우리나라 성인의 의약품 사용 양상: 외래처방의약품과 라이프스타일 의약품을 중심으로

변진옥,정연,정혜주 한국보건행정학회 2012 보건행정학회지 Vol.22 No.4

The purpose of the study is to examine the use of medication among adults by comparing the pattern of outpatient prescription drug use with the pattern of long term taking lifestyle drug use. Furthermore, the study investigates factors associated with the use of medication, particularity focusing on socioeconomic factors. Korea Health Panel data of 2008 was used to conduct the study analysis. By performing four different logistic regression models, the study noticed different patterns of the medication use between prescription drugs and lifestyle drugs. More specifically, the study showed that adults with lower education level tend to more frequently receive prescriptions while adults with higher education as well as income level tend to more use lifestyle drugs than their counterparts. Furthermore, other control factors such as age and gender were statistically significant for the use of both prescription and lifestyle drugs in different patterns. The study findings expect that reimbursement structure of drugs may be significantly associated with the different patterns and accordingly the accessability of medicine in particularly vulnerable population. Therefore, these policy factors should be considered in future study to more comprehensively understand about the diverse patterns in the medication use.

약국약사들의 사회적 역할 실천에 대한 근거이론적 접근

변진옥,조병희 한국보건사회학회 2014 보건과 사회과학 Vol.0 No.35

The professional status of community pharmacists has been controversial for along time. They had been perceived as "incomplete profession" even before theseparation of drug prescribing and dispensing, perceived that pharmacists werequasi-doctors and more business mined than humanitarian. However, theseparation changed radically the community pharmacists’ role and the nature ofworks. Assuming that for community pharmacists the separation might be consideredto be a good chance to reinforce their professional status, this study intended toidentify community pharmacists' social roles, explore their professional identity inchanging environment, and to reconstruct their professionalism. In-depth interviews from over-10-years experienced pharmacy pharmacists wereanalyzed by a qualitative method, specifically grounded theory approach. Community pharmacists perceived that their social roles are maximizing thebenefits and controlling the risks of drugs. Community Pharmacist’s autonomycould be called “interactive autonomy”, because the setting of their professionalpractice has been placed in interactive one between doctors, patients, andgovernment after the separation. Advances in pharmaceutical technology, rationalization of national health care system, enhanced accessibility to knowledge of drugs, and drug safety regulationswill transform social expectation about pharmacy. Ultimately, their ability toperform needing social roles balanced with their business nature will show thefuture of the professionalism of community pharmacists. 전문주의에 대한 도전이 본격화되기 이전부터도 약국약사의 전문직 지위는 논쟁적인 주제였다. 우리나라에서도 의약분업 이전 약국약사는 상업적 세팅과 준의사적 업무성격으로 인해 기존의 전문직이론 하에서 불완전한 전문직으로 인식되어 왔다. 본 연구는 전문직이 사회의 요구와 기대에 부응하는 고도로 훈련된 사회적 역할을 수행함으로써 획득되고 유지되는 것임을 전제로 하여 의약분업 이후약국약사들의 전문주의를 검토하고자 하였다. 이를 위해 본 연구는 20명의 경험이 풍부한 개국약사들의 인터뷰를 근거이론 접근법으로 분석하여의약분업 이후 약국약사들의 경험 안에서 그들이 인식하는 핵심적인 변화, 지향하는 전문적 정체성및 그 추구전략을 확인하였다. 분업 이후 약국약사들의 경험에서 사회적 역할의 실천과 관련된 8개의 범주가 도출되었다. ‘약국의 변화된 위치’, ‘환자관계의 변화’, ‘의사관계의 변화’, ‘사회적 역할의 실천동기’, ‘사회적 역할의 실천’, ‘전문성의 강화’, ‘자율성의 추구’, 그리고 ‘상업적 동기와 전문직 역할의 공존’ 범주들은 의약품에 대한 권한을 강화하여 약물전문가로서의 정체성을 확보하고 유지하기 위한 사회적 실천에 의미를 가지게 된다. 그리고약국약사들은 이러한 사회적 실천을 위한 “상호적 자율성”을 확보하고 있었는데, 이는 의약분업이 약사와다른 사회적 행위자 간의 상호의존성을 더욱 강화하는 측면을 가지고 있었다는 것을 반영하고 있다. 기술 발전 및 산업구조 변화 등과 더불어 보건의료체계의 합리화 및 비용효율성을 위한 정책방향은 약국과 약국약사의 사회적 역할을 지속적으로 변화시켜 갈 것이다. 사회적 기대에 부응하는 약국및 약국약사의 사회적 역할과 약국에 내재된 상업적 성격의 조화로운 모색이 약사 전문주의의 미래에 중요한 전략이다.

병원의 구매대행업체 유형별 치료재료 청구가격 비교: 일반척추수술 재료를 중심으로

변진옥,이주향 한국보건행정학회 2020 보건행정학회지 Vol.30 No.3

Background: It is well known that the distribution of therapeutic materials is very complex. However, it is not easy to demonstrate the concrete problems caused by distribution channels empirically. The purpose of this study was to investigate the differences in the price of therapeutic materials according to the type of purchasing agency and the way in which medical institutions purchase therapeutic materials. Methods: This study compared the claimed prices and the maximum allowable prices for the items of therapeutic material used for general spinal surgery. Results: Ilsan Hospital, which purchased directly without a purchasing agent, had the lowest claimed prices, followed by a large professional purchasing agency, a foundation-related purchasing agency, and a general purchasing agency. In addition, the difference between the claimed prices and the maximum allowable prices according to the purchase type was larger in the expensive treatment materials, and in the case of the lower price treatment materials, it tended to converge to the maximum allowable prices. Conclusion: National health insurance spending for therapeutic materials are to be affected by the distribution channels of them. We proposed several ideas to rationalize the expenditure such as classification of therapeutic materials on the basis of price or other criteria.

의약분업 이후 약국약사의 전문주의 - 전문직 체계론을 활용하여 -

변진옥,이혜재 한국보건사회학회 2019 보건과 사회과학 Vol.0 No.51

The purpose of this study was to examine the collective practice of community pharmacies since the medical reform of the separation of drug prescribing and dispensing in terms of jurisdiction that compete with other professions. First of all, as a theoretical background, the classical professionalism theory and Abbott's theory of jurisdiction, were outlined. These background explained the topography of community pharmacy within system of profession and implications for their collective practices in an interdependent system of profession. We briefly reviewed some issues of the division of medicine related to pharmacy professionalism and analyzed the prescription concentration of community pharmacies after the separation of drug prescribing and dispensing. And also we identified and presented the efforts of the pharmacist in order to improve professionalism in response to these external changes. Finally, through analysis of the humanitarian implications of current pharmacies’ professional practices, we tried to suggest some strategies for the future. while pharmacy pharmacists have confined their social objects to “drugs”, pharmacists' social tasks need not to limit their task into “medicine.” Rather, pharmacists should further consolidate the perception that their social target is medicine, and use it as the basis for the abstraction that constitutes the public health problems. 본 연구는 의약분업이 약국약사의 전문주의에 미친 영향을 검토하고 의약분업 이후 약사들의 집단 적인 전문주의 실천, 특히 다른 전문직과 이해가 충돌할 수 있는 영역에서의 실천을 체계론적 시각으 로 고찰하였다. 전문직은 상호의존적인 체계에서 관할권을 두고 경쟁하고 있다. 외부적 충격은 이러한 전문직 체 계 내 교란을 초래한다. 의약분업이 약국약사 전문주의에 미친 영향을 제도 이슈 중심으로 고찰하고 분업 이후 약국처방의 의료기관 집중도를 분석한 결과, 약국의 의료기관 의존도는 더욱 심화되어 가고 있는 것으로 나타났다. 한편 약사사회 내부에서 전문주의를 향상시키고자 했던 그간의 노력들과 그 방 향을 검토하여 애보트의 전문직 체계와 관할권 이론 하에서 약국약사 전문주의 전략을 제언하였다. 인구 고령화 및 만성질환 증가, 보건의료 산업발전 등 현대 사회의 변화는 의약품의 더 많은 소비 를 요구하는데 반해, 공중보건 차원에서는 의약품 이용의 적정화에 대한 요구가 증대하고 있고 약국 약사들은 이러한 사회적 필요에 맞는 과업을 수행할 필요가 있다. 약사전문성의 근간이 되는 사회적 대상이 ‘의약품’이라고 해서 약국약사들의 과업을 의약품 자체로 만 제한할 필요는 없다. 약국약사들은 자신들의 사회적 대상이 의약품이라는 인식을 더욱 공고히 하 고 이를 통해 공중보건 문제를 약국약사의 문제로 구성하는 기반으로 삼을 수 있다.

특허신약의 가격통제 및 공급 정책으로서의 강제실시 : 한국에서의 가능성과 한계

변진옥,정정훈 한국보건행정학회 2010 보건행정학회지 Vol.20 No.1

Korea has had problems with the price and supply of essential drugs such as Gleevec for leukemia , Fuzeon for HIV/AIDS, and Tamiflu for both avian flu and swine flu. The shortage or refusal of patented drugs supply is imposing a heavy burden in not only developing countries but also developed countries. Thinking over the serious results, we need to concern about the limited access to patented drugs by multinational drug companies' patent monopoly especially for pandemic and life threatening diseases. The effective response regarding to pandemicand life threatening diseases. The effective response regarding to pandemic situation requests collaborative and unbiased provisions of all countries in the world, however, sometimes patent monopoly may hinder the efforts. Compulsory licensing has been considered to be a useful alternative to the abuse of patent rights. However, the Korean experiences of compulsory licensing have left some controversial issues in connection with the availability of it in Korea. ‘Flexibility’ allowed in TRIPS and Doha Declaration has not come into effect in Korea for several reasons. Although the situation shows the limitations of compulsory licensing as a pharmaceutical supply policy, it is clear that compulsory licensing still has the possibilities of enhancing the access to medicines of all countries in need. Through searching the institutionalization process and experiments of compulsory licensing in Korea, this article explores the possibilities and the limits.

강화된 키 교환 프로토콜의 안전성 모델의 관한 연구

변진옥,Byun, Jin-Wook 한국정보보호학회 2010 情報保護學會誌 Vol.20 No.2

키 교환 프로토콜은 대표적인 암호화 프로토콜로서 그 안전성 모델에 관한 연구가 꾸준히 진행되어 왔다. 최근에는 기존의 안전성 모델을 강화시키고 강화된 모델을 바탕으로 키 교환 프로토콜 설계가 이루어졌다. 본 논문에서는 강화된 새로운 안전성 모델 결과들을 정리해서 살펴보고 향후 연구 방향에 대해서 논한다.

청소년의 흡연에 영향을 미치는 사회적 요인으로서의 학교 흡연율 : 다수준 분석의 적용

변진옥(Jinok Byeon),조영태(Youngtae Cho) 한국보건교육건강증진학회 2010 보건교육건강증진학회지 Vol.27 No.4

외국인 국민건강보험 가입현황 및 이용특성 분석

변진옥(Jinok Byeon),조정완(JeungWan Cho),이주향(JuHang Lee),이정면(JungMyun Lee) 한국사회정책학회 2019 한국사회정책 Vol.26 No.4

외국인은 일반적으로 의료이용에 어려움을 겪고 있는 것으로 알려져 있지만, 한편으로는 외국인의 건강보험 부당이용이나 과다이용이 사회적 문제가 되기도 하였다. 그 동안 우리나라에서 외국인의 의료이용에 대한 실증적 탐색과 연구가 충분하지 않았다. 이에, 본 연구는 최근 5년간(2013-2017년) 국민건강보험에 가입한 외국인 전수자료를 분석하여 이들의 의료이용 양상과 특징을 고찰했다. 그 결과, 외국인 건강보험 가입자는 내국인 가입자에 비해 의료 미이용자 비율이 높고, 1인당 입내원일수와 1인당 진료비 등 의료이용이 적었다. 다만, 외국인은 입원 일당 진료비가 내국인보다 다소 높게 나타나 중증의 case mix를 가질 가능성이 있다. Foreigners are known to have various difficulties in accessing medical services in their resident countries. On the other hand, in Korea, illegal or over-utilization of NHIS by a few of foreigners by foreigners became a social problem. However, there was not enough empirical researches for their medical utilization of NHIS foreign subscribers. Thus, this study looked at the pattern and characteristics of medical use of NHIS foreign subscribers through the data of all NHIS subscribed foreigners over the past five years (2013-2017). Foreign health insurance subscribers in Korea have a higher proportion of non-users of medical insurance compared to Korean subscribers, and their overall use of medical care was low, including the number of days per person and cost for medical treatment per person. However, considering the high cost of hospitalization, it is possible that the foreigners have had more serious case mix than Koreans.

OECD국가에서 총 의료비 및 정부지출 의료비와경제성장의 Granger Causality: 2000~2012

변진옥 ( Jin Ok Byeon ),이현복 ( Hyun Boc Lee ) 한국사회보장학회 2014 사회보장연구 Vol.30 No.1

본 연구의 목적은 국민의 건강에 정부재정을 투입하는 정당성으로서 논의되는 경제성장을 위한 투자론에 대한 실증이다. 이를 위해 2000년부터 2012년까지 OECD국가들의 총 의료비 및 정부지출 의료비 등과 GDP와의 관계를 Granger Causality분석과 벡터자기회귀분석(VAR)을 이용하여 실증하였다. Granger Causality 분석결과 GDP와 총 의료비, GDP대비 정부지출 의료비, 정부지출 의료비, 일인당 의료비, 일인당 정부지출 의료비는 서로 쌍방향의 양(+)의 영향을 주고 있는 것으로 나타났다. 또한 충격반응 결과 GDP가 총 의료비 및 정부지출 의료비에 주는 영향에 비해 총 의료비와 정부지출 의료비가 GDP에 주는 영향은 더 장기적이었다. 이러한 결과는 총 의료비 지출과 정부지출 의료비가 노동생산성과 교육을 통한 인적자본의 축적 등에 직간접 영향을 준다는 기존의 논의를 지지할 가능성을 보여준다. The purpose of this study is to identify whether and the extent to which total health expenditure and (or) government health expenditure has granger causality in OECD countries after economic crisis. This study analyze the data including GDP, total health expenditure, government health expenditure, health expenditure per capita, government health expenditure per capita from 2000 to 2012 of each OECD countries and investigates the Granger-causality relationship between GDP and the other variables. The results show the positive(+) bidirectional Granger-causality not only between GDP and total health expenditure but also GDP and the variables relating governmental health expenditure. A VAR test verifies that governmental health expenditure compared to the total health expenditure has been long-term impact on the GDP. Therefore total health spending as well as the share of government affects directly or indirectly to national economic growth with the possibility of both to enforce the labor productivity and to help accumulating human capital.

주요 치료재료 품목군의 건강보험청구액 결정요인분석

변진옥 ( Jin Ok Byeon ),이주향 ( Ju Hyang Lee ),김유리 ( Yu Ri Kim ),이혜재 ( Hye Jae Lee ) 한국보건행정학회 2016 보건행정학회지 Vol.26 No.4

Background: The use of therapeutic materials based on new health technology has increased in recent years in the field of medicine, raising concerns for medical practitioners regarding increased spending on the new therapeutic materials amid the rapid population ageing and increase of chronic diseases in Korea. While therapeutic materials have significant importance in the health care system, they have not been given appropriate attention in the academic world of Korea. The purpose of this study is to identify factors that affect the growth of expenditure on therapeutic materials and to derive implications for an effective management considering the diversity of therapeutic materials. Methods: Using the claims data of the National Health Insurance Services, specific utilization patterns of groups of therapeutic materials in the middle classification level of Health Insurance Review and Assessment Service from 2007 to 2014 were analyzed. Four categories (J5083: drug eluting coronary stent, D0302: nonmetallic anchor, K6014: gauze, K6023: gauze) that exhibit unique patterns with respect to price and volume were selected. Then, decomposition analysis was performed to identify the largest contributor to the spending growth by dividing the products into existing, new, and abandoned products for the period between 2010 and 2013. Results: The effect of new products had larger impact on spending growth than the effect of core items in drug eluting coronary stent (J5083) and nonmetallic anchor (D0302). In addition, existing products in general included items priced relatively lower when compared with another item manufactured by the same company. In the gauze category, however, existing products had the largest impact on expenditure and the effect of volume was greater than that in other categories. Conclusion: This study provides evidence that appropriate management measures classified by the characteristics of therapeutic materials are required for therapeutic materials pricing and reassessment in Korea.