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영국의 건강과 사회적 돌봄 서비스 시스템 통합의 복지정치, 1948-2010

The Welfare Politics of Integrating Health and Social Care Service Systems in the United Kingdom, 1948-2010

박승민
정부학연구소 (Institute of Governmental Studies)|2015.12|정부학연구 (Journal of Governmental Studies(JGS))|제21권 제3호|pp. 121-161|DOI 10.19067/jgs.2015.21.3.121

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참고문헌

키워드

Health Care복지정치Welfare Politics사회적 돌봄Social CareNational Health Service건강 돌봄National Care Service
주제분류행정학

초록

본 논문은 영국의 건강과 사회적 돌봄 서비스 시스템 간 갈등 조정의 역동성을 분석하고 그 결과의 함의를 논하는 것을 목적으로 한다. 1948년부터 2010년까지의 역동성 분석을 위해 정부와 의회 보고서, 전당 대회 원고, 각종 법안, 국립 기록 보존관의 비밀 해제 자료, 각종 연구소의 정책 보고서를 대처 정부 전과 후로 구분하여 분석하였다. 분석 결과, 두 시스템은 정치･경제적인 요인과 사회적 돌봄 서비스 시스템의 열악함 때문에 분리되어 시작되었다. 대처 정부 전에는 응급병상국과 전국노인복지협의회, 보우처 보고서, 병원 계획보고서, 건강과 복지 보고서, 병원 자문 서비스 보고서, 통합 돌봄 기획 보고서를 중심으로, 대처 정부 후에는 지역사회 돌봄 서비스 보고서, 그리피스 보고서, National Health Service와 지역사회 돌봄 법, 지속적인 건강 돌봄 욕구 충족을 위한 NHS 책임에 관한 보고서, 현대화되고 의존할 수 있는 새로운 NHS 개혁을 위한 보고서, 보건법, NHS 계획, National Care Service를 통한 영국형 통합 복지 시스템 구축을 중심으로 두 시스템 간 통합의 복지정치가 시도되었다. 이상의 분석 결과는 구조적 수준에서 두 시스템 간 행정과 재정 운용을 둘러싼 이해관계가, 행위적 수준에서 건강 돌봄 서비스 시스템에 종사하는 전문직들의 사회적 돌봄 서비스 시스템에 종사하는 사람들에 대한 배제의 정치가 작용했음을 보여주고 있으며 이는 영국의 건강과 사회적 돌봄 서비스 시스템 간 통합 시도는 결국 실패를 배태한 복지정치였음을 의미한다.

Abstract

The purpose of this research is to analyse the dynamics of integrating health and social care service systems between 1948 and 2010 in the United Kingdom, and to discuss the corresponding implications. Content analysis was applied to official government documents, including government reports, reports to the Parliament, manuscripts for the party conference, legislation, declassified documents from the National Archives, and the policy reports of relevant institutions. These were analysed based on the Thatcher Government: the periods before and after the Government. The analyses showed that the health and social service systems were divided because of both political and economic reasons, and also the poor condition of the social care service system itself. The welfare politics of integrating the health and social care service systems was carried out by the Emergency Bed Bureaux, National Old People's Welfare Council, Boucher Report, Hospital Plan Report, Health and Welfare Report, HAS Report, Joint Care Planning before the Thatcher Government came into power; and the welfare politics continued after the Thatcher Government with the Community Care Report, Griffiths Report, NHS and Community Care Act, NHS Responsibilities for Meeting Continuing Health Care Needs, The New NHS, Health Act, The NHS Plan, and the National Care Service. The results showed that the interests of the administration and joint finances between the health and social care service systems at the structural level, and the politics of professionalism at the agency level, were behind the failure of the welfare politics of integrating the health and social care service systems.

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