(The) performance of reviewing the medical insurance bills and it's relations with the hospital characteristics

보건학과/석사[한글] 의료보험진료비 조정건율과 조정금액률을 진료항목별, 조정사유별로 나누어 병원특성에 따라 차이가 있는지를 분석하며 병원특성의 어떠한 요인이 병원의 조정건율과 조정금액률에 영향을 미치는지를 알아보고자 1990년 1월1일부터 6월30일가지 직장의료보험 피보험 자 대상의 종합병원 입원건 305,780건을 해당 종합병원별로 조정내역을 세분화하여 자료를 이용하였고 의료기관 특성별로 병상수, 설립구분, 소재지, 의료보험담당 간호사수, 수련병원 유무, 전산청구 유무를 조사하여 연구자료를 이용 분석하여 다음과 같은 결과를 얻었다. 종합병원급의 심사조정건율은 54%에 이르며, 심사조정금액률은 청구진료비의 2% 수준이다. 의료기관 특성별로 심사조정현황은 설립구분별로 국·공립, 사립대학병원의 조정건율, 조정금액률, 조정건당조정금액이 모두 높았고 병상수도 500병상이상급 의료기관의 경우도 위 세지표가 모두 높게 나타났다. 중회귀분석결과 조정건율에서는 설립구분(국·공립), 설립구분(사립대학)이 양의 관계를 갖고 소재지(대도시)는 음의 관계를 갖는다. 조정금액률과 양의 관계를 갖는 변수들로는 설립구분(국·공립)이고 음의 관계를 갖는 변수들로는 보험담당간호사이다. [영문] This study is design to analyze the rate of the adjusted cases and medical expenses by care items and adjustment causes in the medical insurance bills reviewed by National Federation of Medical Insurance in order to find out whether there were differences among the characteristics of medical institutions and, if so, which characteristics could affect the rate. For this analysis, the 305,780 cases of inpatient care were used and classified in datails by the characteristics of medical institutions, and the variables, like number of beds, foundation form, site, number of nurses in charge of medical insurance, apprentice hospital or not, fee claim by computer system or not, were considered. The results are as follows. The rate of adjusted cases attains to 54% and the rate of adjusted amount 2% of total claims requested in general hospitals. In the perspective of hospital characteristics, the adjustment case rate, the adjustment expenses rate and the adjusted amount per adjusted case present all high figures in every university hospitals whether it is national & public hospitals or private hospitals, and the medical institution with over 500 beds, too. The results of multiple regression shows that the rate of the adjusted cases has some positive correlation with the foundation from (national & public, private), in the other hand some negative correlation with the site(large city). And the rate of the adjusted amount has positive correlation with the foundation form(national & public), whereas negative correlation with the number of nurses in charge of medical insurance.restrictio

(A) comparative analysis on the actual health conditions in schools owing to presence and absence of nursing teachers.

보건정책 및 관리학과/석사[한글] 본 연구는 양호교사가 없는 학교에서 학생들의 건강관리에 심각한 문제가 있을 것으로 샹각되어 양호교사 유무별 학교보건실태를 분석하여 그 개선점을 모색하는 연구로써, 충남지역 18학급 이상 전체 중학교(n=38)에서 무작위율을 높여 표본 중학교(n=12)를 채택하였고 양호교사 있는 학교 6곳(n=208), 양호교사 없는 학교 6곳(n=213)이었다. 자료수집은 각 표본 중학교에서 3학년 1반 학생(1반에 30명 이상)들을 대상으로 하였고 기간은 2001년 5월 7일에서 10일 사이에 QK른 등기 우편설문으로 이루어졌고 회수된 설무너지는 421명(87.7％)이었다. 본 연구의 도구는 3월 4일부터 4월 30일까지 사전연구와 내적 타당도,신뢰도 검정을실시하여 개발하였고 일반적 특성 4문항, 학교환경 60문항, 총 84문항으로 이루어져 있다. 이 설문지를 통해 조사된 응답자의 일반적인 특성, 모집단과 표본집단의 특성, 학교보건활동의 횟수와 적절성을 비교하기 위하여 x², t-test를 실시하였고 다음고 같은 결과를 얻었다. 학교보건활동의 횟수(객관적인 측정)에 있어 양호교사 있는 학교는 총치료 횟수, 학교상담 횟수, 보건교육 횟수에 있어서 양호교사가 없는 학교보다 유의하게 높았다. 그 외 보건실 이용횟수, 보건교육 내용별 '안전 및 응급처치, 만성퇴행성질환, 질병예��교육'을 실시하는횟수, 다양한 보건교육방법 활용에 있어서 양호교사가 있는 학교가 양호교사가 없는 학교보다 유의하게 높았다. 학교보건활동의 적절성(주관적 측정)에 있어서 두 군간에 치료으 적절성과 병원방문의 적절성 및 앞의 두 가지를 합한 총 치료의 적절성에서 차이가 없었고 학교상담을 받은 상담시간ㆍ보건교육의 적절성(교육으로 인한 만족도, 지식습득, 실천, 건강향상정도)에서도 두 군간에 차이가 없었다. 오직 양호교사가 있는 학교에서 상담으로 인한 건강향상정도에서만 유의하게 높게 나타났다. 학교 내 환경에서 양호교사가 없는 학교는 충분한 식수, 화장실의 청결ㆍ급식전용 학교식당의 hswo에서 더 잘 되어 있었다. 양호교사가 있는 학교에서는 운동장이 안 미끄러운 것이 유의하게 높았다. 결국에 교내환경에서는 양호교사 없는 학교가 양호교사 있는 학교보다 더 잘 되어있는 경우가 많았다. 교실 내 환경 비교에서는 두 군간에 유의한 차이가 없었다. 보건실 환경을 비교해 보면 양호교사가 있는 학교의 학생들은 교삭 필요하고 자세히 설명하고 있으며 적극적으로 지도하고 믿음직하고 항상 자리를 지켜주신다는 긍정적인식을 하고 있는 것이 유의하게 높았다. 앞으로 바라는 학교보건요구 중에 보건교육 요구에 있어서 양호교사가 없는 학교의 학생들은 양호교사가 있는 학교의 학생들보다 보건교육내용으로는 '응급처치'교육을 실시해주기를 더 많이 원하고 있었고 앞으로 바라는 학교환경에서는 주변에 유해시설이 없어지기 를 희망했고, 보건실이 필요하다는 요구가 높았으며 보건실에 햇빛이 충분하기를 희망하였고 보건실을 깨끗하고 조용히 유지하기를 바라는 것에 요구가 높았다. 또한 교사에 대해서는 앞으로 양호교사가 필요하다는 요구가 높았고 교사에 대하여 믿을 수 있게 되기를희망하는 것이 높게 유의한 차이를 보였다. 이상의 결과를 종합하여 볼 때, 양호교사가 있는 학교가 양호교사가 없는 학교에 비해 학교보건활동(치료 및 병원방문, 학교상담, 보건교육, 학교환경개선)이 양적으로 많이 실시되고 있었다. 그 질적인 측면에서는 양호교사가 있는 학교가 학교상담으로 학생의 건강 을 향상시켜주는 것과 치료 및 응급처치 시에 자세한 설명을 하고 믿음을 주는 것, 보건실 이용에 만족을 주는 것, 보건실 환경이 잘 유지되는 것에서 양호교사가 없는 학교에 비해 더 적절히 이루어지고 있는 것으로 유의한 차이가 있었다. 즉, 양호교사의 역할 중 에 학교(건강)상담자의 역할과 치료 및 응급처치 시에 자세한 설명을 해주는 교육자적 역할은 더 강화되어야 한다는 것을 뜻한다. 반면, 두 군간에 유의한 차이가 없었던 치료 및 병원방문의 적절성에 있어서는 보다 정확한 추후 연구가 필요하며, 보건교육의 질적인 측면에서 양호교사가 있는 학교가 보건교육 방법에서 다양하게 실시하고 있었을지라도 보건교육내용의 질(예, 만족도)에 있어서 양호교사가 없는 학교와 비교했을 때 유의한 차이를 내지 못하였는데 이 부분은 보다 더 질적인 향상을 위해 노력해야할 부분이라고 할 수있다. 전반적으로는 양호교사가 있는 학교가 양호교사가 없는 학교에 비해 학교보건활동이 유의하게 잘 이루어지고 있었으므로 학교보건활동을 위해서는 양호교사의 확보가 필수적이라고 할 수 있다. 그러나, 이 연구는 충청남도 지역의 중학교에서만 조사하였기 때문에 다른 지역ㆍ다른 학급별ㆍ18학급미만의 학교들에까지 확대 적용하기에는 제한점이 있다. [영문] The objective of this study is to analyze and improve the current condition of public health in schools according to whether they have nursing teachers, on the assumption that schools without a nursing teacher may be faced by problems in caring the health of the students. For the study, we selected the sample middle schools (n=12) through random sampling from all the schools (n=38) in Chungcheongnam-do that have over 18 classes. Of the sample schools, 6 schools(n=208) have a nursing teacher, and the other 6 schools(n=213) do not. The subjects of this study were the students at the first class (over 30 students at each class) of the third year in the sample middle schools. The data collection was made from the 7th to 10th of May 2001 through mail survey using special delivery registered mail, and the number of returned questionnaires was 421 (87.7％). We developed the research tool between 4th of March and 30th of April by performing a pre-test and verifying the internal validity and reliability. The tool is composed of 4 questions concerning general features, 6 questions concerning health problems, treatments, and visits to hospitals, 8 questions concerning school counseling, and 60 questions concerning school environments, so total 84 questions. We also performed x² and t-test to compare the general features of the respondents of the questionnaire, the characteristics of the population and the sample group, the numbers of health care activities at schools and their adequacy, and obtained the following results. With regard to the numbers of health care activities, (which were counted objectively,) the numbers of treatments, school counseling and health education at the schools with a nursing teacher appeared significantly higher than those at the schools without a nursing teacher. Besides, the number of use of health rooms, education on 'safety and first-aid treatment, chronic degenerative diseases and disease prevention', and utilizing various methods of health education are significantly superior at the schools with a nursing teacher, compared to the schools without a nursing teacher. With regard to the adequacy of health care activities at schools, (which was determined subjectively,) the adequacy of treatments, that of visiting to hospitals, and the sum of both adequacy were not different between the two groups, neither was the adequacy of counseling time and health education (satisfaction, knowledge learning, practice and improvement of health that were achieved by the education). Only the improvement of health caused by school counseling appeared significant at the schools with a nursing teacher. With regard to school environments, the schools without a nursing teacher were equipped with more sufficient drinking water, cleaner toilets, and finer dining halls. The schools with a nursing teacher were significantly precautious against slippery grounds. In general, the school facilities of the schools without a nursing teacher were superior to those of the schools with a nursing teacher. The classroom environments did not differ significantly between the two groups. Comparing the environments of health rooms, we found that the health rooms at the schools with a nursing teacher were being maintained more properly and the students were highly satisfied with the health room. According to the responses to the question about how they consider the nursing teacher, which was an element of the environment, students considered that the nursing teacher was essential, gives a detailed account, leads the students actively and reliably, as well as always keeps the position. With regard to students' demands related to school health, the students at the schools without a nursing teacher, compared to those at the schools with a nursing teacher, eagerly required 'first aid treatment' education, and wished to remove harmful facilities around the schools in the future. They also made a pressing demand of a health room, which should be maintained clean and quiet with abundant sunlight. Furthermore, they thought that a nursing teacher was essential and he/she should be reliable. Combining the results as stated above, the schools with a nursing teacher have in general quantitatively superior health care activities (treatments and visiting to hospitals, school counseling, health education, improvement of school environments) compared to those without a nursing teacher. In terms of the quality of the activities, the schools with a nursing teacher, compared to the schools without a nursing teacher, are significantly prominent in preserving the students' health through school counseling, giving a detailed account and being reliable when giving treatments or first aids, satisfying the students with the health room, and maintaining desirable health room environment. That is, a nursing teacher is required to give priority to the role as a health counsellor and as an educator, among their likely roles, by giving detailed explanation when giving treatments or first aids. On the other hand, with regard to the adequacy of treatments and visiting to hospitals, which did not show any significant difference between the two groups, we need further following after study in the future. In the qualitative aspect of health education, even though the schools with a nursing teacher employed various educational methods, they were not significantly distinctive in the quality (e.g. students' satisfaction) of the contents of the health education, compared to the schools without a nursing teacher. This implies that a continuous effort for qualitative improvement should be made. As a whole, the schools with a nursing teacher were found to carry out significantly superior health care activities compared to those without a nursing teacher, and we may conclude that a nursing teacher is essential for appropriate health care activities at schools. However, as we investigated only the middle school students in Chungcheongnam-do area, it has an limitation in applying its results to schools in other areas, with different classes, and with less than 18 classes.ope

부동산정보 유통체계 발전방안(Development policies for real estate information network system)

노트 : 이 보고서의 내용은 연구진의 견해로서 서울특별시의 정책과는 다를 수도 있습니다

가구특성별 주거복지정책 연계체계 구축 방안(Integration of housing welfare system by household characteristics)

노트 : 이 보고서의 내용은 연구진의 견해로서 서울특별시의 정책과는 다를 수도 있습니다

Actual State and Direction of Chinese Characterst Education

We know that the effective Chinese characters' education was not accomplished because of the valueless discussion on the exclusive use of Hangeul and the use Hangeul together with Chinese characters for the half a century of the past. A language and a character is different things. The language has the strong racial characteristics. But the character can be borrowed without limit. The Chinese characters are not the character for only china today. The Chinese characters are character to have been used through several countries and peoples of the Oriental culture circle from old times. The Chinese characters are character to have history and tradition that have played an important role in our language life and character life before King Sejong made Hangeul. We will do good language life and character life when Hangeul, phonetic is harmonious with Chinese characters, ideogram European and American scholars foretold that English culture circle will compete against Chinese characters' culture circle in field of politics, economy, culture and so on if we will reach at the middle of 21 century. We have to recognize the change of the world circumstance. We think that the education of Chinese characters has to be strengthened from the viewpoint of national competive power. The education basically transmit the social tradition and present the social development direction to the younger generation. The education can not be separated from the social tradition or actuality. The correct Korean life and the succession development of our racial culture will be difficult without comprehension of Chinese characters because more than 50% of Korean vocabulary is Chinese characters and the majority of classical literature is connected with Chinese characters and a word written in Chinese characters. We have to systematize the Chinese characters' education to be helped to correct Korean life and our cultural development. The scholars of Hangeul exclusive use and the scholars of Hangeul together with Chinese characters have to do our best to find the agreement in the direction of benefit in the future of nation and race

아파트관리 평가모델 구축방안(Development of an evaluation model for apartment complex management)

노트 : 이 보고서의 내용은 연구진의 견해로서 서울특별시의 정책과는 다를 수도 있습니다