老人長期療養報障制度에 대한 比較法的 硏究

다국어 초록 (Multilingual Abstract)

In Korea, the number of the elderly has rapidly increased. In 2007, the percentage of the population aged 65 years or older has reached 9.9%. In this society of the old, the problem of the long-term care of the elderly is not only a problem for the individual family but for the society as a whole. In Germany and Japan, the long-term care insurance system has emerged as an answer to the problem of the rising medical costs of the elderly. Now, the Republic of Korea is trying to resolve the problem of the long-term care of the elderly by adopting a similar long-term care insurance scheme. The resulting recommendations for an improvement plan of the long-term care insurance of the elderly include: (1) Areas of a service supplementation. Firstly, it is difficult to enlarge caretaking facilities on short notice. Even if the numbers of the facilities are sufficient, new problems of the management of these facilities arise. To resolve these problems, it is necessary to increase the extent of the homecare service. Here, in order to prevent the waste of the insurance premiums, services not covered by the regulations should be paid by the family. Moreover, a national supplement policy for the elderly is needed, that supports the self-care community of the elderly. As in the case of Sweden, allowing specialized hospitals for the elderly to provide home-visit nursing care can be a solution for the shortage of nursing hospitals. Secondly, caretaking professional teaching programs must be improved. In the case of Germany and Japan, the training periods forthe caretakers are set at two to three years for a systematic education and the national licensing exam. In Korea, there are no definite provisions in the long-term care insurance law for the enforcement of regulations about the education of the caretakers. The government should make clear regulations concerning education periods and, especially, the period of the practical education. The organization of the exercise program should be licensed to caretaking hospital as well as to general hospitals. Thirdly, the "Family Long-term Care System" must be expanded. This system is only permitted in areas of the countryside that lack professional long-term caregivers and in the case of natural disasters. It is more economical to expand the Family Long-term Care System to lessen the expenses for the caretaker facility enlargement. Fourthly, the numbers of the management work force have to be raised. The supervisory system must be regulated in a way that clearly outlines the limitsof long-term care service. This means that a qualified management work force training system is needed. Fifthly, a volunteer system must be included in the long-term care service system. To foster a climate of volunteering services, a revision of the education law is needed so that related education programs can be newly introduced. (2) The objectives of the long-term care giving services should be enlarged. Firstly, the law of the objectives of the payment must be revised. Here, as beneficiaries, the disabled should be included. The disabled should be recipients of the long-term care giving service regardless of age. The financial resources for them should comefrom welfare budgets for the disabled. Secondly, the final entitlement evaluation should be done only by doctors; if the persons concerned are dissatisfied, a secondary evaluation should be made. The contents of the evaluation should be easy to be understood by common people. Thirdly, the concept of dementia must be defined. The improvement of the dementia symptoms is difficult judge. The law has no clear definitions of dementia, which will invite legal disputes. Fourthly, the scope of recipients of the elderly long-term care insuranceexcludes patients with severe symptoms. This will lead to objections by thepatients. Objective standards about recipients and payment regulation should be revealed (3) We should recheck the medical treatment service in the long-term insurance system. Firstly, we should recheck the effectiveness of the wireless paging project. We should establish a "mutual self-help system of the elderly". Especially, volunteer networking systems should be encouraged. Secondly, we should establish a voucher system and a preventive welfare system for the elderly. Thirdly, there are no provisions terminally ill patients. Care services for them must be included. Fourthly, we should prepare for payment systems and their control. Without proper control systems, there will be moral hazards with the imbursement of family medical treatment costs. (4) We should establish an objective entitlement level evaluation and control system. The decision process should be opened to the public by internet and public notice board. Firstly, level evaluations should be given after careful consideration in two stages. The supervision of service institutes and personal should be strengthened. Secondly, we should make multiple investigations for the preparation of reports of the medical situation. With recipients who receive high amounts of financial support, the medical certificates must be submitted to the authorities. Through this certification process, costs for those patients can be saved. (5) We should prepare sound financial planning for the long-term care of the elderly. Firstly, medical expenses for the aged and nursing expenses are increased like in Sweden. We should investigate the introduction ofa publicmedical public management, which unifies the welfare and medical services. Secondly, staying in long-term care hospitals is quite expensive. A self-supporter community, like in the United States, is recommendable to residents who live in the countryside and outskirts of the cities in Korea. In an industrialized country, staying at home is more common than staying at s hospital. Thirdly, we should introduce an insurance system for parents. In Korea, most of the old generation is not prepared for their declining years. Therefore, we should introduce an insurance system for parents financed by their sons and daughters. Fourthly, subdividing the levels of medical treatment is problematic. Presently, there are three levels of medical treatment. However, the gaps between each level are too large. Therefore, the financial situation of the insurance may change for the worse because of excessive payments. By subdividing the medical treatment levels, establishing preventive medical treatment systems may reduce medical payments. Fifthly, elderlyperson who applied for the long-termcare service should pay for their meals and room costs. This may prevent excessive payments by the long-termmedical treatment insurance. Only the poor people who receive livelihood expenses by the government need not pay for their meals in hospitals. Sixthly, for the financial stability, the retiring age should be extended. For this purpose, wage peak systems and job training systems for the elderly must be introduced. Seventhly, preventive measures against diseases of the elderly should be established. If one becomes sick, he will be a burden to his family and himself and medical costs will be increased. Therefore, we should establish a system of health support for the aged and support the aged who exercise through subsidies by the government. Eighthly, the present government tries to privatize the national health insurance. However, the privatization should be considered as a supplement for problematic fields of the public insurance sector. Private insurance should be made available along with national health insurance according to one's choice. In conclusion, the introduction of the long-time medical treatment insurance for the elderly is inevitable because of our progressing to an aging society. However, the financial maintenance of this system remains the core problem. For the prevention of moral hazards in the implementation of this system, we should establish various control systems.

목차 (Table of Contents)

• I. 서론
• 1. 문제의 제기
• 2. 연구의 배경 및 목적
• 3. 연구의 방법 및 범위
• II. 각국의 노인장기요양보장법제
• 1. 서설
• 2. 미국의 노인장기요양보호정책
• 3. 스웨덴의 노인장기요양 사회서비스법
• 4. 독일의 플레게(Pflege)보험법
• 5. 일본의 개호보험법
• III. 노인장기요양보장법의 법리
• 1. 노인장기요양보험 수급권의 법리 검토
• 2. 한국 노인장기요양보험법
• IV. 노인장기요양보장제도의 문제점과 개선방안
• 1. 제공주체의 문제점과 개선방안
• 2. 대상범위의 문제점과 개선방안
• 3. 급여내용의 문제점과 개선방안
• 4. 전달체계의 문제점과 개선방안
• 5. 재원조달의 문제점과 개선방안
• V. 결론
• 참고문헌
• Abstract

참고문헌 (Reference)

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