신문기사에 대한 의미연결망 분석을 통한 의료 시장화 논리와 의료 보장성 논리 분석

이근찬(Geun-Chan Lee) 한국보건사회학회 2024 보건과 사회과학 Vol.66 No.-

지방과 서울 대형병원에 대한 지방 주민의 서비스 품질 인식 차이

이근찬 ( Geun Chan Lee ),권순만 ( Soon Man Kwon ),유명순 ( Myoung Soon You ) 한국보건경제정책학회 2011 보건경제와 정책연구 Vol.17 No.1

The purpose of this study is to examine the gap of perceived service quality between users and nonusers of large hospitals and to explore relevant factors. It is assumed that service quality perception is the significant factor for local residents` decision to use large hospitals in Seoul instead of those located in their residential area. We classify health service quality as the technical quality as outcome after service delivered and the functional quality that involves perceptual evaluation of the process of service delivery. We analyse telephone survey data of 800 residents of Daegu. Survey questions included the utilization of large hospitals in Seoul and Daegu, first-recall hospital, service quality rating and respondent`s demographic profiles. This study has three main findings. First, non-users rate large hospitals in Seoul higher than those in their residential area in both functional and technical quality, but users rate hospitals in Seoul higher only in terms of functional quality. This difference reflects that nonusers evaluate technical quality using second information sources such as word-of-mouth and media. Second, evaluation of service quality by local residents increases after health care utilization, which implies that service quality perception can be enhanced by an effective management of service encounters. Third, respondents, who said that first-recall hospital is in Seoul, rate hospitals in Seoul higher than those in Daegu, implying that raising public awareness of local hospitals is needed in pre-purchase stage.

병원의 의료기술 수준에 대한 측정 방법론 개발과 이를 이용한 실증 분석

이근찬 ( Geun-chan Lee ) 한국보건경제정책학회 2022 보건경제와 정책연구 Vol.28 No.2

The Guttman scale and Saidin index are commonly used to measure the availability of expensive medical devices such as CT, MRI, and PET. However, they do not account for critical aspects that larger-sized hospitals have two or more per medical device (modality). This study developed an alternative measure of the aggregated estimates of technology availability in hospitals. The quantity-adjusted technology level (QATL) index - accommodates multiple medical technologies (modalities) and the number of hospitals’ installments - compared with the Saidin index. According to the results of the empirical study, the statistically significant factors between the Saidin index and the QATL index are not much different. However, it is noteworthy that the coefficients of Tobit regression analysis in the tertiary hospitals were slightly larger in the QATL index than in the Saidin index. Evidence shows that the QATL index was meaningful in measuring hospital input resources. Based on the empirical test, this paper discussed the construct validity of the QATL index and presented future research directions.

상급종합병원 지정 제도에 대한 의료기관의 인식과 대응 : 진료권역 제도를 중심으로

이근찬(Geun-Chan Lee) 한국보건사회학회 2020 보건과 사회과학 Vol.0 No.54

상급종합병원 지정 및 평가 제도는 진료권역별로 우수한 종합병원을 상급종합병원으로 지정하여중증질환에 대하여 난이도 높은 의료 행위를 전문적으로 제공하기 위한 제도이다. 본 연구는 우리나라 상급종합병원에서 병상의 의미, 진료권역별 소요병상 제도에 대한 인식, 상급종합병원 지정을 위한 의료기관의 동태적 활동을 분석하고자 하였다. 법과 제도에 대한 조직의 대응, 의료 자원에 대한문헌을 고찰하고 상급종합병원에 지정 평가 업무를 핵심적으로 담당한 병원 종사자에 대한 심층 인터뷰를 실시하여 분석하였다. 연구 결과, 병원 종사자에게 병상은 ‘대형’, ‘고급’의 이미지를 지니며, 진료권역별 소요병상제도 도입의 목적에 대한 인식은 의료의 지역화라는 합리적 관점과 서울지역 환자집중을 줄이기 위한 정치적 관점이 공존하였다. 상급종합병원 지정 기준을 정하는 단계에서 지정 가능성이 중간 수준인 병원들은 적극적으로 기준 변경을 요구하는 비순응적 행태를 보이며, 지정 가능성이 높은 병원은 현재의 기준에 순응하는 모습을 보였다. 보건의료정책은 이해관계간의 합의가 요구되는 데 병원군 내부의 결속력을 높이는 대책이 필요하며, 상급종합병원 지정 및 평가 기준을 공고하는 시기를 앞당겨서 기준의 예측가능성을 높이는 것이 필요하다 The tertiary hospital designation system is aimed to provide specialized medical practice for severe diseases, by designating excellent general hospitals as advanced general hospitals for each health service area. This study was intended to analyze the meaning of hospital bed, awareness of demanded bed amount by health service area, and the dynamic behavioral patterns of applied hospitals for the tertiary hospital designation system in Korea. The author did literature review on organizational response to regulation and medical resources and conducted interviews with hospital administers experienced with the tertiary hospital designation process. The findings of the study summarized as follows; The bed size has a “large” and “high-quality” image, and there coexisted the rational view of regionalizing medical care and the political view to reduce the patients’ inflow concentration in Seoul area on motive of introducing needed bed amount for health service areas. In the phase of setting the standard for designation of tertiary hospitals, hospitals with moderate potential for designation showed non-compliance demand changing standards and hospital with higher potential showed compliance with the current standard. Health and medical policies require consensus among stakeholders, and measures are needed to enhance the solidarity within hospital population. It is necessary to increase the predictability of the criteria by advancing the timing of announcing the criteria for designation and evaluation of tertiary hospitals.

중고의료기기 유통제도 관리방안 개선 연구

박순만 ( Soon Mahn Park ),이근찬 ( Geun Chan Lee ),유선국 ( Sun K Yoo ),강태건 ( Tae Geon Kang ) 한국보건경제정책학회 2008 보건경제와 정책연구 Vol.14 No.2

Thesedays some advanced countries have required for Korean government to manage remanufactured medical devices as new devices through FTA negotiations. Korean system is different from the system of those advanced countries. Because Korea manages non-new goods as used goods in a lump. Korean regulation for pre-owned medical devices distribution are ambiguous. There is the management regulation only for imported pre-owned medical devices in Korea. However, there isn`t the management regulation for distributed pre-owned medical devices from domestic sources. Therefore, the Korean management regulation for pre-owned medical devices is not symmetric. And the distribution of domestic pre-owned medical devices could be illegal because there is no clear regulation. On the other hand, domestic pre-owned medical devices are distributed implicitly and negatively in actuality. And the safety and quality of those devices could not be guaranteed. In this paper, we reviewed Korean pre-owned medical devices distribution system and researched other advanced countries system. Then we derived new policy for the distribution of pre-owned medical devices in Korea. We suggest 2-step choice system before selling pre-owned devices. The one who wants to sell the pre-owned devices must either test the device in a public testing institute or do inspection/consent in the manufacturer or importer of that device. The suggested policy option is thought to have higher benefits but lower cost. Therefore we think that the policy has better acceptance to the stakeholders and higher social benefit.

급성 B형 간염의 회복 후 말초혈액 단핵구에서의 HBV DNA 검출

명승재(Seung Jae Myung),이영상(Yung Sang Lee),김형건(Hyung Gun Kim),이근찬(Geun Chan Lee),박능화(Neung Hwa Park),정영화(Young Hwa Chung),서동진(Dong Jin Suh) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.1

N/A Background/Aims: Negative seroconversion of HBsAg with the appearance of anti-HBs and normalization of serum transarninase level have been generally accepted as an evidence of a cure of hepatitis B, and viral clearance. However, there are growing evidences that the hepatitis B virus (HBV) genome persists after those events. HBV DNA could be detected from the serum, peripheral blood mononuclear cells (PBMC) and liver tissue by sensitive PCR method, even when HBsAg is undetectable from the serum during the course of chronic hepatitis B. The aim of this study is to demonstrate whether HBV might persist in the circulation after complete serologic and clinical recovery from acute hepatitis and its clinical manifestations implications. Methods: We tried to detect HBV DNA from the serum and PBMC of 24 healthy individuals (male 16, female 8) with a history of self-limited acute hepatitis B infection using the PCR-Southern hybridization. Results: The mean duration from the onset of acute hepatitis to the time of sampling was 19+11 months, and HBV DNA was undetectable from sera of the individuals with PCR and Southern hybridization. HBV PCR was performed after the separation of PBMC and DNA isulation. HBV DNA was amplifiable in 4 of 24 individuals (17%). By Southem hybridization, HBV DNA was confirmed in 4 positive samples. The duration from the onset of acute hepatitis to the sarnpling time in positive group was 7.0 3.2 montks, and was significantly shorter than DNA negative counterpart (21.5 10.5 months)(p<0.01). Conclusions: Hepatitis B virus DNA can persist in peripheral blood mononuclear cells after resolution of acute hepatitis, and it may persist only for a certain period after clearance of virus in the serurn. The role of HBV DNA in PBMC should be elucidated in the future. (Korean J Gastroenterol 1997; 29:74-84)

심근경색증으로 처음 임상발현된 전신성 홍반성 낭창 1 예

김주영(Ju Young Kim),송재관(Jae Kwan Song),이근찬(Geun Chan Lee),두영철(Young Cheoul Doo),김원호(Won Ho Kim),김재중(Jae Joong Kim),박성욱(Seong Wook Park),문희범(Hee Bom Moon),이종구(Jong Koo Lee) 대한내과학회 1994 대한내과학회지 Vol.47 No.1

Systemic lupus erythematosus is a chronic inflammatory disease of unknown cause, characterized by appearance of variable autoantibodies and multiple organ involvement. Cardiac involvement in systemic lupus erythematosus is well recognized and most frequently manifested as pericarditis, myocarditis, and endocarditis, but myocardial infarction during the course of systemic lupus erythematosus is rare and only a few cases have been reported. In this case report, we present a 20-years old young male patients with acute myocardial infarction and active systemic lupus erythematosus. A young male without any past medical history visited emergency room due to sudden anterior chest pain lasting several hours, whose electrocardiography revealed right bundle branch block and myocardial ischemia pattern. Echocardiography showed regional wall motion abnormality suggestive of ischemic insult of left anterior desending artery territory. Total obstruction of distal left anterior descending artery was demonstrated in coronary angiography. The patient described here meets four of the revised criteria for systemic lupus erythematosus: pericardiopleuritis, positive antinuclear anti- body, positive anti-ds-DNA antibodies, and thrombocytopenia. Screening for systemic vasculitis or other connective tissue disease seems to be necessary for etiologic diagnosis of acute myocardial infarction especially in cases without any major risk factors for atherosclerosis.

경정맥을 통한 간생검의 유용성과 안전성

김도하(Do Ha Kim),김홍자(Hong Ja Kim),박능화(Neung Hwa Park),이근찬(Geun Chan Lee),정영화(Young Wha Chung),이영상(Young Sang Lee),구동억(Dong Erk Goo),윤현기(Hyeon Ki Yoon),성규보(Kyu Bo Sung),유은실(Eun Sil Yu),서동진(Dong Jin Suh) 대한내과학회 1998 대한내과학회지 Vol.54 No.2

Objectives : Liver biopsy is an essential tool to confirm suspected diagnosis and to guide specific therapy in patients with liver disease. But, the standard percutaneous needle biopsy is contraindicated in patients with coagulopathy and large amount of ascites. The transjugular approach has been developed for these problem cases, but its efficacy and safety has not been adequately tested in Korea. Methods : We retrospectively analysed 21 transjugular liver biopsy cases, and the success rate of procedure, the adequacy of obtained specimen for diagnosis and procedure related complications were reviewed. Results : The major reasons for trasjugular liver biopsy were coagulopathy(71%) and massive ascites(19%). Liver tissue was obtained successfully in 20 of 21 cases. The mean number of specimens was 3.4±1.1 per case and the mean size of specimen was 1.8±0.7mm Pathologists reviewed and judged as adequate for diagnosis in 13 cases(65%), helpful in 6 cases(30%), and inadequate in 1 case. Minor complications such as neck pain, hematoma at puncture site, or transient fever occurred in 5 cases (23.8%) but there was no major complication or procedure-related mortality. Conclusion: Transjugular liver biopsy is a safe and valuable technique that provides adequate diagnostic informations in about two thirds of patients for whom conventional percutaneous biopsy is contraindicated.

특징적인 대동맥벽의 기포를 동반한 세균성 대동맥염 ( Bacterial Aortitis ) 1 예

조재근(Jae Kun Cho),송재관(Jae Kwan Song),이근찬(Geun Chan Lee),채제건(Jei Geon Chae),김도하(Do Ha Kim),장재원(Jae Won Jang),김재중(Jae Joong Kim),박승정(Seung Jung Park),이종구(Jong Koo Lee) 대한내과학회 1995 대한내과학회지 Vol.49 No.4

Bacterial aortitis is a rare but fatal infectious disease of underlying atherosclerotic aorta or normal aortic wall in immunecompromised host. The most commonly identified organisms are Salmonella and Staphylococcus. Characteristic findings of computed tomography scan are aortic nodularity, aneurysm of irregular configuration arv3 air in the aortic wall. An-eurysmal dilatation of the infected aorta is the usual course, which is commonly associated with rupture. We report a case of bacterial aortitis with characteristic air in the aortic wall which progressed to aneurysmal formation and rupture.

A case of echinostomiasis with ulcerative lesions in the duodenum

Jong-Yil Chai(채종일),Sung-Tae Hong(홍성태),Soon-Hyung Lee(이순형),Geun Chan Lee(이근찬),Young Il Min(민영일) 대한기생충학열대의학회 1994 The Korean Journal of Parasitology Vol.32 No.3