보건정책과 사회역학

신영전,Shin, Young-Jeon 대한예방의학회 2005 예방의학회지 Vol.38 No.3

Major approaches of Social epidemiology; 1)holistic, ecological approach, 2)population based approach, 3)development and life-course approach, 4)contextual multi-level approach, have stressed the importance of not only social context of health and illness, but also the population based strategy in the health interventions. Ultimately, it provides the conceptual guidelines and methodological tools to lead toward the healthy public policies; integrated efforts to improve condition which people live: secure, safe, adequate, and sustainable livelihoods, lifestyles, and environments, including housing, education, nutrition, information exchange, child care, transportation, and necessary community and personal social and health services.

왜 건강불평등인가?

신영전,김명희,Shin, Young-Jeon,Kim, Myoung-Hee 대한예방의학회 2007 예방의학회지 Vol.40 No.6

Objectives : The aim of this study was to introduce the concept of health inequalities, and to discuss the underlying assumptions and ethical backgrounds associated with the issue, as well as the theoretical and practical implications of health inequalities. Methods : Based on a review of the literature, we summarize the concepts of health inequalities and inequities and discuss the underlying assumptions and ethical backgrounds associated with these issues from the view of social justice theory. We then discuss the theoretical and practical implications of health inequalities. Results : Health inequality involves ethical considerations, such as judgments on fairness, and it could provide a sensitive barometer to reflect the fairness of social arrangements. Discussion on health inequalities could deepen our understanding of the social etiology of health and provide a basis for the development of comprehensive and integrative social policies. Conclusions : Health equity is not a social goal in and of itself, but should be considered as a part of a broader effort to seek social justice.

B형 간염에 대한 경기도 지역 일부 여고생들의 지식 , 태도 및 실천에 관한 연구

신영전,박남희,김수근,최보율 ( Young Jeon Shin,Nam Hee Park,Soo Keun Kim,Bo Youl Choi ) 대한보건협회 1995 대한보건연구 Vol.21 No.2

풍진 예방접종사업의 비용-편익분석

신영전,최보율,박항배,문옥륜,윤배중,Shin, Young-Jeon,Choi, Bo-Youl,Park, Hung-Bae,Moon, Ok-Ryun,Yoon, Bae-Joong 대한예방의학회 1994 예방의학회지 Vol.27 No.2

Rubella is a viral disease with mild constitutional symptoms and generalized rashes. In childhood, it is an inconsequential illness, but when it occurs during early pregnant period, there are significant risks of heart defects, cataract, mental retardation to the fetus. The series of congenital defects induced by rubella is called 'congenital rubella syndrome'. Many research have been performed to find out more effective prevention program on rubella. The objectives of this study are, first, to calculate the incidence rate of acute rubella infection and congenital rubella syndrome in Korea, second, to evaluate economic efficiency of several rubella vaccination policies and to offer data for the most reasonable decision on vaccination policy. Study populations are 663,312 children of one year-old in 1992. The author has performed cost-benefit analyses according to the three vaccination policies-U.S.A.'s. U.K.'s and Sweden's. In this Study, the author got the incidence rate of acute rubella infection using the catalytic model. In the meantime, the author used 50 per 100,000 live births as the incidence rate of congenital rubella syndrome. The discount rate used in this study was 5 percent per annum. The sensitivity analyses were done with different discount rates (4%, 7%) and different incidence rate of congenital rubella syndrome (10,100 per 100,000 live births) : The study results are as follows: 1. Without vaccination, lifetime expenditures per patient for acute rubella infeciton amount to 14,822 won and the total expenditures to about 3.1 billion won. Meanwhile, lifetime expenditures per patient for congenital rubella syndrome amount to about 91 million won and the total expenditures to about 16.3 billion won without vaccination. 2. The cost of vaccination for a child of one year old was 2,322 won and the total cost for the one year old children was about 1.5 billion won (American style). The cost for vaccination of female children at fifteen was about 339 million won (Birtish style). And the cost of vaccination at one for both sex and female children at fifteen was about 1.9 billion won (Swedish style). 3. The benefit to cost ratios of vaccination of female children at fifteen that is the british mode of rubella vaccination, was 60.0 at the level of 80% population coverage and 48.6 at 100% coverage. It shows much higher benefit to cost ratio than those of the other two vaccination policies. 4. Both net benefits of vaccination at one (American style) and that of vaccinations at one and fifteen (Swedish style) range from about 17.0 billion to 17.8 billion won, those were larger than that of vaccinations of female children at fifteen (Birtish style, about 16.0 billion). 5. In marginal cost-benefit analysis of only additional program of revaccination, the benefit to cost ratios were 3.6 (80% coverage rate) or 0.6 (100% coverage rate). It implies that additional program was less efficient or inefficient. 6. In sensitivity analysis with different discount rates(4% or 7%) and different incidence rates of congenital rubella syndrome (10 or 100 per 100,000 live births), the benefit to cost ratios has fluctuated in wide range. However, all the ratios of vaccination of female children at fifteen were higher than those of the others. Even under the most conservative assumption, the benefit to cost ratios of all the rubella vaccination policies were higher than 3.3. In conclusion, all the rubella vaccination policies found to be cost-effective and particularly the vaccination of female children at fifteen was strongly recommended.

의료이용의 지역간 격차 -3차성 내과계 진단군을 중심으로-

신영전 ( Young Jeon Shin ),이원영 ( Weon Young Lee ),문옥륜 ( Ok Ryun Moon ) 한국보건행정학회 1999 보건행정학회지 Vol.9 No.1

This study is conducted to investigate the current status on the utilization of health care and plan for solving this problem. The claims data of study are summarized as follows. Indexes(The Extremal Quotient(EQ), coefficients of variance(CV`s))which represent the regional difference in the admission rate of the tertiary medical diagnosis group report that there is difference in quantity and quality of utilization of care. The admission rate is lower in the big city areas, Kyoungkido, Kangwondo and Chunlapukdo. Even after age-sex adjustment, the admission rate is low in Kangwondo,chunlapukdo and kyoungsangpukdo. The big city areas tend to tend have higher rates in the expenses per claim, hospital days per claim,and daily expenses but rates are still low in some area in Kangwondo, Cangwondo, Chunlanamdo and Kyoungsangpukdo. This result remains as same after age-sex adjustment. There is a large regional difference in average untilion rate for the terital of the tertiary medical diagnosis group: 57.2%(SD 11.53).The utilization rates for the tertiaryhospital in their large catchment area are 96.34%, 83.19% and 73.22% in each Kyoungin. Kyoungnam and Kyoungpuk areas whereas it is lower in Chungpuk and Chungnam areas. The regional differences of hezlth care utilization of the tertiary medical diagnosis group have some relationships with their geographical charaeristics such as socio-economic characteristics and supply factors of medical services. It is important many medical policies should be deveoped in order to minmize and balance out the regional defferences of healtth care untization. The service allocation policy should include the reconstruction of manpower policy, developing the resource allocating formula, finding the self- sufficient catchment area and reforcing of public health services.Morever, in order to achieve the balaned development by region, they should investigate and consider each county`s microscopic properties under the consisten macroscopic policy. The further studies to find causes of regional difference are needod.

국가정신보건체계 모형개발과 정책과제

신영전(Young-Jeon Shin),남정현(Jung Hyun Nam) 대한사회정신의학회 2001 사회정신의학 Vol.6 No.1

국가정신보건정책은 그 문제의 심각성, 문제의 크기 측면 모두에서 중요한 국가보건정책 중의 하나임에도 불구하고, 그간 상대적으로 정책의 관심에서 벗어나 있었으며, 체계적인 접근이 이루어지지 못해왔다. 그러나 1995년말 정신보건법의 제정과 보건복지부내 정신보건과의 설치이후 정신보건부문에 빠른 변화가 나타나고 있다. 이 연구에서는 국가정신보건체계의 궁극적인 목표를‘국민들의 건강한 삶의 연장을 위한 정신건강의 증진’,‘정신질환을 가진 사람들의 건강한 삶의 연장’,‘정신건강의 불균형 해소’로 설정하였다. 개념적인 목표로‘정신질환자 및 가족들의 기본적 삶의 수준확보’,‘정신보건서비스의 접근도 향상’,‘정신보건서비스의 질 향상’,‘효율적인 국가정신보건체계구축’으로 설정하고 이의 달성을 위한 국가정신보건체계를 제시하였다. 또한, 이 체계 모형에는 국가정신보건정책의 대상, 서비스의 유형과 수준들을 포함하였다. 또한 제안한 국가정신보건체계의 구축전략으로써 자원부문, 조직 및 전달체계부문, 재정부문, 관리체계부문의 정책안들을 제시하였다. 이상의 작업에 설정한 국가정신보건의 목표, 모형 및 시행전략은 앞으로도 많은 전문가와 환자 및 가족들의 검토와 비판을 통하여 더욱 현실적이고 구체적인 정책안으로 발전하여야 할 것이다. In spite of its importance and seriousness, mental health has received little attention from politicians and administrators and a systematic approach has been lacking in Korea for a long time. However, the legislation of the Law for Mental Health in 1995 has brought about dramatic changes in the area of mental health. This study was conducted to develop a model and strategies for a national mental health system in Korea. Four goals and six objectives have been proposed. The four goals are: ensuring the essential conditions for life, and improving the accessibility, quality and efficiency of mental health service. The six objectives are:to reduce the incidence and prevalence of mental illness, to reduce mortality associated with mental illness, to reduce the extent and severity of problems associated with specific mental disorders, to develop mental health services, to promote good mental health and reduce the stigma attached to it, and to promote the psychological aspects of general health care. The national mental health system model has been designed to achieve these goals and objectives. The model includes the target population, the type and level of mental health services and four infra-structures - resource and organization, delivery, management and economic support. Finally, political measures and strategies to establish the national mental health system have been proposed.

인권의 관점에서 본 한국 고령화 정책 계획

신영전(Young Jeon Shin),김보경(Bo Kyoung Kim) 한국사회정책학회 2013 한국사회정책 Vol.20 No.1

이 연구는 한국 정부의 고령화 정책이 『마드리드 고령화행동계획』이 요구하는 노인인권의 측면을 잘 반영하고 있는지 확인함으로써 인권친화적인 고령화 정책의 수립을 위한 정책 과 제를 제시하는 것을 목적으로 시행하였다. 이를 위해 『제2차 저출산고령사회 기본계획』(이 하 『기본계획』)의 수립과정에 대하여 인권적 요소를 평가하였고, 『기본계획』, 『2011 중앙부 처 시행계획』 및 『2011 서울시 시행계획』의 내용에 대하여 『마드리드 고령화행동계획』(이 하 MIPAA)의 35개 행동목표와의 정합성 여부를 확인하였다. 분석결과, 기본계획의 수립과 정에서 참여와 투명성이 부분적으로 확인되었으나 인권적 측면에서 충분하지 못하였다. MIPAA와의 정합성 평가 결과, 한국 고령화 정책은 MIPAA가 제안하고 있는 인권적 요소를 상당부분 반영하고 있으나 노인의 의사결정 참여, 여성 · 장애 · 농촌노인 등 취약집단에 대 한 정책과 관련한 일부 영역에서 충분하지 못함을 확인하였다. 향후 고령화 정책의 수립과정 과 계획 작성에 노인인권을 보다 적극적으로 반영하기 위해 기존 계획에서 누락된 영역의 노 인인권정책을 보완할 필요가 있다. 특별히 노인인권 옹호를 위한 담론 개발, 인권영향평가 도 입, 노인인권 모니터링을 위한 지표 개발, 인권기반 고령화 정책 수립과 집행을 위한 지침 제 공, 취약한 노인 집단에 대한 집중 등이 필요하다. 또한 인권 친화적 고령화 정책을 수립 시행 시에는 기본계획과 시행계획 정책 간의 연계를 강화하면서 보다 인권 친화적 과정이 되도록 제도화가 필요하다. The purpose of this study is to examine how the government`s ageing population policies embrace the human rights of older persons to set out policy agenda for the establishment of ageing population policies that help protect human rights. First, the human rights elements in the establishment of 『The 2nd Plan for Ageing Society and Population』(hereinafter the “Basic Plan”) were examined. Second, 『Basic Plan』, 『2011 Central Government Execution Plan』 and 『2011 Seoul City Execution Plan』were reviewed to find out whether they conform to the 35 objectives of『Madrid International Plan of Action on Ageing』(MIPAA). The analysis produced results that participation and transparency assurance mechanisms were identified in the establishment of basic plan but the human rights elements were found out to be insufficient or difficult to verify. The conformity test in comparison with MIPAA, Korea`s ageing population policies turned out to reflect a large portion of human rights elements provided by MIPAA but fail to sufficiently embrace the policies with regard to older persons` participation in decision-making processes and the underprivileged groups such as older women, older persons with disabilities, and older persons in rural areas. Older persons` human rights policies must be upgraded to close loopholes in the existing plans in order to embrace the human rights of the elderly more actively in the establishment and planning of ageing population policies. Furthermore, more efforts are required to develop agenda for the protection of senior human rights, introduce human rights impact assessment, establish guidelines over the establishment and execution of human rights-based ageing population policies, and concentrate resources on underprivileged older population. For the establishment and execution of human rights-based ageing population policies, the basic and execution plans must be associated with each other to assure the systematization of human rights-based processes.

노기순(盧基舜)의 생애

신영전(SHIN Young-jeon),박세홍(PARK Se-hong) 대한의사학회 2009 의사학(醫史學) Vol.18 No.1

미군정 초기 미국 연수를 다녀온 한국인 의사 10인의 초기 한국보건행정에서의 역할

신영전 ( Young Jeon Shin ),서제희 ( Jae Hee Seo ) 한국보건행정학회 2013 보건행정학회지 Vol.23 No.2

On September 24th of 1945, the existing Health Department under the Bureau of Economy and Trade was abolished complying with the Article 1 of the Ordinance of US military occupation Establishment of Health Bureau;`` After the establishment of the Health Bureau, one of its first priorities was to select South Korean medical doctors and send them away to the US for training in order to educate the talents necessary for the Health Bureau to address the public hygiene and health issues of Korea:`` Under the sponsor­ship of Rockefeller Foundation, the US Military Government sent 10 Korean medical doctors to three universities. After they came back to Korea from the training in the US, they played significant roles in building and managing the Korean health and medical system under the US Military Government as well as during the post-war of Korea and in the 1960s- 1 970s. Furthermore, they made a great contribution to expanding and transplanting the``American-style``health and medical system in heath administration, health research and medical education in Korea. On the one hand, this means the limitation and elimination of an independent, progres­sive idea in the health and medical field as the infiuence of the US within the country after the liberation expanded. The lives of 1 0 doctor represent an important symbol of how the Korean health and medical field has been established under the domestic and overseas political conditions, ``colonization-liberation-military occupation of the Powers; and one part of the concrete history.

글로벌 경제위기와 의료보장의 사각지대

신영전(Young Jeon Shin) 한국사회정책학회 2010 한국사회정책 Vol.17 No.1

최근 글로벌 경제위기는 국민의 건강에도 위협이 되고 있으며 사회안전망으로서 의료보장의 중요성이 커지고 있다. 반면 한국의 의료보장체계는 재정적, 관리적, 정치적 요인으로 인해 8%이상이 의료보장제도에서 배제되고 있고, 보장성 수준 역시 약 60%에 불과하다. 의료비지원 및 긴급지원 사업 역시 복잡하고 분절적인 지원 및 관리방식의 문제, 낮은 보장수준으로 인해 의료사각지대 문제를 충분히 해결하지 못하고 있다. 그 결과 지불능력의10% 이상 의료비를 지출하고 있는 가구규모는 전체 가구수의 10-15%에 이르고 한국 성인의 의료 미충족률이 약 3-10%에 달한다. 이러한 의료보장의 사각지대는 경제위기기에 더 큰 문제를 야기한다. 경제위기기 의료사각지대 문제에 대한 단기적 대응으로 기존의 건강 보험, 의료급여, 의료비지원사업 및 긴급지원 사업간의 상이한 기준, 행정상의 혼선, 늦은 결정 등과 같은 문제들은 강력한 조정기구를 통해 신속하고 상호 유기적으로 작동하도록 하는 것이 필요하다. 중장기적으로는 기존의 의료보장체계를 재구성할 필요가 있다. 의료보장체계를 치료중심에서 예방과 건강증진개념으로 전환하고, 재활과 사회복귀 영역을 추가하며, 여전히 의료사각지대에 있는 사람들을 주요 정책대상에 포함시키며, 민간부문을 통한 재원조달과 서비스 제공 역시 그 틀 안에 포함시킬 필요가 있다. 시민사회와 당사자가 참여하는 운영체계를 구축하고 사업을 지속적으로 모니터링 하는 장치도 만들어야 한다. 그리고 소득, 주거, 교육, 문화부문의 사회안전망과 유기적으로 결합하는 형태로 설계, 운영되어야 한다. 이에 더하여 의료사각지대의 해소문제를 정치의제화하고, 국민건강보험의 획기적 보장성 강화와 제도간 통합이 고려되어야 한다. 아울러 공공보건의료의 양적 확대와 질적 강화를 모색하고 취약계층의 특성에 맞는 사업들을 개발 시행하여야 한다. 경제위기기의 제한된 재정으로 이러한 안전망의 실효성을 유지하기 위해서는 의료비 상승을 유도하는 일련의 정책들을 지양하고 공공성에 기반을 둔 양질의 합리적 의료 공급체계 확보에 우선적인 노력을 기울여야한다. 의료보장 사각지대 해소와 보장성을 높이기 위한 과정은 본질적으로 정치적 과정이다. 따라서 견고한 의료보장체계 구축의 성공은 무한 경쟁과 시장담론을 넘어서는 사회연대의 가치에 대한 담론의 확산, 정치적 리더십, 국민의 지지를 얻을 수 있는 실효성 있는 정책수단의 확보, 안정적인 재원의 마련, 의료보장체계 구축을 위해 헌신하는 정책수립자, 관련 일선 전문가, 시민사회의 역량과 노력에 달려있다. 아울러 견고한 의료보장체계는 경제위기를 극복하는 중요한 기반을 제공할 것이다. With the recent global economic crisis posing a threat to public health, the importance of health security as a social safety net is growing. Bucking the trend, more than 8% of South Koreans are currently excluded from its health-security scheme due to financial, managerial, and political factors, and even the level of health security coverage remains a mere 60%. Moreover, medical-bill assistance and emergency aid projects fail to offer sufficient solutions to the blind spots of health security due to the complicated and segmented assistance provided, managerial issues, and the low level of coverage. As a result, the number of households in South Korea that spends more than 10% of what they can afford to pay on their medical-bills accounts for a remarkable 10-15% of the total number of households, and the South Korean adults` medical insufficiency represents 3-10%. These blind spots of health security pose a bigger threat to the nation under an economic crisis. For short-term measures to address the blind spots of health security under an economic crisis, prompt action is necessary,with the parts working in coordination and with the help of stern arbitration regimes in such problematic areas as the existing medical insurance, healthcare bills, the different standards between medical-bill assistance and emergency aid projects, administrative confusion, and the untimely decision-making process. As for mid-to longer-term measures, the existing health safety net should be restructured. The treatment-centered health safety net should be transformed into the concept of prevention and health enhancement, with the addition of rehabilitation and rejoining the society. Furthermore, the inclusion of those who have been left in the blind spots of the health-security system among the beneficiaries of the major relevant policies is necessary, along with the inclusion of resource procurement and service delivery through the private sector in the said framework. In addition, a mechanism that establishes an operating system where the civil society and the concerned parties can participate in, and that monitors projects in a consistent manner, is required. It should be designed and managed in such a way that it will be in good coordination with the social safety net in the areas of income, housing, education, and culture. In addition, the settlement of the blind spots of the health-security system should be made a matter for political discussion, and consideration must be given to the stark reinforcement of security for the public healthcare system and to the integration of the systems. Moreover, the quantitative expansion and qualitative enhancement of the public health system should be sought through the development and implementation of projects that target the extension of assistance to the underprivileged. In an economic crisis, a series of policies that trigger a rise in medical bills should be sublated while preferentially putting much effort in securing a high quality of reasonable medical-service delivery systems based on publicity to maintain the effectiveness of such safety net. The settlement of the issues regarding the blind spots of the health-security system with enhanced security assumes the nature of a political process. Accordingly, the successful establishment of a firm health safety net lies in the following factors: the expansion of the discussion on the value of social solidarity, which surpasses unlimited competition and market discussion political leaderships securing effective political means with the public supportstable resources policymakers dedicated to the establishment of a medical safety net related working experts on the frontline and the relevant capabilities and efforts of the civil society. A firm health safety net will serve as a critical base in overcoming an economic crisis.