울릉군 지역완결형 지역보건의료체계 강화 전략

다국어 초록 (Multilingual Abstract)

M.P.H. Thesis

Strategies for Strengthening a Regionally Self-Contained Healthcare System in Ulleung-gun

Mija Jae

Department of Public Health
Graduate School of Environment and Public Health Studies

（Supervised by Professor Kyeong-Soo Lee）

Abstract

This study seeks to develop strategies for strengthening a regionally self‑contained district health system in Ulleung-gun County, a medically underserved island county, through collaborative governance. In Korea, rapid population aging, regional depopulation, and metropolitan concentration of medical resources have intensified inequities in access to essential health services across rural and island areas, and Ulleung-gun exemplifies structural constraints such as shortages of emergency medicine specialists and heavy dependence on off‑island transfers for critically ill patients. Focusing on policy initiatives implemented since 2024, the study critically analyzes how Gyeongsangbuk-do Province, Ulleung-gun County, public and private healthcare providers, fire and maritime rescue agencies have coordinated to sustain local healthcare delivery through inter-organizational/sectoral collaboration.
Data were drawn primarily from provincial administrative records, including site‑visit and multi-stakeholder meeting reports from 2024–2025, emergency patient transport statistics, and documentation on specialist outreach clinics, which were synthesized through documentary analysis. The analytical framework integrates core components of the district health system—health workforce, healthcare resources, financing, and service delivery—with key dimensions of collaborative governance, namely participating actors, interaction processes, resource integration, and performance outcomes.
The main findings are as follows. First, Gyeongsangbuk-do Province secured a total budget of 4.79 billion KRW through supplementary appropriations and lottery funds, which was allocated to emergency medicine specialist recruitment, reinforcement of backup referral services, expansion of diagnostic and treatment equipment, and improvement of living conditions for health professionals. Second, regional and local hub hospitals（responsible medical institutions） implemented a rotating specialist outreach model, tele-consultation, and upgraded emergency transport and receiving arrangements, thereby enhancing on‑island emergency care capacity and access to specialized services. Third, between 2020 and 2025, the number of patients transferred to mainland hospitals and helicopter transports decreased substantially, while the number of partner hospitals, dispatched specialists, and emergency‑related devices increased, indicating strengthened functional regional self-sufficiency.
The study argues that, in remote island settings, policy priorities should move beyond quantitative expansion of facilities and physical infrastructure toward improving local initial response capacity for essential services and maintaining core outpatient care functions, combined with a supra‑regional collaborative network centered on Gyeongsangbuk-do Province and Daegu Metropolitan City. It concludes that a public–private collaborative governance model can be effectively applied to other medically underserved regions and offers meaningful policy and scholarly implications for sustainable local health administration.

목차 (Table of Contents)

• 서 론 1
• 연구대상 및 방법 7
• 연구 대상 7
• 자료 수집 7
• 분석 방법 8
• 성 적 10
• 울릉군 응급의료 현황 분석과 유관기관 협력 체계 구축 10
• 응급환자 이송체계 및 후송 현황 12
• 질환군별 후송 특성 분석 14
• 협력 거버넌스 구축과 정책 변화 16
• 재정 기반 확보와 의료인력 정주환경 개선 17
• 미개설 전문과목 파견진료를 통한 전문의료 접근성 강화 19
• 협력병원 업무협약 체결과 전문의 파견진료 확대 20
• 전문의 파견진료 정례화·제도화와 응급의료 역량강화 22
• 고 찰 28
• 참고문헌 33
• 영문초록 37