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보건진료소의 상대적 효율성 및 관련요인 분석

Other Titles
 Analysis of relative efficiency of the public health care post and its related factors 
Issue Date
2004
Description
간호학과/박사
Abstract
[한글] 본 연구는 일차보건의료의 중심역할을 하고 있는 보건진료소의 상대적 효율성을 평가하고 이에 영향을 미치는 보건진료원의 특성 및 제반환경 특성 요인을 분석하여 보건진료소의 효율성을 합리적으로 개선시키기 위한 방안마련에 하나의 근거를 제시하고자 시도되었다. 연구대상은 세 개 도에 소재한 보건진료소를 근접모집단으로 하여 무작위 표출한 177개 보건진료소이다. 자료수집은 이들 보건진료소에 근무하는 177명의 보건진료원들에 대해 설문조사를 통해 이루어졌다. 효율성 측정을 위해 투입변수로 보건사업운영비와 인건비를 설정하였으며 산출변수로는 보건진료소 내소자수, 가정방문건수, 전화상담건수, 집단보건교육건수, 일차보건의료기능 이행정도, 특수사업건수를 조사하였다. 한편, 보건진료소 효율성에 영향을 주는 요인을 규명하고자 보건진료원 관련 특성, 보건진료소 환경적 특성, 보건진료소 사업 지원 정도 등의 요인을 분석하였다. 자료수집은 2003년 9월 20일에서 11월 5일까지 우편을 통한 설문조사로 이루어졌으며, 보건진료소의 효율성을 측정하기 위해 자료포락분석이 사용되었고 효율성에 영향요인을 규명하기 위해 t 테스트(또는 χ2 테스트) 및 로지스틱 회귀분석이 이루어졌다. 연구결과는 다음과 같다. 1. 조사대상 177개 보건진료소의 관리운영비 및 보건사업비는 평균 2,010만원으로 최소 303만원에서 최대 7,099만원까지 투입하고 있었다. 한편, 보건진료소의 인건비는 평균 3,361만원이었으며 최소 2,000만원 최대 5,117만원이었다. 2. 대상 보건진료소의 월평균 수행건수는 내소자수 280명, 가정방문건수 28.8건, 전화상담건수 28.4건, 집단보건교육건수 154건이었으며, 일차보건의료기능 이행정도는 평균 73.8%이었다. 3. 효율성 측정결과 조사대상 보건진료소 177개의 효율성은 규모수익고정을 전제로 했을 때 모형1에서 평균 0.75, 모형2에서 평균 0.62였으며, 효율치 1에 도달한 보건진료소는 모형1에서 26개(14.7%), 모형2에서 17개(9.6%)였다. 규모수익가변을 전제로 하였을 경우 효율치 1에 도달한 보건진료소는 모형1에서 42개(23.7%), 모형2에서 27개 (15.3%)였으며 평균은 각각 0.82와 0.78이었다. 4. 단순분석에서 보건진료원의 연령과 직무수행능력, 만성질환자 비율, 보건진료소를 1순위로 이용하는 비율 등이 보건진료소 효율성과 유의하게 관련이 있는 것으로 나타났다. 또한, 지방자치단체의 지원정도, 지방의회의 지원정도, 보건소와의 협력정도, 운영협의회 협력정도가 보건진료소의 효율성과 관련이 있는 것으로 나타났다. 5. 로지스틱 회귀분석을 한 결과를 모형1에서 보면, 보건진료원의 업무관련 보유 자격증 수가 많을수록, 그리고 보건진료원의 직무수행능력이 높을수록 효율적이었다. 보건진료소의 환경적 특성에서 보건진료소 소재 지역이 C도 일 경우 A지역인 경우보다 효율적이었으며, 만성질환자 비율이 낮은 지역일수록, 보건진료소를 1순위로 이용하는 비율이 높은 곳일수록 효율적이었다. 또한, 지방의회의 협조정도가 클수록, 운영협의회 협력정도가 클수록 효율적이었다. 모형2에서는, 보건진료원이 학사학위를 소지하였을 경우, 업무관련보유 자격증 수가 많을수록, 보건진료소 소재 지역이 C도 일 경우 A지역인 경우보다 효율적이었으며 보건진료소를 1순위로 이용하는 비율이 높은 곳일수록 효율적이었다. 결론적으로 보건진료소가 일차보건의료기관으로서 효율적으로 운영되기 위해서는 보건진료원의 전문적 능력을 증진시키고 지역사회의 협조를 확보할 수 있도록 정책적 지원을 포함한 제반 방안이 적극적으로 강구되어야 할 것이다. 또한, 만성질환관리 위주의 기능을 강화함으로써 보건진료소의 효율성을 높일 수 것이다.
[영문]The purpose of this study was to evaluate the relative efficiency of Public Health Care Posts, and to offer evidence that would go to improving the Posts'' feasibility by analyzing the characteristics and general conditions of Public Health Care Posts. The research sample was determined through a random selection of 177 Public Health Care Posts in three provinces. Research data was collected through questionnaire distributed to 177 Community health practitioners(CHPs) at the Public Health Care Posts. In order to measure relative efficiency, input variables such as operational costs and salary expenses of the various Posts were fixed, while the dependent revenue output variables were the number of visitors, home visits, consultation by telephone, health education, and special program, and the level of compliance of primary health care. To identify the factors influencing the efficiency of Public Health Care Posts, analysis was undertaken on characteristics of the CHP, community characteristics, and the level of support and participation for the Post. Data from the questionnaire was gathered through mail from September 20 to November 5, 2003, and to measure the Posts'' efficiency levels, the data envelopment analysis model was used while t-test (also χ2-test) and logistic regression analysis was used to identify the factors influencing the efficiency of the Posts. Research findings were as follows: 1. The mean average of administrative and operations cost of Public Health Care Posts'' was 20.10 million won, ranging from 3.03 million won and 70.99 million won at either end. Also, the mean salary was 33.61 million won, ranging from as low as 20.0 million to as high as 51.17 million won per year. 2. The number of visitors at the the Posts were 280 cases/month, home visits 28.8cases/month, consultation by telephone 28.4 cases/month, and health education 154 cases/month. In turn, the compliance of primary health care made up 73.8% of all cases. 3. The relative efficiency of the 177 Public Health Care Posts, when assuming constant return to scale, was 0.75 in Module 1 and 0.62 in Module 2 was 0.62, and there were 25(14.1%) Public Health Care Posts in Module 1 and 17(9.6%) in Module 2. And the efficiency, when assuming variable return to scale, were 42(23.7%) of Posts in Module 1 and 27(15.3%) in Module 2, with an average of 0.82 and 0.78, respectively. 4. While conducting t-test (also χ2-test) to find whether a relationship exists between the Public Health Care Posts'' efficiency with its related factors, it was found that there is a statistical relationship the age of CHP''s and their job competency, the ratio of patients in chronic conditions, and whether or not visitors used the Posts as their primary source of health care provider. It was also found that a relationship exists between a Public Health Care Post''s efficiency with the level of support from local self-government and community health center, the level of community participation. 5. Logistic regression analysis revealed that in Module 1, Public Health Care Posts the efficiency of were higher depending on the number of professional licenses held by CHP, and the CHP''s job competency. Insofar as the location of Public Health Care Posts was concerned, Public Health Care Posts in province C were found to be more efficient than in province A, and the efficiency was higher where the ratio of patients in chronic condition was lower, and where the ratio of visitors using the Post as their primary source of health care provider was higher. The efficiency is higher when the level of support from local assembly and of participation of the Steering Council is higher. In Module 2, the level of the Posts'' efficiency were higher where CHPs were possessing the bachelor''s degree, and more professional licenses were held. And as far as the location was concerned, the efficiency of Public Health Care Posts in province C were higher than those in province A, where the Posts'' efficiency was higher when visitors used the Posts as their primary source of health care provider. In conclusion, in order for Public Health Care Posts to operate efficiently as primary health care organization, a general support plan should be considered to raise the specialization of CHP and expand the scope of cooperation from their community. Also, the efficiency of Health Care Posts can be enhanced by improving the care for patients in chronic condition.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/128788
Appears in Collections:
2. 학위논문 > 3. College of Nursing (간호대학) > 박사
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