미국 공적 정신보건서비스 관리의료체계가 한국의 정신보건 서비스 전달체계 개선에 갖는 함의
A Study on the U. S. Public Mental Health Managed Care System and Its Implications for Improvement of Mental Health Care Financing System in Korea
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본 연구는 한국의 지역사회 정신보건 서비스 전달체계의 발전을 위해 정신보건 서비스 재원조달체계의 개선이 필수적이라는 관점에서, 이를 위해 미국의 공적 정신보건 서비스 관리의료체계의 재원조달방식과 그에 따른 서비스 전달체계의 구조 및 운영전략의 변화를 살펴봄으로써 우리나라의 정신보건 서비스 분야의 발전을 위한 제안점을 발견하고자 하였다. 미국은 1990년대에 공적 의료서비스와 사회복지 서비스에 대한 재정적 책임이 주 정부에서 지방자치정부로 이양되면서 재정적 책무성과 서비스 효과성 증대를 위하여 다양한 전달체계 구조와 운영전략들이 사용되었다. 본 연구에서는 그러한 변화의 동력이었다고 보는 공적 정신보건 서비스 관리의료체계에 관한 문헌연구와 이와 같은 공적 관리의료체계를 시행하고 있는 캘리포니아의 한 지방자치기구의 경험을 한국의 상황과 비교 분석함으로써 우리나라의 정신보건 서비스전달체계의 문제점과 개선 방안을 제시하고자 하였다. 한국에서 사회복지 재정의 지방이양이 시작되고 있는 현 시점에서, 유사한 과정을 90년대에 겪은 미국의 지방자치정부의 서비스 전달체계 개선노력이 한국적 상황에 갖는 함의를 논의하였다.
Abstract
The Korean Mental Health Law legislated in 1995 signaled a shift of the country's policy for the care of the seriously mentally ill from the institution-based to the community-based service delivery. However, there are many indicators that show the care for the chronically mentally ill still heavily depends on the inpatient programs and long-term mental institutions. This paper contends that the mental health financing mechanism is one of the major drivers in shaping the service delivery system and investigated the U. S. experiences in community mental health financing to find implications or lessons for Korea. The research focused on the public mental health managed care system, a latest financing mechanism that has influenced the mental health service delivery system in the U.S.. Despite of some misgivings and skepticism, the managed care system in general has proven to be cost-effective and improved service coordination and integration, according to numerous evaluation findings. The public mental health managed care system, which comes in many different forms and shapes, has also been reported to improve service delivery system with better coordination, cost-savings without any compromise in the quality of services. The various strategies adopted by a U.S. County mental health system case-studied in this research in the recent years for successful implementation of public managed care system were reviewed for implications for the Korean mental health care financing system. Some recommendations were made for improvement of the Korean mental health financing system.
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- "Director of ACCESS"
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