[논문]정책 전문가의 인식을 통해 본 한국 보건의료정책 거버넌스: 신포괄수가제 사례에 관한 심층면접 결과

손창우; 권순만; 유명순

doi:10.4332/kjhpa.2013.23.4.326

정책 전문가의 인식을 통해 본 한국 보건의료정책 거버넌스: 신포괄수가제 사례에 관한 심층면접 결과
Policy Elites' Perception of Health Policy Governance: Findings from In-depth Interviews of Korean New Diagnosis Related Group Payment 원문보기

Health policy and management = 보건행정학회지, v.23 no.4, 2013년, pp.326 - 342

손창우 (서울대학교 보건대학원) , 권순만 (서울대학교 보건대학원) , 유명순 (서울대학교 보건대학원)

Abstract ▼ AI-Helper

Background: Engaging and Involving stakeholders who have different interests in changing health care policies are difficult task. As the literature on the governance in Korean health care field is rare, this study aims to provide empirical evidence of 'governing health policy'-the ways health care policy is made, implemented, and evaluated from a political perspective. Methods: The authors of this study conducted interviews with elites in policy and clinical areas, which was considered to be the most effective approach to gather in-depth information about the background of changing payment policy as well as the barriers or contributors for making the policy sustainable. A total of 14 experts (3 government officials, 2 representatives from medical profession, 3 professors form academic field, and 6 healthcare providers from New DRG pilot program hospitals) participated in 2 hour long interviews. Results: There was a perception gap of the feasibility and substantiality of new payment system among elites. The score was higher in government officers than those in scholars or clinical experts. Next, the interviewees indicated that Korean New DRG might not sustain without significant efforts to improving democratic aspects of the governance. It is also notable that all interviewees except healthcare providers provided negative expectation of the contribution of new payment system to increase administration efficiency. For clinical efficiency, every stakeholders perceived there was no increased efficiency after introduction of New DRG payment. Like general perception, there was a wide gap between the perception of stakeholders in quality change after implementing the new payment system. Finally, interview participants negatively assumed about the likelihood of New DRG to remain a case of successful reforms. Conclusion: This study implied the importance of social consensus and the governance of health policy.

주제어

질의응답

핵심어	질문	논문에서 추출한 답변
	제도란 무엇입니까?	제도(institution)란 사회의 구성원 사이에서 여러 가지 생활영역을 중심으로 한 규범이나 가치체계에 바탕을 두고 형성되는 복합적인 사회규범의 체계라고 할 수 있다. 학술적 측면에서 Scott [1]은 사회적 행동에 대해 인지적(cognitive) · 규범적(normative) · 법적(regulative) 측면에서 의미를 부여하고, 그 행위가 안정적으로 지속될 수 있게 하는 것이라고 하였고, Shepsle [2]는 이러한 행위들을 지속할 수 있게 하는 행위자들(actors) 1) 간 협력을 촉진하고, 합의를 이룰 수 있도록 하는 사전적 약속이라고 제도를 정의한 바 있다.
	아직까지 거버넌스에 대한 일반화된 개념적 정의가 내려지지 않은 이유는 무엇입니까?	예컨대, 거버넌스는 공치, 협치, 관리, 조정, 조정 등의 다양한 개념들로 정의되고 있으며[13,14], 아직까지도 거버넌스에 대한 일반화된 개념적 정의를 내려지지 않았다. 이는 기본적으로 거버넌스라는 것은 ‘개념’에 관한 것이고, 그 정의들이 각국의 고유한 현실을 반영하고 있으며[15], 아직까지 세계적으로도 거버넌스에 관한 논의가 불과 20여 년 밖에 되지 않았다는 것에 그 이유를 찾을 수 있다[16]. 그러나 그동안 논의된 거버넌스에 관한 개념들을 종합해 볼 때, 거버넌스란 정치적 게임의 공식적 · 비공식적 규칙을 관리하는 것이며, 이는 권력행사의 규칙을 결정하고 그러한 규칙과 관련한 갈등을 해소하는 방법을 의미한다[17].
	보건의료영역이 큰 갈등의 분야인 이유 3가지는 무엇입니까?	그중에서도 특히 보건의료영역은 이해집단 간의 갈등이 큰 분야로 알려져 있는데, 갈등의 원인은 크게 세 가지로 나눠 볼 수 있다. 첫째, 보건의료서비스가 공공의 성격을 갖는 재화이기 때문이다. 그러나 우리나라 의료서비스의 공급은 대부분이 민간영역에서 이루어지는 반면, 의료서비스 이용에 있어서는 아픈 사람 누구에게나 형평적인 서비스가 제공되어야 한다는 두 논리가 부딪히고 있다. 둘째, 의사와 환자 간 ‘정보의 비대칭성’으로 인한 정부의 개입이다. 의학적 지식을 기본으로 한 의사와 환자 간의 정보의 불균형은 보건의료분야의 시장실패(market failure)의 가능성을 높이고, 이러한 문제를 최소화하고자 정부가 국민(principal)의 대리인(agency) 역할을 수행하면서 의료계와의 갈등이 야기된다. 셋째, 보건의료를 둘러싼 이해관계자의 대부분이 전문가들이기 때문이다. 의사, 약사, 간호사를 비롯한 모든 의료인들은 국가로부터 자격을 부여받은 전문직들이며, 이들은 직업의식으로서의 전문가 주의(professionalism)를 가진다. 전문가 주의란 특정 직업의 구성 원들로 하여금 특정한 지식과 기술을 바탕으로 자율적으로 직업 생활을 운영, 유지해 갈 수 있도록 하는 일단의 제도와 가치를 의미 한다고 볼 수 있다[3].

참고문헌 (78)

Scott WR. Institutions and organizations. 2nd ed. Thousand Oaks: Sage; 2001.
Shepsle KA. Studying institutions: some lessons from the rational choice approach. J Theor Politi 1989;1(2):131-147.

상세보기
Freidson E. Professionalism: the third logic. London: Polity; 2001.
Baek HJ. New medical professionalism. J Rheum Dis 2012;19(6):316-325.

상세보기
Park HJ. The concept of medical professionalism as for self-employed physicians in Korea. J Korean Med Assoc 2011;54(11):1154-1163.

상세보기
Kang HG. Changes in central-local relations and self responsibility in local finance in Japan: with a particular reference to bankruptcy of Yubari and policy lessons for local government in Korea. Korean Assoc Gov Stud 2008;20(2):23-47.
Lee KH, Kwon SM. Separation of drug prescribing and dispensing. Korean Assoc Policy Stud 2004;13(5):255-278.
Korean Medical Association. Resolution rally for anti-DRG introduction. Announced news. 2012 Jun 8.
Korean Intern Resident Association. Best practicing is die. Announced news. 2013 Jul 1.
Kim CY. Theory of health security. Seoul: Han-ul Academy Press; 2009.
Busse R, Geissler A, Quentin W, Wiley M. Diagnosis-related groups in Europe: moving towards transparency, efficiency and quality in hospitals. Maidenhead: Open University Press; 2011.
Boyce C, Neale P. Conducting in-depth interviews: a guide for designing and conducting in-depth interviews for evaluation input. Watertown (MA): Pathfinder International; 2006.
Kim SJ, Kang IH, Kim JY, Kang JS, Moon BG, Lee JY, et al. Understanding governance. Seoul: Dae young Co. Press; 2002.
Kim EY. Governance and NGO in national health insurance sector. Korean J Citiz Polit 2003;6:67-96.
Kim JY. The future of government for the governance: new public management and policy network. Korean Assoc Admin Stud 2000;34(1):21-39.
Choi SW. The research trend of governance in Korea: a critical review from new governance perspective. Korean Assoc Gov Stud 2003;10:111-125.
Joseph RA. State, conflict, and democracy in Africa. Boulder (CO): Lynne Reinner; 1999.
Kjaer AM. Governance. Malden (MA): Polity Press; 2004.
Andrews M. Good government means different things in different countries. Governance 2010;23(1):7-35.

상세보기
Olafsdottir AE, Reidpath DD, Pokhrel S, Allotey P. Health systems performance in sub-Saharan Africa: governance, outcome and equity. BMC Public Health 2011;11:237.

상세보기
Davis KE, Kingsbury B, Merry SE. Indicators as a technology of global governance. Law Soc Rev 2012;46(1):71-104.

상세보기
Savedoff WD, Gottret PE. Governing mandatory health insurance: learning from experience. Washington (DC): The World Bank; 2008.
Rhodes R. The new governance: governing without government. Politi Stud 1996;44(4):652-667.

상세보기
Pierre J, Peters BG. Governance, politics and the state. Basingstoke: Palgrave Macmillan; 2000.
Hirst P. Democracy and governance. In: Pierre J, editor. Debating governance: authority, steering, and democracy. Oxford: Oxford University Press; 2000.
Goss S. Making local governance work: networks, relationships, and the management of change. New York: Palgrave; 2001.
Miller WL, Dickson M, Stoker G. Models of local governance: public opinion and political theory in Britain. New York: Palgrave; 2000.
Lovan WR, Murray M, Shaffer R. Participatory governance in changing world. In: Lovan WR, Murray M, Shaffer R, editors. Participatory governance: planning, conflict mediation and public decision-making in civil society. Aldershot: Ashgate Publising; 2004. pp. 1-21.
Tang S, Mazmanian D. An agenda for the study of collaborative governance. [Unpublished Working Paper]; 2008.
Jung YD. Seeking for Korean governance paradigm: governance and state capacity. The Korean Association for Public Administration Conference; 2005; Dec 9-10; Seoul, Korea.
Kim KW. Partnership and effective state administration. Seoul: Beobmoosa Press; 2000.
Moon TH. An analysis of the determining factors in the successful cultural policy governance for the regional innovation: the case of the executive committee. Korean Association of Governmental Studies 2005;17(2): 337-358.
Bae EH. Local governance: from conflict to collaboration. Local Admin Stud 2005;19(2):188-215.
Kim I. Impacts of governance structure on performance in public service delivery: a comparative study by service type. Korean Assoc Admin Stud 2006;40(4):51-75.
Kim DH, Jung JG. Achievements and limits of local governance in Ulsan metropolitan city: a case study on participatory budgeting and civil jury system. Korean Assoc Policy Stud 2006;15(3):131-159.
You JW, Lee SM. Hierarchy, market, network: an empirical analysis of governance of ward office in Seoul. Korean Assoc Admin Stud 2008; (42)3:191-213.
Choi SH, Roh JH, Sung JS. The study of the success factors of cooperative local governance: case of Dohwa knoll in Jinan-gun. J Local Gov Stud 2009;23(1):499-522.
Jung SH, Jung CH. The impact of crisis of governance on increasing debt of local government. Korea Public Admin J 2011;20(3):125-161.
Yang GY. Changing on social service delivery system and public character: focus on community service and the governance. Korean Public Manag Rev 2013;27(3):89-114.

상세보기
Bok MS. Partnership in governance era and reflection upon the regional NGOs. Korean Gov Rev 2005;12(1):25-51.
Ra MG. Governance, NGO, and community: focusing on NGO in Cheong-ju area. Korean Gov Rev 2006;13(3):227-254.
Jeon YS, Back HB. A research on role possibilities of public officials' labor unions in governance system: focused on structural analyses of the public servants' cognition about governance in the central and local government. Korean J Local Gov Stud 2012;26(2):183-216.
Jeon YS. Analyze of the cognitions and the attitudes of local public servants in Chungju city and Hongcheon county about local governance. J Local Gov Stud 2013;25(1):117-143.
Lee SJ, Kim HK, Choi JK. Social capital and formation of policy governance. Korean Assoc Admin Stud 2008;4(1):149-170.
Jung MA. The role of civil society and new governance between Korea and Japan. J Asia-Pacific Stud 2011;18(2):17-41.

상세보기
Choi DO, Ju HH. A consideration on Yellow Sea governance of Korea and China. J Korean Soc Mar Environ Saf 2013;19(1):186-192.

원문보기 상세보기
Shin HJ. Local governance of medical and health sector in developing country: focus on the Philippines and Zambia. Korea Assoc Policy Stud 2002;6(3):93-112.
Hwang SK. A study on the modeling of local healthcare governance. Korean J Local Gov Stud 2012;16(4):137-161.
Jin YC, Moon SH. A study of health care governance in Korea: focus on national health insurance. The Korean Association for Governance Conference; 2006; June 16-17; Gwangju, Korea.
Jung YH. On the governance of health care. Health Welf Policy Forum 2007;131:110-119.
Jung YH. A study on the governance of non-profit health care organizations in selected countries. Health Welf Policy Forum 2009;149:116-129.
Lee HC. Governance and NGOs: a case study of the new drug prescription system, the separation of pharmacy and dispensary. Koran Polit Sci Stud Rev 2001;35(3):217-236.
Kwak JY. Searching for good governance of Korean medical policy: case study of the separation of dispensary from medical practice. Korean Party Stud Rev 2010;9(1):149-180.
Kim SJ, Kwon SM, You MS. An institutional and ecological analysis of the healthcare environment in Korea: focus on institutional logic, actors, governance. J Public Health 2011;21(3):457-492.

원문보기 상세보기
Yu TK. Healthcare system's governance construction type in medical tourism advanced. Korean Public Manag Rev 2009;23(4):257-280.
Department of Health. A first class service: quality in the new NHS. London: Department of Health; 1998.
Wilson J. Clinical governance. Br J Nurs 1998;7(16):987-988.

상세보기
Butterworth T, Woods D. Clinical governance and clinical supervision: working together to ensure safe and accountable practice. Manchester: School of Nursing, Midwifery and Health Visiting, University of Manchester; 1999.
Crinson I. Clinical governance: the new NHS, new responsibilities? Br J Nurs 1999;8(7):449-453.

상세보기
Goodman NW. Clinical governance. BMJ 1998;317(7174):1725-1727.

상세보기
Scally G, Donaldson LJ. The NHS's 50 anniversary. Clinical governance and the drive for quality improvement in the new NHS in England. BMJ 1998;317(7150):61-65.

상세보기
The King's Fund. What is clinical governance? London: Briefings; 1999.
Paris JA, McKeown KM. Clinical governance for public health professionals. J Public Health Med 1999;21:430-434.

상세보기
Finkelstein L. What is global governance? Glob Gov 1995;1(3):367-372.
Frechette L. What do we mean by global governance? London: Overseas Development Institute; 1998.
Kudrle, R. Three types of globalization: communications, market, and direct. In: Vayrynen R, editor. Globalization and global governance. Lanham: Rowman & Littlefield; 1999. pp. 127-149.
Hewson M, Sinclair TJ. Approaches to global governance theory. Albany (NY): State University of New York Press; 1999.
Buse K, Walt G. Global public-private health partnerships: part II, what are the health issues for global governance? Bull World Health Organ 2000;78(5):699-709.
Fidler DP. Architecture amidst Anarchy: global health's quest for governance. Glob Health Gov 2007;1(1):1-17.
Savedoff WD. Governance in the health sector: a strategy for measuring determinants and performance. Portland: Social Insight; 2009.
Ng NY, Ruger JP. Global health governance at a crossroads. Glob Health Gov 2011;3(2):1-37.
Institute for Health Metrics and Evaluation. Financing global health 2010: development assistance and country spending in economic uncertainty. Seattle: Institute for Health Metrics and Evaluation, University of Washington; 2010.
Feachem R, Yamey G, Schrade C. A moment of truth for global health. BMJ 2010;340:c2869.

상세보기
Mikkelsen-Lopez I, Wyss K, de Savigny D. An approach to addressing governance from a health system framework perspective. BMC Int Health Hum Rights 2011;11:13.

상세보기
Brinkerhoff DW, Fort C, Stratton S. Good governance and health: assessing progress in Rwanda. TWUBAKANE Decentralization and Health Program Rwanda Report. Chapel Hill: IntraHealth International; 2009.
Siddiqi S, Masud TI, Nishtar S, Peters DH, Sabri B, Bile KM, et al. Framework for assessing governance of the health system in developing countries: gateway to good governance. Health Policy 2009;90:13-25.

상세보기
World Health Organization. Everybody's business: strengthening health systems to improve health outcomes: WHO's framework for action. Geneva: World Health Organization; 2007.
World Health Organization. Governance for health in the 21st century: a study conducted for the WHO Regional Office for Europe. Geneva: World Health Organization; 2011.

저자의 다른 논문 :

표제어: PCR

동의어: Packet Collision Rate

용어 설명 출처 목록 (6)

용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format

연합인증