Optimal Distribution of Public Health Administration between Local and Central Government

중앙-지방 정부간 보건행정기능 및 재원의 효율적 배분방안

The objectives of this research are (i) to review the functional and financial distribution of public health adminstration between central and local governments, (ii) to find out, based on economic criteria, optimal distribution required to fullfil local need for public health, and finally, (iii) to suggest policy implications in health area in face of the newly arising local autonomy system in Korea. Judging from data on government expenditures and tax revenues, public health administration in Korea is highly concentrated into central government, both functionlally and financially. High dependency of public health on central government has often been critisized that local residents can not participate in the decision making process for local health problems. This study, however, shows that localization of public health administration does not necessarily result in efficient and equitable allocation of resource to satisfy local demand for public health. From this point of view, two eccnomic criteria are suggested, i.e. external effect and economies of scle, as distributive criteria of roles in public health administration between local and central government. In addition, superiority of central concentration of public health administration to localization is emphasized in that public health in a wide sense contains the nature of public good and is part of compulsory socil security system. As a consequence, planned intervention by government is desirable.