정책의 복잡성과 진화 : 의약분업정책을 중심으로
저자
발행사항
서울 : 고려대학교 대학원, 2008
학위논문사항
발행연도
2008
작성언어
한국어
주제어
발행국(도시)
서울
형태사항
viii, 217 p. : 삽도 ; 26 cm.
일반주기명
지도교수: 김영평
참고문헌 : p. 199-211
DOI식별코드
소장기관
This dissertation explains the policy case of the separation of dispensary from medical practices with the framework of complexity theory that emphasizes such key notions as chaos, disorder, non-equilibrium, non-linearity, and wholeness. Important conceptual features of a complex adaptive system (i.e., self-organization, path-dependence, sensitivity to initial conditions, co-evolution, and emergence) are applied to the case analysis of the medical-dispensary separation policy.
This study concludes that the separation policy was emerged in the self-organized process where the medical-dispensary policy system, an organic network consisting of numerous actors, co-evolves and interacts in various ways with external environments and other complex systems.
Firstly, the emergence of the separation policy occurred in the self-organization process that maintains structural integration by a self-generated order of medical-dispensary separation. In a long-term horizon, the new separation-centered order was created by an incremental process in which the past autogeneous non-separation system that was indeed structurally integrative has gradually moved to non-equilibrium status via intra- and extra-system fluctuations such as dramatic changes in political environments (e.g., 5/16 military coup d'état and the inauguration of Kim Daejoong Administration), the start of medical insurance system, and oriental medicine strife.
Second, there has been the strong path-dependence of medical-dispensary non-separation transmitted from in social genes ingrained in oriental medical tradition and the public's long familiarity with integrated services. The path-dependence characterized as both Korean tradition and public convention of non-separation has continuously blocked the medical-dispensary separation policy. Another component causing the path-dependence upon non-separation was the committee system that had existed as a kind of standard operation procedure (SOP) despite the fact that the committee failed in resolving medical-dispensary strife.
Third, participation of civic groups in the policy-making process showed active feedback in interaction with other groups and policy institutions to the extent to which it had a great influence on policy-making system and the degree of policy problem complexity. The unexpected and unintended consequence of this feedback arose from sensitivity to initial conditions.
Fourth, co-evolutionary characteristic described both the process that health insurance system and medical-dispensary policy mutually affects and the process that this mutual influences were fed back to political, economical, social, cultural, and health-medical environments. The health insurance system excludes dispensary services from that insurance policy so that the unbalance between medical interests and dispensary ones let Korean Pharmaceutical Association and governmental authority drive the separation policy. Furthermore, the health insurance system served as a factor to constrain the medical-dispensary separation policy because it always had a higher policy priority than the separation policy. The separation policy breakdown due to the conflict among interest groups was fed back to the health insurance system by dampening the expansion of regional medical insurance or by contributing to the promotion of dispensary health insurance.
The enforcement of health insurance system catalyzed fragmentation of medical groups. Between-group heterogeneity and conflicts led to active participation of fragmented groups in decision-making processes. The serious confrontation among medical interest groups resulted in the 2000 decision less advantageous for medical society than for dispensary one. However, between-group conflicts in collective action processes such as a general strike of the entire medical society increased the number of demanded suggestions and make decision-making procedure complicated; resultingly, the separation policy was amended more favorably for the medical society. The excessive hike in medical fees that was set in the policy correction process was later fed back to health insurance system and medical-dispensary separation, and brought about unintended problems like financial troubles and the increase of total medical charges.
Conclusively, the current version of medical-dispensary separation policy has matured conditions for its implementation in the long-term interaction process of the policy system with political, economic, social, cultural, and health-medical environments (i.e., social factors such as democratization of political system, economic growth, rich-and-poor gap, traditional factors such as oriental medical heritage and non-separation convention, gradual increase in the number of medical doctors, organizations, and pharmacists, the removal of no medical practitioner, the implementation of health insurance system, and oriental medicine strife etc.). And in a short-term horizon, the initiation of the medical-dispensary separation policy has displayed the new emergence in the overall level of health-medical system via the process by which the policy system interacts with a serial of events such as the inauguration of Kim Daejoong Administration, political democratization, participation of civic groups, redemption system in real transaction price, conflicts among groups within medical society, and a general strike of medical society.
Characterized by these features as complex adaptive system, the dynamic change of the medical-dispensary separation policy was similar to the evolution through continuous interaction of an organism with environment. The evolutionary process of the medical-dispensary separation policy can never be satisfactorily explained by substantial or procedural rationality as traditional concepts of rationality.
Evolutionary rationality suggested in this dissertation is assumed to follow through co-evolutionary process as if a biological organism does. Evolution means self-generated change by going through mutual adaptation to environment without predetermined goals and given direction. Hence, evolutionary rationality does not presuppose a priori rational goals or causality beforehand; instead, it implies rationality as intelligence that is expanded through co-evolutionary process by temporary, partial, and regional mutual adaptation and selection between policy and a whole system. In this context, evolutionary rationality of policy refers to the process to improve rationality of policy by extending knowledge via trial-and-errors and learning by experiences.
In the viewpoint of evolutionary rationality, policy can be improved when partial changes are facilitated but that of a whole is evolutionary. For better evolution, it is crucial to accept and enhance diversity of species, flexibility, variability, and integratibility between heterogeneous elements. Regional experiment is a useful way to better a policy by stimulating partial changes.
Even under the reality of complexity, government agencies and policy-related groups would try to make a limited albeit rational decision. The notion of evolutionary rationality is helpful for ultimately rational decision-making of a government. The government will better manage national policies by the guarantee of specific diversity, the incremental increase in local social experimentation, the accumulation of experiences through policy successes and fiascoes, knowledge expansion and innovation diffusion by imitation and learning effect, and the collection of partial and regional rationality that helps minimize social costs in the advent of unanticipated spillover effects
분석정보
서지정보 내보내기(Export)
닫기소장기관 정보
닫기권호소장정보
닫기오류접수
닫기오류 접수 확인
닫기음성서비스 신청
닫기음성서비스 신청 확인
닫기이용약관
닫기학술연구정보서비스 이용약관 (2017년 1월 1일 ~ 현재 적용)
| 주요 개정내역 | 변경 사유 |
|---|---|
| · 개인정보 처리 목적, 항목 및 법적 근거 수정 · 본인대상정보전송요구권 행사 방법 안내 · 개인정보 보호수준 평가 결과 추가 |
|
한국교육학술정보원은 정보주체의 자유와 권리 보호를 위해 「개인정보 보호법」 및 관계 법령이 정한 바를 준수하여, 적법하게 개인정보를 처리하고 안전하게 관리하고 있습니다. 이에 「개인정보 보호법」 제30조에 따라 정보주체에게 개인정보 처리에 관한 절차 및 기준을 안내하고, 이와 관련한 고충을 신속하고 원활하게 처리할 수 있도록 하기 위하여 다음과 같이 개인정보 처리방침을 수립·공개합니다.
목 차
제1조(개인정보의 처리 목적)
제2조(개인정보의 처리 및 보유 기간)
제3조(처리하는 개인정보의 항목)
제4조(개인정보파일 등록 현황)
제5조(개인정보의 제3자 제공)
제6조(개인정보 처리업무의 위탁)
제7조(개인정보의 파기 절차 및 방법)
제8조(정보주체와 법정대리인의 권리·의무 및 그 행사 방법)
제9조(개인정보의 안전성 확보조치)
제10조(개인정보 자동 수집 장치의 설치·운영 및 거부)
제11조(개인정보 보호책임자)
제12조(개인정보의 열람청구를 접수·처리하는 부서)
제13조(정보주체의 권익침해에 대한 구제방법)
제14조(추가적 이용·제공 판단기준)
제15조(개인정보 보호수준 평가 결과)
제16조(개인정보 처리방침의 변경)
제1조(개인정보의 처리 목적)
제2조(개인정보의 처리 및 보유 기간)
5년
(「전자상거래 등에서의 소비자보호에 관한3년
(「전자상거래 등에서의 소비자보호에 관한
제3조(처리하는 개인정보의 항목)
제4조(개인정보파일 등록 현황)
개인정보파일 검색(privacy.go.kr)| 개인정보파일의 명칭 | 수집·이용 근거 | 수집·이용 목적 | 수집·이용 항목 | 보유·이용기간 |
|---|---|---|---|---|
| [학술연구정보 서비스 이용자 가입정보] |
「개인정보 보호법」 제15조 제1항 제4호(계약 이행) |
회원 서비스 운영 |
ID, 비밀번호, 이름, 생년월일, 신분(직업구분), 이메일, 소속분야, 보호자 성명(어린이회원), 보호자 이메일(어린이회원) |
회원탈퇴시 까지 |
| 「전자상거래 등에서의 소비자보호에 관한 법률」 제6조 및 같은 법 시행령 제6조 |
주문 및 결제 처리 |
ID, 비밀번호, 이름, 주소 |
5년 |
제5조(개인정보의 제3자 제공)
제6조(개인정보 처리업무의 위탁)
제7조(개인정보의 파기 절차 및 방법)
제8조(정보주체와 법정대리인의 권리·의무 및 그 행사 방법)
제9조(개인정보의 안전성 확보조치)
제10조(개인정보 자동 수집 장치의 설치·운영 및 거부)
제11조(개인정보 보호책임자)
| 구분 | 담당자 | 연락처 |
|---|---|---|
| KERIS 개인정보 보호책임자 | 정보보호본부 안재호 |
- 이메일 : jinuk@keris.or.kr - 전화번호 : 053-714-0158 - 팩스번호 : 053-714-0195 |
| KERIS 개인정보 보호담당자 | 개인정보보호부 송진욱 | |
| RISS 개인정보 보호책임자 | 교육학술데이터본부 정광훈 |
- 이메일 : giltizen@keris.or.kr - 전화번호 : 053-714-0149 - 팩스번호 : 053-714-0194 |
| RISS 개인정보 보호담당자 | 학술진흥부 길원진 |
제12조(개인정보의 열람청구를 접수·처리하는 부서)
제13조(정보주체의 권익침해에 대한 구제방법)
제14조(추가적인 이용ㆍ제공 판단기준)
제15조(개인정보 보호수준 평가 결과)
제16조(개인정보 처리방침의 변경)
자동로그아웃 안내
닫기인증오류 안내
닫기귀하께서는 휴면계정 전환 후 1년동안 회원정보 수집 및 이용에 대한
재동의를 하지 않으신 관계로 개인정보가 삭제되었습니다.
(참조 : RISS 이용약관 및 개인정보처리방침)
신규회원으로 가입하여 이용 부탁 드리며, 추가 문의는 고객센터로 연락 바랍니다.
- 기존 아이디 재사용 불가
휴면계정 안내
RISS는 [표준개인정보 보호지침]에 따라 2년을 주기로 개인정보 수집·이용에 관하여 (재)동의를 받고 있으며, (재)동의를 하지 않을 경우, 휴면계정으로 전환됩니다.
(※ 휴면계정은 원문이용 및 복사/대출 서비스를 이용할 수 없습니다.)
휴면계정으로 전환된 후 1년간 회원정보 수집·이용에 대한 재동의를 하지 않을 경우, RISS에서 자동탈퇴 및 개인정보가 삭제처리 됩니다.
고객센터 1599-3122
ARS번호+1번(회원가입 및 정보수정)