초록
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IV.연구결과
○공중보건의사 중장기 수습현황 및 대책
-현재 약 5,300명의 공중보건의사 인력은 보건기관,병원,교정시설,사회복지기관,연구기관 등에 배치되어 있으나,향후 공중보건의사 인력 공급이 감소가 예측됨에 따라 공공보...
IV.연구결과
○공중보건의사 중장기 수습현황 및 대책
-현재 약 5,300명의 공중보건의사 인력은 보건기관,병원,교정시설,사회복지기관,연구기관 등에 배치되어 있으나,향후 공중보건의사 인력 공급이 감소가 예측됨에 따라 공공보건의료인력 필수 배치기관을 정립하여,공중보건의사와 대체인력 공급을 통해 필수 배치기관에 인력을 공급함
○공중보건의사 적정 배치기준(안)
-지역의 필요에 기반한 배치를 원칙으로 인력 자원 배분의 적정성을 기하기 위하여 기관 유형별 적정 배치기준(안)을 제안함
-공중보건의사 적정 배치기준은 각 기관 유형별(보건소,보건의료원,보건지소,국공립병원,민간병원,기타기관)로,기관 특성 및 지역적 특성을 고려하여 공중보건의사 역할에 따른 배치기준을 적정/필수 두가지 방향으로 정립하였으며, 각각 배치필요 인원을 예측함
-의과 필수배치 기관은 시(경기 제외),군 지역 보건소,무의면 보건지소,병원선 시 (경기 제외), 군 지역거점병원,교정시설,기타 필요기관이며,약1,600명의 인력이 필요할 것으로 예측됨
-치과 필수배치 기관은 시 (경기제외),군 지역 보건소,도서지역 보건지소,병원선으로 약 330명의 인력이 필요할 것으로 예측됨
○공중보건의사 배치적정성 평가
-공중보건의사 배치적정성 평가란 공공보건의료 인력이 필요한 기관에 적정한 인원이 배치되었으며(양적 평가),지역사회 특성에 따라 목적에 부합하는 인력 배치가 이루어졌는지 평가(질적 평가)하는 것으로 정의함
-양적평가는 본 연구에서 제안한 적정 배치기준을 근거로 평가하였으며,전체적으로 적정 배치기준에 과잉 배치되어 있는 경우가 많았고, 시도별로 배치양상의 차이가 있음을 알 수 있었음
-질적평가는 본 연구에서 체계를 마련하고 실제 적용은 '제5기 지역보건의료계획'부터 반영될수 있도록 제안함.'(가칭) 공중보건의사 배치 및 활용계획'을 제5기 지역보건의료계획에 포함하여 작성하도록 하되,해당지역취약현황분석을통한 배치필요성 도출,지역사회 특성을 반영한 공보의 활용 계획등의 내용을 포함함.평가 결과를 통해 차기년도 공중보건의사 배치에 반영하는 등 정책수단을 개발·준수를 유도함
○공중보건의사 대체인력 방안 마련
-현재 공중보건의사 대체인력 제도로써 가장 현실성 있게 검토되고 있는 제도는 국방의전원(공공의전원 포함),공중보건장학제도,농어촌학생 지역할당제도,의료취약지 근무의사 특례지원 제도 등이 있음
-공중보건장학제도 개선방안 마련을 위한(치)의과대학 및 (치)의학전문대학원 재학생 대상 설문조사 결과,공중보건장학금 신청 의향률은49.0%(적극 신청6.7%,제도 조건에 따른 신청42.3%)였으며,미신청 이유로는'농어촌지역에서 의무복무해야 하는 부담감 때문에'가 가장 높았음
-의무복무 시 급여에 따른 희망근무기관 조사결과,현재 공중보건의사 급여수준(연봉2천~3천만원)이면 '신청안함'(71.8%),시 보건소(19.1%),시 국공립병원(17.0%)등의 순이었으며,전문계약직 급여수준(연봉5천~7천만원)일 경우는 '신청 안함'(58.6%),시 보건소(30.0%),시 국공립병원(27.0%),보건의료원(18.1%)순이었음
-공중보건장학제도 주요 개선 내용은 다음과 같음.공중보건장학생은 1년 단위로 선발·연장하며(매년 의과 25명,치과20명),장학생으로 선발된경우 등록금 전액과 생활비를 지급하고 학기 또는 방학기간 중 의무교육을 이수하도록 하여,공공보건의료인력의 양적· 질적 확충을 꾀함
-조건이행 기간은 장학금을 받은 기간과 동일한 기간 동안 시 보건소 또는 취약지역 보건기관에서 전문계약직공무원신분으로 근무화여,급여는(1안)현재 공중보건의사 급여수준,(2안)전문계약직 공무원 급여수준으로 검토함
-조건이행 완료 후에도 보건기관의 지속 근무를 희망하는 경우,관련공무원 신분 부여 등 연계체계를 통해서 장기적인 공공보건의료인력 양성을 꾀함
-공중보건장학제도 운영을 위한 비용추계 결과,(1안)을 적용하였을 경우에는 매년 5,665백만원이 소요되며,(2안)을 적용하였을 경우는 매년 11,965백만원이 소요되는 것으로 추계됨
-또한 지역 특성별 공중보건의사 대체인력이 추가 필요하거나 공중보건장학제도 및 국방의전원(공공의전원)을 통한 대체인력 공급이 부족한 경우,농어촌학생 지역할당제,의료취약지 근무의사 특례지원제도 등을 탄력적으로 적용· 활용할 수 있는 방안을 마련함
Abstract
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IV.Study results
○ Current state and future plan of medium-and long-term supply of public health doctors
- Approximately 5...
IV.Study results
○ Current state and future plan of medium-and long-term supply of public health doctors
- Approximately 5,300 public health doctors are now posted at public health institutions, hospitals, correctional facilities,social welfare institutions,research institutions,etc.but since the supply of public health doctors will decline in the future,institutions where placement of public health &,medial personnel is essential should be identified so that public health doctors and alternative personnel can be assigned to them.
○ Appropriate placement criteria of health doctors (draft)
-On the priciple of local need-based placement,the appropriate placement criteria(draft)by type of institution are suggested to ensure appropriateness in human resource distribution.
-The criteria for appropriate placement of public health doctors were determined for each type of institution (public health centers , public health and medical care centers,branches of public health centers,national and public hospitals,private and other institutions).In considerationof the characteristics of institutions and geographic areas,the placement criteria largely divide institutions into two categories in accordance with the roles of public health doctors:"appropriate"and "essential."The necessary number of placement is projected for each category.
-The institutions where placement of medical doctors is essential are public health centers in cities (excluding Gyonggi-do) and counties (Gun),branches of public health centers in villages (Myeon)without other medical services,hospital ships,main hospitals in cities(excluding Gyonggi-do)and counties(Gun),correctional facilities,and other institutions in need of medical doctors.It is projected that approximately 1.600 medical doctors will be needed.
-The institutions where placement of dentists id essential are public health centers in cities (excluding Gyonggi-do )and counties (Gun),branches of public health centers on islands ,and hospital.It is projected that approximately 330 dentists will be needed.
○Evaluation of appropriateness of placement of public health doctros
-Evaluation of appropriateness of placement of public health doctors means to evaluate whether an appropriate number of public health and medical personnel has been posted in institutions in need of them(quantitative evaluation )and whether the personnel have been placed to satisfy the specific needs of local communities (qualitative evaluation).
-Quantitative evaluation was conducted based on the appropriate placement criteria suggested herein .In many cases,more personnel were placed than required according to the appropriate placement criteria and the state of placement showed a difference between cities and provinces (Dos).
-In respect of qualitative evaluatio,this study proposes the use of an evaluation system set up herein in the 5th District Healthcare Plan . It is proposed to incorporate the tentatvely named "Placement and Utilization Plan of Public Health Doctors"in 5th District Healthcare Plan,which shall entail,among other things,identifying the necessity of placement through analysis of the needs of the communities concerned,and establishing plans to wage publicity campaigns reflecting the characteristics of local communities.It is recommended to develop and comply with policy measures by applying the evaluation findings to placement of public health doctors in the next year.
○Establichment of an alternative personnel supply plan of public health doctors
-The programs that are currently being reviewed as the most practical for alternative personnel supply of public health doctros are a Defense Medical school (as well as graduate schlls of medicine for pubblic health ),the public health scholarship program,the regional quota system for students of rural areas , and the special support program for doctors working in regions with poor medical systems.
-According to a survey of students in colleges of medicine(dentistry)and graduate schools of medicine (dentistry)on ways to improve the public health scholarship program,49.0 percent answered they intended to apply for a public health scholarship(6.7 percent indicated "very willing to apply "and 42.3 percent indicated"willing to apply upon conditions").Among the reasons not to apply,the highest percentage was "having to serve in an rural area."
-In the survey on the institutions they want to work for during service on duty in accordance with the salary range, the highest percentage of students(71.8 percent)answered they "will not apply "if the salary range is the same as that of current public health doctors (20million to 30million won per annum),followed by health centers in cities (19.1 percent),and national and public hospitals in cities(17.0 percent).when the salary range was the same as that of professional contract workers (50 million to 70 million won per annum),they chose public health centers in cities (30.0 percento ,national and public hospitals in cities (27.0 percent)and public health and medical centers (18.1 percent).
-Major points of improvements of the public health scholarship program are as follows:Public health scholarship students are selected and renewed by one-year terms (25 people for medicine and 20 people for dentistry every year);and if awarded the scholarship,the students's full tuition and living expenses shall be paid and the students shall complete mandatory courses during the semesters or school breaks so as to help enhance the quality of public health and make public health services more readily available.
-The students awarded the scholarsip are obliged to serve as public officials in professional,contractual service in public health centers in cities or public health institutions in regions with poor medical service for a period equivalent to the length of their scholarship.In respect of the salary range , the current salary level of public health doctors (Option 1)and that of public officials in professional, contractual service(Option 2)were reviewed.
-Long-term efforts are made to foster public health and medical personnel through a connectional system, including granting of the status of relevant public official if any person intends to continue to work for the public health institution even after performing the scholarship obligation.
-According to the cost estimation for management of the public health scholarship program,5,665 million won is incurred every year for option ,whereas 11,965 million won is incurred every year for Option 2.
-In addition,in case where additional alternative public health doctors are needed due to special characteristics of regions ,or where the supply of alternative personnel through the public health scholarship program and the Defense Medical School (graduate schools of medicine for public health )is lacking, measures are drawn up to adopt and flexibly utilize the regional quota system for students of rural areas,the special support system for doctors working in regions with poor medical infrastructure,etc.
