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韩国卫生政策的变迁过程与政治因素

The changing process and politics of health policy in Korea.

作者信息

Kwon Soonman, Reich Michael R

机构信息

Seoul National University, Korea.

出版信息

J Health Polit Policy Law. 2005 Dec;30(6):1003-26. doi: 10.1215/03616878-30-6-1003.

Abstract

Korea recently introduced three major health care reforms: in financing (1999), pharmaceuticals (2000), and provider payment (2001). In these three reforms, new government policies merged more than 350 health insurance societies into a single payer, separated drug prescribing by physicians from dispensing by pharmacists, and attempted to introduce a new prospective payment system. This essay compares the three reforms in Korea and draws important lessons about the country's changing process and politics of health care policy. The change of government, the president's keen interest in health policy, and democratization in the public policy process toward a more pluralist context opened a policy window for reform. Civic groups played an active role in the policy process by shaping the proposals for reform-a major change from the previous policy process that was dominated by government bureaucrats. The three reforms also showed important differences in the role of interest groups. Strong support by the rural population and labor unions contributed to the financing reform. In the pharmaceutical reform, which was a big threat to physician income, the president and civic groups succeeded in quickly setting the reform agenda; the medical profession was unable to block the adoption of the reform but their strikes influenced the content of the reform during implementation. Physician strikes also helped block the implementation of the payment reform. Future reform efforts in Korea will need to consider the political management of vested interest groups and the design of strategies for both scope and sequencing of policy reforms.

摘要

韩国最近推行了三项重大医疗改革

融资改革(1999年)、药品改革(2000年)和医疗服务支付改革(2001年)。在这三项改革中,新的政府政策将350多个医疗保险社团合并为单一支付方,将医生开药与药剂师配药分离,并试图引入新的前瞻性支付系统。本文比较了韩国的这三项改革,并总结了该国医疗政策变革过程及政治方面的重要经验教训。政府更迭、总统对医疗政策的浓厚兴趣以及公共政策过程朝着更加多元化背景的民主化,为改革打开了政策窗口。公民团体通过制定改革提案在政策过程中发挥了积极作用,这与之前由政府官僚主导的政策过程有很大不同。这三项改革在利益集团的作用方面也表现出重要差异。农村人口和工会的大力支持推动了融资改革。在对医生收入构成巨大威胁的药品改革中,总统和公民团体成功迅速地确定了改革议程;医疗行业未能阻止改革的通过,但他们的罢工影响了改革实施过程中的内容。医生罢工也阻碍了支付改革的实施。韩国未来的改革努力需要考虑既得利益集团的政治管理以及政策改革范围和顺序的策略设计。

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