A study on the signifcantly influential factors of malpractice suit

보건학과/박사[한글] 본 논문은 의료소송판결중에서 법원의 민사합의부 판결문을 중심으로 어떤 행위가 소송으로 가고 있는지, 그리고 판결의 승소여부와 배상액을 결정하는데는 어떤 요인이 영향을 미치고 있는 지를 분석하였다. 먼저, 판결문에서 사고원인으로 인정하고 있는 의료행위를 분류하였다. 분류하는 기준은 행위의 주체, 적용되는 법리, 행위를 받는 대상, 그리고 의료인에 의해 행해지는 행위로서 8개 범주의 22개 항목으로 분류하였다. 8개 범주의 내용은 진찰 및 검사, 진담 및 처방, 처치 및 수술, 기본적 환자관리. 의료인관리. 물품 및 장비관리, 환자에 대한 설명행위, 기타 의료인 행위로 구분하고 있다. 위의 결과에서 가장 많은 사고원인행위는 기본적 환자관리였고. 다음은 처치 및 수술항목으로서 모든 전문과에 분포하였다. 그리고 사 고원인 의료행위가 가장 많은 과는 산부인과, 정형외과. 외과 등의 순서로 나타났다. 환자승소여부에 관하여 환자 및 사고경위변수, 의사변수, 판사변수를 차례로 통제하여 로지스틱 희귀분석한 결과 승소여부에 영향을 미치고 있는 변수는 91년도 이전에, 결혼은 미혼에 비해 기혼의 경우, 사고후 상해는 장애인 경우, 그리고 판사의 출신지역은 서울, 경기인 경우에 승소할 확률이 높게 나타났다. 환자 및 사고경위변수, 의사변수, 변호사변수를 모두 통제한 다중회귀분석 결과 배상액에 통계적으로 유의한 영향을 미치고 있는 변수는 판결지역이 서울외지역인 경우, 특수진료의 경우, 장애인 경우와 사망인 경우, 의사경력이 9년 이하인 경우, 변호사시험유형이 사법시험인 경우에 배상액이 유의하게 높게 나오고 있음을 알 수 있다. 본 연구에서 나온 의료소송분석결과는 불충분한 자료로 인해 신뢰성이 높은 통계적 모형을 도출하지 못하였으나, 본 연구의 의의는 배상기준을 정하는 방법론을 제시하고, 의료소송과 같은 질적인 자료의 분석을 처음 시도하였다는 데 있다. [영문] This thesis researched ,with focus given to the court's ruling in civil cases of medical malpractice lawsuits, which medical services are more exposed to legal proceedings and what factors are influencial in judge's decision and indemnity. To begin with, medical services which are recognized as the cause of malpractice liability in court's ruling was classified into eight categories and twenty-two items, the criteria of which were : subject of service, principle of law, object of service, and medical activities. Eight categories were : examination and test, diagnosis and prescription, treatment and surgical operation, fundamental patient management, medical personnel management commodities and equipment management act of giving explanation, and other miscellaneous services. Of all, the most common cause far malpractice was basic patient management followed by treatment and surgical operation , which were obviously seen in all professional services. The medical services which contained more notable cause of liability were obstetrics and gynecology, orthopedy, and surgery in sequence. Logistic regression on court's decision with controlling in order the variables of patient, course of malpractice, doctor, and judge was conducted. And it indicated that the variables favorable to patients before the year of 1991 were : marital status of being married, disability incurred by malpractice, Seoul or Kyung-Ki born judges. Multiple regression with controlling the variables of patient, course of malpractice, doctor, and lawyer was conducted. And it showed that the variables favorable to indemnity statistically were : the location of court outside of Seoul, specefic medical services, disability and death, doctor with less than 9 years practice, lawyer having Passed judicial examinations. Insufficient materials on medical malpractice impeded the production of reliable statistical model. The significance of this study, however, can be found in the presentation of methodology to decide the indemnity bases and in initiating an analysis on substantial data of medical malpractice.prohibitio

A Study on Experience of the Indemnity Request from Patiences and Indemnity Paid of Malpractice

The purposes of the study was to analysis the factors on the physicians' indemnity experience and indemnity on malpractice. Data was collected from mail interview for the physicians from August, to October in 1996. Questions were asked to the physician who selected with random sample(n=8.338) about the opinion of malpractice insurance. experience that he(she) have requested the indemnity from patience. context of experienced indemnity and demographic characteristics of physician and patience. Response rate is 37.5%(n=3,124). This study was analyzed in two levels' the first. influential factors on whether physician has experience of indemnity and the second. influential factors of indemnity among physicians who had experienced the indemnity. The major findings were as follows : 1. Logistic regression on whether physicians had experience of indemnity request was conducted. And it indicated that statistically meaningful variables of model 1 (about all physicians) were department of surgery, physicians who have intention of insurance fee, physician age and income, physicians who owned the hospitals and statistically meaningful variables of model 11 (about physicians who owned the hospital) were department of surgery and internal treatment. 2. Multiple regression on the influential factors on indemnity was conducted. And it showed that statistically meaningful variables in model 1 were method of malpractice quarrel(physician association), whether physician had malpractice, whether suit succeeded, physician age, average practice time and income and whether physician owned the hospital and statistically meaningful variables of model 11 were whether physician had malpractice, number of outpatient, number of beds. As the conclusion, the thesis was examined about the variables related with experience of indemnity and cost of malpractice. But in order to prevent malpractice and promote medical quality, the reasonable system to solve a malpractice have to settle and cost estimation on malpractice is essential. Therefore an advanced research is progressed with methodology to decide the indemnity bases.ope

A Study on the Development of the Occupational Health Information System

병원행정학과/석사[영문] [한글] 산업보건정보시스템 사업장 근로자의 건강을 관리하고 신속한 행정직 의사결정의 관리 수단으로 이용하는데 그 목적이 있다. 계속적인 보건부문의 연구와 교육에도 산업보건정 보시스템이 크게 활용될 수 있으리라 기대한다. 정보시스템의 적용은 그 중요성이 큼에도 불구하고 아직 연구가 미흡한 실정이다. 연구방법은 가장 널리 쓰이고 있는 시스템개발수명주기(system development life cycle )를 택하였다. 연구절차는 전략계획수립, 시스템분석, 시스템설계, 시스템평가의 단계를 갖는다. 연구의 결과는 다음과 같다. 첫째, 산업보건정보시스템 구축을 위한 전략계획수립에서는 1단계로 도든 스템구축의 기본이 되는 사업장관리시스템을 구축하고, 2단계로는 건강관리 시스템과 작업장 환경관 리시스템을 각각 개발한 후 이를 기초로 통합하여 근로자 보건관리 프로그램을 개발하기 위한 시스템구축을 한다. 3단계로는 이들 구축된 건강관리, 직업환경관리, 보건관리 등 3 개의 정보시스템을 통합하여 청구결산시스템과 통합통계처리시스템으로 연계될 수 있는 시스템을 개발한다. 둘째, 전략계획에서 언급된 업무의 우선순위에 따라 건강관리부, 산업위생부, 보건관리 부의 세 부서의 업무에 대하여 자료흐름도 및 서식분석표 등을 이용하여 체계적으로 분석 하였다. 셋째, 시스템설계에서는 전산화 대상업무에 대하여 개념적인 설계는 HIPO와 데이터베이 스 설계, 시스템흐름도, 통신망설계 등을 이용하여 실시하였다. 넷째, 시스템 평가에 있어서 위험요인을 분석하고 그에 따른 위험감소 전략을 세웠다. 또한 산업보건정보시스템이 확대되기 위하여 고려되어져야 할 사항을 제시하였다. 위험요 인으로는 전산화 업무를 과외의 업무로 여기고, 선행적으로 이루어져야 할 표준화부문이 많고, 비용부족 등의 행정적 지원의 부족, 전산화에 대한 인식부족 등을 들 수 있으며 위 험감소전략으로는 실무자와 담당 부서의 책임자를 개발과정에 적극 참여시키고, 교육을 통해 컴퓨터와 친숙하게 하며, 실제 개발된 시스템이 업무수행단계를 축소시켜야 하며, 행정업무의 표준화와 더불어 보고서식의 표준화가 이루어져야 하며, 전산으로 출력된 양 식이 실제 보고용으로 활용될 수 있도록 하는 행정적인 조치 등의 실시 전략으로 위험요 인을 감소시켜야 한다. 계속적인 연구를 통하여 시스템의 세부적인 설계를 개발하고 개발된 정보체계에 대한 성과를 정량적으로 측정할 수 있는 시스템 평가에 대한 연구가 함께 이루어져야 한다. A study on the development of the occupational health information system. - For Health Management Agency - Min, Hea Young Graduate School of Health Science and Management Yonsei University (Directed by Professor Chae, Young Moon, Ph.D.) Objectives of Occupational Health Information System are to help manage employee's health and to support decision making for managers. Occupational Health information system can also be utilized in a continuous study and education in this field. While an importance of occupational health information system is realized, a research in this area has not bear actively carried out at present. The purpose of this study is to develop a model for the OGIS System Develpment Life Cycle method system which consists of desgin, and strategic plans, analysis systems, implementation system. Results from the study were as follows: First, strategic plans for Occupational Health Information System is divided into the three stages. The first stage is construction of information system for employee's health management for measurement of workplace. In the second stage, the system for health management and envirenment management are developed and integrated with the system that contains the program for employee's health management system. In the third stage, system for health management and work's environment management and health management are integrated and also interfaced with a system for accounting system and statistical processing system. Second, according to the priorities of work in the strategic plans, the health management department, Occupational hygine department administrative department were analysed using structurd system analysis methods such as Data Flow Diagram. Third, in the system design, conceptual design for the system was performed using HIPO. Database design, Dataase design, System Folw Chart, and network design. Forth. in the system evaluation, the risk factors were analysed and their corresponding risk-reducing strategies were developed. The risk factors : lack of understanding, lack of standardization, lack of administrative support such as budgets. The risk-reducing strategies were actively participate managers into the development process and train users, and develop system in such a way reduce workload and standize a administrative procedures and report forms. In the future, a more comprehensive and datailed design for the system should be carried out, and the performance as well as economic benefits of information system should be evaluated quantitatively.restrictio