The Legal Issues of the Health and Medical Service under WTO/GATS

For health services, there has been slow progress in the trade among countries owing to restricting the movement of natural persons, limiting commercial presence of foreign health institute, and technical barrier against cross-border supply. However, there are also lots of trials for enhancing the health services through extended opening health service markets with positively changing approaches toward the health services among nations. To achieve the goal for the better health services internationally, it is necessary to promote market access and regulation measure in terms of market principles. Therefore, in this paper, international law issues and domestic law issues on the view of opening health service market is discussed in the WTO/GATS' ideas. First, this paper reviews most-favored-nation treatment, transparency, domestic regulation and recognition as well as market access and national treatment as a concrete promised article as basic WTO/GATS general article for international trade. To show this point, it suggests the current domestic arguments on GATS regulations and analyzes the relations between WTO/GATS and health services as well as freedom of health service among nations. Second, on the basis of the general review, this paper also discusses the issue on laws of the telemedicine services with cross-border supply crossing over nations. it also covers and analyzes the issues on qualified telemedicine service professionals, the responsibility of malpractice, personal privacy and personal information protection in the electronic communication system, the legally effective prescription and international law and jurisdiction with malpractice. Third, this paper deals with consumption abroad in terms of health service cost. This issue is related to domestic health service for foreigners and health insurance and the authoritative institute of the responsibility. These regulations enforce to control service trade business directly and indirectly. Forth, the commercial presence has been discussed for health service: for establishing foreign enterprise branch and joint investments, foreign investment laws, and foreign currency laws for covering management and business for health service. According to these regulations, this paper views permissions, licence, register, opening business for health service practice, especially foreigners' domestic practice with high legal barriers against opening health service center. Fifth, the issue on movement of natural persons has been discussed : professional legal qualifications for the health service, though highly professional licences, such as lawyers, cpa, engineers and medical doctors, are not easily effective to other countries. This paper discusses the process of foreigner's acquiring health service licence, mutual recognition for health service qualification and health service legal barrier at foreign countries. Finally, this paper discussed alternative ideas, mutual recognition agreements through bilateral and multilateral negotiations, such as for movement of natural persons and professional legal qualification. These recognitions will not be accepted without agreement and equality of education periods to achieve there licences. However, the movement of natural persons also should be issued with the financial laws through international institutes. There have been lots of issues on the international telemedicine services, such as qualified telemedicine service professionals, the responsibility of malpractice, leaving to WHO/GATS treatments as well as supplementing domestic telemedicine service regulation laws. For the problem to health service users, it is dependent upon being covered by public health insurance. In the days of international health services among nations, the coverage of public health insurance should be revised for the proper utility for the users. To be easy to access the long distant and foreign health services, opening procedure, establishing health service center, and investment policy as well as financial laws must be clear and neat to the related people.第1章 序 論 1 第1節 硏究目的 및 範圍 1 第2節 硏究方法 6 第2章 WTO/GATS상의 貿易 規範과 保健醫療 9 第1節 서비스 貿易의 意義 9 1. 서비스의 定意 9 2. WTO/GATS상 서비스무역의 定意 10 第2節 WTO/GATS 상의 貿易原則 11 1. GATS의 一般原則 12 2. 서비스貿易協定의 主要規定 20 第3節 GATS 國內規制 作業班 論議現況과 爭點 43 1. 國內規制의 必要性 審査 43 2. 國內規制의 透明性 問題 48 3. 國內規制의 同等性 50 4. 國際的 標準 51 第4節 WTO/GATS와 保健醫療서비스의 關係 52 1. 保健醫療서비스 定意 52 2. 保健醫療서비스의 分類 54 3. 保健醫療서비스 讓許 現況 및 論議動向 57 4. 보건의료서비스 貿易去來 自由化 對象 61 5. WTO/GATS와 保健醫療서비스의 關係 64 第3章 保健醫療서비스 自由化의 國際法的 問題 66 第1節 自然人의 移動에 의한 서비스 供給 66 1. 問題의 所在 66 2. 自然人 移動의 意義 69 3. 專門職의 內國民待遇 70 4. 資格의 相互認定問題 70 5. 資格의 認定 方法 72 6. 外國의 醫師 資格制度 73 7. 小結 79 第2節 保健醫療서비스의 國境間 供給의 法的 問題 80 1. 槪要 및 問題提起 80 2. 遠隔醫療의 意義 84 3. 遠隔醫療의 立法 動向 89 4. 遠隔醫療에서 法的 問題 95 5. 遠隔醫療行爲時 過誤에 대한 裁判管轄權과 準據法 112 6. 小結 123 第3節 醫療消費者의 海外 移動 125 1. 消費者의 海外移動의 意義 125 2. 患者의 移動 126 3. 保健敎育을 위한 移動 129 4. 消費者의 海外移動 관련 法的問題 131 5. 小結 133 第4節 商業的 駐在를 통한 서비스의 法的問題 133 1. 商業的 駐在의 의의 133 2. 保健醫療서비스에서 商業的 駐在의 類型 134 3. GATS 委員會 보고 138 4. 外國의 醫療機關 設立 形態 140 5. 小結 142 第4章 保健醫療 서비스의 國內法的 問題 144 第1節 槪 要 144 第2節 保健醫療서비스의 國境間 供給 問題 146 1. 遠隔醫療에 대한 國內法的 檢討 146 2. 遠隔醫療에서 法的 問題 151 第3節 醫療消費者의 海外移動에 대한 法的 問題 167 1. 意義 및 現況 167 2. 國內 關聯法規의 問題 168 3. 檢討 170 第4節 保健醫療서비스의 商業的 駐在의 法的 問題 171 1. 槪要 171 2. 醫療機關의 定義 173 3. 醫療機關 設立 主體 174 4. 醫療保險法의 醫療機關에 대한 規制 177 5. 關聯 國內法 檢討 179 第5節 自然人의 移動에 의한 國內法的 問題 183 1. 免許取得과 資格要件 183 2. 醫療免許에 의한 醫療行爲 184 3. 無免許醫療行爲등 禁止 184 4. 專門 人力의 移動 185 5. 外國人에 대한 制限 186 6. 醫療人力의 國內外 進出入 許容의 爭點 186 第5章 結 論 189 參考文獻 19

(The) effect of Nd-Yag laser irradiation on acid resistance of dentin and shear bond strength of resin

치의학과/박사[한글] 우치 상아질에서 레이저 조사시 상아질의 표면변화 및 내산성 변화와 레진과의 전단결합강도를 측정하기 위하여, 내산성 변화는 표본을 각 20개씩 6개 군으로 나누어 그중 1개 군을 대조군(비조사군)으로 하고 나머지 5개군은 Nd-Yag 레이저를 각각 10, 20, 30, 40 및 50J/cm**2 의 에너지밀도로 상아질 노출면에 조사한 후 산(0.5N HClO4 + 0.5% LaCl3)에 용해시켜 용출된 칼슘과 인의 양을 정량분석하여 내산성 변화를 평가하였으며, 레진과의 전단결합강도를 측정하기 위해서는 표본을 20개씩 6개 군으로 나누어 대조군은 산부식군으로 하였고 실험군은 10, 20, 30, 40 및 50J/cm**2 조사군으로 나누어서, 대조군은 10% phosphoric acid(All-etch, Bisco Co, U.S.A.)로 15초간 산부식, 세척, Primer A&B를 1방울씩 혼합하여 5회 반복도포, bonding resin을 도포, 가시광선 중합기를 사용하여 광중합시킨 후, 복합레진(Aelitefil A3.5 shade, Bisco Co., U.S.A.)을 2회에 걸쳐 직경 3.Omm, 높이 3.Omm로 축성하였다. 실험군은 레이저 조사된 상아질면에 산부식 처리를 하지 않았고, Primer A&B 도포 및 나머지 과정은 대조군과 동일하게 하였다. 만능물성시험기로 0.2mm/min의 cross-head speed로 전단하중을 가하여 전단결합강도를 측정하였다. 레이저 조사 후 상아질의 표면변화를 관찰하기 위해서는 6개 군을 3개씩, 전단강도 측정후의 상아질 표면을 관찰하기 위해 6개 군을 2개씩 주사전자현미경으로 관찰하여 다음과 같은 결과를 얻었다.1. 칼슘 용출량은 대조군보다 10, 20, 30, 및 401J/cm**2 조사군이 적었고, 인 용출량은 대조군보다 30J/cm**2 조사군이 적게 나타났다(p<0.05). 2. 레진과의 전단결합강도는 대조군보다 10J/cm**2 조사군에서 약간 높게 나타났으나 통계학적 유의차가 없었으며(p>0.05), 대조군과 10J/cm**2 조사군이 20, 30, 40, 및 50J/cm**2 조사군보다 높게 나타났다(P<0.05). 3. 레이저 조사시 20J/cm**2 조사군부터 균열이 생겼으며, 조사 에너지 밀도 증가에 따라 균열의 크기가 증가하는 양상을 보였다. 4. 레진과의 전단결합강도 측정 후 주사전자현미경 관찰 결과, 40J 및 50J/cm**2 조사군에서는 상아질내에서 파절이 발생했다. 이상의 결과로 상아질에 Nd-Yag 레이저 조사시에는 에너지밀도를 10J/cm**2 하는 것이 효과적이라고 사료된다. [영문] The purpose of this study was to examine the acid resistance and resin shear bond strength of Nd-Yag laser irradiated bovine dentin. To determine the most effective energy density of laser for improving acid resistance of bovine dentin, 120 specimen were divided into 6 groups consisting of unlased control group and 5 experimental groups. The 100 specimens in the 5 experimental groups were exposed to a pulsed Nd-Yag laser under conditions ranging from 10 to 50J/cm**2 at increments of 10J/cm**2 . All of the specimens were exposed to 0.5 N HClO4 solution containing 0.5% LaCl3 for 30 seconds for demineralization. Dissolved calcium and phosphate concentrations in the demineralizing solution were determined by using an atomic absorption spectrophotometer and the UV spectrophotometer. To determine the resin shear bond strength of a pulsed Nd-Yag irradiated bovine dentin, the 60 specimens were divided into 6 groups consisting of anacid etching control group and 5 experimental groups. The Control group was etched with 10% phosphoric acid for 15 seconds and rinsed thoroughly, mixture of primers A&B was applied 5 times on the dentin surface, and adhesive bonding resin was applied and light cured for 20 seconds, and composite cyliders were bonded to the dentin surface. For 5 experimental groups, after the laser irradiation, other procedures were same as control group except being not etched. All samples were measured for the shear bond strength by using 0.2mm cross head speed. SEM observations were made to examine the change of dentin surface after laser irradiation and to examine the fractured interface after the shear bond test. The results were as follows: 1. The concentration of calcium dissolved from laser irradiated dentin at the energy densities of 10, 20, 30, and 40J/cm**2 were significantly lesser than that of untreated control group(p<0.05). 2. The shear bond strength of 101/cm2 group was higher than that of the control group even though it was statistically insignificant(p>0.05).The shear bond strength of the control and 10J/cm**2 groups were significantly higher than those of 20, 30, 40, and 50J/cm**2 groups(p<0.05). 3. Laser irradiation of the dentin resulted in crack formation at above 20J/cm**2 of energy density and cracks were wider and deeper according to the increase of energy density as the energy density increases. 4. Following the shear bond strength test, bond failures occurred beneath the dentin surface in the 40 and 50J/cm**2 groups. It could be concluded that it is most effective to use 10J/cm**2 of energy density during while irradiating the dentin using an Nd-Yag laser.restrictio

The Effects of Challenge Stressor on Work Engagement : Focused on the mediating Effects of Job Crafting

학위논문(석사)--아주대학교 일반대학원 :심리학과,2016. 8본 연구는 대기업 연구직 종사자 261명을 대상으로 도전적 스트레서가 직무열의에 미치는 영향과 그 과정에서 Approach와 Avoidance측면의 두 가지 차원으로 구분한 Job Crafting의 이중매개효과를 검증하였다. 도전적 스트레서와 Job Crafting의 하위요인 중 구조적 직무자원 증가, 사회적 직무자원 증가, 도전적 직무요구 증가로 이루어진 Approach Job Crafting은 직무열의에 유의미한 영향을 미쳤으며, Job Crafting의 하위요인 중 방해적 직무요구 감소로 이루어진 Avoidance Job Crafting은 직무열의와 유의미하지 않은 것으로 나타났다. 이중매개효과 분석결과, 도전적 스트레서는 Approach Job Crafting을 통하여 직무열의를 증가시키는 것으로 나타났으며 Avoidance Job Crafting을 통하여서는 직무열의를 감소시키는 것으로 밝혀졌다. 이는 조직에서 종업원들이 무조건 Job Crafting을 하도록 장려하기 보다는 구조적·사회적 직무자원을 증가시키거나 도전적 직무요구를 증가시키는 방향으로 Approach Job Crafting을 하도록 해야 직무열의에 더 가까워질 수 있음을 시사한다. 마지막으로 본 연구의 의의 및 제한점과 추후연구에 대한 제안점을 언급하였다.Ⅰ. 서론 Ⅱ. 이론적 배경 Ⅲ. 연구모형 및 가설 Ⅳ. 연구방법 Ⅴ. 연구결과 Ⅵ. 결론 및 논의Maste

RAT 체내에서의 JG-381의 대사체의 규명

학위논문(석사)--서울대학교 대학원 :제약학과 약제학전공,2002.Maste

In vitro study on marginal leakage of Cl Ⅱ restorations in primary molars

치의학과/석사[한글] 저자는 유구치 제 Ⅱ급 와동에서 복합 레진 Inlay의 변연누출을 연구하기 위하여 발거된 유구치 60개를 대상으로 제 Ⅱ급 와동 60개를 형성하고 20개의 Amalgam 충전군, 20개의 Heliomolar 충전군, 20개의 Heliomolar-Inlay 장착군으로 임의로 나누고 실험군 1은 법랑질을 산부식하고 상아질 결합제(Heliobond)를 도포한 후 Heliomclar를 직접 충전하였고 실험군 2는 Heliomolar로 Inlay를 제작하여 Dual cement으로 접착시켰으며 대조군은 아말감 충전하였다. 각 시편은 5℃ 와 55℃ 에서 1000회 온도 변화를 실시하고 Methylene blue로 염색한 후 치아를 근원심으로 절단하여 입체 현미경으로 교합 변연부와 치은 변연부에서 변연누출의 정도를 측정하여 다음과 같은 결론을 얻었다. 1. 교합 변연부에서 Amalgam, Heliomolar, Heliomolar-Inlay 사이에 변연누출 정도에 통계학적 유의차가 없었다. (p〈0.71) 2. 치은 변연부에서 Heliomolar-Inlay가 Amalgam, Heliomolar보다 변연누출이 적었으며 통계학적 유의차가 있었다. (p〈0.01) 3. Amalgam 과 Heliomolar는 치은 변연부의 변연누출이 교합 변연부의 변연누출보다 크게 나타났으며 통계학적 유의차가 있었다. (p〈0.01) 4. Heliolnolar-Inlay는 치은 변연부의 변연누출이 교합 변연부의 변연누출보다 약간 크게 나타났으나 통계학적 유의차가 없었다. (p〈0.01) [영문] The purpose of this in vitro study was to evaluate the marginal leakage of class Ⅱ composite resin inlay restoration and to compare marginal leakage of inlay with directly placed composite restoration and amalgam restoration. 60 MO or DO preparations were cut in 60 extracted human primary molars. 1st experimental group was directly filled with Heliomolar after being etched, and dentin bonding agent (Heliobond) were applied. 2nd experimental group was restored with Heliomolar inlay with dual cement. Ther specimen$ were thermocycled 1000 climes between 5℃ and 55℃. Microleakage was evaluated by use of the methylene blue staining technique. The depth of leakage wart measuredwith stereomicroacopy after the teeth were sectioned. The following results were obtained 1. There was no difference in marginal leakage of occlusal margins of all groups. 2. At the gingival margin, the Heliomolar-inlay leaked less than the amalgam & the Heliomolar, there wag difference between them. 3. There was difference in leakage between the gingival margin and the occlusal margin in the Amalgam and the Heliomolar. 4. There was no difference in leakage between the gingival margin and occlusal margin in the Heliomolar-inlay.restrictio

Clinical Observation on Total and Subtotal Thyroidectomy for Thyroid cancer Patients

We got following results by analyzing 36 cases of subtotal thyroidectomies and 26 cases of total thyroidectomies for thyroid cancers which were operated at the Department of General Surgery in Seoul National University Hospital for recent 2 years. 1. The frequency of In\llticentricity was 16% (in 8 of 51 cases) papillary ca., however, there was no case of multicentricity in follicular ca. (of 6 cases) and medullary ca. (of 1 case). But we can not conelude because of scanty samples in this case. 2. There was little difference in the frequency of postoperative hoarseness due to injury of recurrent laryngeal nerves between subtotal and total thyroid" ectomy (each 3% and 4%). 3. The frequency of permanent hypocalcemia due to injury of parathyroid glands was higher in total thyroidectomies than in subtotal thyroidectomies(each 996 and 0%). 4. A group which had reoperation because of recurrence after the first minor procedure has higher incidence of permanent hoarseness and hypocalcemia than a group which had thyroidectomy once (hoarse ness: each 4% and 22%; hypocalcemia: each 4% and 22%). Most of thyroid cancers were papillary ca. (80%), and multicentricity of it was high. The incidence of postoperative complications of reoperation because of recurrence after minor procedure (simple lobectomy) was higher than that of the first operation. This result suggests that more extensive procedures(subtotal or total thyroidectomy) are more desirable than the minor procedures in the treatment of thyroid cancer. We are going to support this conclusion by longterm comparative follow-up studies of recurrence rates and survival rates between minor procedure group and more extensive procedure- group