국민건강보험정책 결정요인 분석

Abstract

Social welfare policy was introduced as one of relief projects after the restoration of independence in Korea. Medical insurance system as a core of the social insurance system was introduced in 1963 and for the last 40 years, it has been changed and developed a lot through rapid social changes. The medical insurance system was managed by associations from the beginning and then, in 1989 before the implementation of medical insurance for the entire people, it was managed by incorporating management style. Finally, due to the exercise of the veto power by ex-president No Tae-woo, it maintained the association management type. Therefore, until 1997, it was compelled to be managed by the associations. Then on December 1997, the new national insurance law was enacted and except job medical insurance, regional medical insurance were incorporated with medical insurance management associations for public servants and private school teachers. Two months later on December 1998, ‘ the National Health Insurance Law ' was passed and since 2000, all the medical insurance systems including job medical insurance associations were incorporated. This study aims at explaining the process to decide social welfare policy by analysing roles of participants and policy environment factors in decision-making in respect to incorporation of insurance. In particular, this study focuses on analysis of what influences political, social and economic environments as variables of political environment have on decision of policies, what influences roles of participants have on social welfare policy. Therefore, this study categorizes periods of medical insurance incorporation into No-Tae-woo Government, Kim Young-sam Government and Kim Dae-jung Government to analyse sub-variables from political environmental factors and roles of participants It speculates the entire context on medical insurance policy decision-making and analyses decision-making process based on previous studies to identify changing process of micro and flexible dynamics of main participants in each aspect. First, the political environmental variable has the greatest influence on medical insurance incorporating decision-making process. The important political variables that explains flexible properties of social welfare policy decision-making process are nature of political system, competition between political parties and elections. Social and economical variables are social welfare budget, social needs, economic growth rate, and medical insurance finance. Policy decision-making process is complicatedly intervened by many participants. Participants as a factor of decision-making have direct and indirect influences decision of a policy which fits for their interest or ideologies prevent or to prevent disadvantageous decision. This study speculates how such decision-making factors interact in the process of medical insurance incorporation decision-making process as follows: When political environment factors under the government of ex-president No Tae-woo are examined, the political system has authoritative nature and is externally characterized by democratic orientation in legal, institutional devices and procedures. In respect to the power relations in National Assembly, the ruling party was weak and the nongovernment party was strong. In social and economic aspect, thanks to consistent economic growth and increasing financial ability, economic conditions that are advantageous to medical insurance unification were prepared. Activities of interests groups were activated and the needs for social welfare were rapidly exploded. Under the Kim Young-sam government, the political system was changed from transitional authoritarianism to confirming period of democracy. Competitive structures of the political parties were changed into weak ruling party and strong oppositional party again. However, the ruling party attracted members of affiliated with no party and those from oppositional parties to secure a majority at the opening period of Assembly. As a response to the social need of ruling party in consideration of competition between political parties caused by the general election in 1996, and the president election in 1997, the ruling party agreed to medical insurance incorporation, and the law on incorporation was dramatically passed. The great meaning of national medical insurance law enactment is that Korean medical insurance system under the president Kim Young-sam government was a decisive cornerstone pursuing complete incorporation of the management subjects and finance through partial incorporation of the subject of management. The Kim Dae-jung government facing the national crisis departed with strong presidential authority, escaping out of the shadow of Kim Young-sam government which lost its authority as the government. Although it attempted to overcome foreign currency crisis and pursue new development, as it was unionized government and occupied small part of the National Assembly, it tended to rely on the people and labor organizations which were foundations of support when it was an oppositional party. They changed medical insurance system of association management type into incorporated type in 1998 with a help from social forces. Interests organizations played an important role in decision of medical insurance management system in the period of complete incorporation and financial stability and in agreement of incorporation by the tripartite commission. It also played the most important role in decision-making from decision of medical insurance system to the pass of incorporated law.