中国醫疗卫生政策史研究 = A Study on the History of Chinese Health Care Policy

다국어 초록 (Multilingual Abstract)

A Study on the History of Chinese
Health Care Policy


Piao Xian
Advisor: Prof. Kim, Yong-Seob Ph. D.
Department of Social Welfare
Graduate School of Chosun University


History of social welfare can explain the creation and the process of development of social welfare policy. This study uses the development theory of social welfare policy to study China’s history of medical hygiene policy step by step, and analyze the practice of the policy and service offer to draw a new desirable implication in reformation of medical hygiene policy.
China’s social welfare policy that was put into practice since founding of the country in 1950, showed many problems as the reform and openness policy deepened. To solve this problem, Chinese government modified and supplemented social welfare policy through several system reformation. China achieved rapid economical growth after 1978 reformation and opening, but as the gap between area, class, and nation became bigger, developed medical hygiene policy reformation aggressively to ensure continuous growth and safety policy.
China started medical hygiene policy reformation since 1980’s and started new sweeping medical hygiene reformation in March 2009, with proclamation of “Opinion on reinforcement of medical hygiene policy reformation.” Basic idea of medical hygiene policy reformation is to provide all citizens with medical hygiene policy as public commodity so that everybody can enjoy the basic medical hygiene service, and institutionally guarantee equal basic medical hygiene service regardless of area, nation, age, gender, occupation and wage.
China’s basic medical hygiene policy is mainly composed of four systems and eight supports of medical hygiene. Four systems are public hygiene service system, medical service system, medical security system and medical supply security system. Eight supports are to improve medical hygiene care, management, investment, price, supervision, technique and manpower system structure, information and construction of the law to efficient running of the four systems.
In most countries, medical system could be said to have gradually improved from existing institutional frame. China’s medical hygiene policy was developed in China’s economy and social structure reformation, and therefore the development process had links to China’s economy and society. China’s medical hygiene system reformation is, like economical system reformation, is gradual reformation process. This gradual reformation process’s biggest characteristics is that it gradually expands rights of the lower agents of economy, and based on old system and as long as not causing rapid destruction, go through partial, phased practice to gradually expand.
Medical hygiene system, in any country, is decided by its politics and economical system. China’s medical hygiene reformation is a big part of reformation and opening. After 1949, China’s medical hygiene system brought three major changes, and this is actually changes of systems’ inner mechanism. China, under planned economy system, copied Soviet Union’s model and constructed medical hygiene system that combines procuring public resources, public service, public administration. With 1978 reformation and opening system, China’s medical hygiene industry achieved rapid improvement. The first and second reformation was a gradual change into market model from planned model. The third reformation was to realize separation of public administration with service, emphasizing social equality and clear the role of government and market.
This study considers history of China’s medical hygiene policy in steps and understands the structure and characteristics of policy to find out the reasons for change and formation of the policy to draw a desirable implication in new reformation of medical hygiene system. To achieve the goal of this study, analyzed development process of China’s medical hygiene policy using social welfare development theory. The results of study on China’s medical hygiene policy development are summarized as followings.
Formative period of medical hygiene policy can be seen as embodied by medical security system and medical hygiene system. At this time the government had control and monopoly in ownership, processing all expression of profit from profit agents through affiliated unit group. At this time, medical security system had three systems of communist medical system, worker medical system and rural cooperative medical system. Analyzing structure and characteristics of medical security system shows that the government has unconditional power, and medical system of this time applied the hygiene system model of Soviet Union, which is physically close, under planned economy, implementing hygiene supplement system that is under planned economy.
In other words, medical security system in formative period can be explained with diffusion theory and state-centric theory. At this time, medical hygiene service of this time was guaranteed in quality and quantity by the government with highly concentrated public service method, directly controlling investment and foundation of organization in medical hygiene. Also, supplying medical hygiene service was important policy means in maintaining the social order of the time. That is, medical hygiene service in formative period can be explained with state-centric theory and plot theory.
Transition period of medical hygiene policy can be considered four, public hygiene service system, medical service system, medical security system and medicine supply security system.
Country supplied the whole citizens with basic public hygiene service for free and in special disease and special area, country carried out critical public hygiene service project, directly implementing. In other words, public hygiene service system can be explained with social conscience theory by spread of social obligation and satisfaction of social desire and provided to public. After the reformation and opening, the important characteristics of medical hygiene area were innovation of technology, and it achieved rapid economical growth. Under the reformation of system, technology innovation revitalized the area of medical hygiene, and through market expansion effect, made the system to change towards high efficiency. With this characteristic, the medical service system, medical security system, medicine supply security system can be explained with rational theory.
Medical security system, with technical development of policy analyzing the systems’ establishment, practice and evaluation, made the system effective. This area can be explained by technology theory of social welfare development.
Medical hygiene system of this time was first started in order to realize the freedom of ideology, and classes of society were able to have the rights of individual profit and individual happiness, and pursuing individual rights became the basic idea of reformation. Institutional circumstances brought changes in quality, and with localized liberalization realized, many classes, groups, and individuals of the society started to pursue individual happiness.
The method of economical encouragement was to mobilize initiatives of medical organization and medical people, expanding medical service, and improve service quality. New medical hygiene reformation guarantees supplying basic medical hygiene system as public commodity to all people so that individuals can enjoy the basic medical hygiene service, and acquire basic medical hygiene service equally without discrimination in are, nation, ager, gender, occupation and wage. The major point of reformation is to separate the public administration with service to emphasize the social equality. The medical service system of this time has social justice theory and citizenship theory applied.

목차 (Table of Contents)

• 목 차
• ABSTRACT
• 제1장 서론 1
• 제1절 연구목적 1
• 제2절 연구범위 및 방법 6
• 1. 연구범위 6
• 2. 연구방법 7
• 제2장 이론적 고찰 8
• 제1절 사회복지사(社会福祉史) 연구에 대한 이해 8
• 1. 사회복지정책 8
• 2. 사회복지사 연구 18
• 제2절 사회복지 발달이론 26
• 1. 사회양심이론 27
• 2. 합리이론 28
• 3. 테크놀로지론 29
• 4. 시민권이론 30
• 5. 사회정의론 31
• 6. 음모이론 32
• 7. 국가중심적 이론 33
• 8. 확산이론 34
• 제3절 선행연구 검토 35
• 1. 중국의 의료위생체제 개혁 35
• 2. 중국의 의료위생 서비스체제 36
• 3. 중국의 의료보장체제 37
• 4. 중국의 약품공급체제 38
• 5. 선행연구의 한계 39
• 제3장 중국 의료위생정책의 발달과정 40
• 제1절 중국 의료위생정책의 형성 및 내용 40
• 1. 중국의 사회보장정책 40
• 2. 중국 의료위생사업의 현황 49
• 3. 중국 의료위생정책의 구조 및 내용 53
• 4. 중국의 의료위생체제 개혁 56
• 제2절 의료위생정책 형성기(1949∼1979) 60
• 1. 경제발전의 특징 61
• 2. 의료보장제도의 내용 62
• 3. 의료위생정책의 형성 및 변화 65
• 제3절 의료위생정책 전환기(1980∼2011) 67
• 1. 시장경제시기의 경제정책 67
• 2. 제1차 의료위생체제 개혁시기(1980∼1997) 69
• 3. 제2차 의료위생체제 개혁시기(1998∼2003) 77
• 4. 제3차 의료위생체제 개혁시기(2004∼2011) 84
• 제4장 중국의 의료위생정책 발달과정 분석 88
• 제1절 정책발달과정의 이익구조 88
• 1. 정책실행과정의 경제주체 88
• 2. 정책발달과정의 이익구조 변화 91
• 제2절 정책발달과정의 이론분석 102
• 1. 의료위생정책 형성기 102
• 2. 의료위생정책 전환기 110
• 제5장 결 론 125
• 제1절 연구결과의 요약 125
• 제2절 연구의 시사점 132
• 제3절 향후 연구방향 134
• 참고문헌 135
• 표 목 차
• <표 3-1> 계획경제 와 시장경제 시기 사회보장제도의 비교 48
• <표 3-2> 개혁전후 중국의 의료보장제도 비교 57
• <표 4-1> 중앙정부, 지방정부와 시장 간의 권력변화 96
• <표 4-2> 중앙정부, 지방정부와 시장 간의 권력변화(국립병원) 97
• <표 4-3> 경제주체의 자원우세와 전략선택 101
• 그 림 목 차
• <그림 3-1> 의료위생정책, 사회복지정책, 사회보장정책의 범위 42
• <그림 3-2> 중국의 사회보장체제 43
• <그림 3-3> 중국의 의료위생체제의 메커니즘 54
• <그림 4-1> 중국 의료위생정책 형성기의 이론분석 109
• <그림 4-2> 중국의 약품생산유통체제 122
• <그림 4-3> 중국 의료위생정책 전환기의 이론분석 124