노인 의료돌봄 통합지원을 위한 사례관리체계의 충분성에 관한 탐색적 연구

박영옥,김란연,이용재 한국지역사회복지학회 2025 한국지역사회복지학 Vol.- No.93

본 연구는 통합돌봄을 위한 사례관리 체계구축의 충분성을 확인하기 위하여 사례관리구성요소 측면에서 노인 의료돌봄 통합지원 시범사업을 분석하였다. 첫째, 사례관리이용자는 장기요양 재가급여자, 의료기관 퇴원환자 등 명확히 규정하고 있고, 사례관리 이용자에 대한 선별평가와 심화평가를 통해 사례관리이용자를 선별하고 있다. 둘째, 사회자원과 서비스는 사례관리이용자의 욕구에 맞는 서비스 제공을 위해서 지역사회 다양한공공 및 민간기관과 다학제적 지원체계를 구축하고, 민관협의체를 마련하여 운영하고 있다. 셋째, 사례관리자는 구체적인 자격을 제시하고 있지는 않지만, 전담부서를 마련하고사회복지직과 간호직 등 보건과 복지서비스를 연계하여 지원할 수 있는 전문인력을 배치하고 있다. 끝으로 사례관리과정과 운영체계를 위하여 대상 발굴부터 필요도 조사, 지원계획 수립, 서비스 제공, 모니터링 종결의 과정을 마련하여 운영하고 있으며, 전담부서와 지역케어회의를 주기적으로 운영하고 있다. 향후 통합지원의 고도화를 위해서는 사례관리의 효율적 접근을 위한 이용자 분류 및 개입방법 마련, 사회자원과 서비스의 제도적연계협력 체계 마련, 다학제적 이해를 가진 사례관리자 확보를 위한 자격취득과정의 마련, 사례관리 수퍼비전과 솔루션 체계의 마련이 필요하다. This study analyzed the pilot project for integrated support of elderly medical care in terms of case management components in order to confirm the sufficiency of the case management system for integrated care. First, case management users are clearly defined as long-term care home care recipients, discharged patients from medical institutions, etc., and case management users are selected through screening and in-depth evaluations. Second, social resources and services are establishing a multidisciplinary support system with various public and private organizations in the local community to provide services that meet the needs of case management users, and are operating a public-private consultative body. Third, although case managers do not have specific qualifications, they are establishing a dedicated department and deploying professional personnel who can support health and welfare services by linking them with social welfare and nursing. Finally, for the case management process and operation system, the process from target discovery to needs survey, support plan establishment, service provision, and monitoring conclusion is established and operated, and a dedicated department and regional care meeting are operated periodically. In order to advance integrated support in the future, it is necessary to establish user classification and intervention methods for efficient case management approaches, establish an institutional linkage and cooperation system for social resources and services, establish a qualification acquisition process to secure case managers with multidisciplinary understanding, and establish a case management supervision and solution system.

의료서비스대상자의 통합사례관리 방안 연구 : 지방자치단체 총괄 방식의 ‘행정관리 모델’ 중심으로

황미경 한국통합사례관리학회 2010 한국케어매니지먼트연구 Vol.5 No.-

본 연구는 최근 시·군·구, 복지현장에서 부각되는 통합사례관리 논의에서 장기적 사례관리 대상인 의료급여 사례관리 집단이 연계되지 못하거나 간과되고 있음을 파악하였으며, 의료서비스 전달체계 및 의료급여 사례관리 제도의 장기적인 효과성 보장 방안을 모색하고자 하였다. 의료재정의 급증현상은 재원의 효율성 및 사후관리 방식에 대한 효과성 평가의 과제를 부여하고 있다. 이와 관련하여 보건복지부는 2006년부터 전국적으로 저소득층의 의료이용 능력의 향상을 기하기 위한 ‘의료급여 사례관리 제도’를 실시하였다. 한편 의료급여 사례관리와 본인부담제의 시행 등은 의료재정 증가율을 안정시키는 성과에도 불구하고 수급자의 건강권·생명권 침해, 총 진료비의 계속 증가 비판, 의료급여 사례관리 인력 관리, 통합서비스 연계 검토 등의 과제를 안고 있다. 이에 지자체 내 사례관리영역에서 의료급여대상을 포함한 민·관 통합사례관리의 확대 수행 방식으로 지방자치단체가 총괄하고 사전 예방적, 대상 포괄적 방식으로 운용되는 통합사례관리 모델로서 ‘행정관리 모델’을 제시하였다. The Ministry of Health and Welfare carries out ‘medical care case management system’ to upgrade medical care of the low-income bracket to the proper level and improve health care capability of medical care beneficiaries. The increase in medical care funding gives efficiency of finances and assignment of post-management efficiency evaluation. Medical care case management and cost-sharing system are found to have an effect of stabilizing the medical care funding growth rate. However, such visible problems occurred as invasion of right to health and life, increasing total medical expenditures, wrong personnel operation of medical care case management, and lack of integrated local service management system. This study suggests the integrated case management system, a method to secure long-term efficiency of the medical care case management system aiming at improving health care management capability of the low-income bracket. This study is meaningful in that it points out that the medical care case management for the old · high cost · long-term medical care users is insufficient and it is neglected as the separate post-service, in terms of the integrated case management that has been noticed in the discussion of recent local governments and actual fields. In addition, the purpose of this study is to suggest policy foundation to operate the whole low-income residents’ medical services as the local, preventive, and inclusive integrated case management under the local government’s control.

의료급여수급자의 재가의료급여시범사업 만족도 및 재입원의도에 관한 연구

김선미 ( Sunmi Kim ),홍미영 ( Miyoung Hong ),이요셉 ( Yoseb Lee ) 대한보건협회 2021 대한보건연구 Vol.47 No.2

Objectives : The effectiveness of the medical aid community care program was analyzed using the experience, satisfaction, and intention to hospital readmission of medical aid recipients. Methods : The total number of participants was 116, and they were living in 13 areas. We surveyed from May 15th to 28th. We asked satisfaction with the services, degree of intention to readmission, the reason for long-term hospital admission, experience regarding service utilization, frequency of social contacts before and after hospital discharge. Results : Overall, 103 people out of 116 (88.8%) responded that they were satisfied with the project. Ninety-two respondents(79.3%) answered that they do not consider hospital readmission, proving that the pilot project is practical. Satisfaction was different between people who used mobility, meal, personal care assistant and those who do not. Also, there were differences between those who want hospital readmission and those who do not want to. We found the satisfaction with the case manager to be a factor affecting the overall service satisfaction of users. Conclusion : Most of the subjects were satisfied with the services and did not consider re-hospitalization. So the project achieved promising results according to the purpose. Increasing the satisfaction of the case manager can cause increased overall satisfaction. Also, overall satisfaction and satisfaction with the case manager, increasing quality of life can be a strategy to extend the length of residence in their community.

저소득 취약계층 은둔환자들의 탈은둔 사회복귀를 위한 『은둔환자의료지원캠페인』 참여경험에 대한 질적 사례연구

김은재 한국통합사례관리학회 2023 한국케어매니지먼트연구 Vol.- No.48

The purpose of this study was to approach and use participation experience of medical support users who participated in the 'Recluse Patient Medical Support Campaign' project aiming to support social return of secluded patients through a qualitative case study. Results of this project were also evaluated. This study aimed to derive theoretical and practical implications for expanding the base of medical support services for secluded patients by analyzing and evaluating effectiveness. For qualitative evaluation of this project, 12 medical support users participated as research participants who conducted individual in-depth interviews. As a result of the analysis, 60 concepts, 11 subcategories, and 3 categories were derived from individual in-depth interviews of medical support user. Categories of participation experiences of medical support users were “being trapped in the wall of half self-willed and half others-willed seclusion”, “breaking down the wall of seclusion and going back into the world”, and “thoughts for sustainable coexistence together by breaking the egg”. Based on results of analysis, basic data and measures taken to improve the quality of life of vulnerable low Income groups reclusive patients in the medical blind spot are presented.