점진적 제도 변화는 어디서 유래하는가? = 영국 보수당 정부의 NHS개혁에 대한 노동당 정부의 개조 (1997-2010)

국문 초록 (Abstract)

본 논문은 영국의 국민건강서비스(National Health Services)제도가 20세기 후반 보수당과 노동당의 집권을 거치면서 왜 그리고 어떻게 변화했는지를 분석하는 데 목적이 있다. 우리는 공식적으로 구별되는 제도 변화에도 불구하고, 보수당과 노동당의 집권 시기의 NHS제도 변화를 관통하는 핵심적 규칙-성취도 향상을 위해 공급자의 경쟁 유인을 창출하는 방법, 즉 ‘경쟁’규칙-이 존재한다는 점에 주목한다. 우리는 노동당 정부의 정책입안자들이 자신의 목적과 의도에 맞게 보수당 정권의 정책 유산을 다르게 해석함으로써 이전 정권과 구별되는 새로운 형태의 NHS운영방식을 산출했다는 점을 밝히고자 한다. 이는 점진적 제도 변화의 유형 중 ‘개조’에 해당한다.<br/>
노동당 정부는 보수당의 내부시장을 폐지함으로써 공식적으로는 전임 정부의 정책을 거부한 것처럼 보였다. 하지만 이들은 내부시장 제도의 골자인 경쟁 규칙은 보존함으로써 근본적으로는 보수당의 유산을 수용했다. 이들은 이전 보수당 정부에서 비판의 대상이 된 서비스의 형평성과 질 저하의 문제를 해소해야 한다는 점을 인식하면서도, 그에 못지않게 효율성 향상에 대한 대중의 요구 역시 고려하지 않을 수 없었기 때문이다. 말하자면, 노동당 정부는 NHS의 의료 서비스의 성취도를 향상시킬 수 있는 강력한 자원으로서 경쟁 규칙을 재활용했던 것이다. 흥미로운 대목은 이들의 수용이 단지 유산을 수동적으로 받아들여 모방한 데 그친 것이 아니라, 동시에 일차의료 트러스트와 규제체계를 신설하는 한편 민간부문과 보다 능동적으로 협력함으로써, NHS운영방식에 있어 새로운 패러다임(“강제된 자기-규제”)을 창출했다는 점이다.

다국어 초록 (Multilingual Abstract)

This article aims to analyze why and how the British National Health Services (hereafter NHS) has evolved during the Conservative and the Labour government in the second half of the 20th century. We focus on the fact that despite official and distinct institutional changes, there is a common rule that continued within these two political regimes: a way for policymakers to create incentives for providers to compete for improving their performance, that is, a rule of competition. We clarify that policymakers in the Labour government interpreted the Conservative legacy differently in terms of their own goal and intention. As as a result, the Labour gorvernment generated a new type of management for the NHS, distinct from their predecessor. This type of management comes under the conversion among four modes of gradual institutional change.<br/>
Given the abolition of the internal market which the Conservative government made, the Labour government seemed to reject its predecessor’s policy. By preserving the rule of competition, which was the core of internal market system, however, it accepted the Conservative legacy. This is because the government not only acknowledged the fact that it had to solve the problem of exacerbating equity and quality of the service, but also considered the public’s need for its efficiency. Accordingly, the Labour government redeployed the rule of competition as a resource for enhancing the performance of providers in the NHS system. It is interesting that the government did not just imitate its prior legacy passively. Instead the government created a new paradigm, that is, enforced self-regulation concerning the NHS management, by making Primary Care Trusts and regulatory systems and by cooperating with private sectors actively.

목차 (Table of Contents)

• 초록
• Ⅰ. 서론
• Ⅱ. 선행연구 검토 및 분석틀 제시
• Ⅲ. 보수당 정권의 NHS개혁: 내부시장 창출의 배경과 문제점
• Ⅳ. 노동당 정권의 NHS개혁: 보수당 유산의 재활용과 ‘강제된 자기-규제’운영방식의 창출
• Ⅴ. 결론
• 참고문헌
• Abstract

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