노인장기요양보험제도의 개선방안에 관한 연구 : 지역선교 실천적 접근을 중심으로

다국어 초록 (Multilingual Abstract)

People pursue happiness through social welfare. Happiness, however, cannot be

found only with personal well-being and efforts, as exemplified by Eden, a

paradise which God created. By creating Eden, God fostered an environment

where people will not experience any inadequacy. And God created humans in

his own form, giving them the authority to rule and conquer all beings in

Eden. This is recognized as the very first case of social welfare practice.

We discover the importance of social welfare from Eden, a beautiful,

lush place created by GOD, because we encounter God’s vast, impressive and

everlasting love towards the mankind. The details are as follows:

First, the first commandment of the promise that God gave us was to

never eat fruits from the tree of knowledge in any case. God gave us the

commandment to let us know that God is with us humans forever, and let us

experience his full grace, thereby leading us to thanking, praising and

honoring God, which is the final goal of Christian social welfare.

Second, even in such an abundant and lush environment as Eden,

happiness and joy cannot be achieved through personal efforts. God took a

rib from Adam, after watching him live alone for some time, to create Eve

as his companion, his flesh of flesh, so as to form a family community

where people found their needs satisfied. God practiced social welfare in this

way, and walks with the mankind with love and grate that grow larger ever

more.

We use the term “poverty in the midst of plenty.” The modern

society gives us the illusion that there is nothing wanting here, that we can

enjoy anything we want.

Such twofold characteristic of human life puts more importance on

welfare. People cannot enjoy even the equal rights to survive and pursue

happiness under the current socialistic welfare system: in this sense,

empowering the democratic Christian social welfare is given great importance.

God loves the mankind, and finds joy in everyone’s happiness. The

humans, however, broke the promise with God out of their futile desires. This

led to destruction of their home of happiness, subjecting themselves to

everlasting punishments, wandering through the burning pit of conflicts and

wars, through the cycle of deaths and pain, ending in their punishment in

hell.

Despite such betrayal, God pitied us the humans, and sent us Christ,

the “sacrificial love and welfare” reincarnated, so as to open a new road of

blessing, an everlasting, warm and true rest, a way to life as human beings,

for us, leading to achieving full intervention and implementation of well-being

of spirit, soul and body.

This study sheds a new light on christian social welfare, an area

which had been lost from our attention, to explore the relationship between

the current welfare system and Christian missions, for the purpose of

discovering what role the long-term care insurance system for aged must play

in terms of Christian mission, as well as realizing that God gave us Eden,

we lost the opportunity for true “freedom, peace and happiness”, and that

happiness through welfare is a precious gift that only God may provide.

Long-term care insurance system for the aged presents a new way

for Christian mission today. The program has been receiving much attention

from various nations around the world, which South Korea implemented for

the third time in the world, after Germany’s care insurance and Japan’s care

insurance. The South Korean program ensures stable treatment, protection and

living by rating the patients suffering from various senile diseases, and

relieving their families of financial burden and psychological/physical

suffering. This program holds great importance as a service system.

Under the program, however, not everyone suffering from, or

diagnosed with senile diseases benefit equally from the program. Therefore,

this study seeks to point out various issues of the long-term care insurance

system for the aged, and propose a way to provide social services to the

poor, ill and alienated people through the teachings of Jesus described in the

Bible, and propose a way to create disciples of Jesus through active

participation in mission social welfare (Christian social welfare) designed to

complete the sacrificial mission of Jesus to save our souls, and discover

missionary aspects of the long-term care insurance system, thereby presenting

the fundamental idea of the social welfare while completing the Jesus’

commandment for us in this world.

In conclusion, the Christianity and the Christians seek to discover and

establish the effects of the “long-term care insurance system for the aged” on

Christian missions, as well as the relationship between mission and welfare.

Thus, the study aims to contribute to implementing Christian social welfare in

the spirit of commitment, sacrifice and love of Jesus Christ, subsequently

helping to realize true happiness through welfare approached from the

spiritual, psychological, social, evangelistic and missionary perspectives.

국문 초록 (Abstract)

사회복지에서 인간은 누구나 행복을 추구하고자 한다. 그러나 행복이란 혼

자만의 풍요로운 삶과 노력만으로 이루어 지지 아니함을 하나님께서 창조

하신 에덴동산에서 찾게 된다. 하나님께서는 에덴동산을 통하여 인간이 살

아가기에 조금도 부족함이 없는 환경을 조성하여 놓으시고, 하나님의 형상

을 따라 사람을 창조하신 후에 에덴의 모든 것을 다스리고, 정복하도록 하

셨다. 이는 최초의 사회복지를 실현한 것으로 인식한다.

하나님께서 아름답고, 풍요롭게 창조하신 에덴동산에서 사회복지

의 중요성을 발견함은 인간을 향하신 하나님의 크고도 놀라운, 영원하신

사랑을 발견하게 될 수 있기 때문이다. 그 내용은 다음과 같다:

첫째는, 하나님께서 인간에게 주신 약속의 첫 계명으로, 에덴동산

중앙의 선악과는 절대적으로 따먹지 말라는 것이었다. 이는 사회복지에서

의 약속으로서 그 이유는 하나님이 인간과 영원히 함께하시며, 창조하신

풍성한 은혜와 은총을 누리게 하기 위함이요, 기독교 사회복지의 최종 목

표인 하나님께 감사와 찬송과 영광을 돌리게 하기 위함이다.

둘째로, 사회의 환경이 에덴동산과 같이 풍요롭고, 풍성하다 할지

라도 혼자의 삶으로는 참된 기쁨과 행복을 누리지 못한다. 에덴에서의 홀

로 사는 아담의 모습을 보시고 갈빗대 하나를 취하여 뼈 중의 뼈요, 살

중의 살인 돕는 배필로써 여자인 하와를 만드셔서 인간의 욕구 해결과 가

정이라는 공동체를 이루게 하심으로 사회복지를 실천하셨고, 더 크신 사

랑과 은혜로 인류와 함께하신다.

우리는 현대를 가리켜 말하기를 “풍요속의 빈곤”이라고 한다. 인간

이 살아가기에 조금도 부족함이 없는 듯한, 착각 속에 빠지게 하여, 누구

나 모든 것을 누리며 살아갈 수 있는 것처럼 한다.

이러한 인간의 이중적인 삶의 환경이기에 “복지의 중요성”이 더욱

강조 되고 있는 것이다. 현재의 사회주의적인 복지체계로써는 인간이 누

릴 최소한의 생존권과 행복추구권이 누구에게나 공평하게 누릴 수 없으므

로 민주적인 기독교 사회복지의 역량 강화가 매우 중요하다.

하나님은 인간을 사랑하시며, 모두가 행복하기를 기뻐하신다. 그

러나 에덴동산에서 인간에서 주셨던 언약을 인간의 헛된 욕망으로 하나님

과의 약속은 파괴되었다. 따라서 인간에게 주어진 행복의 보금자리가 파

괴 되었고, 영원한 징벌을 받아 사망을 비롯한 온갖 고통의 둘레 속에서

방황과 싸움과 전쟁의 늪에서 헤매며 지옥 형벌을 받아야 할 처지가 되었

다.

그런데도 하나님께서는 인간을 불쌍히 여기셔서 새로운 산길, 축

복의 길, 영원토록 따스하고 포근하며, 참된 안식으로, 인간답게 살아갈

길을 열어주시기 위하여 “희생적 사랑의 복지인” 예수 그리스도를 보내주

시므로 영 혼 육의 온전한 복지의 개입과 실천을 이루셨다.

본 연구에서는 지금까지 상실 되었던 성경적인 기독교 사회복지

의 재조명을 통하여, 선교적인 측면에서 현재의 복지와의 관계성을 연구

하면서 지금의 노인장기요양보험제도가 선교적 의미에서 어떠한 역할을

해야 하며, 하나님이 에덴에서 주셨던 것으로 인간이 누릴 진정한 “자유와

평화와 행복” 등의 상실한 것을 살펴보면서 복지에서의 행복은 오직, 하나

님께로부터 오는 고귀한 선물임을 발견하고자 한다.

오늘날 기독교의 선교의 새로운 방안이 되는 노인장기요양보험

제도는 세계의 많은 국가들의 주목을 받는 제도로서 독일의 수발보험, 일

본의 개호보험에 이어 세 번째로 이루어진 제도이다. 이 제도는 노인복지

법에서 말하는 질병의 종류에 따른 노인성 질병으로 인하여, 고통을 당하

는 환자분들이 등급을 통하여 안정적인 치료와 보호 및 생활을 보장받게

하며, 가족들에게는 물질적인 부담과 정신적, 신체적인 고층을 덜어주는

서비스 체계로서 매우 중요한 제도이다.

하지만 노인성 질병을 갖고 있거나, 진단을 받았다고 누구나 공정

한 혜택을 받지 못하고 있다. 그러므로 본 연구를 통하여 노인장기요양제

도의 문제점을 제기하며, 성경에서 나타난 예수의 사상으로 가난하고, 병

들고, 소외된 이들에게 사회적 서비스를 제공받도록 하며, 영혼구원을 위

한 그리스도의 희생적 선교를 완성하기 위한 선교적 사회복지(기독교사회

복지)의 적극적인 참여를 통하여, 예수의 제자화 방안을 제시하고, 노인장

기요양보험제도에서의 선교적인 측면을 발견하여, 예수 그리스도의 지상

명령을 이루어 가며 사회복지가 추구하는 근본 사상을 전달하려고 한다.

따라서 기독교와 그리스도인들은 “노인장기요양보험제도”가 선교

에 미치는 영향과 선교와 복지와의 관계를 새롭게 발견하고, 정립하고자

한다. 이를 위하여 영적, 심리적, 사회적, 복음적, 선교적 차원에서의 복지

를 통한 참된 행복을 누리도록 그리스도의 헌신적인 희생과 사랑의 정신

으로 기독교적 사회복지를 실현하는데 기여 하고자 한다.

목차 (Table of Contents)

• 서론
• 제1절. 연구의 목적 ······························································1
• 제2절. 연구내용 및 연구의 방법·············································3
• 제1장 연구의 이론적 배경·····················································6
• 제1절. 선행연구 고찰····························································6
• 제2절. 선교와 사회복지와의 관계············································7
• 2.1. 선교에 대한 이해························································9
• 2.2. 복지선교의 발전 과정················································13
• 2.3. 복지와 선교와의 관계성·············································20
• 제2장 노인장기요양제도에 대한 이해·····································25
• 제1절. 사회보험제도로서 노인장기요양보험제도··················25
• 1.1. 독일의 수발보험제도··················································25
• 1.2. 일본의 개호보험제도··················································29
• 1.3. 한국의 노인장기요양 보험제도····································35
• 1.3.1. 요양보호제도 목적에서의 요양보호의 필요성············35
• 1.3.2. 요양보호의 기능··················································38
• 1.3.3. 요양보호제도의 기본 원칙·····································43
• 1.3.4 요양보호제도의 서비스 유형···································44
• 제2절. 노인장기요양제도에 있어서의 문제제기···································45
• 2.1. 노인장기요양제도의 근본 목적에 대한 문제제기············45
• 2.2. 노인장기요양제도에 있어 등급기준의 대한 문제점·········46
• 2.3. 노인장기요양제도에 있어 등급판정의 문제점··············· 47
• 2.4. 노인장기요양기관에 있어 평가기준 및 포상금 제도의 문제
• 점·······································································49
• 2.5. 서비스 이용자에 대한 문제제기···································50
• 2.5.1. 요양원 종사자에 대한 수급자 및 보호자 인식의 문제
• 점··································································50
• 2.5.2. 가족요양의 문제점···············································51
• 2.5.3. 바우처 서비스의 문제점·······································53
• 2.5.4. 본인 부담금에 대한 문제점···································53
• 2.6. 서비스 인력배치에 대한 문제점···································54
• 2.6.1. 인력기준에 대한 문제점········································54
• 2.6.2. 직원급여의 문제점(요양보호사의 수)·······················57
• 2.7. 서비스 시설기준에 대한 문제제기·······························58
• 2.7.1. 각종 시설의 면적 기준·········································58
• 2.7.2. 노인요양원 생활 면적의 문제점······························61
• 제3장 노인의료복지서비스로서의 노인장기요양보험제도···············63
• 제1절. 의료복지서비스로서의 기관·········································63
• 1.1. 의료복지시설의 개념···············································63
• 1.1.1. 노인복지시설의 개념 이해·····································63
• 1.1.2. 노인복지시설의 종류와 유형··································64
• 1.1.3. 노인의료복지시설의 입소 기준과 대상자··················65
• 1.1.4. 노인성 질병의 종류·······································68
• 제2절. 전문기관으로서의 요양기관·······································70
• 2.1. 전문화, 세분화되어야 한다·(노인의료복지시설 중심)··71
• 2.2. 요양시설 입소 신청자격 및 입소기준 조정의 필요성···73
• 제4장 노인장기요양과 지역선교 발전방향····························79
• 제 1 절 . 사회복지사업법에 의한 보조 및 선교적 지원· · · · · · · · · · · · · · · · · · · · · 8 1
• 1.1. 정부 보조사업의 주체················································82
• 1.2. 사회복지사업의 주체로서의 교회··························85
• 제2절. 등급 기준에 있어서의 선교적 역할·························86
• 2.1. 등급 기준에 대한 문제점············································86
• 2.1.1. 등급판정 조사표·················································86
• 2.1.2. 등급인정에 대한 위원 문제 제기····························89
• 2.1.3. 조사에 있어 지역에 있는 기독교의 역할·················91
• 제3절. 등급판정위원회의 목회자 개입에 대한 제언····················· 94
• 3.1. 현재의 등급위원회·············································94
• 3.2. 등급판정위원에 지역교회 참여 제안·························96
• 3.3. 장기요양 판정의 다양한 제안···································98
• 3.3.1. 전문성을 지닌 전문가를 통한 판정·························98
• 3.3.2. 프로그램을 통한 등급판정 참여····························100
• 제4절. 서비스 이용자에 대한 제언································102
• 4.1. 노인장기요양보험 운영비의 주체·······························102
• 4.2. 노인장기요양보험 이용 중단에 대한 방안····················104
• 4.3. 요양원의 특성화된 프로그램 활용을 통한 선교적 지원 방
• 안·······························································109
• 4.4. 근로자를 통한 선교적 방안 제안······························111
• 4.4.1. 근로자의 근무 현황··········································111
• 4.4.2. 근로자의 근무 현황에 따른 선교 제안···················113
• 결 론················································································115
• 참고문헌···········································································123
• 영문초록············································································130