중국의 통치성과 공립병원의 경제·정치적 분화
China’s Governmentality and the Economic and Political Differentiation of Public Hospital
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본 연구는 중국의 경제개혁과 의료개혁 속에서 공립병원이 경제적·정치적으로 상당한 수준의 분화를 겪는 과정을 탐색하고, 이러한 과정이 공산당 통치의 정당성 확보 전략과 밀접하게 연계되어 있음을 밝힌다. 푸코에 의하면 통치성은 개인 혹은 인구집단의 건강과 사회적·경제적 삶을 특정 방식으로 형성하려는 권력관계 및 통치 전략에 밀접하게 연계되어 있다. 중국의 공립병원은 사회주의적 통치성하에서 정부의 재정 지원을 받으며 ‘인민에 대한 봉사’라는 공공의 역할을 수행해 왔다. 그러나 개혁개방 이후 신자유주의적 통치성에 따른 정부의 공립병원에 대한 재정 지원 감소는 병원 생존을 위협했으며, 개별 병원은 운영과 이윤의 기반을 스스로 마련해야 했다. 이러한 변화는 매우 부정적인 결과로 나타났다. 의사들의 과다처방과 각종 수뢰 행위, 이로 인한 개인 지출 의료비의 급증, 의료분쟁 증가 등의 심각한 문제들이 양산된 것이다. 이를해결하기 위해 2009년부터 추진된 신의료개혁은 공립병원의 등급과 의료서비스의 질, 환자의 경제적·사회적 지위에 따른 분화의 양상을 더욱 심화시키는 모습을 보인다. 즉, 상급 병원은 중국의 신자유주의적 통치성과 발전주의적 성과를 기반으로 양적·질적 성장을 추구하는 한편, 상대적으로 비용이 저렴하고 정부 의존도가 높은 하급 병원은 인민을 위한 의료접근성을 확대하고 정치적 사상 선전의 공간으로 활용되며, 공산당 통치의 정당성을 사회주의 이데올로기 측면에서 강화하고자 하는 면모를 보이는 것이다.
Abstract
In this paper, I explore the economic and political differentiation of China’s public hospitals and argue that this process is closely associated with the Chinese Communist Party’s governmentality. According to Foucault, governmentality is intimately related to power relations and ruling strategy to configure the health, social, and economic lives of individuals and populations in a specific way. Public hospitals have played a main role in China’s healthcare system since the establishment of the People’s Republic of China. Regardless of China’s market-oriented transition and the government’s withdrawal from social welfare provision in the 1980s and 1990s, socialist ideology and practices have been consistently imposed on public hospitals. Nevertheless, hospitals’ financial situation was exacerbated and had to find various informal ways for survival. This resulted in doctors’ over-prescriptions, informal payments from patients to doctors, soaring individual healthcare spending, and increasing medical disputes. In 2009, China’s new healthcare reform began to address these problems. Despite some successes, hospitals have been increasingly differentiated by their grades, medical services, and patients’ socioeconomic status. Higher-grade hospitals pursue their growth on China’s neoliberal and developmental governmentality. On the other hand, lower-grade public hospitals, which depend more on government subsidies, are used as places for increasing medical accessibility and socialist propaganda to strengthen the ideological legitimacy of the Chinese Communist Party.
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