본문 바로가기
KERD
논문KCI 등재

영국의 National Health Service 개혁과 집권당과의 선택적 친화성, 1948-1978

The British National Health Service Reform and Its Elective Affinities with the Ruling Political Parties, 1948-1978

박승민
정부학연구소 (Institute of Governmental Studies)|2011.04|정부학연구 (Journal of Governmental Studies(JGS))|제17권 제1호|pp. 187-223

0

조회

0

다운로드

4

인용

0

참고문헌

키워드

공공성PublicityNHSCentralization선택적 친화성병원의 국유화병원의 현대화중앙 집권화Elective AffinityNationalization of HospitalModernization of Hospital
주제분류행정학

초록

본 논문의 목적은 1948년부터 1978년까지 영국의 National Health Service 개혁의 구체적 내용과 그것의 특징이 당시 집권당과 어떤 선택적 친화성 관계에 있었는지를 분석하고 그 결과를 바탕으로 한국의 의료 복지 정책에 주는 함의를 도출하는 것이다. 30년간의 NHS 개혁 정책을 1974년에 이뤄진 NHS 재구조화 개혁을 기준으로 그 이전과 이후로 나눠서 분석 한 결과, 1948년부터 1973년까지 NHS는 병원의 국유화, 각종 의료협회의 통 ․ 폐합, 재정 축소 개혁, 병원의 현대화, 의사 인력 개혁, 의사 및 간호사 교육과 간호 행정의 개혁이 행해졌고, 1974년에는 NHS 행정 구조의 중앙 집권화 개혁이 이뤄졌다. 이후부터 1979년 Thatcher 정부 출범 전까지 NHS는 지역 간 불평등한 예산 분배 구조 개혁과 Pay-Beds의 축소 개혁이 이뤄졌다. 이와 같은 30년간의 NHS 개혁 중 의료 서비스의 공공성, 사회복지 제도(NHS)에 대한 공적 재정의 지출, NHS 행정 권력 구조의 분권화, NHS내 불평등 해소에 대해 노동당은 옹호한 반면 보수당은 반대하는 선택적 친화성을 보여주었으나, 의사 인력 개혁, 의사와 간호사의 교육 개혁과 유의미한 선택적 친화성은 나타나지 않았다. 끝으로, 이상과 같은 분석 결과가 한국의 의료 복지 정책에 줄 수 있는 함의를 논의하였다.

Abstract

The purpose of this research is to analyze the core characteristics of the British National Health Service reform and their elective affinities with the ruling political parties from 1948 to 1978 as well as providing policy implications for Korean medical welfare policy. Analyses were classified into three parts: 'The 1974 Reorganization', and the periods before and after the Reorganization. The first part of the reform from 1948 to 1973 included nationalization of hospitals, merging or abolishing medical associations, cutting NHS revenue, modernization of hospitals, as well as changes to the number of GPs and the education system for GPs, nurses and nursing administration. The second part of the reform in 1974 centralized the NHS administration structure. The last part of the reform from 1974 to 1978 addressed the inequal structure of NHS budget distribution for every district and enhanced the publicity of the NHS. The NHS reform during those thirty years simultaneously showed both elective affinities and non-relationships with the ruling political parties: the Labour Government supported the reduction of pay-beds, public expenditure for NHS, de-centralization of NHS administration structure, tackling inequal structure of NHS budget distribution whilst the Conservative Government was against all of them. However, there were no significant elective affinities between rearrangement of the number of GPs, reform of education system for both GPs and nurses and ruling political parties. Finally, some implications are suggested for Korean medical welfare policy.

참고문헌 (122)

  1. 경향신문, "“의료 민영화 신호탄 우려, 제주도에 영리 병원 첫 허용” 10월 3일 인터넷 판", ~ (2009)
  2. "≪경제자유구역 내 외국 의료기관 설립･운영에 관한 특별법≫. 2011년 4월 4일 기준으로 제 45차 일부개정을 거친 법률 제 10529호" (2011)[URL]
  3. 김헌진, "영국 신노동당 정부의 NHS 개혁", 한국사회복지정책학회 전기학술대회발표집, pp.145~186 (2006)
  4. 명재일, "NHS와 시장원리의 결합", 보건경제연구, 3, pp.137~163 (1997)
  5. 박순우, "이데올로기와 개별 복지정책의 관계에 관한 연구- 영국 NHS의 구조개혁을 중심으로", 사회복지정책, (25), pp.363~391 (2006), 한국사회복지정책학회
  6. 보건복지부, "지속가능한 의료보장 논의를 위한 보건의료미래위원회 발족" (2011), 보건복지부
  7. ≪제1차 보건의료미래위원회 심의 안건≫. 보건의료미래기획단 심의안건 제3호(4월 8일 보고서), "보건복지부", 보건복지부, ~ (2011)
  8. 이태진, "차 의료 중심의 NHS 개혁에 대한 고찰", 보건경제연구, 6(1), pp.163~180 (2000)
  9. Abel-Smith, B., "The Cost of the National Health Service in England and Wales" (1956), Cambridge University Press
  10. Asthana, S., "The Pursuit of Equity in NHS Resource Allocation", Social Science and Medicine, 58(3), pp.539~551 (2004)
  11. Beland, D., "What is Social Policy" (2010), Polity Press
  12. BMJ, "The Royal Commission on the NHS", BMJ, 6184, pp.288~289 (1979)
  13. BMJ, "Pay-Beds in the NHS", BMJ, 6136, pp.580~ (1978)
  14. BMJ, "Health Service Act 1976", BMJ, 6054, pp.185~186 (1976)
  15. BMJ, "The Financing of the NHS", BMJ, 5939, pp.297~300 (1974)
  16. BMJ, "NHS Reorganization", BMJ, 5838, pp.444~ (1972)
  17. BMJ, "NHS Reorganization: Summary of White Paper", BMJ, 5824, pp.147~153 (1972)
  18. BMJ, "The Platt Report", BMJ, 5263, pp.1341~1342 (1961)
  19. BMJ, "Members of Willink Committee", BMJ, 5054, pp.153~ (1957)
  20. Bonoli, G., "The Politics of Pension Reform" (2000), Cambridge University Press
  21. Braudel, F., "The Mediterranean and the Mediterranean World in the Age of Philip II(Vol 1-3)" (1995), University of California Press
  22. Chester, TE, "The Guillebaud Report", Public Administration, 34(2), pp.199~210 (1956)
  23. CHSC(Central Health Services Council), "The Function of the District General Hospital" (1969), HMSO
  24. CMAS(Council on Medical and Administrative Services), "Dawson Report(The Interim Report)" (1922), CMAS
  25. Crinson, I., "Health Policy" (2009), Sage
  26. Dean, H., "Social Policy" (2006), Polity Press
  27. DHSS(Department of Health and Social Security), "Sharing Resources for Health in England" (1976), HMSO
  28. DHSS, "Priorities Resources for Health and Personal Social Services in England" (1976), HMSO
  29. DHSS, "Democracy in the NHS" (1974), HMSO
  30. DHSS, "National Health Service Reorganization: England" (1972), HMSO
  31. DHSS, "National Health Service Reorganization: Wales" (1972), HMSO
  32. DHSS, "Management Arrangements for the Reorganized Health Service" (1972), HMSO
  33. DHSS, "National Health Service Reorganization" (1971), HMSO
  34. DoH(Department of Health), "Equity and Excellence" (2010), Department of Health
  35. DoH, "Liberating the NHS" (2010), Department of Health
  36. Donald, BL, "Volunteers Retained as Managers", Public Administration, 53(3), pp.299~320 (1975)
  37. Donald, BL, "Planning and Health Care", Long Range Planning, pp.33~42 (1974)
  38. Doner, RF., "Flexible Production and Political Decentralization in the Developing World", Studies in Comparative International Development, 34(1), pp.45~82 (1999)
  39. Draper, P., "The Organization of Health Care, In An Introduction to Medical Sociology", pp.254~290 (1976), Tavistock Publication
  40. Fischer, P., "The NHS from Thatcher to Blair", Paper Presented at the 12th IAHP and XIV FADSP Conference(23rd May) (2002), Palma de Mallorca
  41. George, V., "Political Ideology, Globalisation and Welfare Futures in Europe", Journal of Social Policy, 27(1), pp.17~36 (1998)
  42. Gill, DG, "The Reorganization of the National Health Service, In The Sociology of the National Health Service", pp.9~22 (1976), Wood Mitchell
  43. Godber, GE, "The Hospital Surveys 1942-44", Lancet, 352, pp.49~50 (1998)
  44. Godber, GE, "Health Services, Past, Present and Future", Lancet, 272, pp.1~6 (1958)
  45. Grimes, SS, "The British National Health Service" (1991), Garland
  46. Hall, C., "Health Insurers Revive Hospital Pay-Bed Scheme.The Independent 3월 3일 기사", ~ (1993)
  47. Hardie, MC, "What Should We Spend on Health Care", Long Range Planning, pp.2~9 (1974)
  48. HCs(House of Commons), "Pay Beds. 1월 23일 하원 의회 회의록", ~ (1976)
  49. HCs, "Pay Beds.7월 8일 하원 의회 회의록", ~ (1975)
  50. HCs, "Pay Beds.3월 15일 하원 의회 회의록", ~ (1974)
  51. HCs, "Parliamentary Debates.3월 27일 하원 의회 회의록", ~ (1973)
  52. Himatsingani, C., "Approaches to Health and Personal Social Services Planning in the National Health Service and the Place of Health Indices", International Journal of Epidemiology, 2(1), pp.15~21 (1973)
  53. HLs(House of Lords), "Hansard Regular Report(Vol 337)" (1972), HMSO
  54. HLs, "Social Services. 1월 29일 상원 의회 회의록", ~ (1969)
  55. HLs, "Parliamentary Debates(Col. 1140)" (1961), HMSO
  56. HMSO, "Health Service Act 1976" (1976), HMSO
  57. HMSO, "National Health Service Reorganization Act 1973" (1973), HMSO
  58. HMSO, "National Health Reorganization Bill" (1972), HMSO
  59. Report of the Committee on Nursing, "HMSO", HMSO, ~ (1972)
  60. Report of the Royal Commission on Local Government in England, 1966-1969, "HMSO", HMSO, ~ (1969)
  61. Report of the Royal Commission on Medical Education, "HMSO", HMSO, ~ (1968)
  62. Report of the Committee on Senior Nursing Staff Structure, "HMSO", HMSO, ~ (1966)
  63. Report of the Committee to Consider the Future Numbers of Medical Practioners and the Appropriate Intake of Medical Students, "HMSO", HMSO, ~ (1957)
  64. Report of the Committee of Inquiry into the Cost of the National Health Service, "HMSO", HMSO, ~ (1956)
  65. HMSO, "National Health Service Act 1946" (1946), HMSO
  66. HMSO, "Health Service Act 1946" (1946), HMSO
  67. Horowitz, N., "“Britain’s NHS at 25.” Hospital Tribune(11월 12일 기사)", ~ (1973)
  68. Hudson, B., "The NHS and Social Care", Policy and Politics, 30(2), pp.153~166 (2002)
  69. Immergut, E., "Health Politics" (1992), Cambridge University Press
  70. Jonas, S., "The Future of the British National Health Service", Physician Forum, 2, pp.2~ (1965)
  71. Jonas, S., "The 1974 Reorganization of the British National Health Service", Journal of Community Health, 1(2), pp.91~105 (1975)
  72. Kirby, M., "Sociology in Perspective" (2000), Heinemann
  73. Kissick, WL, "From Cradle to Grave", American Journal of Medical Association, 282(4), pp.384~386 (1999)
  74. Kitchin, H., "Pay-Beds in Voluntary Hospitals", BMJ, 4067, pp.373~375 (1938)
  75. Klein, R., "The New Politics of the NHS" (2010), Radcliffe Publishing
  76. Klein, R., "The Tale of Two Committees or the Perils of Prediction", BMJ, 6000, pp.25~26 (1976)
  77. Klein, R., "Policy Making in the National Health Service", Political Studies, 22(1), pp.1~14 (1974)
  78. Korpi, W., "Contentious Institutions", Rationality and Society, 13(2), pp.235~283 (2001)
  79. Korpi, W., "The Democratic Class Struggle" (1983), Routledge & Kegan Paul
  80. Lafitte, F., "Second Thoughts on the Willink Report", Lancet, 7149, pp.538~542 (1960)
  81. Lees, DS, "Amenity and Private Pay Beds", BMJ, 5344, pp.1531~1533 (1963)
  82. Levitt, R., "The Reorganized National Health Service" (1977), Croom Helm
  83. Lister, J., "The NHS after 60" (2008), Middlesex University Press
  84. Levitt, R., "Health Policy Reform" (2005), Middlesex University Press
  85. Lowe, R., "The Welfare State in Britain since 1945" (1945), Palgrave
  86. Massam, A., "British Physicians See Pay-Bed Issue Moderating", Canadian MedicalAssociation Journal, 114, pp.841~ (1976)
  87. McKeown, T., "The Concept of a Balanced Hospital Community", Lancet, 7023, pp.701~704 (1958)
  88. Report for 1967, "MH(Ministry of Health)", HMSO, ~ (1967)
  89. MH, "The Administrative Structure of Medical and Related Services in Engalnd and Wales" (1968), HMSO
  90. MH, "The Hospital Building Programme" (1966), HMSO
  91. MH, "On the State of the Public Health" (1963), HMSO
  92. MH, "A Hospital Plan for England and Wales" (1962), HMSO
  93. OHE(Office of Health Economics), "The NHS Reorganization" (1974), Office of Health Economics
  94. Owen, D., "In Sickness and In Health" (1976), Quartet Books
  95. Paton, A., "Reorganization", BMJ, 5973, pp.729~730 (1975)
  96. Pollock, AM, "NHS Plc" (2004), Verso
  97. Poterba, JM, "Government Intervention in the Markets for Education and Health Care, In Individual and Social Responsibility", pp.277~308 (1996), University of Chicago Press
  98. Royal Commission on Medical Education Report, "RCME(Royal Commission on Medical Education)", HMSO, ~ (1968)
  99. RCN(Royal College of Nursing), "A Reform of Nursing Education" (1964), RCN
  100. RCNHS(Royal Commission on the NHS), "The Workings of the National Health Service" (1979), HMSO
  101. RCNHS, "Management of Financial Resources in the National Health Service" (1979), HMSO
  102. RCNHS, "Patients’ Attitude to the Hospital Service" (1979), HMSO
  103. RCNHS, "Access to Primary Care" (1979), HMSO
  104. RCNHS, "Management of Financial Resources in the NHS" (1978), HMSO
  105. Richard, V., "Thatcher’s Britain" (2009), Simon and Schuster
  106. Rintala, M., "Creating the National Health Service" (2003), Frank Cass
  107. Rivett, G., "From Cradle to Grave" (1998), King’s Fund
  108. Roberts, F., "The Cost of the NHS", BMJ, 4598, pp.293~297 (1949)
  109. Ryan, M., "The Royal Commission on the National Health Service", Social and Economic Administration, 11(3), pp.194~205 (1977)
  110. Ryan, M., "Hospital Pay Beds", Social and Economic Administration, 9(3), pp.164~183 (1975)
  111. Santerre, RE., "Government Intervention in Health Care Markets and Health Care Outcomes", Cato Journal, 11(1), pp.1~12 (1991)
  112. Seale, J., "Supply of Doctors", BMJ, 5266, pp.1554~1555 (1961)
  113. Sked, A., "Post-War Britain" (1984), Penguin
  114. Smith, J., "Hospital Building in the NHS", BMJ, 6454, pp.1298~1300 (1984)
  115. Spicker, P., "Social Policy" (2008), Policy Press
  116. Stevens, R., "Medical Practice in Modern England" (1966), Vail-Ballou Press
  117. Timmins, N., "The Five Giants" (1995), Harper Collins
  118. Tudor-Hart, J., "The Inverse Care Law", Lancet, 7696, pp.405~412 (1971)
  119. Watkin, B., "Documents on Health and Social Services" (1975), Butler and Tanner
  120. Webster, C., "The National Health Service" (2002), Oxford University Press
  121. Webster, C., "The Health Services since The War(Vol 2)" (1996), HMSO
  122. Webster, C., "The Health Services since The War(Vol 1)" (1988), HMSO

관련 논문AI추천

복지국가 보건의료 정책의 정치경제학: 1979년부터 2010년까지 영국의 보수당 정부와 신 노동당정부의 National Health Service 개혁을 중심으로박승민국회입법조사처 · 입법과 정책2018 · 제10권 제3호영국의 건강과 사회적 돌봄 서비스 시스템 통합의 복지정치, 1948-2010박승민정부학연구소 · 정부학연구2015 · 제21권 제3호의료정책 변화 과정에서의 이익집단과 제도의 역할 분석: 영국과 미국의 비교최종호사단법인 한국민족연구원 · 민족연구2015 · 제63호민주화 이후 정치행위자들의 의료민영화 및 의료공공성 관련 정치적 행위 분석손승혜, 이귀옥, 이수연한국사회복지연구회 · 사회복지연구2016 · 제47권 제1호전후 영국의 보편적 복지국가의 발전 조건과 전환김인춘극동문제연구소 · 한국과 국제정치2012 · 제28권 제4호의료계와 정부의 관계에 대한 역사제도적 고찰허순임한국사회정책학회 · 한국사회정책2024 · 제31권 제4호

이 간행물의 다른 논문 (5건)

한국 행정문화의 지속과 변화에 관한 연구: Grid-Group 문화이론의 적용주재현pp. 1-33시장-정부 이분법에 대한 비판적 검토: R.H.Coase와 E.Ostrom의 제도 연구 방법을 중심으로안도경pp. 35-56일제시대 근대 '국민' 개념 형성과정 연구한승연pp. 57-107부동산정책을 둘러싼 규제정치 분석: 종합부동산세정책에 대한 확장된 Wilson의 규제정치이론 적용양승일pp. 109-143과학기술인식의 다원성과 영향요인: 유전자변형식품(Genetically Modified Food: GM Food)에 대한 일반인의 인식을 중심으로이현정, 왕재선pp. 145-185
원문 보기