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문옥륜 서울大學校保健大學院 1993 國民保健硏究所硏究論叢 Vol.3 No.2
The purpose of this study is to draft the blueprint of policy directions for developing the national health care system in the coming era of 2000's. In order to achieve this objective, the author has identified the ideal of a nation's health care and the role of a government, and measured the gap between the ideal and the realities facing Korea. And then this study has figured out the central value concerning the reform of the health care system in Korea. As for the ideal, three different perspectives, conservative, radical and reformative/progressive, have been compared and found that their goals of achieving health for all as a basic human right are the same despite of their differences in ideology and approaches. Five goals identified are as follows: 1) Health care should be guaranteed regardless of age, sex, income, residence, occupation and education. 2) A comprehensive range of quality care should be provided with continuity. 3) Financial burden should equitably be distributed over the population. 4) Health resources should be managed efficiently and effectively. 5) People's participation should be maximized in the process of policy decision-making, implementation and evalution. Current health service problems have been analyzed from the perspectives of utilization of health resources, organizational efficiency, provision of health services, financial equity, and managerial efficiency. The analysis confirms the existence of wide gaps between the ideal and the realities. The study indicates that it is important to maintain the balance between equity and efficiency in the fulfillment of the gap reduction. Finally, the study has attempted to materialize five policy objectives in accordance with problems mentioned above for the reform currently in operation under the name of New Economic Plan. First, with respect to provision of health services, twelve policy measures are specified for the reduction of gap in utilization of health services among areas and income brackets. Second, as for the provision of comprehensive quality care, twenty-six policy measures are specified for the construction of health service network and management of quality. Third, six policy measures are identified in relation to the equitable financing of health services, such as fund raising through the introduction of tax based on alcohol and tobacco consumption. Fourth, as for managerial efficiency, thirty-three policy measures are identified in the seven different areas: improvement in claim review, improvement in payment method, expansion of preventive services, enhancement of public interests particularly in the operation of private medical facilities, efficient administration in running health insurance association, productivity increase in the use of health resources, and administrative organization reform. Fifth, and lastly seven policy measures are listed to have people participate actively in health planning process.