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[20世纪70年代医疗保险政策与社会福利话语的变迁]

[The change of the health insurance policy and social welfare discourse in 1970s].

作者信息

Hwang Byoung-joo

机构信息

National Institute of Korean History, 86 Gyoyukwon-gil, Gwacheon-ro, Gyeonggi-do 427-805, Korea.

出版信息

Uisahak. 2011 Dec 31;20(2):425-62.

PMID:22343702
Abstract

This study is to analyze the change of the health insurance policy in the 1970s in relation to social welfare discourse. The public health care in Korea was in very poor condition around the first amendment of the National Health Insurance Act in 1970. Furthermore, due to the introduction of new medical technology, increasing number of big hospitals participating in the medical market, inflation, and other factors, medical expenses skyrocketed and made it hard for ordinary people to enjoy medical services. Accordingly, the social solution to the problem of medical expenses which an individual found hard to deal with became of demand. And as the way to the solution, it was inevitable to consider the introduction of health insurance as social insurance. In this condition, Park regime began to stress the social development from the 1960s. It was to aim to settle various social problems triggered by the rapid industrialization in the 1960s through social development as well as economic development. As the social development was emphasized, the matter of social welfare appeared of importance and led to the first amendment of the National Health Insurance Act in 1970. However, it was impossible for Korean government to enforce a nationwide health insurance. The key issue was how to fund it. Park regime was reluctant to use government fund; it was also hard to burden private companies. Even while the health insurance policy was not determined yet for this reason, the social demand for health insurance became large and large. In particular, in the midst of the first "Oil Shock" which gave a big blow to people's living condition from the late 1973, some reported issues in relation to health service, such as hospitals' rejection of the poor, became a big problem. Coupled with the social demand for a health insurance system, the changes occurred within the medical community was also important. Most of all, hospitals was facing the decrease of the effectiveness of their medical facilities. Therefore, they began to see health insurance as a means of developing potential demand for medical service. In addition, the business world, which already expanded their own corporate welfare for employees from the early 1970s, sharing the idea that it was impossible to keep the issue of public health insurance unsolved, showed an enthusiastic attitude. These factors finally enabled Park regime to adopt the public health insurance system. Likewise, it is critical to understand the establishment of the public health insurance system in Korea through pursuing the process to it. What matters is the discoursive changes as well as the changes in social condition around the establishment, not merely the policy changes per se. Then most people, including decision makers in Park regime, thought of social welfare as a privilege developed countries. Thus, in the 1970s when unbalanced industrialization brought about widening gap between social classes, the employment of a social welfare policy could be recognized as a symbol of an escape from backwardness. In fact, with the introduction of the national health insurance in the 1970s, Park regime could fortify the material fundamental of a social welfare discourse which would be mobilized to strengthen the dichotomous discourse of developedness and backwardness and to dump the social crisis caused by Park regime's industrialization drive on the next generation.

摘要

本研究旨在分析20世纪70年代医疗保险政策的变化及其与社会福利话语的关系。20世纪70年代初,韩国首次修订《国民健康保险法》时,公共医疗状况非常糟糕。此外,由于新医疗技术的引入、参与医疗市场的大医院数量增加、通货膨胀等因素,医疗费用飙升,普通人难以享受医疗服务。因此,社会需要解决个人难以应对的医疗费用问题。作为解决方案,将医疗保险作为社会保险引入成为必然选择。在这种情况下,朴正熙政权从20世纪60年代开始强调社会发展。其目的是通过社会发展和经济发展来解决20世纪60年代快速工业化引发的各种社会问题。随着社会发展受到重视,社会福利问题变得至关重要,导致1970年对《国民健康保险法》进行了首次修订。然而,韩国政府无法实施全国性的医疗保险。关键问题是资金来源。朴正熙政权不愿动用政府资金,也难以让私人企业承担。即便如此,由于这个原因医疗保险政策尚未确定,但社会对医疗保险的需求却越来越大。特别是在1973年末对人们生活造成巨大冲击的首次“石油危机”期间,一些与医疗服务相关的问题,如医院拒收穷人,成为了大问题。加上社会对医疗保险制度的需求,医疗界内部发生的变化也很重要。最重要的是,医院面临医疗设施效率下降的问题。因此,它们开始将医疗保险视为开发医疗服务潜在需求的一种手段。此外,商界从20世纪70年代初就开始为员工扩大企业福利,他们也认为无法解决公共医疗保险问题,表现出积极的态度。这些因素最终促使朴正熙政权采用了公共医疗保险制度。同样,通过追溯韩国公共医疗保险制度的建立过程来理解它也很关键。重要的不仅是政策本身的变化,还有制度建立过程中的话语变化以及社会状况的变化。当时,包括朴正熙政权决策者在内的大多数人都认为社会福利是发达国家的特权。因此,在20世纪70年代不平衡工业化导致社会阶层差距不断扩大的情况下,实施社会福利政策可被视为摆脱落后的象征。事实上,随着20世纪70年代国民健康保险的引入,朴正熙政权能够强化社会福利话语的物质基础,这种话语将被用来强化发达与落后的二分话语,并将朴正熙政权工业化进程引发的社会危机转嫁到下一代身上。

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