1970년대 의료보험 정책의 변화와 복지담론

Abstract

This study is to analyze the change of the health insurance policy in the 1970s in relation to social welfare discourse. The public health care in Korea was in very poor condition around the first amendment of the National Health Insurance Act in 1970. Furthermore,due to the introduction of new medical technology, increasing number of big hospitals participating in the medical market, inflation, and other factors, medical expenses skyrocketed and made it hard for ordinary people to enjoy medical services. Accordingly, the social solution to the problem of medical expenses which an individual found hard to deal with became of demand. And as the way to the solution, it was inevitable to consider the introduction of health insurance as social insurance. In this condition, Park regime began to stress the social development from the 1960s. It was to aim to settle various social problems triggered by the rapid industrialization in the 1960s through social development as well as economic development. As the social development was emphasized,the matter of social welfare appeared of importance and led to the first amendment of the National Health Insurance Act in 1970. However, it was impossible for Korean government to enforce a nationwide health insurance. The key issue was how to fund it. Park regime was reluctant to use government fund; it was also hard to burden private companies. Even while the health insurance policy was not determined yet for this reason, the social demand for health insurance became large and large. In particular, in the midst of the first “Oil Shock” which gave a big blow to people’s living condition from the late 1973, some reported issues in relation to health service, such as hospitals’ rejection of the poor,became a big problem. Coupled with the social demand for a health insurance system, the changes occurred within the medical community was also important. Most of all, hospitals was facing the decrease of the effectiveness of their medical facilities. Therefore, they began to see health insurance as a means of developing potential demand for medical service. In addition, the business world, which already expanded their own corporate welfare for employees from the early 1970s, sharing the idea that it was impossible to keep the issue of public health insurance unsolved,showed an enthusiastic attitude. These factors finally enabled Park regime to adopt the public health insurance system. Likewise, it is critical to understand the establishment of the public health insurance system in Korea through pursuing the process to it. What matters is the discoursive changes as well as the changes in social condition around the establishment, not merely the policy changes per se. Then most people, including decision makers in Park regime, thought of social welfare as a privilege developed countries. Thus, in the 1970s when unbalanced industrialization brought about widening gap between social classes, the employment of a social welfare policy could be recognized as a symbol of an escape from backwardness. In fact, with the introduction of the national health insurance in the 1970s, Park regime could fortify the material fundamental of a social welfare discourse which would be mobilized to strengthen the dichotomous discourse of developedness and backwardness and to dump the social crisis caused by Park regime's industrialization drive on the next generation.