Asssociation with emergency department use and Long-term care beneficiaries among patients who got serious grades such as diagnosis or symptom of dementia in Korean elderly

건강증진교육전공인구 고령화와 치매 등 만성질환 발병 증가로 국가차원에서 노인장기요양보험을 시행하고 있다. 응급실을 이용한다는 것은 평소 건강상태가 관리되지 않거나 급박한 증상이 일어나게 됨을 의미하는 변수로 본 연구에서는 65세 이상 치매 질환 및 증상을 가지고 있으며 와상도가 높은 장기요양 중증대상자를 대상으로 장기요양서비스 이용과 응급실 이용의 관련성을 파악하고자 한다. 본 연구는 ⌜국민건강보험공단의 노인장기요양보험과 건강보험 자료⌟를 활용하여 2014년 1월 1일부터 2015년 11월 30일까지 65세 이상 치매 질환 및 증상을 가지고 있는 장기요양 중증대상자 15,231명 전수를 분석하였다. 연구결과 장기요양서비스 미이용군은 181명(1.2%), 이용군은 15,050명(98.8%, 재가서비스 28.9%, 시설서비스 69.9%)이었다. 장기요양서비스 미이용군과 장기요양서비스 이용군은 재가서비스 중위수인 494(회)를 기준으로 재가서비스 이용 하위군, 재가서비스 이용 상위군으로, 시설서비스 중위수 696(회)을 기준으로 시설서비스 이용 하위군, 시설서비스 이용 상위군으로 나누어 응급실 이용 관련요인에 대한 로지스틱 회귀분석을 시행하였다. 미이용군에 비해 시설서비스 이용을 많이 한 경우(OR 0.45, 95%CI 0.32-0.63) 응급실 이용이 적은 반면, 장기요양 2등급에 비해 1등급(OR 1.13, 95%CI 1.03-1.23), 남자일수록(OR 1.23, 95% CI 1.11-1.37), 일반에 비해 의료급여(OR 1.45, 95%CI 1.04-2.01), 만성질환개수가 없음에 비해 2개 이상(OR 1.13, 95%CI 1.01-1.26), 비장애인에 비해 장애인인 경우(OR 1.10, 95%CI 1.01-1.20)는 응급실 이용과 관련되어 있었다. 장기요양 중증대상자들은 재가서비스보다 시설서비스를 많이 이용하고 있으며 시설서비스를 많이 이용한 경우 응급실 이용이 적은 경향을 보였다. 또한 성별, 노인장기요양 중증도, 취약계층이 응급실 이용과의 관련요인으로 나타나 이러한 특성을 고려한 정책강화가 필요하다. 그러나 본 연구는 장기요양서비스 미이용자의 수가 매우 적어 미이용자와 이용자를 비교하기에는 충분치 못한 조사로 생각되며, 향후 장기요양서비스 이용의 효과는 이용 양상과 비교가 가능한 연구 설계를 통한 다차원적인 전향적 연구를 통해 지속적으로 검증되어야 할 것이다.open석

An Inquiry into the Skills Attainment Policy for the Knowledge-Based Economy In Kore

지식기반경제에서는 고기술 확보를 위한 연구개발투자 확대 창의성 있고 고숙련을 갖춘 지식노동력의 창출 유연하고 분권화된 작업조직 협력적 노사관계 등이 중시된다. 이 가운데에서도 지식기반경제가 새로운 국가경제의 생존전략으로서의 지위를 확보할 수 있는 관건은 창의력과 고숙련을 겸비한 우수한 노동력의 창출에 있다. 따라서 본 연구에서는 지식기반 경제가 요구하는 숙련의 성격을 고찰하고 이를 토대로 지식기반경제에서의 숙련형성정책 방향을 위한 시사점을 도출하고자 한다. 나아가 본 연구에서 고찰한 지식기반경제에서의 숙련의 성격은 향후 직업훈련제도와 교육제도의 개편과정에서 유의미한 함의를 가질 것으로 기대된다.Ⅰ. Introduction The Korean economy has been achieving high growth for the last 30 years. Recently, the growth rate of the manufacturing indutstry is declining and international competitiveness is weakening seriously. This means that the growth potential of existing production system in Korea is withering. Korean production system is characterized by a 'subordinate Fordism' which is combined by 'high productivity-low wage-mass production-mass exportation'. Korean production system began to lose competitiveness in the early 1990s. One of the fundamental reasons might be the fact that the Korean system failed to accommodate new environments that were characterized by changes and competition. To regain competitive advantage in the world market and to sustian high growth, the Korean economy should establish the knowledge-based economy instead of Fordist mass production system. For the purpose of the building an alternative development model of Korean economy, it is very important to establish a mechanism of new skill formation. Ⅱ. Purpose of study For the last 50 years, the mass production system has been a dominant paradigm in the world. Nowadays, the world economy has been experiencing paradigm shifts in its production system. Fordist mass production system heavily relied upon expensive single purpose macnhine. The workforce under this production system were unskilled or semi-skilled. They performed narrowly defined jobs and were subordinate to the machine. The main characteristic of work orgarnization of mass production system was a 'seperation of conception from execution' in the point of skill formation. To overcome the limitation of the Fordist mass production system, the development of worker's new skills and worker's participation is necessary. From the 1990's, OECD economies are increasingly based on knowledge and information. It is clear that information and communication technology(ICT) is a driving force of economic growth in OECD countries. The main characteristic of the knowledge-based economy is as follows. First, knowledge and information is a driving force for economic growth in knowledge-based economy. Second, building knowledge networks is needed for knowledge-based economy. Third, continuous learning is critical factor for the implementing of knowledge-based economy. Forth, government should allow the even opportunity accessible to knowledge and information for all individual and groups in same society. From the inducement of commom factors of OECD countries, we can conclude that new work organization which derived from the technological change, globalization and limitaion of Fordist mass production requires more skills and participation of workers. The general trends in concerning new skills for the knowledge-based economy are as follows. Frist, cooperative spirit and communication ability are necessary for effective operation of the networks. Second, theoretical knowledge and intellectual skills are main skill need for the knowledge-based economy. Third, creativity and autonomy is also needed for the knowledge-based economy. In sum, the knowledge-based economy which overcomes limitation of the Fordist mass production system requires new and high-skilled workers. This study aims to seek the best policy of new skill formation regarding the knowledge-based economy of the 21st century in Korea. The paradigm shift in the production system should be supported by skill formation policy. Before the proposal for the new skill formation policy can be discussed, the character of skill need in Korean workplace should be reviewed. Ⅲ. Findings and Perspectives Starting with the basic opinion in previous studies about skill deficiencies in Korean economy, I reviewed the main characteristics of skill formation mechanism in the Korean manufacturing industry on the basis of labor process analysis. Also, it was reviewed that how can existing product strategy, technology, incentive and industrial relations systems affect the skill formation mechanism in Korea. Another main factor in determining the skill formation system is government's labor policy for training and education. For this dissertation, I used mail survey result which carried out by Kyungpook University. The mail survey for all 510 listed firms in the stock market in Korean manufacturing industry carried out from November 1997 to this February 1998. Fifty-nine firms responded to this survey. The main characteristics of skill formation mechanism in Korean manufacturing industry are as follows. First, existing product strategy requires increased and higher skills than current skill level. Second, automation technology and emerging new product method (low volume with multiple products) demands highly skilled workers. These changes in production system reject the hypothesis of the 'low skill equilibrium' in Korean economy. Third, the level of intellectual skills and social skills for the effective production system is still very low. Thus, skill gap in manufacturing industry might be a serious obstacle for Korean economy to build the knowledge-based economy. Ⅳ. Policy Implications To raise the level of worker's skills and make new skills in Korea, the existing education and vocational training system should be reformed fundamentally. New education and vocational training system must contain new curriculum which improve theoretical and technical skills, cooperative spirit and communication ability. We assert that the social consensus among the government, the management and the labor is necessary condition for the new skill formation. To seek the best policy of new skill formation regarding the knowledge based economy of the 21st century in Korea, three major actors in society have to form the 'skill formation network'. To maintain the cooperative relationship in the 'skill formation network', the government should support incentive systems for the skill formation. Also, the government must collect the idea and opinion for the skill formation which submitted by the management and the labor. The management have to permit the 'skill based pay' and the 'training bargaining'. Finally, the labor should change their role and participate in skill formation system as one of the active social actors.연구요약 Ⅰ. 서 론 1 1. 연구의 필요성 및 목적 1 2. 연구 내용 2 3. 연구 대상과 방법 4 Ⅱ. 포드주의 경제의 위기 5 1. 포드주의적 대량생산체제의 한계 5 2. 대량생산체제에서의 숙련의 성격 8 Ⅲ. 정보통신기술(ICT)의 출현과 지식기반경제의 성립 11 1. 새로운 정보통신기술(ICT)과 지식기반경제 11 2. 지식기반경제를 위한 새로운 숙련요건 16 3. 지식기반경제와 숙련의 장기추세 24 Ⅳ. 한국에서의 지식노동의 필요성-제조업 상장기업의 실증 분석을 중심으로 27 1. 생산체제의 비효율성과 저숙련 27 2. 새로운 숙련에 대한 요구 29 3. 숙련형성에 대한 정책적 함의 52 Ⅴ. 지식기반경제를 위한 숙련형성정책 방향 55 1. 제도의 재구축 필요성 55 2. 숙련형성을 위한 네트워크화된 시스템의 형성 62 참고문헌 67 ABSTRACT 7