육군 병사의 의료이용 수준과 관련 요인에 관한 연구

Abstract

[한글]

이 연구는 우리나라 병사들의 의료이용 수준을 조사하고 이에 영향을 미치는 요인을 분석하여 적절한 의료이용을 도모하고자 2007년 5월 1일 최전방 한 개 사단의 병사들을 대상으로 설문지를 이용하여 자료를 수집하였고, 대상자의 특성과 의료이용수준은 단변량 분석을, 의료이용수준과 관련된 요인을 구명하기 위해서는 이변량 분석 및 회귀분석을 이용하였다. 연구의 결과를 요약하면 다음과 같다.첫째, 개인속성요인의 교육 수준은 80.2%가 전문대졸 이상이었고, 계급은 상병이 가장 많았고, 병장이 가장 적었다.둘째, 건강행태 중 수면 충분도 및 휴식 충분도는 불충분한 경우가 충분한 경우보다 많았으며, 스트레스를 느끼는 편이 77.6%로 느끼지 않는 경우보다 3배 이상 많았다. 현재 흡연은 65.9%로 비흡연의 2배 이상이었다. 평소 건강수준은 보통이가장 많았으며 지난 4주간 와병경험 및 현재 활동 제한 경험은 없는 경우가 대부분이었다.셋째, 전체 대상자 중 외래는 21.8%, 입원은 18.2%가 이용하였고, 미치료·치료지연 경험율은 37.7%였다. 의료이용 주 의료기관은 대대의무대, 주 교통수단으로는 도보 및 앰블런스, 주 인솔간부는 외래 이용시 선임병, 입원 이용시 군의관이었다.넷째, 군 관련 요인 중 외래이용수준에 영향을 미치는 유의한 변수는 의료기관 위치로서 원거리부대일수록 외래이용수준이 낮았다. 입원이용수준에 유의하게 영향을 미치는 변수는 계급, 의료기관 위치로서 계급이 낮을수록, 원거리부대일수록 입원이용수준이 낮았다.이는 의료이용에 있어 병 상호간 개입과 의료기관과의 거리가 영향을 미치는 것으로 향후 적정 의료이용을 도모하기 위하여 다음의 개선책을 도출해 보았다.첫째, 병사들이 진료의사 표현 시 보고 절차 간 계급이나 선임병의 영향을 받지 않도록 절차를 간결화하고, 진료에 한해서는 병사들의 편의를 고려하는 여건 조성이 요구된다. 또한 병사들이 원하는 시간대에 군의관이 진료할 수 있고, 군의관이 진료할 수 있는 시간대에 병사들이 진료 받을 수 있도록 그 시간을 찾고, 확보하도록 관심이 제고되어야 하겠다.둘째, 군의관이 미보직된 원거리 예하 부대의 진료접근성 보장을 위해 최기 인근 부대 및 민간 의료 시설과 연계한 진료시스템을 구축하고, 정기적인 순회 진료나 원격화상진료시스템을 도입, 활용하여 볼 수 있을 것이다.셋째, 사단 내 의무지원 능력을 보강하고 전문 의료 인력을 늘려 병사들이 진료의사를 표현하기 전에 정기적인 의료 및 건강 상담을 통해 사전에 건강위해요인을 파악하고, 나아가 건강증진·예방활동을 실시해야 할 것이다.

[영문]

This research is aimed at examining our country's privates' using level of medical facilities and contributing to properly using medical facilities by analyzing factors affecting medical facility using level. For this purpose, I conducted a questionnaire survey on one division stationed at the forefront and collected data on May 1, 2007. As for the surveyed's characteristic and medical facility-using level, a single variant amount analysis was applied; for finding out factors related to medical facilities-using level, dual variant amount analysis and regression analysis were adopted. The result of this research is summarized as follows:First, as for the educational level in the individual attribute factor, about 80.2% of the surveyed were above the level of junior college graduate; as for the rank in the army, the number of the corporals noticeably excelled other ranks, and the number of the lance corporals was fewest.Secondly, as for sleep and resting adequacy among healthy behaviors, cases of inadequacy were more than those of adequacy; those who felt stressed out accounted for 77.6%, which was more than three times the number of those who didn't feel stressful. At present, smoking population accounted for 65.9%, which was more than double the number of those who didn't smoke. As for usual health level, the ordinary level were a legion accounting for 45%; as for the experience in lying in bed for the past four weeks and limited experience in current activity, 84.6% and 82.4% of the survey respondents said "no" respectively to the two question items.Thirdly, the major medical facilities they used was a medical corps to a battalion; the major means of transportation to a facility was on foot or by ambulance; the major leader was a senior private in time of visiting there as an outpatient and a military surgeon in time of using the facility as an in-patient.Fourth, as a result of regression analysis, a purposeful variable-the location of a medical facility-affecting medical facility-using level as an outpatient, among the military-related factors, showed that the farther the medical corps located, the lower the using level of it as an outpatient was than a medical corps located in a short distance. The variables purposefully affecting the using level of a medical corps as an in-patient are the rank and the location of a medical corps, and the survey result showed that the lower the rank was and the father the medical corps is located, the lower the medical corps-using level was; in addition, the lower the rank was, the higher the skipping medical treatment in the past was.Such aspects, in using a medical facility, prove that mutual involvement among the privates and the distance to the location of a medical corps has an effect on the medical facility-using level. Therefore, I deduced the following improvement measure to encourage using medical facilities for now.First, it's necessary to simplify the procedure to report to their senior for their wish to have a medical treatment so that they could not be influenced by ranks or senior privates; as far as the medical treatment concerned, fostering a condition to consult privates' own convenience is required. In addition, it's also necessary to examine and secure a proper time slot for medical treatment between privates and military surgeons by raising more interest in privates.Second, to guarantee accessibility to medical treatment of a long-distance-located corps under the command, in which a military surgeon is still not posted, it will be worthwhile to consider positively setting up a medical treatment system by linking its neighboring army unit and private medical facilities, and to introduce a regular circuit medical service system or tele-diagnosing system and to make full use of it for our privates.Third, it is necessary to reinforce the supporting capacity for medical service in the division and increase professional medical staff so that privates could grasp the factors of health hazard through regular medical, health counselling before they show their wish to get a medical treatment - and further programs for health improvement and preventive activities from diseases should be developed and executed.