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보건의료 정책결정과정에서 환자 및 시민참여 연구: 영국 신노동당정부의 국영의료체계 내에서 환자 및 시민참여 사례들을 중심으로

In serarch for patient and public involvement in health care policy-making process: case studies of England NHS under new labor government (1998-2009)

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한국사회정책학회 (Korean Association of Social Policy)|2012.12|한국사회정책 (Korea Social Policy Review)|제19권 제4호|pp. 175-205|DOI 10.17000/kspr.19.4.201212.175

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키워드

NHS정책결정과정Englandpatient and public involvement환자 참여시민 참여

초록

이 연구는 1998년부터 2009년까지 영국 노동당 집권기간동안 국영의료체계(NHS)의 환자 및 시민참여 정책의 경험을 분석하였다. 노동당 집권초기부터 환자 및 시민참여 프로그램들이 국영의료체계에 적극 도입되었으며 집권 중반 2004년 이후 시장주의적 의료개혁의 강화로 다소 후퇴하였으나 지속적으로 운영되었다. 환자 및 시민참여 프로그램들을 대상으로 실질적이고 효과적인 참여기준을 충족했는지와 최종의사결정에 참여가 영향력을 미쳤는지를 평가하였다. 지역주민참여네트워크(Local Involvement Network)는 지역단위별로 의료 및 사회서비스 중개를 책임지는 지역의료트러스트와 지방정부를 대상으로 지역주민이나 환자의 의견을 반영하기 위한 조직으로 참여자들의 대표성은 떨어졌지만 정보접근성, 참여자의 의견이 의사결정에 반영될 수 있는 공식적인 기전이 있었으며, 참여자를 위한 교육 및 기술 지원 조직을 운영하였다. 참여가 해당기관의 의사결정에 영향력을 미쳤는지에 대해서는 명확하지 않았다. 운영위원회(Board of Governors)는 파운데이션트러스트의 이사회의 비상임이사를 임명하고 이사회에 환자 및 시민들의 의견을 반영시키기 위한 조직으로 회원들에 의해 선출된다는 점에서 어느정도 대표성이 띠었으나 정보접근성, 의사결정단위에 의견을 전달하는 공식적인 기전, 상시적인 교육 및 기술지원이 불충분하였으며 이사회에 대한 실질적인 영향력이 없다는 평가가 지배적이었다. 임상진료지침개발 과정에서 환자 및 보호자 2인의 직접적인 참여와 환자단체의 이해관계자로서의 참여는 대체로 실질적이고 효과적인 참여기준들을 모두 충족시켰으며, 임상진료지침 작성에 실질적인 도움을 준 것으로 평가되었다. 이와 같은 영국의 경험은 환자 및 시민참여 제도 도입 여부를 판단하고 구체적인 제도를 설계하고 정책의 효과를 추정하는데 있어서 유용한 자료가 될 것이다.

Abstract

This study explored the experiences of the public and patient involvement(PPI) in the NHS under the Labor government(1998-2009). From the outset, the Labor government had applied actively the PPI policy to all NHS organizations. Though there was a little backdrop due to the reinforcement of the marketization of the NHS after the midpoint of the lifetime of the labor government, these policy has maintained continuously without a break. Three PPI programs were analyzed on the points that their process met four criteria for effective participation process and influenced the outcome of a decision-making. Local Involve Networks was built up to reflect patient and public views on a decision making process of Primary Care Trust and Local Authority. It had access to information, official route for delivering public view to decision maker, educational and technical support for participants despite of there being a lack of representation. Citizen and patient governors, who are members of the board of governors for NHS foundation trust, had somewhat representation due to being elected by members, while they had little influence on the board of directors as well as insufficiency of the other three criteria for effective participation process. Two lay people among patients or carers concerned with target disease of clinical guidelines were involved in the guildeline development and also patient organization related to the disease could work as a stakeholder in the condition that the patient organziation had members nationally. These program met sufficiently four criteria for the effective participation process and also showed a visible impact on clinical guideline even though it was concentrated on non medical part such as family education. These experiences in the NHS may be very available for making judgement over introuducing PPI policy, designing a effective participation process, and predicting what that policy will bring to us.

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