Lee Sang-Yi, Kim Chul-Woung, Seo Nam-Kyu, Lee Seung Eun
Department of Health Policy and Management, Jeju National University, School of Medicine, Jeju, Korea.
Department of Preventive Medicine and Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea.
Osong Public Health Res Perspect. 2017 Aug;8(4):247-254. doi: 10.24171/j.phrp.2017.8.4.03. Epub 2017 Aug 31.
Many economically advanced countries have attempted to minimize public expenditures and pursue privatization based on the principles of neo-liberalism. However, Korea has moved contrary to this global trend. This study examines why and how the Korean health care system was formed, developed, and transformed into an integrated, single-insurer, National Health Insurance (NHI) system.
We describe the transition in the Korean health care system using an analytical framework that incorporates such critical variables as government economic development strategies and the relationships among social forces, state autonomy, and state power. This study focuses on how the relationships among social forces can change as a nation's economic development or governing strategy changes in response to changes in international circumstances such as globalization.
The corporatist Social Health Insurance (SHI) system (multiple insurers) introduced in 1977 was transformed into the single-insurer NHI in July 2000. These changes were influenced externally by globalization and internally by political democratization, keeping Korea's private-dominant health care provision system unchanged over several decades.
Major changes such as integration reform occurred, when high levels of state autonomy were ensured. The state's power (its policy capability), based on health care infrastructures, acts to limit the direction of any change in the health care system because it is very difficult to build the infrastructure for a health care system in a short timeframe.
许多经济发达国家试图基于新自由主义原则尽量减少公共支出并推行私有化。然而，韩国却逆这一全球趋势而动。本研究探讨韩国医疗保健系统为何以及如何形成、发展并转变为一个整合的、单一保险人的国民健康保险（NHI）系统。
我们使用一个分析框架来描述韩国医疗保健系统的转变，该框架纳入了诸如政府经济发展战略以及社会力量、国家自主性和国家权力之间的关系等关键变量。本研究聚焦于随着国家经济发展或治理战略因全球化等国际形势变化而改变时，社会力量之间的关系会如何变化。
1977年引入的社团主义社会健康保险（SHI）系统（多个保险人）在2000年7月转变为单一保险人的NHI。这些变化受到外部全球化和内部政治民主化的影响，使得韩国以私立为主导的医疗保健提供系统在几十年间保持不变。
当确保了高水平的国家自主性时，诸如整合改革等重大变革就会发生。基于医疗保健基础设施的国家权力（其政策能力）会限制医疗保健系统任何变革的方向，因为在短时间内建立医疗保健系统的基础设施非常困难。
