최근 자원으로서의 시간에 대한 개인의 인식은 인간의 생활을 영위하는 기초적 단위로서 시간의 가치활용도를 높이고 인간관계의 맥락을 심화시키며, 그들의 「삶의 질」을 극대화하는 핵심적인 가치를 부여하는데 초점을 맞추고 있다. 그렇지만 어느 누구에게나 정해져 있는 시간의 양(quantity)을 어떻게 효율적으로 사용하고, 필요한 분야 및 항목에 얼마나 배분하는가에 따라 시간의 질(quality)을 증대시킬 수 있다. 본 연구는 1999년 통계청에서 처음으로 실시한 자료를 심층 분석하는 것이다. 연구목적은 기혼여성의 혼인상태 및 사회경제적 특성에 따라 생활시간 배분이 어떻게 상이한지를 분석하고 문제점을 찾으며, 아울러 효율적 시간활용방안을 제시하고 정책적 지원방안도 함께 모색하는데 있다. 주요 결과는 우리나라 기혼여성의 생활시간 배분은 혼인상태에 따라 현저한 차이가 있었다는 점이다. 아울러 기혼여성의 경제활동여부도 생활시간 배분에 영향을 크게 미치고 있었다. 특히 이혼부인은 생계유지를 위하여 경제활동에 적극 참여해야 하기 때문에 적절한 시간배분에 문제점을 노출시키고 있었다. 이와 같은 일련의 분석연구는 우리나라 부인의 혼인상태, 연령, 경제활동참여 및 직업유형 등의 특성에 따라 생활방식과 삶의 질을 파악하고, 시간자원을 효율적으로 활용하는 데 필요한 기초자료로 제공될 수 있을 것이며, 궁극적으로 여성의 「삶의 질」을 향상시키는 데 기여할 것으로 사료된다.;Individual's view of time as resource has recently been geared toward making the best use of time as the basic unit of human life in order to deepen the context of interpersonal relationships and maximize quality of life. The quality of one's time can be enhanced depending on how efficiently one allocate, manage, and spend the quantity of time. The present study aims to conduct an in depth examination of the first time-allocation survey carried out in Korea by the National Statistical Office in 1999 and analyze differences and identify problems in time allocation among married women according to their marital status and socioeconomic characteristics. Along the way, strategic plans and policy implications are suggested for improving the efficiency of time allocation. Major findings can be summarized as follows. Patterns of time allocation among married women in Korea vary widely depending on their marital status. The largest portion of their time in general is spent on ‘self-care’ which includes time allocated for sleep. However, divorced women are found to spend the next largest portion of their time on work, while widowed women and women with spouse spend the second largest portion their time on 'leisure and friends/acquaintances'. Divorced women are found to spend significantly more time at work than widowed women and women with spouse do. This is presumably a result stemming from the fact that divorced women, unlike women with spouse present, are highly responsible for household livelihood not only because they do not have income-earning husbands, but also because they are generally younger than their widowed counterparts and therefore are less likely to have income-earning children. Divorced and widowed women in their thirties/forties as compared with other groups are found to spend much more time on work. This may be not only because they unlike women with spouse present－must fulfill their responsibilities and role as the main breadwinner for the family, but also because they are more likely to have school-aged children and are responsible for earning money for bringing up and educating them. Unemployed women, regardless of their marital status, are found to spend more time on household and family care than employed women. This implies that there is an accentuated policy need for paying particular heed to social support toward helping divorced women balance their work and family lives. Koreans in general－irrespective of socio-demographic factors such as gender, age, educational level, marital status, and employment status－are found to devote little time to voluntary activities, even during weekends or holidays. Non-working women and elderly people, in particular, spend very limited amount of time participating in voluntary activities despite having relatively much spare time. Divorced and widowed women as compared to women with spouse are found to suffer from lack of time to care for their preschool children due to other obligations. This calls for more policy attention to be placed on the protection of physical and emotional health of children in these female-headed households. For instance, the availability/accessibility of desired services should be ensured through the expansion of home-helper programs, educare centers, and financial aid programs. Based on these results, the following time management strategies and policy options can be considered. First, more time needs to be allocated, especially in the case of married non-working women, to voluntary activities. This can be made possible by reducing time spent on friends/acquaintances, leisure activities, and self-care. Second, it is hard for many divorced and widowed women to allocate much time to household and family care because they are responsible for engaging in income-earning activities. Therefore, social support should be provided to enhance the availability and accessibility of home-helper programs and daycare services. Third, cultural/leisure programs should be developed for working married women who generally have little or no time for leisure and interpersonal relationships. Forth, the longstanding inequalities in gender roles must be redressed. To do this would require men to escape from their traditional ‘male gender role’ and assume an increased, if not equal, role in household tasks and family care.
본 연구는 소규모 지역별 의료이용 변이의 정도를 파악하고, 변이 발생에 영향을 미치는 요인을 분석하였다. 또한 변이를 발생시키는 요인(즉, 수요자 요인, 공급자요인 등)들로 설명 가능한 변이의 정도가 어느 정도인지를 파악하고, 이러한 요인들을 모두 통제한 상태에서도 설명되지 않는 부적절성과 불확실성 등으로 인한 의료이용의 변이를 측정하였다. 마지막으로 지역 간 의료이용 변이로 인해 발생되어지는 사회적 후생 손실을 표준화된 경제모델(Phelps등, 1990)을 통해 화폐단위로 파악해 보았다. 상병별 분석결과, 내과계 상병의 표준화 전 변이계수는‘만성폐쇄성 폐질환(chronic obstructive pulmonary disease)’이 0.6676으로 가장 높았고, 표준화 후 변이계수는‘호흡기 감염 및 염증(respiratory infection and inflamation’이 0.5188로 가장 높았다. 반면‘신부전(renal failure)’이 표준화전 변이계수가 0.3167로 가장 낮았고, 표준화 변이계수는‘뇌졸중(cerebrovascular accident)’이 0.2856으로 낮았다. 상병별 후생손실 계산 결과, 내과계 중‘단순폐렴 및 흉막염(simple pneumonia and pleuritis)’의 손실금액이 221억원으로 가장 컸고, 손실률은‘고혈압(hypertension)’이 39.34%로 가장 높았다. 그리고 ‘소화기 악성종양(malignat neoplasm of gastrointestinal tract)’의 경우 손실률이 5.57%로 가장 낮았다. 내과계 20개 상병을 합한 결과 총 진료비 8864억 중 1366억원(15.41%)가 설명되어 지지 않는 변이로 인한 후생손실로 나타났다. 본 연구는 지역간 의료이용의 변이가 어느 정도인지 그리고 변이의 원인이 무엇인지 등을 파악하는 것뿐만 아니라 그 변이로 인한 사회적 후생손실이 얼마인지를 산출해 냈다는 점에서 선행 연구들과 구별된다. 이러한 후생손실 계산은 변이를 줄이는 비용과 연계하여 정책의 우선순위를 설정하는데 중요한 근거가 될 것이다.;This study looks into small area variations in health care utilization and analyzes determinant factors conventionally known to be responsible for the emergence of such variations. Further, this study explores how much of the variations can be explained by socio-economic factors (e.g., the user factors and the provider factors) and how much is due to the inappropriateness and uncertainties that remain unexplained even when the socio-economic factors are controlled. Also, an attempt is made, following a standardized economic model (Phelps, 1990), to calculate the monetary value of social welfare loss arising from variations in health care utilization in terms of monetary value. By disease, the pre-standardized coefficient of variation was highest for chronic obstructive pulmonary disease at 0.6676 and lowest for renal failure at 0.3167. The standardized coefficient of variation was highest for respiratory infection and inflammation at 0.5188 and lowest for cerebrovascular accident at 0.2856. Among the disease fields, the welfare loss was greatest in the case of simple pneumonia and pleuritis at 22.1 billion won, while the rate of loss was highest for hypertension at 39.34% and lowest for malignant neoplasm of gastrointestinal tract at 5.57%. The total spending on the 20 diseases were estimated to be 886.4 billion won, of which 136.6 billion won was thought to be a welfare loss due to unexplainable variation. This study differs from previous studies not only in that it examines the extent and causes of small area variations in health care utilization but also in that it estimates the welfare loss arising from such variations. This estimation will lay a foundation for setting policy priorities in connection with the cost-effectiveness of reducing variations in health care. Although what methods to use to reduce the variations at what cost and whether they will be effective have not been substantially discussed, the priority-setting per se based on the absolute value or the rate of loss may be a testament to how serious the present situation is. Attention should also be paid to the fact that what welfare loss implies is something that needs to be reduced by redressing not only over-utilization but also under-utilization of health care.