의대생의 전문직 사회화 과정에 대한 고찰

한달선,조병희,배상수,김창엽,이상일,이영조,Han, Dal-Sun,Cho, Byung-Hee,Bae, Sang-Soo,Kim, Chang-Yup,Lee, Sang-Il,Lee, Young-Jo 대한예방의학회 1996 예방의학회지 Vol.29 No.2

This paper concerns professional socialization of medical students. Professional socialization, in the context of this paper, means the process through which a layperson becomes a doctor equipped with professional identity and values. While medical education does not include such process in the curriculum, medical students obtain certain values and identity informally. The dependent variables were professional values and professionalism. The former means the desirable attributes required to conducting professional works such as humane attitudes, science-oriented mind, capability for organizational management. The latter means socio-political reasoning with which doctors can rationalize their privileges such as autonomy. A specially designed questionnaire was developed. The data were collected from five medical schools for 1,318 students in 1994. A total of 1,070 cases were finally included in the statistical analysis. The students emphasized the human factor in the professional values. Their attitude did not change with the grade. Other independent variables such as motives for entering a medical school, socioeconomic status, satisfaction with medical education, etc. also did not influence professinal values. It implies that professional values were not consolidated among the students. However, the factors of professionalism change significantly with the grade. It implies that the students paid more attention to socio-political issues related to doctor's interests as the grade went up. And the factor scores for professionalism were higher for those students who had more positive attitude towards doing medical practice for profit, expected higher income, and were more conservative about social reform. Other independent variables did not influence professionalism. It seems that the students also give emphasis on professionalism, like current medical doctors, mainly because of their concern with recent unfavorable changes in economic conditions of medical care providers.

보험진료체계 개편의 효과에 대한 연구

한달선,김병익,이영조,배상수,권순호,Han, Dal-Sun,Kim, Byungy-Ik,Lee, Young-Jo,Bae, Sang-Soo,Kwon, Soon-Ho 대한예방의학회 1991 예방의학회지 Vol.24 No.4

This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discouraging the use of tertiary care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131 (3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care utilization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.

21세기 초 한국의 보건의료체계 - 공급체제를 중심으로 -

한달선,Han, Dal-Sun 대한예방의학회 1994 예방의학회지 Vol.27 No.2

This paper is an attempt to identify major challenges to be faced by the Korean health care delivery system for about 30 years in the future and to deliberate over possible policy responses to them. It is not intended to make a precise prediction of the future profile of the system, but the focus is given to understanding what we have to do from now on in order to develop health care in Korea toward a desirable direction. Although the discussion has been made in a rather fragmented manner, it would hopefully provide stepping stones for a systematic study of the Korean health care system from a long range perspective.

입원의료의 진료권별 자체충족도에 관한 연구

한달선,권순호,Han, Dal-Sun,Kwon, Soon-Ho 대한예방의학회 1990 예방의학회지 Vol.23 No.3

The utilization of medical care services has been partly regionalized with the implementation of referral requirement by the government since July 1, 1989 when the health insurance coverage was extended to all the people. For the purpose of regionalization, the whole country has been primarily divided into tertiary care regions, and each of them again into secondary care regions. This study investigates the self-sufficiency for in-patient care services of secondary care regions focusing on why it varies among the regions. In doing so, analysis is performed to examine a model which embodies three sets of hypotheses as follows : 1) The regional self-sufficiency for medical care services would be subject to direct influences of regional characteristics, amount of available services and structural properties of regional medical care system ; 2) The regional characteristics would have indirect effects on the self-sufficiency which are mediated by medical care services ; and 3) The amount of available services would indirectly affect the self-sufficiency by influencing the structure of regional medical care system. The results of analysis were generally consistent with the model. The findings have some practical implications. The regional self-sufficiency for medical care services partly depends upon basic properties of each region which cannot be changed in a short period of time. Thus the self-sufficiency for medical care services can be improved mainly by health policy measures. In some of the regions the self-sufficiency for in-patient care services was much higher or lower than can be predicted from the bed-population ratio. Indication is that the allocation of health resources should be made considering a variety of factors bearing upon the supply of and demand for health care ; not on the basis of just a single criterion like the availability. The self-sufficiency of a certain region is related to not only its own characterstics but also the characteristics of neighboring regions. Therefore, attention should be also directed to the inter-regional relationships in health care when the needs for investment of health resources in a region are assessed. However, it should be noted that this study used the data collected before the referral requirement was imposed. A replication of this analysis using recent data would provide an evaluation of the impact on the self-sufficiency of the referral requirement as well as a confirmation of the findings of this study.

Origins and Evolution of Social Medicine and Contemporary Social Medicine in Korea

한달선,배상수,김동현,최용준,Han, Dal Sun,Bae, Sang-Soo,Kim, Dong-Hyun,Choi, Yong-jun The Korean Society for Preventive Medicine 2017 예방의학회지 Vol.50 No.3

Social medicine is recognized as one of medical specialties in many countries. However, social medicine has never been formally introduced to Korea, presumably because the term and its principles were not accepted for some years in the past in American medicine, which has strongly influenced Korean medicine. This paper describes the origins and evolution of social medicine and briefly discusses contemporary social medicine in Korea. Social medicine was initiated in France and Germany in 1848. Since then, it has expanded globally and developed in diverse ways. Included in core principles of social medicine is that social and economic conditions have important effects on health and disease, and that these relationships must be subjected to scientific investigation. The term 'social medicine' is rarely used in Korea, but many of its subject matters are incorporated into preventive medicine which, besides prevention, deals with population health that is inescapably social. However, the Korean preventive medicine directs little attention to the basic concepts and principles of social medicine, upon which systematic development of social medicine can be based. Thus, it is necessary to supplement the social medicine contents of preventive medicine through formalizing the linkages between the two fields. One way of doing so would be to change the title of 'preventive medicine' course in medical colleges to 'preventive and social medicine,' as in many other countries, and to adjust the course contents accordingly.

보험환자의 의료이용 추구경로

한달선 ( Dal Sun Han ),김병익 ( Byong Yik Kim ),이영조 ( Young Jo Lee ),권순호 ( Soon Ho Kwon ) 한국보건행정학회 1992 보건행정학회지 Vol.2 No.1

The purposes of this paper are twofold: to identify what pathway insured patients are seeking medical care services through, and then, to provide the basis for the prediction and evaluation of the effects of a new policy intervention. To change the patient flow across different types of medical care facilities, this intervention has been enforced since July 1, 1989. It is mainly aimed at discouraging the use of the tertiary hospitals by imposing some restrictions on the patient`s choice. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for about 1% of the enrollees using medical care facilities during 2 years since January 1, 1985. The sample included 91, 483 for 1985 and 81,914 for 1986, among them the number of patients to initiate the use of medical care service were 66,757 and 59,498 respectively. This paper analysed what types of and how many medical care facilities the patient with same disease had used.

保健行政의 組織理論的 硏究 序說

韓達鮮(Dal Sun Han) 서울대학교 보건환경연구소 1974 보건학논집 Vol.11 No.2

A Conceptual Framework for Administrative Analysis of Family Planning Programs

Dal Sun Han(韓達鮮) 서울대학교 보건환경연구소 1976 보건학논집 Vol.13 No.3

특별기고 : 의료위기의 본질과 과제

한달선 ( Dal Sun Han ) 한국사회보장학회 2002 사회보장연구 Vol.18 No.2

These days many people believe that we are in a health care crisis. Perhaps, this belief resulted from our unfortunate experience with the unprecedented nationwide strike by physicians which had lasted for several months in 2000 and the recent financial crisis of the health insurance system. In order to observe major features of the crisis situation, a brief review of the health care system was made. The aggressive implementation of health insurance unification, the separation of dispensing practice from medical pratice and the promotion of other reform policies of doubtful effectiveness and feasibility are blamed for the current crisis situation. However our health care system has had fundamental problems for a long time and they may be seen as the background for the situation. foremost of them is our society has given policy attention and resources to health care far less than it deserves in view of the state of our nation`s development. Based upon the observation of the major features and background of our current health care problems, this paper proposes four policy issues which should be given priority in our efforts for health care improvement.

진료의 질관리에 대한 시론 -장애와 접근-

한달선 ( Dal Sun Han ) 한국보건행정학회 1992 보건행정학회지 Vol.2 No.2

Patient care services are provided to individual patients in response to their health needs pro-duced by illnesses or injuries. The services are often addressed to very serious conditions, and also they constitute the most expensive component of health care services. Therefore, the importance of quality is emphasized, but there are many indications that patient care quality is far from a satisfactory state in most of the countries. Based upon this observation, it is attempted to exam-ine obstacles and approaches to quality improvement in patient care services. In doing so, follow-ing Taguchi`s(1986) definition of product quality, quality of patient care services is conceived of as better when the less is the sociental loss attributable to variability of intended function and harmful side effects they exhibit after being delivered. Some distinguishing features of medical care sector pose difficulties in implementing effective quality improvement programs in patient care services. Nevertheless, newly proposed method of quality management, based on industrial quality management approach, seems to have a great deal of potential to effectively cope with such difficulties. This method, unlike the traditional ap-proach to quality assurance, focuses on total organizational processes, not individuals, as the ob-jects of quality improvement; variation, not comparison with standards, in quality measurement; and continuous improvement, not removing only bad quality care, as an ideal. Prerequisite to a successful use of any quality mangement method is motivating providers to improve quality. Con-ceivable approaches for such motivation are self-regulation, external controls and promotion of competition. Since these approaches are not mutually exclusive, they may be employed in an ap-propriate combination. In Korea, medical care providers are now functioning under the circumstances where they have little reason for making efforts to improve quality of their services. Once these circumstan-tial conditions are changed to exert pressures on providers to improve quality, the use of adequate quality management method becomes an issue. In this connection, much attention shoould be di-rected to the newly proposed method described above. In all these efforts for improving quality of patient care services, health insurance would be able to play a pivotal role. Poviders of medical care, both individuals and organizations, are usually very responsive to the measures that affect their financing, and thus health insurance can be a strong instrument for motivating providers to improve quality. Also, the insurance continuously acquires data on patient care, which could be processed to produce information required to effective quality control.