농어촌 지역의료보험의 정책과제와 전망

문옥륜 서울大學校 保健大學院 1994 보건학논집 Vol.31 No.1

The cost of rural health insurance has in creased 23.5% per annum for the past five years, which is equivalent to two-fold that of the industrial workers health insurance. Those 136 rural health insurance associations have made a surplus of 101 billion won by 1993. However, it is problematic that differences in the power of financial solvency among rural health insurance associations become greater. In fact, 8 rural associations ran financially red in 1993. The rural conditions expect to be aggravated rapidly under the pressure of the Uruguay Round agreement. The eight policy objectives are set to overcome the impending financial problems. This study recommended that: ① The grants-in-aid be provided to the worthy poor rural associations at the end of fiscal year. The worthy poor rural associations have indicated that those rural associations paying the national average amount of contributions, yet making a financial deficit. ② The average net amount of contributions for the rural health insurance be maintained less than that for industrial workers and public officials and private school teachers. It is decided that in the long run the rural farmers and fishmen pay contributions according to their financial ability. ③ The benefit period of 180 days per annum be gradually expanded to 365 days within three and six years. ④ The use of high cost technology such as CT and MRI be included under the benefit package. ⑤ The copayment of the poor be adjusted according to their ability to pay. ⑥ The corresponding preventive health services be included for members of rural insurance like those of other health insurances. ⑦ As to the efficient management, the optimum size of rural health insurance associations be pursued to get the advantage of economy of scale effect. ⑧ A change of payment method be considered for correcting the known disadvantages of fee-for-service payment. The DRGs is an example. Some proposals mentioned above are the same as those made by the National Medical Security Reforming Committee. This study recommends the six stepwise approach to implement the proposals: ① The law be amended in a manner for the government to subsidize rural health insurance for the half of administration costs and that of benefit expenses. About 100 billion won will be reserved from this measure. ② A financial adjustment scheme be developed for the assistance to elderly care. From the scheme, about 70 billion won will be reserved in 1996. ③ Another financial adjustment scheme be added for the financial solvency of the worthy poor association. ④ The corresponding raise of contribution is another potential source in accordance with the raise of insurance benefits. ⑤ (If financially in red still) the organization of a national farmers health insurance is another possibility. ⑥ (Despite these measures deficit financing continuing) the last approach is to switch into the tax system for farmers and fisbmen. The author believes that gradual reform can serve people better health. Thus, a stepwise approach is strongly needed in planning the rural health insurance program.

학교보건조직의 강화방안

문옥륜 韓國學校保健學會 2001 韓國學校保健學會誌 Vol.14 No.1

한·양방동시개설 의료기관의 협진실태 분석

서동윤,문옥륜,이윤현 남서울대학교 2001 남서울대학교 논문집 Vol.7 No.-

This study was carried out to find out the current status of the cooperative medical practices of the oriental and western medicine in Korea. The structured questionnaires were mailed to 93 oriental medical doctors(OMDs) and 93 western medical doctors(MDs) working in cooperative institutions of oriental & western medicine and 29 OMDs working in oriental medical hospital from September 16 to October 31, 1999. The response rate is 47(50.5%) cases from OMDs and 20(21.5%) cases from MDs working in cooperative institutions of oriental & western medicine and 10 cases (34.5%) from OMDs working in oriental medical hospital. These data were analyzed by χ^2 test, T-test, ANOVA and multiple regression by using SAS package. The major findings were as follows: There were 122 oriental hospitals in August 1999. The 76.2% of oriental hospitals was doing cooperative practices. The number of cooperative institutions was increasing rapidly in recent years and there were many OMDs who intend to open cooperative practices in the near future. Only 15% of the cooperative institutions had guidelines to do cooperative practices. The majority of the cooperative institutions is combination of oriental hospital and western clinics. It was turned out that both side of MDs and OMDs recognized necessity of cooperative practices keenly and it would be effective for control of diseases. Many MDs and OMDs answered that cooperative practices was practically helpful for patients. the OMDs feel decrease in emotional stress but MDs feel increase in emotional stress in case of cooperative practices. The OMDs were not satisfied with the government medical policies on legal matters. Three disease categories such as cerebrovascular accidents, back pain and musculoskeletal disease occupied majority of disease. It is recommended that western medical students study oriental medicine. MDs and OMDs should have seminars and workshops to exchange knowledge and experiences. It is most urgent that the guidelines for cooperative practices should be provided. And more cooperative relation between OMDs and MDs should be provided.

보건분야 종사 졸업생에 의한 서울대학교 보건대학원 교육효과 평가

이상이,문옥륜 韓國保健敎育學會 1997 보건교육건강증진학회지 Vol.14 No.2

Educational goals of SPH were two-fold : One was to train a health professions who should take charge of a leading roles, another were to educate the researchers of public health. There were strong demands to evaluate whether these goals had been effectively achieved through the master's course of SPH or not. According to the educational goals of SPH, public health is an applied science to be applicable to health-related fields. The curriculum of SPH has to be built under this principle and be evaluated by someone regularly. who evaluates that? The most pertinent appraiser is the graduates of public health currently working at health-related jobs. It was the purpose of the study to let the graduates evaluate their education and the curriculum that they had undertaken during master's course at SNU. If the results of the evaluation by the graduates were not satisfactory, we should find the actual causes of low scored apraisal and reform the curriculum of SPH as the process of problem solving. During September and October 1996, a postal survey was undertaken of the 293 SNU graduates of public health who had been engaged in the health related jobs. As 198 graduates answered out of 293, the response rate was 67.6%. The questionnaire was designed to ascertain how well the SNU master's course of public health had helped their practice. The SAS package was used for statistical analysis and ??-test as a test of statistical significance. Major findings of the study were summarized as follows: The health related abilities consisted of three categories, which were health administration abilities composed ol 14 items, health education abilities composed of t item, health research abilities composed of 10 items. ·The respondents had acquired "Worldwide trends of health policy", "evaluation concepts of health projects", "interpersonal relationships in professional life", and "communication through writings" more than other detailed items in the category of health administration abilities. ·"Establishment of educational and learning goals" was the most acquired item of 5 detailed items of health education abilities. ·Respondents indicated that they had acquired ability "to search reference", "to understand health problems", "to establish study plannings", and "to collect health related data" more than other detailed items in the category of health research abilities.

都市低所得階層의 醫療福祉模型定立을 爲한 基礎調査硏究

金正根,金貞順,鄭慶均,洪在雄,文玉綸,李詩伯 서울大學校 保健大學院 1983 보건학논집 Vol.20 No.1

가속된 공업화에 의한 경제발전은 인구의 도시집중을 초래하여 대도시의 변두리에는 새로 유입된 저소득집단거주지역을 형성하게 마련이다. 제한된 공간 기본 시설행정서비스등 생활수요에 과부족 상태에 있는 이들 지역은 많은 사회적문제를 안고 있을 뿐 아니라 건강관리면에서도 여러 가지 문제점을 내포하고 있다. 더구나 의료보험제도가 도입되면서 직장이 없는 대부분의 저소득주민은 의료보호 및 보험수가 때문에 불균형상태에 놓인 의료기관의 수지평형을 메꾸어주는 당착가지 낳게 하였다. 따라서 본연구는 종래의 보건의료체계에 의존하기보다 현실에 맞는 저소득층을 위한 보건의료복지모형을 모색하고자 기초조사를 실시하였다. 본연구의 대상지역은 종로구동숭동 낙산기슭에 위치한 11평형시민아파트, 전수와 근접한 5개통을 1982년 8월부터 11월까지 면접조사하였다. 그 주요결과를 요약하면 다음과 같다. 1) 조사비율은 가구단위로 아파트 지역 80%, 비아파트지역 60%였으며 인구별로는 전체인구의 64%였는데 65세 이상군의 조사율이 다른 년령군보다 낮았다. 2) 인구 및 사회경제적 특성 (1) 인구 및 가구의 특성 인구의 성별 및 년령별 구성은 서울 시인구의 구성과 아주 흡사하였으나 45세 이상의 인구비율이 약간높은 경향이었다. 혼인상태도 두드러진 특징은 없으며 25세 이상 성인인구의 교육수준도 다른 영세지역에 비해 높았다. 경제활동인구의 직업에 있어서 남자의 무직율은 13.6%였고 여자중 직업을 가진 비율은 36%나 되었다. 직종별로는 공원이 23%, 공무원 18%, 사회원 10%등이었다. 한편 현주소에 거주기간은 3년미만이 약 50%였고, 30%는 7년이상 살고 있는 사람들이어서 비교적 안정된 지역이었다. 또한 자가소득율도 62%였고 사용방수 2개가 50.6%, 1개는 8%에 불과하였다. 난방시설은 연탄온실이 대부분(84%)이었다. 변소는 공동수세식이 27.6%, 공동재래식이 18%였고 단독사용인 경우도 재래식 33%, 수세식 22%였다. (2) 가구단위의 경제상태 수입과 지출을 감안하여 생활형편이 충분하다는 가구는 19%, 빠듯하다는 가구가 68%였는데 이들 중 어떤 형태이건 저축을 하고 있는 가구가 48%였다. 월생활비가 40만원이하인 가구가 92%였다. 생활용품보유상태를 보면 흑백 TV가 72%, 칼라 TV 3.2%, 냉장고 75%, 세탁기 17%, 전화도 63%가지고 있어 이 지역의 경제상태를 종합해볼 때 우리나라 중류하층쯤이라 고려되어 지역의료보험을 실시하기에는 아주 적합한 지역이라고 생각되었다. (3) 주요사회문제 집안에 근심거리가 있다고 한 가구는 34%로 경제문제가 18%, 건강문제가 9%였다. 청소년문제를 간접적으로 엿보기 위하여 학교중단상황을 보았는데 학교를 중단한 학생이 2명이하 가진 가구는 98가구(2308가구중) 뿐이었으며 중고등학교중단이 가장 많았는데 그 이유로는 경제적사정이 가장 빈번하였다.

Health Care Cost Containment in the Korean Health Insurance Program

Moon,Ok Ryun 서울大學校 保健大學院 1990 보건학논집 Vol.27 No.1

A Memorandum on the Role of the Public and Private Sectors of Health Care in the Republic of Korea

Moon,Ok Ryun 서울大學校 保健大學院 1989 보건학논집 Vol.26 No.1

Issues of Health Manpower Management in Korea

Moon,Ok Ryun 서울大學校 保健大學院 1989 보건학논집 Vol.26 No.1

The National Health Insurance Policy Issues in Korea

Moon,Ok-Ryun 서울大學校 保健大學院 1989 보건학논집 Vol.26 No.1

Health Care Cost Containment in the Korean Health Insurance Program

Ok Ryun Moon 서울대학교 보건환경연구소 1990 보건학논집 Vol.27 No.1