Earticle

While the local health insurance and the employment-based insurance were integrated in July 2000, the insured is divided into employment-based insured and the local insured and the relevant premium has been applied to both groups. The health insurance premium having the feature of social solidarity has to be determined depending on income, that is, the ability to pay in accordance with the principles of social insurance. While employment-based insurance premium has been determined depending on the earned income, the local insurance premium for the local insured has been determined by scoring gross income(evaluated income), property and possession of automobiles. A variety of improvement approaches has been implemented including introduction of the employment-based insurance premium ceiling system (2002) and the change of property scoring system for the local insured (2006). However, the health insurance system which was merged in 2000 has been implemented up to now without significant change even though there were lots of socio-demographic change including increase of income level and the population structure such as low birth and aging. In other words, it is required to implement the premium rating system securing the income-based equity. Nevertheless, it was inevitable to apply the diverse rating standards in the early stage because it was very difficult to verify the income of the self-employed. Although the income verification rate was significantly increased from 23% in 1989 to 44% in 2010, the irrational standards including property, automobiles, living standard and activity rate have been still applied to the local insured because it is difficult to secure the validity of insurance premium rating system and it severely lacks of security. This paper investigated whether the current insurance premium rating system for the local insured imposing the premium on the basis of ‘gender’ and ‘age’ complies with the basic human rights secured by the current Constitution of the Republic of Korea with respect to the practical and theoretic irrationality of insurance premium rating system and standards for he local insured. In accordance with the analysis results, this paper proposed the approach to improve the system.

본 연구는 일본 국민건강보험제도의 형성과정에서 보험사무를 처리하는데 필요한 가 장 적합한 단위구역 및 실시주체의 설정이라는 원리에 따라 다양한 제도설계의 선택지가 있었음에도 불구하고, 지방종합행정의 실현이라는 요청에 따라 행정주체의 동정화과정을 통해 국민건강보험사무가 지방자치단체의 기능 및 구역에 총체적으로 수렴되어가는 과정 을 분석한다. 그 주된 내용은 다음과 같다. 첫째, 국민건강보험제도 형성의 전사로서 일 본 최초의 사회보험입법으로서 건강보험법이 성립한다. 둘째, 전전에는 국민건강보험사업 을 둘러싼 중앙정부 내의 대립 및 조정을 반영하여 그 설치 단위가 기초자치단체의 행정 구역으로 설정되었지만, 그 사업주체는 기초자치단체 행정과 분리된 임의제에 의한 조합 주의가 채택되었다, 셋째, 전후에는 경제공황과 재정적자 상황 속에서 국민건강보험제도 의 기초자치단체 공영제의 실시와 기초자치단체 임의의 자치사무로 전환되었다. 넷째, 사 회보험에 대한 중앙정부 책임의 명확화와 국민의 개보험화가 요청되는 가운데 국민건강 보험사업은 중앙정부 책임으로 인식됨과 동시에 그 실시가 기초자치단체의 단체위임사무 로 됨으로써 국민건강보험 사업주체의 기초자치단체 행정으로의 동정화가 실현되었다. 다섯째, 본 연구의 의미와 과제를 정리한다.

This study analyzes converging process of the national health insurance work in general within the function and area of local government through the identification process by the request of the realization of Local Comprehensive Administration, even though there were numerous choices of system design according to the principle of the best proper unit area and implementing entity required to deal with insurance work in the formulation process of the Japan's National Health Insurance System. Main contents are as follows: First, Health Insurance System is established as the prehistory of the formulation of National Health Insurance System. Second, in the pre-war years, while establishment unit was set up as administrative district reflecting the confrontation and adjustment surrounding the National Health Insurance Business, but unionism was adopted as business entity based on the administration of elementary local government and separate voluntary. Third, in the post-war years, under the conditions of economic depression and fiscal deficit it is converted into implementation of publicly managed elementary local government' national health insurance system and local government's voluntary autonomous affairs. Fourth, under the request of clarification of central government's responsibility on social insurance and universal health insurance, national health insurance business was recognized as responsibility of central government, and at the same time as the implementation becomes delegated affairs of local government, identification of local government's administration as business entity of national health insurance was realized. Fifth, meanings and assignments will be summarized.

The health center has to play an important role in promoting community health and satisfying a variety of community health needs and demands in the decentralized Korea. The nearly enacted Community Health Act compels every health center to make its own health plans which intend to deal with local health problems and plan its future health care. This obligation is obviously a big burden to most health centers. They do not have experiences in and abilities of making local health care plans. In order to establish a systematic community health plan, health centers have to concentrate their efforts on enhancing the ability of making health care plan through gathering and analysing the local health informations. However, it is very difficult in reality. This is simply because it will take long time to accomplish these activities. It seems natural that various professionals and researchers participate in carrying out the process of making community health plan in the initial stage. No standardized methodology and analysing framework exist even in the health professional society. Nonetheless, it is common to introduce survey research methodologies in analysing consumer's health care utilization and cost, and in identifying factors influencing health behaviors. Many researchers and professionals have applied social survey methodologies in obtaining information on providers and health policy makers as well. The authors have found that few studies have ever utilized local health data stored at the self-employed medical insurance society as the data source of planning activities. The purpose of this study is to illustrate the usefulness of the data stored at the Sung-Dong Gu Self-employed Medical Insurance Society in establishing the community health plan. The major contents of this study are as follows ; 1. frequency of utilization by age, area, sex, type of medical care institutions, and some major diseases 2. Medical treatment by type of medical care institutions, by classification of 21 diseases, by frequency of three-character categories 3. Medical treatment of major neoplasm and some chronic diseases by age, sex, and area. The conclusion of this study is that it is of great potentiality to find out the local health problems and to use them in blueprinting the community health plan through comparing the frequency of medical utilization analyzed by a variety of variables with NHI health data or the health data from survey research.

노인장기요양보험제도가 도입됨에 따라 노인장기요양체계의 패러다임이 공공부조 방식의 선별주의(selectivism)에서 사회보험 방식의 보편주의(universalism)로 전환되었다. 현행 노인장기요양체계는 보편적 복지를 실현하기 위한 효과적인 ‘정책조준(targeting)’ 차원에서 기존의 경제력을 기준으로 한 지역노인보건복지체계가 건강상태를 기준으로 한 노인장기요양보험체계의 제도적 한계를 보완하기 위한 수단으로 활용하도록 설계되어 있다. 이러한 관점에서 양 서비스 간 연계성 확보는 현행 노인장기요양체계의 근본목적을 달성하기 위한 필수적인 전제조건이라 할 수 있다. 이에 본 연구의 목적은 서비스 중복 및 사각이 발생할 수밖에 없는 구조적인 위험요인에 초점을 맞추어 노인장기요양보험체계와 지역노인보건복지체계간 서비스 연계성을 분석하여 그에 따른 제도적 개선과제를 모색하는 데 있다. 이를 위해 노인장기요양보험제도 도입에 따른 제도적인 변화와 보편적 복지의 관점에서 노인장기요양보험제도 도입의 의의 및 서비스 연계의 중요성을 종합적으로 고찰하여 분석의 논거를 확보하였으며, 이에 기초하여 다각적인 분석을 시도하였다.

When long-term care insurance was introduced, the paradigm of the long-term care system was shifted from selectivism operated by public assistance to universalism operated by social insurance. The existing local health and care services focusing on elderly poor who cannot get long-term care insurance make up for the weak points in long-term care insurance, in order to improve the effectiveness of targeting from the perspective of universalism. Therefore, ensuring service linkage between both systems is an essential precondition for achieving the goal of the current long-term care system. The purpose of this paper is to analyze the service linkage between long-term care insurance and local health and care services, focusing on the institutional risks, and to suggest significant policy implications for improving the efficacy of the current long-term care system.