일본 건강보험의 한약 급여제도 현황

현은혜,임병묵 대한예방한의학회 2022 대한예방한의학회지 Vol.26 No.1

Background & Objectives : As the government of South Korea implemented policies to strengthen health insurance coverage, the health insurance benefit for raw herbal medicines has been promoted. This study investigated the current status of the herbal medicines coverage in the Japanese national health insurance to secure reference data for the design of herbal medicines coverage in South Korea. Methods : Literature review was conducted to collect and analyze the history and current situation on herbal medicines coverage in the Japanese health insurance system. To supplement the contents not presented in the documents, on-site interviews were conducted at the medical institutions and pharmacies that prescribed or prepared herbal medicines in Tokyo, Japan. The contents of the survey included the background and progress of the herbal medicines coverage, the status of herbal medicines use, the payment system, and the safety management of herbal medicines. Results : Since the introduction of health insurance in the 1960s, Japanese insurance system has covered herbal medicines, and so far, it has been maintained without any additional restrictions. When the raw herbal medicines are prescribed to outpatients, the preparation fee is set higher than that of other medicines, but overall payment regulations and systems for herbal medicine are generally the same as other medicines. Conclusions : The case of Japan can be a useful references and implications for national health insurance policy on herbal medicines in south Korea.

자동차보험 의료 제도에 대한 임상의의 인식

박지선,현은혜,도영경 한국보건사회연구원 2023 保健社會硏究 Vol.43 No.3

자동차보험은 일차적으로는 자동차의 운행에 따르는 인적·물적 손해배상을 보장하는 제도이나, 교통사고환자가 의료기관에서 진료를 받아 발생한 의료비를 보험회사가 의료기관에 지급하고, 그러한 기전을 통하여 궁극적으로 의료의 질과 환자의 건강에 영향을 미칠 수 있다는 점에서 의료 제도의 성격 또한 지닌다. 그러나 의료 제도로서의 자동차보험에 대한 연구는 부족하다. 이 연구에서는 교통사고환자를 진료하는 임상의를 대상으로 자동차보험 의료 제도에 대한 인식을 기술하고 관련 요인을 탐색하기 위하여 수행되었다. 교통사고환자 진료를 담당하는 7개 진료 과목의 임상의 145명을 최초 접촉하였고, 1차 설문조사(2021년)에 128명, 2차 설문조사(2022년)에 다시 76명이 참여하였다. 임상의들은 전반적으로 자동차보험 의료 제도의 효과성을 건강보험 및 산재보험에 비해 낮게 보고하였다. 특히 3분의 2 이상이 자동차보험 의료 제도하에서는 다수의 경증 환자에게 과다 의료 제공이 이루어지고 소수의 중증 환자에게 과소 제공이 이루어지고 있다고 인식하였다. 약 80%가 자동차보험 중증 환자 진료 시 적정진료 제공에 제약이 있다고 보고했으며, 이 제약은 주로 진료비 인정 항목의 제한된 적용에 기인한 것으로 나타났다. 자동차보험 의료 제도의 효과성에 대한 인식은 진료과목과 자동차보험 중증 환자 비율, 중증 환자 적정진료 저해 경험에 따라 차이를 보였다. 이러한 결과는 자동차보험을 경제적 손실 배상이라는 전통적인 역할에 한정하지 않고 의료 제도로 적극적으로 인식하고 그 효과성을 개선해야 할 필요성을 시사한다. While car insurance primarily serves as a system designed to compensate for casualties and property damages resulting from road traffic accidents, it also encompasses features of a medical system, providing coverage for medical expenses incurred by road traffic injury patients. This study aimed to describe clinicians' perceptions of the institutional effectiveness of the car insurance medical system in treating patients with road traffic injuries and explore factors associated with perceived effectiveness. A total of 145 clinicians from seven medical specialties were initially contacted. In the first survey conducted in 2021, 128 clinicians participated, and in the second survey conducted in 2022, 76 participated again. Clinicians, overall, rated the institutional effectiveness of the car insurance medical system lower than that of National Health Insurance and Workers' Compensation Insurance. Of the five patterns of care provision presented, ‘overprovision among most, non-severe patients with low care needs and underprovision among a small proportion of severe patients with high care needs’ was chosen as the dominant pattern under the current car insurance medical system by more than two-thirds of the survey participants. Furthermore, approximately eighty percent of clinicians reported facing barriers to providing appropriate care for severe road traffic injury patients, largely due to the restricted application of covered services. The perceived institutional effectiveness of the car insurance medical system varied based on specialty, the proportion of severe road traffic injury patients regularly seen, and limitations on appropriate care provision for this patient group. Taken together, these results indicate the need to actively recognize car insurance as a medical system, going beyond its conventional role of providing compensation, and to improve its institutional effectiveness.

한약재의 연도·산지·업체별 가격변동 분석 연구

김동수,임병묵,현은혜,이은경,Kim, Dongsu,Lim, Byungmook,Hyun, Eunhye,Lee, Eunkyung 대한예방한의학회 2019 대한예방한의학회지 Vol.23 No.2

Objectives : This study aimed to analyze price variance by year, region and company of raw herbal medicines to draw payment system for herbal medicine insurances in the National Health Insurance. Methods : To analyse price variance, we used 2015-2017 data of 'Quality test results of imported herbal medicines' provided by Korea Pharmaceutical Traders Association and 'Price data of 56 raw herbal medicines' that was surveyed by the Association of Korean Medicine. We analysed gap of highest price and lowest price those were compared with average price and coefficient of variation(CV) of prices by year, region and company of raw herbal medicines. Results : In analysing 3 years data, the highest price was 23.2% higher, and the lowest price was 19.1% lower than the average price. As of 2018, the average price of domestic produced herbal medicines was 1,8 times higher than that of imported herbal medicines. By companies, the highest price was 117.5% higher, and the lowest price was 57.3% lower than the average price. Conclusions : The price of herbal medicines varied by production year, region and company. This results suggest that comprehensive payment model needs to be considered in modeling the health insurance coverage for herbal medicine decoctions.

침술의 마약성 진통제 남용 해결을 위한 미국 의료정책 고찰

김주철(Juchul Kim),현은혜(Eunhye Hyun),김동수(Dongsu Kim) 대한한의학회 2020 대한한의학회지 Vol.41 No.2

의학전문대학원생의 죽음에 대한 태도와 공감능력이 자살충동억제의지에 미치는 영향

이수현,최은혜라,김성수 한국의료윤리학회 2012 한국의료윤리학회지 Vol.15 No.2

The purpose of the study was 1) to examine the relationship between medical students’ attitudes toward death and their suicidal impulse control and 2) to investigate the effects of empathy on death attitudes and suicidal impulse control. A questionnaire was developed consisting of six death-attitude factors, a suicidal impulse control item, and two empathy related items. The questionnaire was administrated to medical students at one university in Pusan, South Korea. One hundred and six completed questionnaires were analyzed. The results show that the more often respondents think about death and consider death as liberation, the lower their ability is to control suicidal impulses. Respondents who avoided thinking about death or who thought the impact of their death on their family members would be high were more likely to have a higher level of control of suicidal impulses. The impact of their own death on family members was most strongly correlated with an attitude toward death as a natural part of life. Regarding the effects of empathy on suicidal impulse control, cognitive empathy had a stronger correlation with suicidal impulse control than affective empathy. The results of regression show that cognitive empathy has the strongest effect on suicidal impulse control compared to other significant factors. The results of this study imply that the causes of suicide are not limited to the conventional psychological factors, such as depression. Understanding attitudes toward death and empathy could enhance society’s continuing efforts to reduce suicide among college students generally and medical students in particular.

한국형 건강정보이해능력 측정도구(Korean Health Literacy Assessment Tool)의 비교 및 개선 방안

이수현(Su Hyun Lee),최은혜라(Eun Hye Ra Choi),제민지(Min Ji Je),한흥식(Heung Sik Han),박병규(Byung Kyu Park),김성수(Sung Soo Kim) 한국보건교육건강증진학회 2011 보건교육건강증진학회지 Vol.28 No.3

유방암 환자의 우울장애 예측변인

하은혜,서주은,정준,양정현,남석진,백혜진,이정언 한국임상심리학회 2008 Korean Journal of Clinical Psychology Vol.27 No.4

The purpose of this study was to examine the prevalence and analyze the various predictors of depressive disorder in women with breast cancer on the basis of biopsychosocial model. A total of 128 breast cancer patients were recruited, and they were assessed on the basis of cancer-related variables, sociodemopraphic variables, symptoms of depression, cancer-related somatic symptoms, and psychosocial variables (optimism, self esteem, husband support). The results showed that 31% of the patients exhibited a high level of depressive symptoms, and 14% of the patients were classified as having depressive disorder. The 4-step hierarchical binary logistic regression analysis was significant, and the rate of correct prediction was 94.9%. Before entering the psychosocial variables, none of the cancer-related variables, sociodemographic variables or cancer-related somatic symptoms was significant. The high risk of depressive disorder in breast cancer patients was associated with a personality trait. The results supported that depressive symptomatology in breast cancer patients is not associated with objective variables, but rather that it is very strongly linked with psychological variables. Finally, the implications for the identification of and psychosocial intervention for depressive disorder in breast cancer patients were discussed.

2) 초음파 장비의 해상도 비교 평가

홍은혜,김정웅,강대현 대한방사선사협회 1999 대한방사선사협회지 Vol.25 No.1

유방암 환자의 삶의 질 예측요인

하은혜,이선희,정준,이희대,이정언,남석진,양정현 한국유방암학회 2010 Journal of breast cancer Vol.13 No.2

Purpose: The purpose of this study was to identify biopsychosocial predictors of the quality of life in breast cancer patients. Disease factors (disease stage, type of surgery, type of treatment, family history), personal factors (age,education level, income), and psychosocial factors (psychological symptoms, optimism, self-esteem, husband’s support, cancer coping) were included in biopsychosocial predictors. Methods: A total of 128 breast cancer patients were recruited. Subjects were assessed by the Optimism Scale, the Selfesteem Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Breast Cancer Module (EORTC QLQ-BR23), the Symptom Checklist-90-Revision (SCL-90-R), and the Korean Cancer Coping Questionnaire (KCCQ). Results: Disease factors and personal factors were not different between the high and low quality of life group. But the psychosocial factors were significantly different. Somatization, anxiety, depression, interpersonal sensitivity, hostility, and phobic anxiety showed significantly lower scores in the high quality of life group than the low group. Optimism, self-esteem and husband’s support showed significantly higher score in the high quality of life group than the low group. In a stepwise multiple regression analysis, not disease factors and personal factors but the psychosocial factors significantly predicted the quality of life in breast cancer patients. Especially, somatization and depression significantly predicted the quality of life. Conclusion: Among psychosocial factors, somatization and depression were the most significant predictors of the quality of life in breast cancer patients. These results supported psychosocial intervention should be needed to breast cancer patients, in order to improve the quality of life.

온라인공연에서 안무는 어떻게 발생하는가 : 낫띵 시어터(Nothing Theater)의 사례

양은혜 ( Yang Eun Hye ),권태현 ( Kwon Taehyun ),박이선 ( Park Leesun ) 무용역사기록학회 2021 무용역사기록학 Vol.63 No.-

본 연구는 코로나19 팬데믹으로 침체된 공연예술계에서 게임엔진 유니티(unity)를 기반으로 개발한 온라인 극장 낫띵 시어터(Nothing Theater) 사례를 중심으로 온라인에서의 공연예술 활동과 극장의 가능성을 살펴본다. 이에 본 극장에서 개발하여 발표한 허윤경의 「미니어처 공간극장: 오픈베타 (2020. 12. 28.)」와 차지량의 「떠나려는 사람만이 모든 것을 본다 2012.12.20. - 2020.12.20. (2020. 12. 31.)」를 대상으로 안무와 신체성 그리고 공연과 관객의 정의와 관계성을 분석하여 온라인공연에서 안무의 가능성을 제시하였다. 안무를 구현하던 무대와 신체라는 매개체가 가상공간으로 바뀌었을 때 안무의 고유성을 질문하는 것은 안무의 새로운 해석과 담론을 열어주는 계기가 된다. 퍼포머의 신체 없이도 공간의 구성만으로 감각되고 공간의 구성과 시점의 사이에서 안무의 고유성을 질문할 수 있다는 점, 가상극장이 관객의 참여와 감각하는 몸을 통해 존재할 수 있다는 점을 본 사례연구를 통해 살펴볼 수 있었다. This study introduces the online theater development case of the Nothing Theater, which Korea’s performing arts scene depressed by the COVID-19 pandemic developed based on the game engine Unity. In the online theater, choreographer Hur Yoon-Kyung’s Miniature Space Theater: Open Beta and Cha Ji-Ryang’s Only People Who Want to Leave See Everything were presented as online performances. This study seeks to present the possibility of choreography in online performances by analyzing the choreography and physicality as well as the relationship between performance and audience displayed in those works. When the stage where choreography is implemented and the human body as its medium are displaced into a virtual space, questioning the uniqueness of choreography opens the way for a new interpretation of and discourse on choreography. In the work of Hur, it was observed that the three designed theaters-virtual theater, performance theater, and sound theater-were linked and combined through the audience’s movements. In the work of Cha, the audience moves in a three-dimensional space built by twisting and reconstructing a specific space. Suggesting the possibility of online performance, we demonstrate that choreography can be sensed through the composition of space without the physical body of performers and that the online theater can exist through the audience’s participation with their sensing bodies.