• 한국아동복지학
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• 제36호
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• pp.65-99
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• 2011

본 연구는 OECD 국가를 대상으로 복지국가의 아동 가족복지지출과 아동빈곤율의 관계를 분석한 탐색적 연구이다. 아동 가족복지지출은 복지국가의 아동 가족을 대상으로 한 복지 노력(welfare effort)을 나타내는 지표이며, 본 연구에서는 아동 가족복지지출 총량뿐 아니라 아동 가족을 대상으로 한 다양한 분야의 복지지출을 구분해서 분석함으로써 아동 가족에 대한 구체적인 복지국가의 복지노력과 아동빈곤율의 관계를 분석하였다. 본 연구에서 사용된 아동빈곤율 자료는 LIS와 OECD에서 계산한 데이터를 이용하였고 아동 가족복지지출 자료는 OECD SOCX 자료를 활용하였으며 23개국을 대상으로 상관관계 군집분석 방법을 이용하여 분석하였다. 이 분석을 통해 아동빈곤율에 대한 급여전략(benefit strategy)과 근로전략(work strategy)의 유효성을 파악할 수 있었다. 아동빈곤율이 높은 국가들은 대부분 전체빈곤율보다 아동빈곤율 수치가 더 높은 반면, 스칸디나비아 국가들은 아동빈곤율 수준이 전체빈곤율 수준보다 낮았다. 아동 가족복지총지출과 아동빈곤율의 상관관계는 매우 높았고, 특히 서비스지출, 휴가급여지출과의 상관관계가 높았으나 현금급여지출과 아동빈곤율의 상관관계는 통계적으로 유의미하지 않았다. 이상의 결과를 통해 우리나라 아동빈곤율 완화를 위해서는 무엇보다 아동 가족 분야 사회복지 예산과 지출을 증가시켜야 하며, 아동 가족복지지출 중에서도 서비스지출, 휴가급여지출을 증대시켜야 하며, 아동이 있는 가구 부모의 경제활동을 지원하는 적극적노동시장 정책 등 아동가구 부모에 대한 근로지원정책을 확대시켜야 한다는 정책적 함의를 도출할 수 있었다.

• 보건행정학회지
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• 제29권2호
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• pp.206-219
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• 2019

This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 2018 constructed according to the SHA2011, which is a manual for System of Health Accounts (SHA) that was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. Comparison is made with international trends by collecting and analyzing health accounts of OECD member countries. Particularly, scale and trends of the total CHE financing as well as public-private mix are parsed in depth. In the case of private financing, estimation of total expenditures for (revenues by) provider groups (HP) is made from both survey on the benefit coverage rate of National Health Insurance (by National Health Insurance Service) and Economic Census and Service Industry Census (by National Statistical Office); and other pieces of information from Korean Health Panel Study, etc. are supplementarily used to allocate those totals into functional classifications. CHE was 144.4 trillion won in 2018, which accounts for 8.1% of Korea's gross domestic product (GDP). It was a big increase of 12.8 trillion won, or 9.7%, from the previous year. GDP share of Korean CHE has already been close to the average of OECD member countries. Government and compulsory schemes' share (or public share), 59.8% of the CHE in 2018, is much lower than the OECD average of 73.6%. 'Transfers from government domestic revenue' share of total revenue of health financing was 16.9% in Korea, lower than the other social insurance countries. When it comes to 'compulsory contributory health financing schemes,' 'transfers from government domestic revenue' share of 13.5% was again much lower compared to Japan (43.0%) and Belgium (30.1%) with social insurance scheme.

• 한국사회복지학
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• 제59권4호
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• pp.297-317
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• 2007

이 연구는 임금분산의 축소는 사회성원으로 하여금 복지정책의 확대를 선호하게 하며, 사회성원들의 그러한 선호를 이끌어낸 것이 바로 특정한 방식으로 구성된 노동시장 제도임을 보이고자 한다. 달리 말한다면, 임금분산의 축소를 지향하는 노동시장 제도와 관대한 복지정책 사이에는 제도적 상보성이 존재한다는 것이다. 이 연구의 앞부분에서는 특정방식으로 구성된 노동시장제도가 임금분산의 축소에 영향을 미친다는 점과 임금분산의 축소가 중위소득자의 복지정책에 대한 선호를 증가시킨다는 점을 이론모형으로 제시한다. 또한 연구에서 제시한 이론적 모형을 검증하기 위해 14개 복지국가들에 대한 결합시계열회귀분석이 논문의 뒷부분에서 이루어진다. 그 결과, 이 연구에서 제시한 이론모형은 경험적으로도 검증되었다. 이러한 연구결과는 제도적 상보성이 어떤 과정을 통해 발생하는지를 이론적인 차원에서 논의할 뿐 아니라 복지정책은 언제나 노동시장 제도와 함께 고려되어야 함을 보여준다.

• 한국사회정책
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• 제25권2호
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• pp.243-280
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• 2018

본 논문은 문재인 정부의 핵심 국정운영 전략으로 '알려진' 소득수도성장과 관련된 논의를 한국 복지체제의 관점에서 검토했다. 소득주도성장 전략에 대한 다양한 논점들을 제시했지만 소득주도성장 전략은 1980년대 이래 공급중심의 성장전략이 장기침체를 유발하고, 불평등을 심화시켰다는 점을 고려하면 수요측면을 강조한 시의 적절한 대안 담론으로 보인다. 특히 소득주도성장 전략은 한국 복지체제의 관점에서 사회지출이 인적자본을 향상시켜 성장에 기여한다는 사회투자전략의 협소한 공급측면의 논리와 사회지출을 안정화 장치로 접근했던 전통적 접근을 넘어 생산과 소비를 선순환시키는 중요한 성장 동력으로 위치시켰다는 점이 중요하다. 하지만 본 논문은 단순히 임금을 높이고, 사회지출을 늘린다고 해서 총수요가 증가하고 투자와 생산이 증가해 경제가 성장하는 것은 아니라는 것을 확인했다. 더욱이 경험적 연구에 따르면 대외부문과 부채를 분석에 포함할 경우 한국 성장체제의 임금주도성은 약해지는 것으로 나타났다. 이러한 이유로 본 연구는 실질임금의 증가와 사회지출 증가가 경제성장과 선순환하기 위해서는 정부의 정교한 정책개입이 필요하다는 결론을 내렸다.

• 보건행정학회지
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• 제20권1호
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• pp.37-63
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• 2010

Public expenditures on long-term care are a matter of concern for Korea as in many other countries. The expenditure is expected to accelerate and to put pressure on public budgets, adding to that arising from insufficient retirement schemes and other forms of social spending. This study tried to foresee how much health care spending could increase in the future considering demographic and non-demographic factors as the drivers of expenditure. Previous projections of future long-term expenditure were mainly based on a given relation between spending and age structure. However, although demographic factors will surely put upward pressure on long-term care costs, other non-demographic factors, such as labor cost increase and availability of informal care, should be taken into account as well. Also, the possibility of dynamic link between health status and longevity gains needs to be considered. The model in this study is cell-base and consists of three main parts. The first part estimated the numbers of elderly people with different levels of health status by age group, gender, household type. The second part estimated the levels of long-term care services required, by attaching a probability of receiving long-term care services to each cell using from the sample from current year. The third part of the model estimated long-term care expenditure, along the demographic and non-demographic factors' change in various scenarios. Public spending on long-term care could rise from the current level of 0.2~0.3% of GDP to around 0.44~2.30% by 2040.

• 보건행정학회지
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• 제26권2호
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• pp.95-106
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• 2016

A new manual of System of Health Accounts (SHA) 2011, was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. This offers more complete coverage than the previous version, SHA 1.0, within the functional classification in areas such as prevention and a precise approach for tracking financing in the health care sector using the new classification of financing schemes. This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 1970-2014 constructed according to the SHA2011. Data sources for public financing include budget and settlement documents of the government, various statistics from the National Health Insurance, and others. In the case of private financing, an estimation of total revenue by provider groups is made from the Economic Census data and the household income and expenditure survey, Korean healthcare panel study, etc. are used to allocate those totals into functional classifications. CHE was 105 trillion won in 2014, which accounts for 7.1% of Korea's gross domestic product. It was a big increase of 7.7 trillion won, 7.9%, from the previous year. Public share (government and compulsory schemes) accounting for 56.5% of the CHE in 2014 was still much lower than the OECD average of about 73%. With these estimates, it is possible to compare health expenditures of Korea and other countries better. Awareness and appreciation of the need and gains from applying SHA2011 for the health expenditure classification are expected to increase as OECD health expenditure figures get more frequently quoted among health policy makers.

• 농촌의학ㆍ지역보건
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• 제16권2호
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• pp.179-194
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• 1991

Despite its universal coverage of health insurance, the rural health insurance program(RHIP) stands at the crossroads in Korea. The RHIP has weaknesses in stability of financing, problems of inequities in the provision of health services and has suffered from high cost of running the program. The author has analyzed these problems from the perspective of health insurance policy and presented several options for improvement. First of all, this study urged the importance of a firm Governmental commitment of RHIP with the 50% subsidization of contributions as the Government had promised, instead of the current 40%. This can be justified from the 20% subsidization by the Government for the contributions of private school teachers and their dependents, who belong to richer segments of the population. Second, various cost containment measures ought to be sought curbing the rising demand for medical through strengthening health education and increasing individual responsibility, and tightening the claim review process. Third, this study requires the Government to run a demonstration project on the introduction of case payment system for primary health care. Fourth introducing an income-related cost sharing scheme is another possibility. Reforming the cost sharing formula for large medical expenditures is recommendable for a beginning. This measure can take the form of tax credit for medical expenditures of the poor. Fifth, the degree of financial adjustment among health insurance plans should be levelled up for enhancing stability of RHIP and social solidarity. Sixth, health policy should be redirected toward development of rural health resources and higher priority should be put on relieving difficulties in access to care. Seventh. the insurance plan owned-hospital needs to be developed or provision of health services in the medically underserved areas, and the need of such facilities is particularly acute for geriatric care, rehabilitation and renal dialysis, etc. Eighth, more generous insurance benefits are required of the elderly who are suffering the most : elimination of the maximum 180 days of benefit period and provision of glasses and artificial dentures, etc. Ninth. the economies of scale principle is working for the operating expenses of regional self-employed insurance plan. Thus, measures should be instituted to pursue an optimum size of health insurance plans. Lastly, excessive dependence on exclusion items is an evil so that some radical remedies are urgently required to cut them.

• 보건행정학회지
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• 제19권1호
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• pp.81-96
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• 2009

The expansion of long-term care hospitals (LTCHs) is expected to contribute to meeting the long-term care needs of the elderly with chronic diseases in a rapidly aging society. It is also expected to increase efficiency of health resource use and decrease elderly health expenditures by transferring patients from acute care hospitals (ACHs) to LTCHs. This study aimed to empirically examine how the expansion of LTCHs had influences on the length of hospitalization of the elderly in ACHs. Panel regression analysis was employed as an analytic tool using data of the National Health Insurance and the National Statistical Office from 2002 to 2006. The expansion of LTCHs was measured as location quotient (LQ) of LTCHs, denoting the share of LTCHs in a large city or province relative to the share of LTCHs at the national level. In addition, per capita GRDP (gross regional domestic product) and the proportion of population over 65 were included as control variables. The main findings are as follows. First, it was observed that LQ of LTCHs showed a statistically significant negative association with the length of hospitalization of the elderly in ACHs. Second, the negative correlation was evident among general hospitals with over 100 beds while it was not among hospitals with less than 100 beds. Third, LQ of LTCHs had more influences among the elderly over 85. In conclusion, the expansion of LTCHs seems to contribute to decrease in the inpatient cost of the elderly in ACHs and to increase efficiency in the utilization of health resources.

• 보건행정학회지
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• 제27권3호
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• pp.199-210
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• 2017

Background: This paper aims to demonstrate current health expenditure (CHE) and National Health Accounts of the years 2015 constructed according to the SHA2011, which is a new manual of System of Health Accounts (SHA) that was published jointly by the Organization for Economic Cooperation and Development (OECD), Eurostat, and World Health Organization in 2011. Comparison is made with international trends by collecting and analysing health accounts of OECD member countries. Particularly, financing public-private mix is parsed in depth using SHA data of both HF as financing schemes as well as FS (financing source) as their revenue types. Methods: Data sources such as Health Insurance Review and Assessment Service's publications of both motor insurance and drugs are newly used to construct the 2015 National Health Accounts. In the case of private financing, an estimation of total expenditures for revenues by provider groups is made from the Economic Census data; and the household income and expenditure survey, Korean healthcare panel study, etc. are used to allocate those totals into functional classifications. Results: CHE was 115.2 trillion won in 2015, which accounts for 7.4 percent of Korea's gross domestic product. It was a big increase of 9.3 trillion won, 8.8 percent, from the previous year. Government and compulsory schemes's share (or public share) of 56.4% of the CHE in 2015 was much lower than the OECD average of 72.6%. 'Transfers from government domestic revenue' share of total revenue of HF was 17.8% in Korea, lower than the other contribution-based countries. When it comes to 'compulsory contributory health financing schemes,' 'Transfers from government domestic revenue' share of 14.9% was again much lower compared to Japan (44.7%) and Belgium (34.8%) as contribution-based countries. Conclusion: Considering relatively lower public financing share in the inpatient care as well as overall low public financing share of total CHE, priorities in health insurance coverage need to be repositioned among inpatient care, outpatient care and drugs.

• 보건행정학회지
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• 제32권3호
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• pp.282-292
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• 2022

Background: Aging societies face social problems of increased medical expenses for older adults due to increased geriatric diseases. This study aims to analyze the relationship between the state change of multiple chronic conditions (MCC) and out-of-pocket medical expenses in the elderly aged 60 or older. Methods: The 2014-2018 Korean Longitudinal Study of Aging data were used for 2,202 elderly people. Four status change groups were established according to the change in the number of chronic diseases. The association between the change of MCC and the out-of-pocket medical cost was analyzed using the generalized estimating equation model analysis. Results: The average out-of-pocket total medical costs were 1,384,900 won for participants with MCC and 542,700 won for those without MCC, which was a statistically significant difference (p<0.0001). Compared to the reference group (simple chronic disease, SCD→SCD), the change in multiple chronic conditions significantly increased the total out-of-pocket medical expenses in MCC→MCC and SCD→MCC groups (MCC→MCC: 𝛽=0.8260, p<0.0001; SCD→MCC: 𝛽=0.6607, p<0.0001). Conclusion: In this study, it was confirmed that the prevalence of MCC increased with age, and the out-of-pocket medical cost increased in the case of MCC. Continuity of treatment can be achieved for patients with MCC, and the system and management of treatment for MCC are required to receive appropriate treatment.