한국노년학

The Korean Gerontological Society (한국노년학회)
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Literature Review on Empirical Studies of the Impact of Marketization on Quality of Care in Long-Term Care Sectors

장기요양서비스 시장화가 서비스 질에 미치는 영향에 대한 국내외 경험적 연구 리뷰(review)

  • Lee, Mi Jin (Department of Social Welfare, Konkuk University) ;
  • Joo, Eun-Sun (Department of Social Welfare, Kyonggi University)
  • 이미진 (건국대학교 사회복지학과) ;
  • 주은선 (경기대학교 사회복지학과)
  • Received : 2020.03.09
  • Accepted : 2020.04.20
  • Published : 2020.08.30
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Abstract

This study reviews empirical studies that investigated the impact of marketization of long-term care services on quality of care in Korea, England, Sweden, United States, and Japan. The trend and characteristics of marketization and regulatory system in those countries were compared. Since 2008 when long-term care insurance was introduced in Korea, we selected and reviewed empirical studies which were listed in the National Research Foundation, PubMed and Web of Science and examined the relationship between marketization and quality of care. Seven Korean, three English, two Swedish, seven American studies and one Japan study were identified and there was little evidence supporting that marketization would lead to better quality of care. Specifically, competition had no consistent relationship with quality of care while there was little evidence supporting that for-profit nursing homes tended to exhibit greater quality of care compared to non-for-profit nursing homes. The chains of for-profit nursing homes were revealed to have greater deficiencies. The findings of this review imply that improvement of quality of care may not be achieved by making for-profit nursing homes have chains. Reconstruction of nursing home markets should be needed, and the number and the proportion of public and non-for-profit nursing homes should be increased.

이 연구는 영국, 스웨덴, 미국, 일본, 한국 5개국 대상의, 장기요양서비스 시장화가 서비스 질에 미치는 영향에 관한 경험적 연구 결과를 리뷰(review)한 문헌연구이다. 본 연구에서는 먼저 한국, 영국, 미국, 스웨덴, 일본의 시장화 및 서비스 질에 대한 규제체계에 대해 비교하였다. 다음으로 우리나라 장기요양보험제도가 도입된 2008년부터 2019년까지 국내에서 출판된 등재지 또는 등재후보지 논문과, PubMed, Web of Science에 등재된 국외 논문 중 시장화와 서비스 질의 관계를 경험적으로 검증한 논문을 선별하여 리뷰하였다. 국내 논문 7편과 국외 논문 13편(미국 7편, 영국 3편, 스웨덴 2편, 일본 1편)을 리뷰한 결과, 시장화가 서비스 질을 향상시켰다고 보기는 어려운 것으로 나타났다. 구체적으로 경쟁이 서비스 질을 향상시킨다는 결과는 미약하였으며, 영리시설의 서비스 질이 비영리시설보다 우수하다는 근거는 찾기 어려웠다. 영리시설 체인화는 서비스 질에 부정적인 영향을 미친다는 근거가 제시되었다. 국내외 연구 분석 결과는, 영리시설의 체인화 등을 통해 서비스 질 개선방안을 추진하는 전략은 재고해 볼 필요가 있으며, 국공립시설 및 비영리시설의 확대를 통한 공급주체 재편 필요성이 있음을 시사한다.

Keywords

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