영국 일차보건의료부문 개혁의 경험과 과제:Primary Care Groups/Trusts를 중심으로
Primary Care Reforms in United Kingdom:Primary Care Groups/Trusts
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최근 선진국을 비롯한 많은 국가들은 보건의료부문에서의 보건의료수요와 공급 간의 격차해소에 많은 관심을 보이고 있다. 이에 일부 선진국의 경우 지역 중심의 일차보건의료제도의 개선과 그 기능 확대를 통한 대응 방안을 강구하고 있다. 우리나라도 최근 인구고령화, 의료비 상승 등과 같은 보건의료 환경 변화는 일차보건의료부문의 역할 강화와 관련 제도 개선이 요구된다고 볼 수 있다. 본 연구의 목적은 영국 NHS제도 개혁 중 가장 주목을 받고 있는 일차보건의료조직의 발전과정의 체계적인 기술과, 그러한 전개과정이 보건의료부문에 미친 영향 평가이다. 이를 위하여 1990년도 후반에 도입한 일차보건의료그룹과 트러스트 제도를 중심으로 도입배경 및 과정을 기술하였으며, 영국 보건의료부문에 어떠한 영향을 주었는지를 탐구하였다. 연구방법으로 영국정부에서 시행되었던 일차보건의료조직관련 자료와 일차보건의료그룹과 트러스트 제도 뿐 만아니라 이 제도 이전의 기금보유일반의 제도에 관련한 자료와 문헌에 대한 체계적인 내용분석을 수행하였다. 마지막으로 본 연구의 결과를 요약하면, 영국 일차의료부문 개혁은 결국 일차의료와 지역보건의료간의 통합적인 활동을 할 수 있는 계기를 제공하였다. 또한 영국 NHS제도의 근간을 이루고 있는 일차보건의료부문 특히 일반의(GP)의 기본적인 역할은 계속 지속되고 있으나, 일차보건의료그룹과 트러스트제도의 시행으로 지역중심의 지역주민수요에 민감하게 반응하는 일차보건의료 조직과 기능 및 향후 방향에 광범위한 영향을 미치고 있다. 이는 결국 ‘미래의 NHS’ 로의 변화에 대한 방향을 반영하고 있다고 볼 수 있다.
Abstract
The purpose of this study is to describe the development of the primary care organisations; and to reviews the impact of successive experiments in the development of primary care organisations in England and assesses the impacts of English primary care groups and trusts on health care sector. This article is based on a systematic review of the literature from the UK Government's evaluations of successive primary care organisational developments and published articles and books related to GP fundholding, primary care groups and trusts. The role of primary care organisation in the British health care system is discussed and new initiatives aimed at strengthening and integrating primary care are outlined. The results of this study shows that: the changes in primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. The development of primary care groups/trust in England are an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services.
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