保健政策의 選擇과 保健醫療體系의 成果에 관한 國家간 比較硏究 : OECD國家를 中心으로 = (A)comparative analysis of health policy and its impacts on performance of health care systems in OECD countries

다국어 초록 (Multilingual Abstract)

The purpose of this paper is to evaluate the performance of health care systems and identify its determinants with a comparative analysis of panel data for the last 30 years in OECD countries, suggesting policy implications for Korea.
The main findings could be summarized as follows: A universal coverage for the entire population improved accessibility to health services and equity in financing and utilization. A universal coverage can be accomplished through either social insurance or private insurance. However, a universal coverage has not been completed in a health care system without mandatory policy. Accessibility was not insured by universal coverage only, indicating need of public investments in order to remove social barriers to accessibility.
An increase in cost-sharing was effective in reducing public expenditure on health services, but could not decrease national health expenditure in most OECD countries. It showed crowding out effect or shifting medical costs to private sector, and hardly reduced expenditures on health services with inelastic demand, specially hospital services, while it influenced negatively on equity and accessibility to health services.
Horizontal index measuring equity in health service utilization showed little inequity in ambulatory care services but there were serious inequites in hospital services and dental care.
Quality of care, safety, and consumer satisfaction were enhanced through improvements in management information system, health care delivery system, evidence-based medicine.
Payment system has given effective incentives to improve performance of health care system. Empirical results showed good performance in global budget and capitation, while bad in fee-for-service.
A public-integrated model(public financing-single payer system), service volume control, and global budget are considered as effective policy instruments for cost containment and improving efficiency. Competition policy was not successful due to a fundamental characteristic of monopoly in medical service market. Selective contracts with providers, economic evaluation for medical technology, price control for pharmaceuticals were also effective in cost containment.
Significant determinants of good performance in health care systems were identified as public financing, payment system of capitation or salary, public-integrated model, prospective payment, increase in physicians per population.
All these results imply government regulation policy(Policy X) is more effective than competition policy in improving performance of health care system, which means health care system belongs to System X.
Responsiveness to comsumer's demand, measured by waiting time for elective surgery, has positive association with number of beds, number of specialists, medical expenditure, and fee-for-service. This suggests that responsiveness and efficiency may be in trade-off in health care system.
Consumer satisfaction and medical technology progress have been enhanced in a system with fee-for-service and public financing. However, private health insurance has been negative in quality of care, equity, and efficiency, although it has contributed to responsiveness for small number of subscribers.

목차 (Table of Contents)

• 차계
• ABSTRACT
• 제1장 서론 = 1
• 1.1 연구의 배경 = 2
• 1.2 연구의 목적 = 4
• 1.3 연구의 범위 = 5
• 제2장 이론적 배경 = 7
• 2.1. 기존 연구의 검토 = 8
• 2.2. 이론적 접근 = 21
• 제3장 분석모형 = 41
• 3.1. 개념적 분석틀 = 42
• 3.2. 보건정책의 분류 및 정책수단 = 45
• 3.3. 성과의 정의와 측정지표 = 48
• 3.4. 설명변수의 정의와 측정방법 = 55
• 3.5. 연구가설 = 58
• 3.6. 실증분석모형 = 62
• 제4장 보건정책과 성과에 관한 국가간 비교분석 = 75
• 4.1 개요 = 76
• 4.2 보건의료체계의 구조 = 78
• 4.3 효과성 = 96
• 4.4 국민의료비와 효율성 = 100
• 4.5 형평성 = 135
• 4.6 대응성 = 153
• 4.7 소비자 만족도 = 156
• 4.8 의료기술의 진보 = 159
• 제5장 성과의 결정요인에 관한 실증분석 = 165
• 5.1 효과성의 결정요인 = 166
• 5.2 효율성의 결정요인 = 169
• 5.3 형평성의 결정요인 = 175
• 5.4 대응성의 결정요인 = 178
• 5.5 소비자만족도의 결정요인 = 179
• 5.6 의료기술의 확산요인 = 181
• 5.7 민간의료 보험이 성과에 미친 영향 = 183
• 제6장 성과제고를 위한 보건정책 = 199
• 6.1 성과결정요인의 평가와 정책대안 = 200
• 6.2 민간의료보험의 평가와 정책방향 = 204
• 제7장 결론 = 209
• 참고문헌 = 212