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미국 보건의료개혁의 정책 연혁 및 공공성 분석

Reform and Publicness of Healthcare System in the United States

박정원|이세진|여영현|이건형
한국공공관리학회 (Korean Association for Public Management)|2018.06|한국공공관리학보 (Korean Public Management Review)|제32권 제2호|pp. 211-236|DOI 10.24210/kapm.2018.32.2.009

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참고문헌

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미국Healthcare systempublicnessreformU.S.A의료개혁의료공공성비영리병원PPACA
주제분류사회과학일반

초록

미국은 민간의료보험과 민간 위주의 의료전달체계를 가지고 있어 의료의 공공성보다는 시장성이 강조되는 국가로 인식된다. 그러나 지난 100년 동안 미국에서도 의료 공공성을 강화하려는 다양한 정책적 노력이 지속되어왔다. 이러한 노력의 결과 1960년대에는 메디케어, 메디케이드 프로그램이 시행되었고, 마침내 오바마 정부에서는 「환자보호 및 건강보험료 적정 부담법」이 통과되어 의료제도의 일대 개혁이 이루어졌다. 본 연구는 우선 미국의 의료개혁 과정을 시기별로 고찰해보고, 의료 공공성에 대한 다양한 지표를 활용해 미국 의료의 공공성 정도를 평가해 보았다. 공공성에 대한 평가 결과 의료 공공성을 강화하려는 노력에도 불구하고 미국의 의료체계는 대부분의 지표 부문에서 공공성이 상대적으로 낮은 것으로 평가되었다. 이는 미국의 의료전달체계에서 공공의료기관보다는 민간의료기관의 역할이 상대적으로 중요하기 때문으로 평가된다. 따라서 본 연구는 미국의 공공성을 위한 의료개혁의 정책연혁과 미국 보건의료의 의료공공성 측면을 평가하였다.

Abstract

The healthcare system in the United States is known as the most market-oriented system in the world. In the U.S., hospitals are largely owned and operated by private sector businesses, and only one-fifth of hospitals are public. Nevertheless, public hospitals play a key role as a safety-net for low-income and vulnerable populations, and public spending accounts for nearly half of total healthcare spending in the U.S. Today, government is a major player in the U.S. healthcare system, which is the result of years of healthcare reform. Throughout the last century, U.S. presidents and legislators have attempted healthcare reforms without success until the Affordable Care Act . This study reviews the history of healthcare reform in the U.S. since World War I. Then, this study examines the degree of “publicness” in healthcare in the U.S. using national indicators that show the performance of public healthcare. It compares the overall levels of “publicness” in healthcare between Korea and the U.S. and discusses the role of non-profit hospitals in the U.S. healthcare system.

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