한국 노인수발 보장제도의 정책과정에 관한 연구

Abstract

This thesis investigates the policy process of long-term care security for the elderly which consists of five stages such as agenda setting, policy formation, policy decision, policy implementation, and policy evaluation. It accounts for three stages(except for policy implementation and evaluation) which have currently been inactive. Investigated are some important issues arisen from the policy process involving the following stages: the first how to select the long-term care problems as a policy agenda, the second how to make these proposals, and how to determine the correct policy among alternatives. By using the framework proposed by Gilbert & Specht for social welfare policy the present thesis analyzes the alternatives and the final determination systematically for four dimensions such as bases of social allocation, types of social provision, strategies for delivery, and modes of finance. First, it was noted that the long term care problem was submitted to the government agenda with some political purposes and not by the public. This way may be called a mobilization model because some social problems are not suggested as a political agenda by the public and the government gets the prevailing opinion after the agenda is institutionalized. Second, the plans were formed shortly and intensively for the long-term care security system agenda by a task force team that included professionals. This task force team was capable to efficiently make policy initiatives. This team had limitations for maintaining public support and for propagating contrary issues because some issues were discussed only by a few groups in a restrictive manner. The result was that other perspectives and other proposals were not examined fairly. Third, the government lopsidedly determined the final plan at the policy decision stage in spite of strong disagreements. This decision process was often made behind closed doors. It seems to be one of representative features for the top-down decision mode and similar with some of the features appearing in the garbage-can model. Next, as the results obtained by using the framework of social welfare policy it was noted that there were a number of problems in long-term care systems for the elderly. The long-term care security act was announced into a legislative framework in October, 2005. However, it encountered serious solicitudes and criticisms from citizen organizations and social groups. This was because the allocation and provision of the acts was curtailed substantially in comparison with the long-term care insurance act that had been recommended as a final proposal in policy formation stage. Besides, expensive charge for users, inaccurate finance estimator, and lower fixed insurance bill were major problems. Moreover, there were a lot of things that were disagreeable between the central government, the local autonomy, and the public and private sectors about the share of responsibility in service delivery system finance. It is noted that even today the infrastructure of a long-term care service becomes absolutely deficient and the social agreements are insufficient for the social insurance system of a long-term care security. Those problems are very crucial in implementing the policy. From results, the present thesis involves some concluding remarks and suggestions, which are summarized as follows: it is emphasized that the policy process for long term care security act should be reconsidered, considering the policy formation stage, the reconsidered issues, and the renewed policy process. At least modes of finance must continuously maintain public support. Since long-term care service for the elderly is provided in the community more elaborate effects should be made to establish a service delivery system that includes the role of local autonomy in more detail.