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싱가포르 외국인 노동자 건강보장의 쟁점과 과제: 의료보험의 보장성과 의료접근성을 중심으로

The Issues and Challenges of Migrant Workers’ Health Coverage in Singapore: Focusing on the Medical Insurance Coverage and Access to Health

김주영
한국동남아학회|2022.05|동남아시아연구 (The Southeast Asian Review)|제32권 제2호|pp. 35-78|DOI 10.21652/kaseas.32.2.202205.35

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코로나19COVID-19외국인 노동자Migrant Workers의료접근성Singapore싱가포르Universal Health Coverage의료보험 보장성보편적 건강보장Medical Insurance CoverageAccess to Health
주제분류지역학

초록

이 연구는 의료보험의 보장성과 의료접근성을 중심으로 싱가포르의 저숙련 외국인 노동자 건강보장의 쟁점과 과제를 살펴보는 것을 목적으로 한다. 특히, 코로나19라는 중대한 분기점을 맞이하여 어떻게 싱가포르에서 의료보험의 보장성 확대와 의료접근성 향상을 위한 노력이 이어졌는지 살펴본다. 이로써 외국인 노동자가 포함된 보편적 건강보장을 달성하기 위해 필요한 과제를 제시해본다. 코로나19에 대한 대응으로 도입된 1차진료계획은 기숙사에 거주하지 않거나 지정된 산업분야에 종사하지 않는 외국인 노동자와 가사노동자를 대상에 포함하지 않는 한계가 있지만, 그동안 보장하지 않았던 1차 의료를 저렴한 비용으로 제공한다는 데 의의가 있다. 코로나19 이후에 NGO가 외국인 노동자 건강보장에 있어 정부와 긴밀히 협력한 것도 이례적인 일이었다. 이전에 여러 장벽으로 인해 의료접근성이 제한되었던 외국인 노동자는 NGO를 통해 보완적인 의료서비스에 접근할 수 있었다. 코로나19는 NGO의 역할을 드러냈지만, 경직된 싱가포르의 정부-시민사회 관계로 인해 보다 확장된 역할을 수행하기 어려운 현실적 여건이 있다. 이 연구는 외국인 노동자의 보편적 건강보장이 미약하게나마 진전되고 있는 현재, 정부는 고용주와 보험사를 엄격하게 관리 감독하고 NGO와 수평적으로 협력할 필요가 있다고 강조한다.

Abstract

The purpose of this study is to examine the issues and challenges of health coverage for low-skilled migrant workers in Singapore with a focus on medical insurance coverage and access to Health. In particular, I will look at how Singapore’s efforts to expand the coverage of medical insurance and improve access to health in the critical turning point of COVID-19. As a result, I present the tasks to achieve universal health coverage that includes migrant workers. The primary care plan introduced as a response to COVID-19 has limitations in not including migrant workers who do not live in dormitories or work in designated industries and domestic workers, but it is meaningful to provide primary care at low cost. After COVID-19, NGOs cooperated with government in ensuring the health coverage for migrant workers. Migrant workers, who previously had limited access to healthcare due to various barriers, were able to access complementary medical services through NGOs. Although COVID-19 has revealed the presence of NGOs, Singapore's rigid government-civil society relationship has made it difficult to fulfill its expanded role. This study highlights the need for the government to strictly supervise employers and insurance companies and to attract NGOs as more active partners.

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