在家老人福祉서비스 傳達體系의 評價에 관한 硏究 : 大邱·慶北의 境遇를 中心으로

다국어 초록 (Multilingual Abstract)

Since the oil-shock in 1970s resulted in the crisis of welfare finance and modification of facility care, the western nations have paid attention to 'the in-home care elder welfare service', based on 'deinstitutionalization' and 'community care' movement. The concept of 'in-home care elder welfare service 'can be characterized as welfare pluralism, in which the function of family was emphasized so that the elderly can be provided a variety of services and keep the normal life under the ordinary circumstances.
With the influence of welfare pluralism, Korea began to emphasize the role of market, family, and community as the provider of welfare services since 1990s and, as a result of it, made a major revision of the elderly welfare law in 1993. The revision of the law has shifted the direction of welfare policy from facility care by state assistance to home care, emphasizing the role of market and family. Based on the law, both private enterprises and individuals are able to run the elder welfare institution. By incorporating the legal bases for 'home help,' 'day care,' 'short stay care,' and 'home helper,' most local governments can provide more active 'in-home care elder welfare service, ' instead of conventional facility care. In fact, the quality of welfare service depends on the delivery system, not on the contents. Bearing this in mind, the study aims at evaluating the current status and problems inherent in the delivery system of 'in-home care elder welfare service. '
Even though some scholars define the concept of the delivery system as the organizational arrangements among providers of welfare service or between allocators and recipients of it, it might be hard to define its concept exactly. For this study, however, the delivery system, in broad sense, might be understood as a network, including local governments as a public delivery system, implementing institutions as a private delivery system, and the recipients of welfare service. The research scope of the study confines to the cases of Daegu Metropolitan City and Kyungpook Province.
Chapter 2 deals with the literature review regarding the concept and delivery system of 'in-home care elder welfare service. ' To more specific, the main theme of this chapter includes the importance of delivery system, historical background, outsourcing, and the comparative description among Korea, the United States, the United Kingdom, and Japan. The principle and evaluation criteria of delivery system of 'in-home care elder welfare service ' are discussed.
Chapter 3 consists of the conceptual dimension and research design for the systematic study. The conceptual dimension is classified into three sub-dimensions, that is, relationship dimension between local governments and program implementing institutions, production and delivery dimension for the service of program implementing institutions, and the recipient dimension related to program implementing institutions. For the first dimension, three categories, such as the outsourcing process, job monitoring, and performance evaluation, are employed. For each category, the degree of specificity in performance evaluation and of reflecting its results are used. For the second, three categories called manpower for the welfare service, financial aspects, and program characteristics are adopted, For the third, the recipients' satisfaction to the service and its determinant factors influencing their satisfaction are developed. For the analysis of each dimension, interview and survey were conducted simultaneously, investigating the current documents related to the welfare service. The survey was conducted from July 13 to August 13, 2001 and the interview was made from April to September, 2001. For the statistical methods, the factor analysis was used to test the construct validity and descriptive statistics was also employed to understand the differences among the variables. Analysis of variance was conducted whether there is a statistical difference among the variables and the hierarchical regression method was employed to investigate which factor influences on the recipients' satisfaction.
Chapter 4 presents the analytic results drawn from the statistical analysis. First, for the relationship dimension between local governments and program implementing institutions, major problems might be due to the lack of expertise, manpower shortage, insufficient criteria for direction and monitoring, and the lack of transparency in the selection of the private enterprise. Second, for the production and delivery dimension for the service of program implementing institutions, serious problems might be resulted from the lack of manpower, expertise, and the adequate budget needed to develop the effective programs. For this reason, the quality of programs is so poor that nobody can satisfy for the service. The problems are partly related to ineffective personnel management system. Third, it seems to be urgent not only to train employees related to the welfare service for the integration of health and welfare but also to improve the expertise of home helpers. Fourth, for the recipient dimension related to program implementing institutions, despite the analytic result that the beneficiary's satisfaction to 'in-home care elder welfare service' is high, there seems to be not sufficient regarding the adequacy of programs and the linkage to other institutions.
Chapter 5 seeks to investigate the policy alternatives to remedy the major problems inherent in 'in-home care elder welfare service.' Those problems might be due to the shortage of manpower, the lack of expertise, inadequate fund, the poor quality of programs, and the lack of transparency in procedures. In this respect, the following policy alternatives should be investigated. First, more strong measures should be taken to develop desirable educational system for cultivating professional manpower. Second, in order to secure stable funds for building the infrastructure of 'in-home care elder welfare service, ' it needs introducing 'the long-term health insurance for the elderly' as well as 'fee-for-service' system. The rationale for introducing those systems might be found in terms of the continuation of 'in-home care elder welfare service ' as well as the change of program contents. By doing so, the policy-makers in charge of 'in-home care elder welfare service ' will be able to replace the low quality programs related to non-professional area with the high quality programs focused on health and medical services, or the elderly participation in social activities. At the same time, the conventional wisdom that 'in-home care elder welfare service ' entirely belongs to the lower class should be discarded. This means that the measures for the elderly in the middle class and over should be considered by central or local governments.
To summarize, as the social environment has changed, the need for 'in-home care elder welfare service ' is increasing rapidly. At this time, therefore, the national consensus for the scope and content of 'in-home care elder welfare service ' should be made among the parties concerned. For securing the adequate fund of 'in-home care elder welfare service, ' it needs benchmarking a variety of welfare service systems in operation by the advanced countries, such as Kiago Insurance in Japan, Elder Nursing Insurance in Germany, and Old-Age Insurance, a kind of a private insurance, in the United States. The extension of the fee-for-service system might not only to guarantee the quality of service and continuance of 'in-home care elder welfare service ' but also to make valuable contributions to the reproduction of the labor forces by building the welfare market. The rapid increase of the ageing population due to a so called 'ageing society' is expected to make negative effects on the financial management of national health insurance by incurring the increase of medical costs. To solve the serious problem directly connected to the deficit of national health insurance, both 'the long-term health insurance for the elderly' and 'fee-for-service' system should be adopted. In addition, the adult patronage system(Betreuung) might be recommend by the policy analysts for the private protection of the elderly, like the minor or handicapped patronage system stipulated by the minor protection law in Korea.

목차 (Table of Contents)

• 목차
• 제1장 서론
• 제1절 연구의 목적 = 1
• 제2절 연구의 범위 및 방법 = 6
• 1. 연구의 범위 = 6
• 2. 연구의 방법 = 7
• 제2장 재가노인복지 및 전달체계에 관한 이론적 논의
• 제1절 재가노인복지의 의의 및 전개과정 = 9
• 1. 노인복지서비스의 신경향 = 9
• 2. 재가노인복지의 의의 = 11
• 3. 재가노인복지의 전개과정 = 18
• 1) 외국의 경우 = 18
• 2) 한국의 경우 = 26
• 4. 재가노인복지서비스와 민간위탁 = 28
• 제2절 재가노인복지서비스의 전달체계 = 33
• 1. 사회복지서비스의 분석 차원 = 33
• 1) 급여내용 = 33
• 2) 급여대상 = 34
• 3) 전달체계 = 35
• 4) 재정 = 35
• 2. 전달체계의 의의 = 36
• 3. 전달체계에 관한 이론적 쟁점 = 38
• 1) 집권화와 분권화의 문제 = 38
• 2) 서비스 통합 연계성의 문제 = 40
• 3) 공·사 부문간 관계의 문제 = 41
• 4) 서비스 수혜자 선정의 문제 = 44
• 제3절 재가노인복지서비스 전달체계의 원칙과 평가기준 = 46
• 1. 전달체계의 원칙 = 46
• 2. 전달체계의 평가기준 및 평가지표에 관한 선행 연구 = 51
• 3. 선행연구의 한계점 = 66
• 제3장 분석의 차원 및 조사설계
• 제1절 분석차원의 구성 = 69
• 제2절 조사설계 = 75
• 1. 조사 개관 = 75
• 2. 설문의 구성 = 76
• 3. 표본의 추출 및 특성 = 77
• 제3절 통계학적 방법론 = 83
• 제4장 분석결과 및 논의
• 제1절 지방자치단체와 사업실시기관간의 관계 차원 = 85
• 1. 정부간 관계 = 87
• 1) 중앙정부와 광역자치단체 = 88
• 2) 광역자치단체와 기초자치단체 = 91
• 2. 수탁자 선정과정 = 95
• 3. 업무지도·감독과정 = 97
• 4. 성과평가 과정 = 102
• 제2절 사업실시기관의 서비스 생산 및 전달 차원 = 107
• 1. 인력 측면 = 109
• 2. 재정 측면 = 136
• 3. 프로그램 측면 = 144
• 제3절 서비스 수혜자 차원 = 150
• 1. 재가노인복지서비스의 적용범위 = 150
• 2. 수혜자의 서비스 만족도 = 157
• 3. 수혜자의 서비스 만족도의 영향요인 = 162
• 4. 각 영향 요인별 분석 = 167
• 제4절 분석결과의 논의 = 193
• 제5장 결론 및 정책적 함의
• 제1절 결론 = 199
• 제2절 정책적 함의 = 207
• 제3절 연구의 한계 = 209
• 참고문헌 = 211
• 부록1 설문지 = 225
• 부록2 면접내용 = 234