Earticle

본 논문은 중국 조선족의 코리안 드림에 따른 해외노무에 있어서 1980년부터 현재에 이르기까지 약 20년에 걸 친 한국정부의 출입국관리정책의 변화과정 및 그 특징을 정리하고, 해외노무 당사자가 직면한 송출국과 유입 국에서의 현실에 주목하면서 정책과 현실간의 모순 및 문제점을 돌출하고자 하였다. 지난 20년 동안 한국정부의 수용정책은, ‘정책부재의 시기’부터 ‘외국인노동자로서의 관리중심의 시기’ 그리고 ‘재외동포로서의 배려에 기초한 현재의 정책’까지 크게 세 가지 단계로 구분할 수 있다. 그 특징은 규제에서 완 화로, 거부에서 수용으로, 관리에서 포용으로 파격적이고도 숨 가쁘게 변화하여 왔다. 이는 많은 조선족들의 꿈과 희망을 실현시켜주었으며 경제적인 부를 가져다주었다. 하지만 정부는 중국 조선족을 포함하여 외국으로부터의 단순기능노무에 종사하는 체류자에 대하여 일관하여 정주화(定住化)방지 원칙을 고수하여 왔다. 즉 한국 내에서 경제적인 목적을 달성할 수 있는 충분한 기간을 설 정하기는 하지만, 장기체류에 의한 정주화문제가 발생하지 않도록 수년이내의 취업기간을 정함으로써 취업연 수와 직종제한, 입국연령제한을 둠으로써 가족의 이주로 인한 정주화를 방지하고 있다. 그럼에도 불구하고 현재 재한 조선족 사회는 해외노무의 장기 체류와 정주화 경향을 보이고 있다. 이러한 현 상은 송출지역에 직접적인 영향을 줌으로써 남겨진 자녀들의 교육문제 즉 유수아동문제라는 사회적 문제를 발생시키고 있다. 해외노무의 뒤에 숨겨진 제도 밖의 사람들의 일과 생활의 실태는 간과함으로써 제도와 현실 간의 모순으로 인한 여러 가지 과제를 남겨두고 있다. 이러한 과제에 대하여 우리는 이주노동자 문제에서 한국과 비슷한 길을 걷고 있는 현재 일본 사회의 일계남미 인의 이주노동의 장기화와 정주화로 인하여 발생하는 사회적문제의 선례에서 미래의 재한 조선족사회를 추측 해 볼 수 있다. 이는 차세대 동포사회의 교육문제, 이주노동자의 사회통합문제와도 직결됨으로써 장기적인 안 목에 근거하여 현재의 정책에 대하여 다양한 차원에서 전면적인 조사 및 검토를 통하여 인증해 볼 필요가 있다.

Transition of the Korea’s Acceptance Policy towards Chinese-Korean People and Its Problems: Focusing on the Problems of Prolonged Work-Away-From-Homes and Children in Absence in Their Home AreasThe South Korean Government’s acceptance policy towards the Chinese-Korean people is roughly divided into three phases: ‘No policy time’, ‘time of managing them as foreign workers’ and ‘time of consideration as fellow Korean in a foreign country. Their characteristics are changing from tightening to relaxed policy, from refusal to acceptance and from managerialism to engagement policy. On the other hand, however, it is not paying enough attention to the reality of the works and lives of the people outside of the system, such as the children who are left at home as the parents work-away-from -homes are prolonged and becoming permanent, creating various problems caused by the gap between the system and the reality.

Purpose: This study aims to investigate factors related to long-term length of stay (LOS) of patients with chronic diseases in Korean veterans hospitals. Methods: The subjects were 196 elderly patients with chronic disease staying in the hospital for more than 10 days, Data were collected by the survey of patients with structured questionnaires and medical records review by nurses from July 15 to August 10, 2019. Collected data were analyzed using t-test, ANOVA, Pearson's correlation coefficient and stepwise multiple regression. Results: The present and desired LOS were 37.78±32.66 days and 60.87±45.95 days, respectively. Factors affecting hospital LOS were found to be main disease (genitourinary) (p<.001), assistance in activities of daily living (p<.001), area of hospital (p<.001), payment of medical fees (p=.026), hospital satisfaction (p=.036) and the explanatory power of these variables was 26.4%. The most common health problems that need to be solved after discharge were symptom alleviation and health promotion. These problems can be solved using community-based facility services or visiting medical-welfare services (especially home care nursing). Conclusion: In order to reduce hospital LOS, the following measures are required: personalized self-management education, provision of transportation services for dialysis therapy of inactive patients, linking patients with visiting medical-welfare services including home care nursing and mobile healthcare services, operation of the case management system including the notice of the discharge date at admission, interim check of patient status, and connecting the patient with community resources or transferring the patient to long-term care facilities at discharge.

The purpose of this study is to identify the current status of foreign workers(E-9) in non-professional employment in Korea, analyze the problems related to the period of stay, and then propose a policy alternative that enables social consensus and cooperation and coordination between government departments. Recently, Korea is entering a period of rapid low birthrate and aging, and the labor force is decreasing day by day, and most of the 3D industry as well as the low-wage unskilled labor market is dependent on foreign workers. The influx of foreign workers into Korea is expected to continue in the future. Now, foreign workers are not only being used as labor force, but also as members of our society who have to live together. In the case of foreign workers, there is a tendency to stay for a long time, whether illegal or legal. It seems that this trend cannot be stopped even by the conscientious worker system, which is applied only to limited foreign workers. Then, it is more persuasive to view the increase in the number of illegal immigrants over time as a structural problem fundamentally caused by the employment permit system itself, rather than as a result of a lack of will to control. Allowing foreign workers to settle down will be a way to efficiently secure the insufficient working-age population, prevent illegal stay of foreign workers, and guarantee their human rights(Lee, 2017: 241~242). Migrant workers should be viewed as human beings rather than as mere labor force. Human dignity and fundamental rights precede policy needs, and this is why we have established a system for guaranteeing fundamental rights and established theories. It does not change even for foreign workers who do not have Korean citizenship. In the end, the issues of long-term stay, settlement, and family reunification of non-professional foreign workers(E-9) should be approached from the perspective of universal human rights, such as human dignity, the right to pursue happiness, and the right to liberty.

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Purpose: In this study, we determined the long-term effects of the Independent Capacity Protocol (ICP), in which the emergency department (ED) is temporarily used to stabilize patients, followed by transfer of patients to other facilities when necessary, on crowding metrics. Materials and Methods: A before and after study design was used to determine the effects of the ICP on patient outcomes in an academic, urban, tertiary care hospital. The ICP was introduced on July 1, 2007 and the before period included patients presentingto the ED from January 1, 2005 to June 31, 2007. The after period began three months after implementing the ICP from October1, 2007 to December 31, 2010. The main outcomes were the ED length of stay (LOS) and the total hospital LOS of admitted patients. The mean number of monthly ED visits and the rate of inter-facility transfers between emergency departments were also determined. A piecewise regression analysis, according to observation time intervals, was used to determine the effect of the ICP on the outcomes. Results: During the study period the number of ED visits significantly increased. The intercept for overall ED LOS after interventionfrom the before-period decreased from 8.51 to 7.98 hours [difference 0.52, 95% confidence interval (CI): 0.04 to 1.01] (p=0.03), and the slope decreased from -0.0110 to -0.0179 hour/week (difference 0.0069, 95% CI: 0.0012 to 0.0125) (p=0.02). Conclusion: Implementation of the ICP was associated with a sustainable reduction in ED LOS and time to admission over a six-year period.

Digital transformation and remote work have fueled rising demand for long-term stays and workations. This study explores the institutional feasibility of introducing a multi-residence registration system in Korea, with reference to Germany’s Zweitwohnsitz model. Germany links secondary residence registration with taxation and local governance, thereby supporting tourism and municipal finance. In contrast, Korea’s single-address system constrains flexibility and policy integration. To address this gap, the study proposes a two-tier registration system distinguishing between primary and secondary addresses. This system would be combined with stay duration?based taxation and phased regional pilot projects. Legal and administrative analysis indicates such a framework could strengthen long-stay tourism infrastructure. It may also improve the quality of local public services. Finally, the study suggests that if properly adapted, the system could contribute to regional revitalization in Korea.

목적 본 연구는 장기체류 외국인 근로자의 한국 내 삶의 경험을 외국인 근로자의 관점에서 참여자들의 진술을 통해 심층적으로 이해하고 그 의미를 밝히는 데 있다. 방법 고용허가제로 입국한 저숙련 단순 기능인력(E-9) 외국인 근로자로서 한국어로 원활한 의사소통이 가능한 장기체류 외국인근로자 8명을 대상으로 2019년 5월부터 9월까지 반구조화된 질문지를 사용하여 일대일 심층면담을 실시한 후 Colaizzi의 현상학적 연구 방법을 적용하여 구성된 의미와 주제 및 주제군을 도출하였다. 결과 장기체류 외국인 근로자의 한국에서의 경험은 돈 벌고 싶었으나 일자리가 없었음, 오고 싶은 한국, 긴 기다림 끝에 오게 되어설렘, 외롭고 서러운 한국 생활의 어려움, 어려운 한국 생활을 견디게 한 힘, 장기체류를 위한 한국어 공부와 끈기, 편안하고 여유있는 한국 생활, 수준 높은 한국에서의 만족스러운 삶이라는 8개의 주제군과 31개의 주제, 90개의 구성된 의미로 나타났다. 결론 장기체류 외국인 근로자의 한국 내 경험의 의의는 다음과 같다. 첫째, E-9 자격으로 오랜 세월 장기체류 중인 외국인 근로자들의 삶의 경험을 심층적으로 탐색하여 현상이 드러나게 한 질적 연구이다. 둘째, 장기체류를 위한 노력의 과정에서 외국인 근로자들의정서적 외로움과 고독이라는 심리적 고통이 있었음이 밝혀졌다. 셋째, 회복탄력성의 개인적 요인이 한국 생활의 어려움을 극복하는데 도움이 되었다.

Objectives This study aims to understand in depth the life experiences of long-term foreign workers in Korea from the perspective of foreign workers through the statements of the participants and to reveal their meaning. Methods From May to September 2019, eight long-term foreign workers who were low-skilled simple skilled workers (E-9) who entered the country under an employment permit system and who could communicate smoothly in Korean were subjected to one-on-one in-depth interviews using semi-structured questionnaires and derived the meaning, theme, and theme group composed by applying Colaizzi's phenomenological research method. Results The experience of long-term foreign workers in Korea was manifested in 8 theme groups, 31 topics, and 90 compositions: wanting to earn money but not having a job, wanting to come, excitement to come after a long wait, the difficulty of living in Korea lonely and sad, the strength that made them endure a difficult life in Korea, studying Korean and perseverance for long-term stay, living in Korea comfortably and relaxingly, and satisfying life in Korea at a high level. Conclusions The significance of the experience of long-term foreign workers in Korea is as follows. First, it is a qualitative study that explores the life experiences of foreign workers who have been staying for a long time with E-9 status for a long time, and has revealed the phenomenon. Second, in the course of efforts to stay for a long time, it was found that there was psychological pain of emotional loneliness and loneliness among foreign workers. Third, the personal factor of resilience helped me overcome the challenges of living in Korea.

오늘날 전 세계적으로 해외 고급전문인력 유치의 중요성이 증가하고 국가 간 전문인재 확보를 위한 경쟁이 치열해지고 있으나, 한국의 인재유치실적은 안타깝게도 저조한 편이다. 이에 따라 본 연구는 국내 거주하고 있는 전문외국인력(E1~E5, E7)을 대상으로 그들의 장기체류결정에 영향을 미치는 요인들 간의 인과구조를 밝히고자 하였다. 이를 위해 가치-기대이론(Value-expectancy theory)에 기초하여 De Jong과 Fawcett (1981)이 제시한 이민의사결정모델(Model of Migration Decision-Making)을 적용하여 이민동기요인, 삶의 만족도, 이주의사 및 장기체류결정 변수들 간 인과관계분석 및 경로의 유의성 여부를 확인하였다. 분석결과에 따르면 한국사회에서 전문외국인력의 삶의 만족도는 그들의 사회적 지위 및 소속감, 주변 이웃이나 친구와의 친밀감, 안락한 생활여건 등의 이민동기와, 언어의 유창성 및 한국사회로의 편입장벽 등 기회구조에 의해 영향을 받고 있는 것으로 나타났다. 또한 이러한 삶의 만족도는 한국으로의 이주의사를 통해 국내 장기체류결정으로 간접적인 영향을 미치는 것으로 나타났다. 한편, 언어유창성, 한국상황인지도, 국적취득절차, 한국사회로의 편입장벽 및 내국인과의 차별경험 등의 기회구조는 국내 장기체류결정에 직접적인 영향을 미치는 것으로 나타났다. 이러한 분석결과는 De Jong과 Fawcett의 모델이 한국의 맥락적 상황에도 그대로 적용될 수 있음을 시사한다. 본 연구는 해외 우수인재확보를 통해 국가경쟁력을 높이려는 정책적 노력에 비해 저조한 전문외국인력 유치실적을 보이고 있는 현 시점에서 의미 있는 정책적 시사점을 제공하고 있다. 이와 더불어 국내에서 관련연구가 전무한 점을 고려할 때 본 연구가 이민동기 관점에서의 이민의사결정연구를 위한 기초연구를 제공한다는 점에서 학문적 의의가 있다.

Despite the importance of luring foreign professional manpower, Korea’s performance in this area has fallen far short of expectations. The purpose of this study is to examine the causal relationship among the factors that may influence the immigrants' long-term stay in Korea, targeting foreign professional immigrants with visa types such as E1∼E5 and E7. This study employs the model of migration decision-making suggested by De Jong and Fawcett in 1981, which is based on value-expectancy theory. According to the empirical findings, the life satisfaction of foreign professional manpower in Korea falls under the influence of a variety of motivational factors for immigration and opportunity structures. Moreover, it turns out that the immigration intention of foreign professional immigrants mediates the relationship between their life satisfaction and decisions on the long-term stay in Korea(i.e. acquisition of Korean nationality). Meanwhile, the opportunity structure variables such as fluency in Korean are likely to influence the immigrants' decision on acquiring Korean nationality. These results imply that De Jong and Fawcett's model is applicable to the Korean context, providing policy implications for attracting foreign brains.

노인장기요양보험의 도입과 함께 장기요양인력에 대한 수요는 꾸준히 증가하고 있다. 장기요양서비스의 핵심인력인 요양보호사의 근속은 인력의 안정적 확보와 서비스 질 향상을 위해 매우 중요하다. 본 연구는 국민건강보험공단의 행정자료를 활용하여 요양보호사의 근속현황과 근속에 영향을 미치는 요인을 파악하고자 시도되었다. 2015년 장기요양기관평가를 받은 노인요양시설과 노인요양공동생활가정에서 2016년 말 기준 근무 중인 상근 요양보호사 35,944명을 분석대상으로 선정하였고, 인구학적 요인, 근무조건 요인, 근무환경 요인들을 중심으로 요양보호사의 근속연수 차이분석과 다변량 회귀분석을 실시하였다. 연구결과 요양보호사의 평균 근속기간은 2.73년, 중위 근속기간은 2.10년으로 나타났다. 인구학적 요인에서는 여성일수록, 고령일수록, 근무조건 요인에서는 월근로시간과 월보험료분위가 높을수록 근속기간이 증가하는 것으로 나타났다. 근무환경 요인의 하드웨어적 특성으로는 입소시설 정원규모가 10인 미만보다 10인-30인, 30-50인 기관에서 근속기간이 감소하였으며, 농어촌에 위치할수록, 정원 충족률이 높을수록, 운영기간이 길수록 근속기간이 증가하는 것으로 나타났다. 소프트웨어적 특성으로는 장기요양기관평가 항목 중 근로계약, 운영규정교육 항목이 우수할수록 근속기간이 감소하였고, 건강검진, 처우개선 항목이 우수할수록 근속기간이 증가하는 것으로 나타났다. 본 연구를 통해 임금 외에도 다양한 비금전적, 조직관리적 요인들이 요양보호사의 근속에 영향을 미친다는 것을 확인하였다. 요양보호사의 근속 장려 정책을 설계할 때 다양한 측면의 접근이 필요하다.

Long term care(LTC) workers are one of the main pillars of the formal LTC delivery system. The study identifies factors affecting job tenure among personal care workers(PCW) in LTC facilities using 2016 administrative big data of the National Health Insurance Service(NHIS). We applied OLS regression using the sample of 35,944 full-time PCWs in LTC facilities, which participated in 2015 NHIS LTC Quality Evaluation. We hypothesized that the job tenure of PCWs was affected by socio-demographic characteristics, job conditions, organizational characteristics, and organizational policies. The average job tenure was 2.73 years, and its median was 2.1. Older women PCWs stayed longer. Higher monthly salary and longer hours of work extended the tenure of PCWs. PCWs stayed longer in LTC facilities with less than ten residents; a higher occupancy rate; longer operation history in a rural area. PCWs’ job tenure was related positively with LTC facilities’ organizational policy such as annual health screenings and job improvement efforts, but negatively with paying salaries based on labor contracts and training employees about internal organizational procedures. This study found that various financial and non-financial factors can motivate PCWs to stay long in LTC facilities. The long term care workforce retention policy should be designed considering those findings.

Background: This study examined patient and hospital factors related to long-stay admissions in long-term care hospitals (LTCHs) among older people in Korea. Methods: We analyzed health insurance claims data, entitlement data, and institutional administrative data from the National Health Insurance Service databases between 2010 and 2012. At the patient level, we compared characteristics of patients staying in LTCHs for over 180 days (the long-stay group) with those staying in LTCHs for less than 90 days during a calendar year. At the hospital level, we examined the general characteristics and staffing levels of the top 10% of hospitals with the highest proportion of patients whose length of stay (LOS) was 180+ days (the hospitals with long-stay patients) and compared them with the top 10% of hospitals with the highest proportions of patients whose LOS was less than 90 days (hospitals with shorter-stay patients). Results: The long-stay group accounted for about 40% of all LTCH patients. People in the group were more likely to be women, aged 80+, living alone, and experiencing more than two health conditions. Compared to the hospitals with shorter-stay patients, those with long-stay patients were more likely to be occupied by patients with behavior problems and/or impaired cognition, owned by corporate or local governments, have more beds and a longer period of operation, and deliver services with lower staffing levels. Conclusion: This study found long-stay older people in LTCHs and those in LTCHs with high proportions of long-stay older patients had several distinct characteristics compared to their counterparts designated in this study. Patient and hospital characteristics need to be considered in policies aiming to resolve long-stay admissions problems in LTCHs.

Purpose: This study aimed to determine the effect of adjusted out-of-pocket maximum rules in the 'differential co-payment ceiling', which means having a higher burden of co-payment, that expanded to the entire ceiling level in long-stay admission patients in long-term care hospitals(LTCH). Methodology: We used health insurance claim data between January 1, 2022, and December 31, 2022 received from the National Health Insurance Service. The study populations were inpatients in long-term care hospitals more than 1 days during the study period. We performed the difference in characteristics of the LTCH patient of the differential and general ceiling by the chi-square test. We estimated the change of the population, cost, and co-payments per person under the assumption of restructuring. Finding: Based on adjusted out-of-pocket maximum rules in 2023, it was expected that the number of benefits decreases at the high-income level while increasing at the low-income level. The burden of health expenditure after reimbursement of co-payment ceiling, is expected to increase by 65.1% in the highest medical necessity, whereas the low medical necessity would decreases compared to 2022. Practical Implications: The results demonstrate that the current out-of-pocket maximum rules do not reflect the needs of medical necessity. This study suggested the need to reflect the medical necessity in LTCH on the out-of-pocket maximum rules in the future.

Background: In Korea, the length of stay and medical expenses incurred by medical aid patients are increasing at a rate faster than the national health insurance. Therefore, there is a need to create a management strategy for each type of hospitalization to manage the length of stay of medical aid patients. Methods: The study used data from the 2019 National Health Insurance Claims. We analyzed the factors that affect the length of stay for 186,576 medical aid patients who were hospitalized for more than 31 days, with a focus on the type of hospitalization in long-term care hospitals. Results: The study found a significant correlation between gender, age, medical aid type, chronic disease ratio, long-term care hospital patient classification, and hospitalization type variables as factors that affect the length of hospital stay. The analysis of the differences in the length of stay for each type of hospitalization showed that the average length of stay is 291.4 days for type 1, 192.9 days for type 2, and 157.0 days for type 3, and that the difference is significant (p<0.0001). When type 3 was 0, type 1 significantly increased by 99.4 days, and type 2 by 36.6 days (p<0.0001). Conclusion: A model that can comprehensively view factors, such as provider factors and institutional factors, needs to be designed. In addition, to reduce long stays for medical aid patients, a mechanism to establish an early discharge plan should be prepared and concerns about underutilization should be simultaneously addressed.