08-이용갑

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. 2006 (, 2008 17, 2008)., 20., 2007 1883, (Niejahr, 2006).,,, (van de Ven, Beck, van de Voorde, Wasem & Zmora, 2007; Wasem, 2007). 2000 OECD., 20.. 1980., 1980 187

29(2), 2009, 186-212 Health and Social Welfare Review. 1883.,., 1883,,, (Busse & Riesberg, 2004; Bäker, Bispinck, Hofemann, Naegele & Neubauer, 2008).,... 2009 48,600, 4,050 (BMA, 2009). 2007 2,263 (BMA, 2008).,, 1) 2006. 2 1941.. 1987 Dekker,., 2006, (Exter, Hermans, Dosljak & Busse, 2004; Niejahr, 2006). 188

.. 85%,.,. 75%.. 2009 43,200, 3,600 (BMA, 2009).,. 2007 8,230 85.5% 7,040, 3.9% 320, 0.12% 10., 10.3% 850 (KBV, 2008). 100 1908 22,887 1951 1,992, 1991 1,135, 2009 202 (BMA, 2009). 1993, / 6 ( 1 )., (AOK),,. 15 33.9%., (BKK) 1,000. 2009 155 19.6%., (IKK) 1,000. 189

29(2), 2009, 186-212 Health and Social Welfare Review 15 23.7 33.9 155 13.7 19.6 1 14 5.5 7.9 1 1.7 2.4 9 0.9 1.3 2 1 2 24.5 35.0 2 7 202 70.0 100.0 : BMA. (2009). Übersicht über das Sozialrecht. 14 7.9%., (LKK),. 2009 9 1.3%., (BKnsch-Bahn-SeeKK),. 1 2.4%., 2 (Arb. EK) 2 (Ang. EK). 2009 8 2 35.0%. 6,,,, / 1. 2 2 1911 1 2. 2009 202 6 190

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29(2), 2009, 186-212 Health and Social Welfare Review. 1883. 16.,.,.,. (Mossialos & Le Grand, 1999; Saltman, Busse & Figueras (ed.), 2004). 1970 1980. 1980 1990. 1990 2000,. 1980.. 1982 1998 16 (CDU) 192

(CSU) (FDP). 19., (Bäker, Bispinck, Hofemann, Naegele & Neubauer, 2008). 1989,,. 1989,,,,, (Frerich & Frey, 1996). 1990 ( 2 ). 1990 1993, (Nagel, 2007). 1993, ( ), ( ) 3).,, ( ) 68., /.,, (Frerich & Frey, 1996). 1995, 3) 1993, 3. 193

29(2), 2009, 186-212 Health and Social Welfare Review ( 2 ). (CDU) (CSU) (FDP) 1997. 1996, 1997 0.4%., 0.1% 1DM, 1%., (Busse & Riesberg, 2004).,,,,,.,,,, (Nagel, 2007). 1992 109-4.78 1993 108 +5.33 1994 117 +1.11 1995 124-3.56 1996 126-3.98 1997 125 +0.0005 1998 128 +0.0006 1999 131-0.00008 2000 134 +0.0001 2001 139-2.69 2002 144-3.41 2003 145-3.44 2004 140 +4.02 2005 143 +1.78 : Busse & Riesberg. (2006). Health Care Systems in Transition, Germany, WHO Regional Office for Europe, 2004; AOK, Zahlen und Fakten 2005/2006. 194

1998 2005 (SPD) 90 (Bündnis 90 Drünie Gre),. (Busse & Riesberg, 2004). 1998,. 1997 (Nagel, 2007). 16 1998.,., (Busse & Riesberg, 2004; Nagel, 2007). 2000,. 2000 ( ),. 2000,,,., 2000. 195

29(2), 2009, 186-212 Health and Social Welfare Review (%) 8.40 10.50 11.38 12.53 13.24 13.52 13.58 14.00 14.35 14.27 13.77 13.38 13.97 14.00 15.50 : BMA. (2009). Übersicht über das Sozialrecht.. 40% 2002 11, 2002 11 7 2003 12. 2004 (Nagel, 2007). 2004. 10. 3~5%,, (KBV, 2004). 2004. ( 2 3 )..., 2004. 2006. 2005. 2004. 10 2004 1/4 10., 2004 1/4 380, 370 ( 4 ). 1% ( 3 ). 196

58.48-4.5 20.21 +0.5 8.83 +7.0 48.91-15.4 10.55-12.1 7.72-4.3 116.87 +1.9 15.89-11.4 5.68-10.5 5.36-2.6 2.47 +9.9 3.82 +3.4 17.96 +2.9 : KBV. (2004). Grunddaten zur Vertragsärztlichen Versorgung in Deutschland 2004. 2004,., (Nagel, 2007; Bäker, Bispinck, Hofemann, Naegele & Neubauer, 2008). 2005 2009 (CDU) (CSU) (SPD) 2005 11 197

29(2), 2009, 186-212 Health and Social Welfare Review. 2007,,. 2007. 2007 4 1, 2007 7 1. 2007 0.12% 10. 2007, 2007 4 1, 2009 1 1., 4)., 2007 500,. 2007. 50%, 50%,. 2007. 2005 11 2006 27, 2007 15 2008., 2007., 2008 15, 2009 40, 2010 15 140. 4) 2006 (Niejahr, 2006). 198

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29(2), 2009, 186-212 Health and Social Welfare Review.. 2007 30.9% 1993 (Nagel, 2007) 6). 2007 6 1. ( ), 1.. (AOK-Bundesverband, 2008). 2007 (Gesundheitsfunds). 2009 1 1 7)., ( 1 ) 8). 6) 2007 330.1 57.3% 189.0, 11.2% 36.9, 30.9% 102.1 (PKV, 2008). 7) 2009 1 15.5%.,. 200

8 9)., 1%.. 1,500 202 100 1,400... 8) 40, 6 106., 1 1.,,., (Drabinski, 2008). 9). 0.9% 1.0%, 1.9%. 201

29(2), 2009, 186-212 Health and Social Welfare Review 1993 (, 2007)..,,,, (Bäker, Bispinck, Hofemann, Naegele & Neubauer, 2008).,, (AOK-Bundesverband, 2008). 2007 2006 1,386.8 18.6% 258.3. 2003, 2007. (AOK) 2009 10. (AOK-Bundesverband, 2008). 2007.,. 2. 2007 20.,. 202

,,, (Nagel, 2007; Bäker, Bispinck, Hofemann, Naegele & Neubauer, 2008). (Goepffarth, Greß, Jacobs & Wasem, 2007).., 202... 2009, 2011 4 1883. 6 1 7,000.. 2009 100%, 2010 95%, 5%... (AOK-Bundesverband, 2008).. 2004 0.9% 1%..,, 1%. 203

29(2), 2009, 186-212 Health and Social Welfare Review. 4. 2007 2011., 4 2010 12 31. 2011 1 1,,..., /. 2007 2009.,.., 2008 1,511.2 15.1%., 10%, 0.25% (KBV, 2009). 2009. 2000 2005.. 204

.,.. 2008 32.7%., 2008 2009 67, 20 (AOK-Bundesverband, 2008).. 20 1883 / /,,,,,. 2007,,.. 1982 1998. 1998 2005 205

29(2), 2009, 186-212 Health and Social Welfare Review. 2005, ( 5 ). 2007., 2007, (CDU) (CSU) (SPD) (Hoffmann, 2006; Breyer u.a., 2006). GDP 6.4% 87.3% (CDU) (CSU) (FDP) (SPD) 90 Bündnis 90 Die Grüne) (CDU) (CSU) (SPD) 1989 1993 1997 1998 2000 2004 2007 ( 2005, 2009 ) ( ) ( ) / (2009 ) 206

..,. 2007 (Kumpmann, 2006). (FDP) 10)...., ( 17, 2008)..,,,,,.,.. 10) 2009 9 (CDU) (CSU) (FDP)., (CDU) (CSU). 207

29(2), 2009, 186-212 Health and Social Welfare Review.,. (E-mail: lankwitzer@empal.com). 208

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29(2), 2009, 186-212 Health and Social Welfare Review Reforms of the German Public Health Insurance during the Last Twenty Years and Their Lessons for the Korean National Health Insurance Yong-Gab Lee (Sogang University) Recent issues surrounding the reform of Korean National Health Insurance (NHI) include the introduction of a multi-insurers system with competition and efficiency, the limitation of the NHI in basic health security for the activation of private health insurance. But, the reforms of German Public Health Insurance during the last 20 years, especially the Reform 2007, provide definitely different lessons for the recent discussions of NHI reform in Korea. The major contents of the Reform 2007 are the coercion of public/private health insurance entry, extension of the state subsidy for the public health insurance, the state's direct management of the Health Insurance Funds that is comprised of state subsidies and contributions, the redistribution of the financial resources to Sickness Funds through the Health Insurance Funds. This study is to review the reforms of the German Public Health Insurance from the perspective of strengthening state's role and responsibility. The major lessons of the German reforms are not only in the strengthening of the state's role and responsibility for the public health insurance, but also in sharing financial burdens between all stake-holders of the public health insurance, maintenance of the fundamental functions and structure of the public health insurance through reforms. Keywords : Reform of the German Public Health Insurance, Health Insurance Funds, Strengthening the State s Role and Responsibility, Contribution Rate 212