한국 보건의료 환경의 변천 : 제도적 로직, 행위자, 거버넌스를 중심으로 = An Institutional and Ecological Analysis of the Healthcare Environment in Korea: Focus on Institutional Logics, Actors, and Governance structures

다국어 초록 (Multilingual Abstract)

The primary goal of our study was to investigate the vast transformations of the healthcare sector in Korea during the past half century. Official data reported in the Korean statistical yearbooks and secondary data suggested by previous studies were used for institutional analysis of healthcare environment. Information on hospital released by the Korean Hospital Association was also used for ecological analysis.
Institutional analysis: We identified three distinctive eras based primarily on changes in institutional logics, institutional actors, and governance structures : ‘professional dominance (1952-1976)’,‘government involvement (1977- 1999)’, and‘coexistence of competing institutional logics (2000-present)’. During the first era, physician association supported by Korean government comprised the primary governance regime. During the second era, the government became a major actor as a regulator and purchaser in health care sector, introducing of the‘mandatory national health insurance’. During the third era, making healthcare system sustainable and providing health care efficiently was overarching goals although it was hard to find a single central logic dominating this period.
Ecological analysis: Evidence from the analysis of hospital population suggested that the expansion of the bed capacity was made from different processes, shifting from the ecological process in 1980s to the adaptive process in 1990s. And Korean hospitals had changed following both ‘directional process’ and‘stabilizing process’ over time.
Based on our results, we concluded that more studies to compare more organizational populations other than hospitals and to empirically test the effects of institutional changes on organizational changes and vice-versa, need to be conducted.

참고문헌 (Reference)

1 보건복지통계연보,

2 신오성, "한국전쟁 전후의 보건의료에 대한 연구, 1945-1959" 서울대학교 1989

3 조병희, "한국의사의 위기와 생존전략" 명경출판사 1994

4 이경표, "한국 의료체계의 신자유주의적 개편 : 의약 및 보험체계의 변화와 다국적 자본" 서울대학교 2008

5 김윤수, "한국 건강보험 제도변화에 관한 연구 : 역사적 제도주의 분석을 이용하여" 성균관대학교 2007

6 이창순, "조직" 박영사 2009

7 "조선일보 기사검색"

8 조우현, "정부의 의료제도 개혁과 병원의 구조조정" 한국병원경영학회 1998

9 조병희, "재벌병원과 의료체계의 변화" 1 (1): 65-87, 1997

10 조병희, "의약분업정책과 사회적 갈등" 1 (1): 35-52, 2000

11 보건의료단체연합 의약분업 평가위원회, "의약분업 10년, 그 평가와 과제" 2010

12 이상이, "의료의 산업화와 공공성에 관한 연구-의료산업화를 위한 바람직한 정책방안 모색" 국민건강보험공단 2005

13 조병희, "의료보험제도의 실시와 의료체계의 변화" 12 : 323-344, 1993

14 김민식, "의료보험 행정의 역사적 변천 과정 소고" 11 : 261-291, 2002

15 성창기, "우리나라 서구식 병원의 발전과정에 관한 연구" 서울대학교 1995

16 정용덕, "신제도주의 연구" 대영문화사 1999

17 정기택, "신제도주의 관점에서 본 의약분업 이후의 의료공급 행태 및 구조변화" 한국보건행정학회 2002

18 김용익, "보건의료시장개방에 대비한 보건의료체계 공공성 강화방안 연구" 국회보건복지위원회 2002

19 정영호, "보건의료부문의 거버넌스 현황과 발전방향" 보건사회연구원 2006

20 손명세, "보건의료법제의 변천: 그 평가와 전망" 511 : 3-22, 2000

21 "보건사회통계연보"

22 정희태, "병원 코디네이터도입이 병원경영성과에 미치는 영향분석" 한국시스템다이내믹스학회 11 (11): 5-23, 2010

23 김용익, "병상자원관리기준 및 체계개발 병상자원관리정책개발연구 보고서" 한국보건산업진흥원

24 이용갑, "민간의료보험 활성화 정책 결정과정 연구 - 국민건강보험의 보장성 강화와 민간의료보험의 활성화 논쟁 분석 -" 한국보건사회학회 26 (26): 5-39, 2009

25 오영호, "만성질환실태와 관리방안" 한국보건사회연구원 2001

26 유승흠, "대한민국 보건의료 60년. 대한민국60년, 보건의료60년-향후 보건의료발전방향 포럼 자료집" 보건복지가족부․대한민국의학한림원 1-28, 2008

27 국가통계포털, "국가통계포털"

28 이원형, "건강보험제도 개혁특별위원회 설치 및 운영등에 관한 특별법 제안" 한나라당 정책위원회 2003

29 권순만, "건강보험재정위기의 원인과 정책과제" 10 (10): 177-198, 2001

30 박재용, "건강보험의 제도변화와 재정 안정화. 한국사회보장학회 학술대회 연제집" 한국사회보장학회 2001

31 권순원, "건강보험의 구조개혁 필요성: 재정안정화 방안을 중심으로" 7 (7): 1-38, 2001

32 김진현, "건강보험 보장성 강화와 지속가능한 재정구조 구축을 위한 제도 개선방향" 경제정의실천시민연합 2002

33 Evan WM, "the organization set: toward a theory of interorganizational relations In Approaches to Organizational Design" University of Pittsburgh Press 173-88, 1966

34 Hannan M, "the Population Ecology of Organizations" 82 : 929-964, 1977

35 Pherson MM, "The Size of Voluntary Organizations" 61 (61): 1044-1064, 1983

36 Hall PA, "The Movement from Keynesianism to Monetarism:Institutional Analysisand British Economic Policy in the 1970s. In Structuring Politics: Historical Institutionalism inComparative Analysis" Cambridge University Press 1992

37 Burns T, "The Management of Innovation" Tavistock 1961

38 DiMaggio PJ, "The Iron Cage Revisited: Institutional Isomorphismand Collective Rationality in Organizational Fields" 48 : 147-160, 1983

39 Pfeffer J, "The External Control of Organizations" Harper& Row 1978

40 Selznick P, "TVA and the grass roots: a study in the sociology of formalorganization" Univ. of California Press 1953

41 Hannan M, "Structural inertia and organizational change" 49 : 149-164, 1984

42 Krasner SD, "Sovereignty: an Institutional Perspective" 21 : 66-94, 1988

43 Thompson JD, "Organizations in Action" Mcgraw Hill 1967

44 Scott WR, "Organizations and Organizing: Rational, Natural, and OpenSystem Perspectives" Pearson International Edition 2007

45 Davis G, "Organization-Environment Relations. In: Dunnette M, editors.Handbook of Industrial and Organizational Psychology vol. 3" ConsultingPsychologists Press 1992

46 DiMaggio PJ, "Introduction. In The NewInstitutionalism in Organizational Analysis" TheUniversity of Chicago Press 1-38, 1991

47 Meyer JW, "Institutionalized Organizations: Formal Structure as Mythand Ceremony" 83 (83): 340-363, 1977

48 Tolbert PS, "Institutional sources of change in the formal structure oforganizations: the diffusion of civil service reform, 1880-1935" 28 : 22-39, 1983

49 Dacin MT, "Institutional Theory and Institutional Change:Introduction to the Special Research Forum" 45 (45): 43-56, 2002

50 Scott WR, "Institutional Change andHealthcare Organizations: From Professional Dominance to Managed Care" The University of Chicago Press 2000

51 Miles RH, "Findings and implications of organizational life cycle research: Acommencement. In TheOrganizational Life Cycle: Issues in the creation, transformation and declineof organizations" Jossey-Bass 430-450, 1980

52 Van de Ven AH, "Explaning development and change in organizations" 20 : 510-540, 1995

53 Dill WR, "Environment as an Influence on Managerial Autonomy" 2 (2): 409-443, 1958

54 Amburgey YL, "Disruptive selection and populationsegmentation: interpopulation competition as a segregating process in Evolutionary Dynamics of Organizations" Oxford University Press 240-256, 1994

55 Lawrence P, "Differentiation and Integration in Complex Organizations" 12 : 1-30, 1967

56 McKinley W, "Determinants and development of schools inorganization theory" 24 (24): 634-648, 1999

57 Westphal JD, "Customization or conformity? An institutionaland network perspective on the content and consequences of TQMadoption" 42 (42): 366-394, 1997

58 Streeck W, "Community, market, state and associations: theprospective contribution of interest governance to social order" 1 (1): 119-138, 1985

59 Friedland R, "Bringing Society Back In: Symbols, Practices, andInstitutional Contradictions. In The newinstitutionalism in organizational analysis" University of ChicagoPress 232-263, 1991

60 김한중, "4장 의료시설의 수급과 정부의 역할. 한국보건행정학회 편. 국민의료와 정부의역할" 한국보건행정학회 73-102, 1991