요양병원 수가제도에 대한 소고-환자군 조정 판결을 중심으로-

권혜옥 대한의료법학회 2017 의료법학 Vol.18 No.2

The increase in medical expenses for convalescent hospitals is increasing abnormally, which puts enormous burden on the National health insurance finances. This is a phenomenon that has been associated with the social phenomenon of rapid aging. The fact that the convalescent hospitals are paid the fixed amount per day for hospitalization became the incentive for some hospitals to use the patients as means of making money. And these hospitals intend to get regular care or take medicines at other hospitals in order to reduce medical expenses, even when the medical fee is paid. In order to prevent such financial leaks, the Health Insurance Review and Assessment Service adjusted the patient group for inpatients in a hospital with the above behavior, and then cut the cost of medical care benefits. However, Above decision was canceled by the court on the grounds that there was no basis rule. However, based on the above case, I think that it can be an opportunity to draw up the problem and to improve of the Medical Fee System of hospital. The modified medical fee system can strengthen the medical function of the convalescent hospital. In addition, it seems reasonable to exclude admission for "physically disabled group". Even if admission is allowed for the physically disabled group due to social needs, it should be excluded from the National health insurance for the fianacial soundness and the sustainability of the system. 요양병원에 대한 진료비의 증가폭이 비정상적으로 늘어나고 있어 건강보험재정에 막대한 부담을 주고 있다. 이는 요양병원 특수성이 급속한 노령화라는 사회적인 현상과 맞물리면서 나타나게 된 현상인데, 이 중 요양병원에 대하여 입원일당 정액수가제에 의하여 비용이 지급되는 점은 일부 요양병원이 환자를 돈벌이 수단으로 이용하는 유인이 되었다. 이러한 요양병원들은 일당정액수가를 지급받고도 그에 합당한 진료비용의 지출을 줄이기 위해 의도적으로 입원 환자를 타병원에서 정기적으로 진찰을 받게 하거나 주요 약제를 처방받게 하는 등 건강보험재정이 이중으로 지출되게 하였다. 이러한 재정누수를 방지하기 위하여 심사평가원은 위와 같은 환자들에 대하여 기존의 환자군을 부정하고 ‘신체기능저하군’으로 환자군을 조정한 다음 요양급여비용을 삭감하였다. 그렇지만 위 결정은 규정상근거가 없음을 이유로 법원으로부터 취소판결을 받았다. 그러나 위 사건을 계기로 요양병원 수가제도의 문제점을 도출하고 제도를 정비하는 기회가 될 수 있다고 생각한다. 현재의 정액수가제를 수정하여 약제비 및 진료자체에 대한 행위별 청구를 일부 도입하면 요양병원의 의료적 기능을 강화할 수 있다고 생각한다. 또, 현재의 환자군 중 비슷한 군들은 통합하고 신체기능저하군은 입원이 부적절하므로 환자군에서 제외하는 것이 타당하다고 보인다. 다만, 사회적 필요에 의해 신체기능저하군을 입원대상으로 인정하게 된다 하더라도 장기요양대상과의 형평성, 건강보험재정의 건전성 등을 고려하여 건강보험대상에서는 제외되어야 한다고 생각한다.

한국전쟁기 병원선의 파견과 활동

이창영(Lee Changyoung) 부경대학교 인문사회과학연구소 2022 인문사회과학연구 Vol.23 No.1

한국전쟁기 병원선의 활동은 유엔 안전보장이사회의 군사지원 결의를 통해 시작되었다. 한국전쟁 당시 의료지원국으로 활동한 국가는 이탈리아, 인도, 덴마크, 스웨덴, 노르웨이였다. 이 중 병원선을 파견한 국가는 덴마크였다. 미국은 군사지원과 함께 병원선 세척을 파견했다. 각 병원선은 MS Jutlandia(덴마크), USS Consolation(AH-15), USS Haven(AH-12), USS Repose(AH-16)(이상 미국)였다. 네 척의 병원선은 한국전쟁 전반에 걸쳐 의료 활동을 적극적으로 수행했다. 이들의 활동은 크게 군 의료지원과 민간인 치료 및 구호로 나뉜다. 병원선은 최신식 시설을 갖추고 부상자에 대한 수술 및 치료를 진행했다. 부상자 중 치료가 더 필요한 장병은 후방 지대인 부산, 일본 등으로 후송되었으며, 일정 기간에 한번 본국에 귀국하기도 하였다. 네 척의 병원선은 헬리콥터 플랫폼을 설치하면서 더욱 진일보한 의료지원을 할 수 있었다. 한편 민간인들에 대한 치료 및 구호도 진행되었다. 특히 고아에 대한 구호가 많이 진행되었다. 해군 장병들은 고아원에 구호금을 모아 전달하기도 했고, 고아들을 초청하여 선상에서 파티를 열고, 치료를 해주기도 했다. 전쟁 기간 병원선의 치료를 받은 환자는 군과 민간을 합쳐 대략 20만 명이 넘는다. 병원선은 질적으로도 굉장히 우수한 치료를 선보였다. 병원선은 죽어가는 부상병들이 실려 오는 공간임과 동시에 부상병과 민간인에 대한 치료 구호가 이루어지는 이중의 공간이었다. 치료 및 구호자들은 이러한 광경을 지켜보았다. 그럼으로써 병원선은 전쟁의 파괴자적 모습과 구원자적 모습을 동시에 확인할 수 있는 공간 중 하나가 되어 갔다. During the Korean War, the hospital ship began with a resolution of military support by the UN Security Council. The countries that served as medical support countries during the Korean War were Italy, India, Denmark, Sweden, and Norway (West Germany is post-war and recognized as medical support countries in 2018). Among them, Denmark sent hospital ships. The United States dispatched hospital ships with military support. Each hospital ship was MS Jutlandia (Denmark), USS Consolation (AH-15), USS Haven (AH-12), and USS Repose (AH-16) (USA). Four hospital ships actively carried out medical activities throughout the Korean War. Their activities are largely divided into military medical support, civilian treatment, and relief. The hospital ship was equipped with state-of-the-art facilities and operated and treated for the injured. Among the injured, soldiers who needed more treatment were evacuated to Busan and Japan, which are rear areas, and returned to their home country once in a certain period of time. Four hospital ships were able to provide more advanced medical support by installing helicopter platforms. Meanwhile, treatment and relief for civilians were also carried out. In particular, there were many slogans for orphans. Navy soldiers collected and delivered relief funds to the orphanage, and invited orphans to hold parties and treat them on board. During the war, more than 200,000 patients were treated by hospital ships, including the military and the private sector. It showed excellent quality treatment. As such, the hospital ship was a space where dying wounded soldiers were carried in, and at the same time, it was a double space where treatment relief was provided for injured soldiers and civilians. The hospital ship was one of the spaces where you could simultaneously confirm the destructive and savage aspects of the war.

현역병사의 의료이용 경험에 따른 진료의료기관 선택 의향

황병덕(Byung-Deog Hwang) 한국콘텐츠학회 2010 한국콘텐츠학회논문지 Vol.10 No.4

이 연구는 현역병사를 대상으로 설문지를 이용하여 조사하였다. 조사기간은 2009년 10월 5일부터 24일까지 20일이었으며, 600부를 배부하여 565부를 회수하였다. 연구의 목적은 현역병들의 의료 이용실태를 조사하고 의료기관이용경험에 따른 향후 민간병원의 선택의사 및 군병원의 진료서비스 수준에 대한 인식을 파악하는데 있다. 연구의 결과는 다음과 같다. 외래이용경험률은 군병원이 60.7%, 민간병원이 18.9%이었으며 계급이 높을수록 이용경험이 높았다(p<.000). 민간병원을 이용하게 된 동기는 우수한 의료진이 58.9%로 가장 높았으며 의료장비 및 시설만족 49.6%순이었다. 군복무중 진료의료기관의 선택의향에서는 ‘입원?외래 모두 민간병원 선택’이 가장 높았으며 계급이 높을수록 민간병원을 선호하는 경향이 통계적으로 유의하게 나타났다(p<.005). 결론적으로 현역병의 군병원에 대한 선호도를 높이기 위해서는 군의료수준을 민간의료수준으로 발전시켜야 하며, 의료인력의 확충과 첨단의료장비의 도입 등 적극적인 재원투자가 필요하다. 또한 군병원도 일반병원과 경쟁하도록 외부의 의료서비스 평가를 의뢰하고 그 결과를 적극 수용하도록 하여 의료 서비스의 질적개선 향상을 위한 노력을 하여야 한다. This study, using questionnaires to target Servicemen were investigating. Study period of 2009 October to 24 was 20 days. All 600 questionnaires distributed affair, but 565 cases were collected. The purpose of the this study was serviceman investigate the actual conditions of utilization of private hospitals and awareness for the level of military hospital medical service as well as to the selection of future for the private hospitals is to finding. Results of the study are as follows: Outpatient utilization rate of each other the military hospital and private hospitals was 60.7% and 18.9%.(p<.000) The results of frequency study of the factors which affect the private hospital is satisfaction of medical workforce(58.9%), medical equipment and facilities(49.6%), etc. The choice of hospital were inpatient and outpatient both the selected by private hospitals. Had to prefer a private hospital were statistically significant (p<.005). In conclusion, to increase the preference of the military hospital is level of private hospital health care level of should be to developed. More support to financial should provide for medical workforce and setting of cutting edge medical equipment in the military hospital. Military hospital is should be competition with private hospital. Also should be improve the quality of military medical service.

군병원 종사 의무병들이 환자로부터 경험한 무례함이 직무 스트레스에 미치는 영향 분석

문석준,이호철,김지언,남은우 한국군사회복지학회 2019 한국군사회복지학 Vol.12 No.2

reduce job stress for medics who worked in the armed forces hospitals. Specifically, it showed that reducing incivility from military officers and military personnels, especially those who have hierarchical status, is essential. the results of this study, can be used as basic data for future policies and programs to reduce the job stress of medics who worked in the armed forces hospital. 본 연구에서는 국군의무사령부 예하 국군병원에서 의무병으로 복무한 병사 96명을 대상으로 설문조사를 통하여 그들의 일반적 특성, 환자로부터의 경험한 무례함, 직무 스트레스를 분석하였다. 분석 결과 군병원 에 종사한 의무병들이 환자들로부터 받는 무례함은 직무스트레스에 통계적으로 유의한 양의 상관관계로 나타났으며, 이 중 병사 환자와 민간인 환자로부터의 무례함은 직무 스트레스에 영향을 주지 않았으나, 간 부 환자로부터의 무례함과 군무원 환자로부터의 무례함은 직무 스트레스에 통계적으로 유의미한 영향을 준 것으로 나타났다. 이러한 결과를 바탕으로 본 연구에서는 군 병원 의무병들의 직무스트레스 감소를 위 해 힘희롱 예방교육의 실시, 부정청탁 금지에 대한 홍보, 힘희롱 근절을 위한 제도 개선을 제언하였다.

군병원 수술부의 건축적 특성에 관한 연구 : 통합병원의 이용실태를 중심으로 Focused on the Utilization of A.F.M.H

권오봉,박재승 한국의료복지시설학회 1999 의료·복지 건축 Vol.5 No.9

The purpose of this study was to get the design guidelines of the operating department in army hospital. New A.F.M.H. is now under construction but army hospital's characteristics are not reflected. This research is accomplished through an understanding of the characteristics of operating department in army hospitals by analyzing the plans and behavior survey of some A.F.M.H. This study attempts to examine the current states of domestic army medical center and to establish the design guideline of the operating department of the army hospitals.

군 통합병원 병동부의 건축적 특성과 계획에 관한 연구 : 사례분석을 중심으로 Focused on Case Studies

김호영,박재승 한국의료복지시설학회 1999 의료·복지 건축 Vol.5 No.9

Now new A.F.M.H. is under construction but it didn't reflect army hospital's characteristics. The purpose of this study was to get the design guidelines of the wards for the design of wards in army hospital. This research is accomplished through an understanding of the characteristics of wards in army hospitals by analyzing the plans of the bundang A.F.M.H. and behavior survey of other A.F.M.H. This study attempts to examine the current status of domestic and to establish the design guideline of the wards of the army hospitals.

군병원 간호사의 소진, 조직 의사소통과 환자안전역량

김민성,조순영,김리아 국군간호사관학교 군건강정책연구소 2023 군진간호연구 Vol.41 No.3

Purpose: The purpose of this study was to assess the burnout, organizational communication, and patient safety competency of military hospital nurses and to analyze their correlations. Methods: This descriptive study was conducted on 160 military nurses working in 12 armed forces hospitals in South Korea. Data were collected from May 4th to May 14th, 2023, using an online survey. Results: Military hospital nurses had an average of 2.71±0.62 for burnout, 3.25±0.48 for organizational communication, and 4.11±0.40 for patient safety competency. Burnout had a significant negative correlation with organizational communication (r=-.49, p<.001) and patient safety competency (r=-.16, p=.039), while organizational communication showed a significant positive correlation with patient safety competency (r=.23, p=.004). Conclusion: It is important to actively implement patient safety education and provide diverse opportunities to gain experience in patient safety-related roles. The need for effective burnout management for military hospital nurses and strategies to enhance organizational communication within military hospitals is highlighted.

군병원 간호사의 전자의무기록과 표준간호진술문에 대한 인식 조사

안진옥 ( An Jinok ),정유미 ( Jung Yoomi ),차진희 ( Cha Jinhee ),이현지 ( Lee Hyunji ),이순영 ( Lee Soonyoung ) 국군간호사관학교 군건강정책연구소 2018 군진간호연구 Vol.36 No.1

Purpose: This study is to examine nurses' perception on electronic medical record (EMR) and standardized nursing statements (SNS) in the Korean Armed Forces Hospitals. Methods: 525 nurses from 14 Korean Armed Forces Hospitals across the nation reported their perception of EMR and SNS, the intention to use, and actual use of SNS. Data were collected though self-reported questionnaires in February, 2017 and analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation coefficient. Results: The mean score for the perception on EMR and SNS were 3.44 and 3.93 on average out of a 5-point Likert, respectively. The mean score for the intention to use and the actual use of SNS was 73 and 65 out of 100 points, respectively. Inconvenience to use SNS was the main reason for not using SNS. Education (F=6.90, p=.001), ranks (F=6.05, p<.001), job positions (F=2.68, p=.047), previous education of EMR (t=2.67, p=.008) and previous education of SNS (t=-.43, p=.667) were the significant factors for the perception of SNS. The correlation between the perceptions on EMR and SNS were significant (r=.44, p<.001). Conclusion: This study suggests that education for using EMR and EMR refinement are needed to improve the usage level of SNS in military nurses.

군 병원 간호관리자가 지각하는 간호관리역량의 중요도와 수행도

최승혜,이순영,조도선,정유미 국군간호사관학교 군건강정책연구소 2020 군진간호연구 Vol.38 No.1

Purpose: The purpose of this study is to examine the Republic of Korea's military nurse managers' perceived importance and performance of nursing managerial competencies and to measure the gap between them. Methods: With a questionnaire asking clinical nursing managerial competencies categorized into 42 competencies under 5 nursing management processes, the authors analyzed a total of 146 data collected from first-line, middle and top managers working in military hospitals. One-way ANOVA and Importance-Performance Analysis were mainly conducted to identify the current status of the managers' perceptions and the discrepancy between them. Results: The average perception scores on the importance and performance were 4.36 and 3.66, respectively. There were significant differences in the perceived importance and performance on nursing managerial competencies among the different manager groups. An IPA demonstrated that top managers needed to concentrate on developing competencies of vision-building, motivation, and performance management, middle managers on vision-building, human resources development, professionalism, and self-management, and first-line managers on change management, staffing management, human resources development, leadership, professionalism, motivation, and development of nursing standards. Conclusion: To strengthen the clinical nursing managerial competencies, education/training programs customized for each management group should be developed and delivered.

군병원 낙상위험 사정도구 개발

서경완 ( Kyung Wan Seo ),이문숙 ( Moon Suk Lee ),이정옥 ( Jung Ok Lee ),황혜정 ( Hea Jeng Hwang ),김윤미 ( Yon Mi Kim ) 국군간호사관학교 군건강정책연구소 2014 군진간호연구 Vol.32 No.2

Purpose : The purpose of this study was to find the precarious factors by analyzing the precedent data of fallen case, and to develop fall risk assessment tool in armed forces hospitals. Method : We analyzed 227 fallen cases in armed forces hospitals. 170 arbitrarily selected nurses, who have more than three years of career in three different hospitals, answered the questionnaire. Furthermore, we used secondary data of the cases and delphi method to make the study more confident and to develop the fall risk assessment tool. Result : There were seven different types of fall risk assessment in armed forces hospitals and they were mental status, history of fall, secondary diagnosis, and treated equipment for patient, medication, mobility, and activeness Conclusion : By understanding the primary factors of the risk of falling, it helped making a fall risk assessment tool. This development will contribute to the prediction and prevention of falling, and improvement of nursing services around the armed forces hospitals in Korea.