Annals of Occupational and Environmental Medicine

Review article

Medical certification in sickness benefit scheme (II): practical approaches for evaluating work disability: Yangwoo Kim, Inah Kim; Ann Occup Environ Med 2025;e24. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e24 [Accepted]

Abstract Abstract in Korean PDF: Work disability evaluation plays a central role in medical certification in sickness benefit schemes. This guides effective decision making for return-to-work timelines. Countries that incorporate it have varied approaches. To improve fairness and consistency, Sweden adopted disease-specific guidelines, particularly for complex health conditions such as mental disorders, cancer, and neurological diseases, whereas in the United Kingdom, a fit note system highlights the ease of fitness-for-work assessments in clinical settings. For a successful implementation of the sickness benefit scheme in Korea, it is essential to review international acumen in work disability evaluation and medical certification. This study also examines challenges that physicians face in certification, factors influencing assessments, and the usefulness of disease-specific guidelines. In many countries, administrative burdens, uncertainty in diagnosis, and ethical conflicts complicate physicians' tasks. Countries such as Sweden, France, and Ireland, have addressed these issues by developing structured certification tools and support systems. Learnings from the recent Korean pilot programs, this review identifies the following core priorities: developing disease-specific guidelines, providing clinical support for physicians’ decisions, and integrating occupational health expertise. These guidelines should function not only as administrative checklists, but also as potential clinical tools that consider both patient functionality and job characteristics. Finally, this study offers policy and practical insights to help design a consistent and fair medical certification system for Korea’s sickness benefit program that encourages timely medical intervention, prevents presenteeism, and promotes sustainable workforce reintegration.; 상병수당 제도에서의 의료인증체계(2): 근로능력 평가의 실제
근로능력 평가는 상병수당 의료인증체계에서 가장 핵심적인 요소로, 근로활동불가기간을 정확히 산정하여 근로자의 적절한 직장복귀를 지원한다. 국가마다 근로능력 평가 방식은 상이하며, 형평성과 일관성을 제고하기 위해 스웨덴 등은 질병별 가이드라인을 도입하였다. 특히 스웨덴은 정신질환, 암, 신경계 질환과 같이 평가가 어려운 질병군까지 포함하는 포괄적인 지침을 보유하고 있다. 영국의 핏 노트 제도는 업무적합성 평가를 임상 현장에서 어떻게 적용할 수 있는지에 대한 구체적 사례를 제공한다.
한국의 상병수당 제도가 성공적으로 도입되기 위해서는, 근로능력 평가와 상병수당 의료인증에 관한 국제적 경험을 고찰하는 것이 필수적이다. 본 연구에서는 의료인증 과정에서 의사가 겪는 어려움, 근로능력 평가에 영향을 미치는 요인, 질병별 가이드라인의 활용 가능성 등을 함께 분석하였다. 여러 나라에서 진단 불확실성, 행정 부담, 윤리적 갈등 등으로 인해 의료진이 인증 업무에 어려움을 겪고 있으며, 스웨덴·프랑스·아일랜드 등은 이를 해결하기 위해 구조화된 인증 도구와 지원 체계를 마련하고 있다.
한국의 시범사업 경험을 바탕으로, 본 논문은 질병별 가이드라인 개발, 임상의의 의사결정 지원 체계 마련, 직업보건 전문성의 제도적 통합을 제시하고자 하였다. 이러한 지침은 단순한 행정 문서가 아닌, 환자의 기능과 직무 특성을 반영한 임상 도구로서 기능해야 할 것이다.

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Review article

Medical certification in sickness benefit schemes (I): theoretical perspectives and return-to-work: Yangwoo Kim, Inah Kim; Ann Occup Environ Med 2025;e23. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e23 [Accepted]

Abstract Abstract in Korean PDF: This study explores the theoretical foundations and practical applications of medical certification within the sickness benefit systems, particularly in the context of Korea’s pilot program and its planned national rollout. While sickness benefit systems have long existed in many Organization for Economic Cooperation and Development (OECD) countries, Korea has only recently initiated pilot projects, largely prompted by the coronavirus disease 2019 pandemic. These systems aim to compensate for income loss due to illness or injury, and medical certification plays a central role in determining eligibility and work ability. This study defines medical certification as a two-stage process: clinical diagnosis and formal assessment of a worker’s ability to return-to-work. The dual nature highlights the distinct objectives of the medical treatment and social security policies. Drawing on international practices, this study reviews the International Classification of Functioning, Disability, and Health (ICF) as a key global framework for assessing disability and work ability, although it acknowledges the limitations of its application to sickness benefits. The research emphasizes a shift in global trends toward return-to-work–oriented certification models, such as the UK’s “fit note” system, which focuses on evaluating fitness-for-work rather than merely documenting illness. Sweden and Japan also offer models that integrate rehabilitation with flexible work accommodations. Three key issues were identified in Korea’s system: the role of medical certification and concerns about moral hazard, the burden of proof and workload on physicians, and public perceptions of the program’s purpose. We believe that medical certification should not only verify illness but also support early intervention and a healthy workforce. Ultimately, this study advocates for a balanced and efficient medical certification system tailored to Korea’s healthcare context closely aligning with labor market policies to ensure long-term sustenance and integration of the sickness benefit program.; 상병수당 제도에서의 의료인증체계(1): 이론적 배경과 직장복귀
본 연구는 한국의 시범사업과 향후 전국적 시행을 앞둔 상황에서 상병수당 제도에서 의료인증의 이론적 기반과 실제적 적용을 살펴보고자 하였다. 상병수당 제도는 많은 OECD 국가에서 오래전부터 시행되어 왔으나, 한국에서는 COVID-19 팬데믹을 계기로 최근에야 시범사업이 시작되었다. 이 제도는 질병이나 부상으로 인한 소득 상실을 보상하는 것을 목적으로 하며, 의료증명은 수급 자격 및 업무 수행 능력을 판단하는 핵심적 요소이다.
의료인증은 진단이라는 1단계와, 업무복귀 가능성을 공식적으로 평가하는 2단계로 구성되며, 이는 의료적 목적과 사회보장 정책 목적의 차이를 드러낸다. 국제적 관행을 참고하여, 본 연구는 장애 및 업무능력 평가의 세계적 기준인 ‘기능장애건강국제분류(ICF)’를 검토하되, 이를 상병수당에 적용하는 데 있어 한계점도 지적한다. 연구는 세계적으로 ‘복귀 중심(return-to-work)’ 의료증명 체계로의 전환이 이루어지고 있음을 강조한다. 예를 들어, 영국의 ‘핏 노트(fit note)’ 제도는 단순한 질병 증명에서 벗어나 업무수행 가능성을 평가하는 방식이다. 스웨덴과 일본은 재활과 유연한 업무조정을 포함한 모델을 운영 중이다.
한국 제도 설계에서 중요한 세 가지 이슈는 의료인증의 역할과 도덕적 해이 우려, 의료진의 입증 책임 및 행정 부담, 그리고 제도 목적에 대한 대중의 오해이다. 본 연구는 의료적 증명이 단순한 질병 확인을 넘어 조기 개입과 건강한 노동력 유지로 이어져야 한다고 주장한다.
궁극적으로 본 연구는 한국의 의료이용 환경에 적합하고 노동시장 정책과 조화를 이루는, 균형 있고 효율적인 의료증명 체계의 구축을 제안한다. 이는 상병수당 제도의 지속 가능성과 신뢰성을 확보하는 데 핵심적인 요소다.

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Original Article

Impact of neck posture and insulating stick use on neck disability in Korean line workers: a cross-sectional study: Bounggyun Ju, Jaehoo Lee, Hye-min Kim, Chul Gab Lee, Hansoo Song; Ann Occup Environ Med 2024;36:e11. Published online April 15, 2024; DOI: https://doi.org/10.35371/aoem.2024.36.e11

Abstract Abstract in Korean PDF Supplementary Material

Background

Occupational neck disability is a prevalent issue, especially among line workers, who are often exposed to elevated levels of cervical ergonomic stress. The aim of this study was to investigate the impact of neck posture and insulating stick use on neck disability in a specific occupational group in Korea.

Methods

This cross-sectional study was conducted among 483 line workers in Gwangju and Jeonnam, Korea. Data were collected using the Neck Disability Index, Cervical Degenerative Index, and a structured questionnaire focusing on demographic and occupational factors. Logistic regression analysis was applied to determine the adjusted odds ratio (OR) and 95% confidence interval (CI) for neck posture and factors related to neck disability.

Results

Neck disability prevalence was 17.2% among the participants. Multivariate logistic regression analysis showed that factors related to neck disability included age over 60 years (adjusted OR: 3.08; 95% CI: 1.63–5.83), depression (adjusted OR: 8.33; 95% CI: 3.85–18.00), a history of cervical trauma (adjusted OR: 2.13; 95% CI: 1.04–4.40), and radiological degenerative changes in the cervical spine (adjusted OR: 2.33; 95% CI: 1.26–4.33). In particular, the adjusted OR of neck disability among live-line workers was 2.10 (95% CI: 1.12–3.92) when compared with support workers (model 1). Other analysis models showed that use of insulating sticks for more than 10 hours per week (adjusted OR: 2.46; 95% CI: 1.32–4.61) and higher neck extension (adjusted OR: 2.98; 95% CI: 1.14–3.46) were significant work-related risk factors (model 2,3).

Conclusions

Neck posture, age, depression, cervical trauma history, degenerative changes in the cervical spine, and use of insulating sticks are significant risk factors for neck disability among line workers in Korea. These findings highlight the need to improve the working environment and reduce the burden of cervical ergonomic stress among line workers.

한국 배전보수원의 목 부담자세와 절연스틱사용이 목 장애에 미치는 영향
목적
직업성 목 장애는 특히 높은 수준의 목 부담에 자주 노출되는 배전보수원 사이에서 흔한 문제다. 본 연구는 배전보수원을 대상으로 목 부담자세와 절연스틱사 용이 목 장애에 미치는 영향을 알아보고자 한다.
방법
본 단면연구는 광주와 전남 지역의 배전보수원 483명을 대상으로 실시되었다. 목 장애 지수, 경추퇴행성 지수, 인구통계학적 및 직업적 요인에 초점을 맞춘 구조화된 설문지를 사용하여 데이터를 수집했다. 목 부담자세와 목 장애 관련 요인에 대한 보정 교차비와 95% 신뢰구간(CI)을 알아보기 위해 로지스틱 회귀분석을 시행하였다.
결과
목 장애 유병률은 활선작업자(22.6%)에서 가장 높았으며, 연령이 높아질수록 증가하는 경향을 보였다. 목 장애 관련 요인은 우울증(8.13, 95% CI: 4.02~16.43), 경추 외상 병력(3.53, 95% CI: 1.88~6.63), 경추 방사선학적 퇴행성 변화(2.35, 95% CI: 1.36-4.07)였다. 직업적 요인으로 활선작업자의 보정교차비는 2.10 (95% CI: 1.12-3.92)이었고, 절연스틱을 주당 10시간 이상 사용하는 경우 보정교차비는 2.46 (95% CI: 1.32-4.61)이었다. 또한, 높은 목 신전 부담의 보정교차비는 1.98 (95% CI: 1.14-3.46)이었다.
결론
연령, 우울증, 경추 외상, 경추의 퇴행성 변화와 같은 일반적 요인뿐만 아니라 활선작업, 절연스틱 사용, 목 부담 자세와 같은 직업적 요인은 국내 배전보수원의 목 장애를 유발하는 위험 요인이다. 이러한 결과는 배전보수원의 작업환경 개선의 필요성을 시사한다.

Citations

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List of occupational diseases among farmers in Korea: a literature review
Hansoo Song, Seok-Ju Yoo, Won-Ju Park, Seunghyeon Cho, Ki Soo Park, Joo Hyun Sung, Sang Jin Park, Seong-yong Yoon, Kyeongsoo Kim, Dong-phil Choi, Hye-min Kim, Bounggyun Ju, Kanwoo Youn
Ann Occup Environ Med.2025; 37: e2. CrossRef
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Disability and Rehabilitation.2025; : 1. CrossRef

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Clinical Trial

A Pilot Study on the Validity and Reliability of the Korean Version of the Oswestry Disability Index in a Farming Community: No Yul Yang, Hae Yean Park, Jin Su Kim, Joo Hyun Lee, Soo Hyun Park, Min Ye Jung, Sang Baek Koh; Korean Journal of Occupational and Environmental Medicine 2010;22(4):290-297. Published online December 31, 2010; DOI: https://doi.org/10.35371/kjoem.2010.22.4.290

Abstract PDF

OBJECTIVES
The Korean version of the Oswestry Disability Index (ODI) is the most widely used tool validated instrument for measuring and the level of disability associated with low back disorders. We wanted to validate use of the Korean version of the ODI in Korean farmers with low back pain.
METHODS
The object of this study was to examine the reliability and validity of the Korean version of the ODI. The Korean version was tested on 53 farmers (62.3+/-10.3 years of age) with low back-related disorders. We investigated the Test-retest reliability, internal consistency, and construct validity of the ODI. The Test-retest reliability was assessed in 30 farmers within a time interval of approximately 14 to 18 days. Differences between the Korean version of the ODI and the Short Form 12 (SF-12), which includes 8 domains (general health, physical functioning, role-physical limitation, bodily pain, role-emotional limitation, mental health, vitality, social functioning) were analyzed for construct validity. The correlation of the Korean version of the ODI with the SF-12 was analyzed, as well.
RESULTS
The intra-class correlation coefficient of test-retest reliability was 0.854. Reliability estimated by the internal consistency reached a Cronbach's alpha of 0.879. The correlation between 7 domains of the SF-12 except for the mental health domain and the Korean version of the ODI was statistically significant (p<0.05). Four domains (general health, physical functioning, role-physical limitation, bodily pain) that measured physical status all showed high correlations (p<0.01), as did a domain that measured mental status (role-emotional limitation) (p<0.01).
CONCLUSIONS
The results showed that the Korean version of the ODI is a reliable and valid instrument to measure the level of disability in Korean farmers with low back-related disorders. The use of this instrument is recommended for future clinical trials in Korea.

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A Case Report of Combined Korean Medicine Treatment of Spinal Stenosis with Lipomatosis
Mihye Kim, Su-Bin Han, Byunghak Park, Jaemin Son, Nam-Woo Lee, Jeong-Hun Han, Do-Hyeon Kang, Tae-Woon Min, Jae-Seo Ahn, Hansol Lee, Hyun-Jun Lee
Journal of Korean Medicine Rehabilitation.2020; 30(4): 195. CrossRef
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Hui-Yeong Chu, Sang-Woon Lee, In-Su Bae, Kyung-Young Yoon, Jun-Heum Youn, Dong-Wook Hwang, Hyun-Woo Cho
Journal of Korean Medicine Rehabilitation.2020; 30(3): 163. CrossRef
Acculturation and Health of Korean American Adults
Cha-Nam Shin, Helen W. Lach
Journal of Transcultural Nursing.2014; 25(3): 273. CrossRef
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Original Article

The Effects of Disabilities of the Upper Extremities on Daily Activities of Workers in Manufacturing Industry, and the Factors Influencing Those Disabilities: Kyoo Sang Kim, Chang Woo Hong, Min Gi Kim; Korean Journal of Occupational and Environmental Medicine 2009;21(2):115-130. Published online June 30, 2009; DOI: https://doi.org/10.35371/kjoem.2009.21.2.115

Abstract PDF: OBJECTIVES
Discomfort in the upper extremities affects and restricts the daily activities and work of many workers. This study was conducted to apply a standardized tool for identifying musculoskeletal symptoms and measuring how greatly these symptoms affect the performance of workers in small manufacturing industries as well as to analyze the relationships between the socio-demographic characteristics of the workers, the psychosocial factors, and ergonomic risk factors on the one hand and the reported musculoskeletal symptoms and their effects on work performance on the other.
METHODS
Workers in small manufacturing companies were asked to self-evaluate musculoskeletal symptoms, restrictions on work performance, and the ergonomic risk in their working environments. A standardized tool (musculoskeletal symptoms table, DASH [Disability of the arm, shoulder, and hand]) was used to evaluate the musculoskeletal symptoms and the restrictions on work performance.
RESULTS
1) The DASH score was significantly higher among women, older workers who had been in that job for a long time, married workers, those with no leisure activities or hobbies, those with long hours of housework, those who had experienced a disease in the past, and those who had had an accident in the past; 2) the DASH score was also significantly higher for those workers who were unsatisfied with their work, who worked hard, who no control over their work, and whose work required heavy equipment, tools, and materials; 3) the DASH score was significantly higher in workers with major ergonomic risk factors; 4) the DASH score was significantly higher among workers with occupational musculoskeletal disease and was distributed as follows, from highest to lowest rates of occurrence; symptoms in the upper arms, difficulty sleeping, difficulty with work, restrictions in daily activities, restrictions in social activities, and difficulties in specific work performance; 5) explanatory power increased in the model with the addition of socio-demographic variables, i.e., in analyses with the DASH total score as the dependent variable and psychosocial factors, ergonomic risk factors, and upper extremity discomfort symptoms as the independent variables. The total explanatory power found a significant effect at 35.3%.
CONCLUSIONS
The results of this study show that to enhance the upper extremity performance level of workers in the manufacturing industry, preventive measures should be based on a consideration of ergonomic risk factors, psychosocial factors, and the socio-demographic characterisitics of the individual workers.

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Original Article

Development of Coalworkers' Pneumoconiosis in Korea: Risk Factors and Incidence Density: Byung Soon Choi; Korean Journal of Occupational and Environmental Medicine 1996;8(1):137-152. Published online February 29, 1996; DOI: https://doi.org/10.35371/kjoem.1996.8.1.137

Abstract PDF

Pneumoconiosis, especially Coal-workers' Pneumoconi6sis(GWP), is the principal occupation-related disease in Korea because of the large number of affected workers. Coal mines and miners have been reduced abruptly during recent 8 years, but coal mining should be kept in Korea. Recently, pneumoconiotic workers are increasing in manufacturing industry. It is necessary to know the characteristics of CWP to prevent the development of CWP and manage employed or retired pneumoconiotic workers. Furthermore, it is also necessary to study CWP to protect workers from pneumoconiosis in manufacturing industry. Of the total of 6,452 workers who were diagnosed as CWP initially during the 20 years from 1973 to 1992, X-ray category was as follows: category 1(35.2%), category 2(23.1%), suspicious (0/1 category, 13.4%), category 3(5.7%), large opacity (3.5%), unknown by. complete classification (19.1%). The patients' cardiopulmonary disability was as follows: no disability 79.3%, slight 14.2%, mild 4.1%, moderate 1.9%, severe 0.5%. The patients' X-ray category and disability were not related with the initially exposed age or job position, but their severity was positively related with the exposed duration that was adjusted by the initially exposed age. Also, the patients' X-ray category and disability had positive relationship each other. The cumulative exposure dose of silica/was more important than that'of respirable dust in the. development of large opacity CWP. The annual incidence density of CWP was 73.2 persons in 1982 and 75.8 persons in 1986per 10,000 person years. Afterthen it has been gradually decreasing and was in the range of 20-30 persons in the period of 1989-1992.

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Kwan Lee, Hyun-Sul Lim, Min-Gi Kim, Young-Sun Min, Young-Hyun Lee, Sung-Woo Kim, Hye-Sook Choi, Yeon-Soon Ahn, Joon Sakong, Seung-do Yu, Geun-Bae Kim, Mi-Ra Yoon
Journal of Korean Society of Occupational and Environmental Hygiene.2015; 25(3): 355. CrossRef
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