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원석조,김은혜 한국보건복지학회 2019 보건과 복지 Vol.21 No.4
This paper is intended to find out why the private health insurances are center of the American medical security system and what the background of Obama Care was. For the purpose, the Social Security Act, the Medicare and Medicaid, the Managed Care and Obama Care were analysed on historical perspective. The results are as follows; First, a critical cause of the private insurance centered system of the American health care was the Social Security Act of 1935 which excluded the public health insurance. Second, Johnson Administration made Medicare for the aged and Medicaid for the poor. But workers and self-employed were not included in the national health security system. Third, the hospitals and the private insurance companies made the private insurances as center of the US health care system. They were sure that huge health care needs would made big medical market. Fourth, the weakest problem of the private health insurance is the blind spot of medical security. Near poverty group could not be beneficiaries of Medicaid and had not enough money for buying the private health insurance. Almost of them are minorities like blacks and hispanics. Fifth, the blind spot of the medical security system became the major social problem. Obama Care was a policy for solving it. Health care for the minorities was one of the presidential election pledge of Obama. He kept his promise. However, Obama Care’s future is uncertain because President Trump and the Republicans strongly want abolition of Obama Care. 본 연구는 민간건강보험이 미국 보건의료시스템의 중심이 된 원인과 오바마케어와 같은 보건의료시스템이 등장한 배경을 고찰하는 데 목적이 있다. 이를 위해 1935년 루스벨트 사회보장법, 1965년 존슨 정부의 Medicare와 Medicaid, 1980년대의 관리의료, 2010년 오바마 정부의 오바마케어를 분석하였다. 그 결과 첫째, 미국이 민간보험 중심의 보건의료시스템을 만든 근본 원인은 1935년 사회보장법 제정 시 건강보험(사회보험)을 제외했기 때문이다. 둘째, 존슨 정부는 Medicare와 Medicaid 등 공적 의료보장제도를 실시했으나 사회적 취약계층만 대상으로 하였다. 셋째, 일하는 계층의 의료수요에 주목한 병원과 보험회사가 민간보험회사를 설립해 의료서비스를 보험 상품으로 만들었다. 넷째, 민간건강보험의 가장 큰 약점은 의료보장 사각지대이다. 공공부조 대상이 아닌 차상위계층은 Medicaid 수급자에서 배제되었고, 값비싼 보험료로 민간건강보험에도 가입할 수 없었다. 다섯째, 오바마케어는 미국의 주요 사회문제인 의료보장 사각지대의 해소를 위해 마련되었다. 전 국민 의료보장을 공약으로 내건 오바마 후보가 대통령에 당선되어 실시될 수 있었지만, 오바마케어 폐지가 공언되어 앞날이 매우 불확실한 상황이다.
國民의 醫療保險 認識度에 관한 硏究 : 公職者를 中心으로
元奭朝 圓光大學校 1989 論文集 Vol.23 No.1
Civil servants and private school teachers are typical of middle class and major leading group of pub-lic opinions. Therefore, their attitudes toward the social welfare insitutions are considered most important the production of welfare ideology. In this study, both civil servants' and private school teachers' attitudes toward the medical insurance are empirically surveyed. To this, 1,000 insured persons of the medical insurance among civil servants and private school teachers are sampled through the multi-stage cluster sampling method. And for collecting the data, the questionaire method of personal self-administration is applied. The survey boils down to the following results : first, their understanding level of medical insurance is on a low level for their social status and educational background. Second, their attitudes toward it are contradictory. They are egoistic as well as altruistic. Third, their way of thinking tends toward ego-ism. Especially professors and teachers prove to be the group of the lowest understanding, contradictory and egoistic attitudes toward the medical insurance system. To conclude, I think that the most important value in social insurance and social welfare is nothing other than altruism, which should be the basis for furtherance of the Korean social welfare and, therefore, their attitudes would be a barrier to development of it.