, grade at work, work hours, shiftwork, employment type, and magnitude of workplace), and health-related habits (smoking, drinking, coffee intake, and exercise). Two types of measurement for fatigue were used to evaluate the magnitude of fatigue: self-rated question and a standardized measurement tool (Multidimensional Fatigue Scale: MFS). Results : According to the self-rated fatigue, 32% of employees reported that they felt fatigue for the past two weeks, and 9.6% of males and 8.7% of females had experienced excessive fatigue (6 months or more). Hierarchical multiple regression analysis showed that fatigue measured by MFS was more common in women, younger, college or more graduated, single, and employees who do not regularly exercise. Fatigue was also associated with long work hours, and the size of the workplace (<1,000 employees). Conclusions : These results suggest that fatigue has been considered as a common complaint, and that it is affected by job-related factors like work hours and the workplace size as well as sociodemographics or health-related behaviors. Further research is needed to clarify the effects of fatigue on adverse health outcomes, work performance, work disability, sick absence and medical utilization, and to examine the relationship of job characteristics (e.g.: work demand, decision latitude) to fatigue.

우리나라 농업인의 직무스트레스와 피로

이기현(Ki-Hyun Lee),고상백(Sang-Baek Koh),강동묵(Dongmug Kang),정진주(Jin-Joo Chung),김형렬(Hyoung-Ryoul Kim),김인아(In-Ah Kim),이경숙(Kyung-Suk Lee),현숙정(Sook-Jung Hyun),이강명(Kang-Myoung Lee),윤진하(Jin-Ha Yoon),김성경(Sung-Kyun 대한직업환경의학회 2011 대한직업환경의학회지 Vol.23 No.2

일부 농촌지역 주민의 BMI 관련요인

장세진(Sei Jin Chang),현숙정(Sook Jung Hyun) 한국보건교육건강증진학회 2006 한국보건교육·건강증진학회 학술대회 발표논문집 Vol.- No.-

우리나라 직장인 스트레스의 역학적 특성

장세진,강명근,차봉석,박종구,현숙정,박준호,김성아,강동묵,장성실,이경재,하은희,하미나,고상백,Chang, Sei-Jin,Kang, Myung-Gun,Cha, Bong-Suk,Park, Jong-Ku,Hyun, Sook-Jung,Park, Jun-Ho,Kim, Seong-Ah,Kang, Dong-Mug,Chang, Seong-Sil,Lee, Kyung-Jae 대한예방의학회 2005 예방의학회지 Vol.38 No.1

Objective : To estimate the magnitude of psychosocial distress and examine eligible factors associated with the development of psychosocial distress in Korean employees, using a nationwide sample. Methods : A total of 6,977 workers were recruited from 245 companies. A structured questionnaire was used to assess sociodemographics, health-related behaviors, job characteristics, social support at work, personality traits (locus of control, type A behavior pattern), self-esteem, and psychosocial distress. Results : The results showed that 23 % of workers were categorized as high stress, 73% as moderate, and 5% as normal. Hierarchical multiple regression analysis showed that psychosocial distress was more common in younger workers, both male and female. Regular exercise was negatively associated with increase of psychosocial distress. In job characteristics, as expected, low decision latitude, high job insecurity, and low social support at work were related to high psychosocial distress. Personality traits such as locus of control and type A behavior pattern, and self-esteem were more powerful predictors of psychosocial distress than general characteristics, health-related behavior, and job characteristics. There were some gender differences. While men who are less educated and single (unmarried, divorced, and separated) experienced higher levels of psychosocial distress than those who are educated and married, women who feel high job demand experienced higher levels of psychosocial distress than those who feel low job demand. Conclusions : The proportion of the high stress group was higher than expected, and psychosocial factors like social support and personality characteristics (e. g. locus of control, type A behavior pattern and self-esteem) were more significant factors for psychosocial distress than other variables. This finding suggests that some psychosocial factors, especially inadequate social support, low self-esteem and lack of internal locus of control for the development of psychosocial distress, will also operate as an intervention strategy in the worksite stress reduction program. It is strongly required that worksite stress reduction programs should be established in at both occupational and level as well as in individual levels.

일부 지역주민의 비만 수준과 비만 관련요인

박종구(Jong Ku Park),고상백(Sang Baek Koh),강명근(Myung Gun Kang),김진백(Jin Back Kim),현숙정(Sook Jung Hyun),홍주희(Ju Hee Hong),박준호(Jun Ho Park),장세진(Sei Jin Chang) 한국역학회 2004 Epidemiology and Health Vol.26 No.2

Objective: The aim of present study was to assess the distribution and correlates of obesity in a Korean rural people using both body mass index(BMI) and body far percent. Methods: A total of 1,243 participants were recruited using a two-staged stratified sampling. A structured questionnaire was used to ask their sociodemographics (gender, age, marital status, educational background, and etc.) and health-related behaviors (smoking, drinking, and regular exercise etc.). The data of weight-for height, and body fat percent were also collected by physical examination. POI' the estimation and analysis of con-elates of obesity, we used BMI(≥25kg/㎡) and body fat percent(male≥25%, female≥30) as a cut-point of obesity. All analyses were stratified to three age groups(<20,20-39,40≥). Results: The prevalence of obesity in this study was higher than that in previous studies. This study showed that 32.6% (male: 33.7%, Female: 31.7%) of participants according to BMI, and 45.6% (male: 43.8%, female: 47.4%) of them according to body fat percent were obese group. Logistic regression analysis showed that, in the criteria of BMI, while obesity was associated with female and low educational background under the age of 40, prevalence of obesity was higher in non smokers over the age of 40. In case of body fat percent crteria, single(unmarried, divorced, separated, widowed) were more likely to be obese in male aged 20 to 39 years. In the group aged 40 years and over, risk of obesity was higher in female than in male. Conclusion: This result suggests that obesity is common in Korean rural areas, especially among adolescents and female aged 40 years or over, and the risk factors for obesity were different by age. It is required that health management program focusing on obesity and its adverse outcomes should be developed in a community setting.

직무스트레스와 심혈관계질환 위험요인과의 상관성

고상백(Sang Baek Koh),장세진(Sei Jin Chang),박종구(Jong Ku Park),박준호(Jun Ho Park),손동국(Dong Koog Son),현숙정(Sook Jung Hyun),차봉석(Bong Suk Cha) 대한직업환경의학회 2005 대한직업환경의학회지 Vol.17 No.3

국가필수예방접종 보장범위 확대 시범사업의 정책 내용분석 -국가필수예방접종 공급방식을 중심으로-

김춘배 ( Chun Bae Kim ),안양희 ( Yang Heui Ahn ),차병호 ( Byung Ho Cha ),김효열 ( Hyo Youl Kim ),이석구 ( Sok Goo Lee ),이중정 ( Jung Jeung Lee ),박혜숙 ( Hye Sook Park ),신택수 ( Taek Soo Shin ),현숙정 ( Sook Jung Hyun ),고운영 ( 한국보건행정학회 2008 보건행정학회지 Vol.18 No.3

The purpose of this study was to evaluate comparatively the content of the Expanded National Immunization Program according to the provision method between 2005 and 2006 in Korea. We assessed the impact of the mutually exclusive vaccination policy using the result reports of the 2005 and 2006 Demonstration Project and the related references by the content analysis. The public health centers paid vaccination fees to the private clinic and hospital in the 2005 Demonstration Project in Daegu metropolitan city and Gunpo city. But, the public health centers directly supplied free vaccination services to the children in the 2006 Demonstration Project in Gangneung city, Yangsan city, and Yeongi-gun. The total budgets of 2005 and 2006 Demonstration Project were 6.57 billion won and 0.65 billion won, respectively. The computerized registration rates and timeliness rates of administration of each vaccination had improved all in the 5 Demonstration Project regions. However, the computerized registration rates of most vaccination in Gunpo city were higher than those in the 2006 Demonstration Project regions except hepatitis B. Especially, the computerized registration rate of BCG was 48.3%, but the BCG coverage rate by the follow-up telephone survey was 99.8% in Daegu metropolitan city. The community parents in all the regions were satisfied because of expanding financial and geographical access to immunization coverage. In conclusions, from the aspect of the main outcomes, the implementation of two different financial immunization aids appears to be widely accepted among these parents and to have had an impact on vaccination coverage. In the future, the government must try to enact that the national immunization policy including under-immunised or incompletely immunised groups would be achieved by the affordable method of the public-private dynamics.