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쿠바의 히포크라테스 선서
2011-08-16
쿠바의 히포크라테스 선서 2011.08.05 02:27 | My Articles | 장동만 http://kr.blog.yahoo.com/dongman1936/812451 쿠바의 ‘히포크라테스 선서’ 쿠바의 ‘히포크라테스 선서’ “의술을 개인의 사욕(돈 벌이)을 위해 쓰지 않겠다”. 고대 그리스 히포크라테스의 선서가 아니다. 21세기 쿠바의 의과 대학 입학 때 학생들이 하는 선서(문) 다. 쿠바의 의사들은 코뮤니티 내에 상주하면서 밀착형으로 개개인의 건강을 돌본다. 일체 무료다. 이같은 패밀리 닥터 제도는 초기 치료와 예방을 가능케 해 쿠바 의료의 질을 획기적으로 높였다. 전 국민의 98% 이상이 이 패밀리 닥터의 혜택을 누리고 있다. 의사 1명 당 환자수가 165명, 세계 최저 수준이다. 무상 교육인 쿠바는 의과 대학도 무료다. ‘국제 의료 사관 학교’로 불리는 ’라틴아메리카 의과 대학 (ELAM)’은 가난한 가정의 학생 중 졸업 후 어려운 지역에 가서 가난한 사람들을 돌보겠다는 희생 정신이 투철한 학생들을 뽑는다. 입학 때 ‘의술을 개인의 사욕을 위해 쓰지 않겠다”는 서약서를 써야 한다. 이 학교는 지난 5년 간 전 세계 30개 국에서 온 1민여 명을 의사로 배출했다. 아프리카 대륙에만 2,000명 이상의 쿠바 의사들이 내전의 전쟁터나 난민촌, 또는 의료 혜택이 부족한 오지에서 봉사하고 있고, 베네수엘라, 엘살바도르, 동티모르 등 105개 국에 3만 명 정도의 의사가 나가 있다. 이같이 ‘인간의 얼굴을 한 의료’ 체계인 쿠바에선 의사가 저소득 직종으로 분류된다. 평균 임금이 고작 월 25 달라 안팍이다. 모든 의료 기관이 국가 소유이고, 모든 의사가 공무원이기 때문이다. 그런대도 놀랍게시리 그 의료 수준이 선진국을 뺨친다. 한국이나 미국에 별로 뒤지지 않는다. 기대 수명과 영아 사망률, 백신 접종 등 각종 보건 지표에서 선진국에 맞먹는다. 생명 공학 분야 특허를 500여개나 보유하고 있고, 2003년 합성형 뇌수막염 (Hib) 백신을 세계 최초로 개발했으며, 남미 국가 중 의약품 최대 수출국 (연간 5,000만 달라) 이다 . 지난 7월엔 차베스가 쿠바에서 대장암 수술을 받았다. <07/19 /11 자 ‘미주中央‘ & ‘의료 천국, 쿠바를 가다’ 참조> 한편, 요즘 미국 의과 대학들은 입학 사정 때 학업 성적보다 ‘의사로서의人性‘을 더욱 중시하는 경향으로 바뀌고 있다. ‘돈 벌이 醫術‘ 보다 ‘봉사의 仁術‘을 더 중시하게 됐다는 얘기다. 오바마가 추진하는 미국 의료 개혁의 최우선 과제인 성 싶다. 한국의 의료 당국, MD들, 의과생들이 깊이 생각하고 본받아야 할 바가 많을 줄 안다. <08/04/11. 記> http://kr.blog.yahoo.com/dongman1936 http://twtkr.com/dong36 http://twitter.com/dong36 * 다음은 NYT 09/07/11 / 기사 * Doctor Fees Major Factor in Health Costs, Study Says By ROBERT PEAR Published: September 7, 2011 WASHINGTON — Doctors are paid higher fees in the United States than in several other countries, and this is a major factor in the nation’s higher overall cost of health care, says a new study by two Columbia University professors, one of whom is now a top health official in the Obama administration. “American primary care and orthopedic physicians are paid more for each service than are their counterparts in Australia, Canada, France, Germany and the United Kingdom,” said the study, by Sherry A. Glied, an assistant secretary of health and human services, and Miriam J. Laugesen, an assistant professor of health policy at Columbia. The study, being published Thursday in the journal Health Affairs, found that the incomes of primary care doctors and orthopedic surgeons were substantially higher in the United States than in other countries. Moreover, it said, the difference results mainly from higher fees, not from higher costs of the doctors’ medical practice, a larger number or volume of services or higher medical school tuition. Such higher fees are driving the higher spending on doctors’ services, the study concluded. Ms. Glied, an economist, was a Columbia professor before President Obama named her assistant health secretary for planning and evaluation in June 2010. She said the paper, based on academic research, did not reflect the official views of the administration or the White House. But the journal said the findings suggested that, as policymakers struggle to find ways to restrain health spending, they might consider doctors’ fees. Doctors have generally been excluded from recent cost-cutting proposals because under existing law, Medicare, the federal insurance program for older people, will reduce their fees by 29.5 percent on Jan. 1. In addition, many states have frozen or reduced fees paid to doctors treating poor people under Medicaid. The study examined fees paid by public programs and private insurers for basic office visits and for hip replacement surgery, and found that Americans were “very low users of office visits and relatively high users of hip replacement surgery.” “Fees paid by public payers to orthopedic surgeons for hip replacements in the United States are considerably higher than comparable fees for hip replacements in other countries,” the authors found, “and fees paid by private insurers in the United States for this service are double the fees paid in the private sector elsewhere.” For primary care office visits, the gap between fees paid by Medicare and by public programs in other countries was smaller. But the study found that private insurers paid more for such services here than in other countries. “U.S. primary care physicians earn about one-third more than do their counterparts elsewhere,” mainly “because a much larger share of their incomes is derived from private insurance,” the study said. Ms. Laugesen and Ms. Glied said that among primary care doctors, those in the United States had the highest annual pretax earnings after expenses — an average of $186,582 in 2008 — while those in Australia and France had the lowest earnings, $92,844 and $95,585. “Among orthopedic surgeons, those who had the highest annual pretax incomes, net of expenses, were in the United States,” with an average of $442,450, the study said. In Britain, which ranked second, the comparable figure was $324,138. Annual pretax earnings of orthopedic surgeons in the other countries were less than $210,000. Medical students often cite higher pay as a reason for choosing to become specialists, and the researchers said the income gap between primary care doctors and orthopedic surgeons was larger here than elsewhere. “In the United States, primary care doctors earned only about 42 percent as much as orthopedic surgeons earned,” the study said. “In Canada, France and Germany, in contrast, primary care doctors earned at least 60 percent as much as orthopedic surgeons earned.” “High physician fees in the United States may reflect the cost of attracting skilled candidates to medicine in a society with a relatively more skewed income distribution,” the study said. A version of this article appeared in print on September 8, 2011, on page A19 of the New York edition with the headline: Doctor Fees Major Factor In Health Costs, Study Says.

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