초판발행 2023.12.07

We are very delighted that the book “History of Healthcare Policy in Republic of Korea” is going to be published.

This book provides information on the history and development process of Korea’s healthcare policy and the transformation process of the healthcare system. The vast amount of research data collected in this book is believed to be a major foundation for the development of the healthcare system and conducting research on policies in the future. In addition, We believe that this book can be an important resource tool for establishing healthcare projects and policies in developing countries.

The 2019 World Health Assembly adopted an ambitious resolution recognizing the role of healthcare system and policy in providing the full range of health services needed throughout the life course, including prevention, treatment, rehabilitation, and palliative care. Achieving the health?related SDGs, including UHC, will not be possible without a stronger healthcare system and policy.

The current healthcare system in Korea is the product of continuous development over the history of 80 years. Although the system is not in the ultimate, finalized state but still in the process of improvement in all dimensions, the Korean healthcare system has achieved a high level of development compared to that of advanced countries in terms of the health of national population or industrialization. However, this high level of healthcare system is not something that has been achieved by an overnight miracle or by simple adoption of other countries’ systems. The healthcare system as an institution is a historical product of continuous development in which all related parties in healthcare ? health professionals, those responsible for drafting and enforcement of health policy, and the general public ? are involved in shaping and changing the system to suit specific situations of Korea in the midst of turbulent changes that the society has experienced since the enlightenment period of the country. In this context, there is no doubt that the domestic healthcare system is currently in a highly mature stage, but it is also evident that there are still a range of problems that need to be addressed and resolved. In order to identify these problems, it is necessary to examine and study the historical background from an objective standpoint, draw implications for today’s healthcare system in Korea, and come up with rational solutions for real-world problems based on the lessons learned from the history. This will serve as a sensible and articulate basis for establishing the future direction and targets of the healthcare system in Korea.

In this book, the records from 1959 to 2020 related to governmental projects, policies, and institutions held by the government or healthcare-related organizations that are judged to have value in health history are investigated and objective accounts on the records and data are described. Thus, the healthcare policy and system have been described as “actions and products that are performed or produced for adequate combination of the state intervention and the principles of market economy for fair distribution of health and medical resources under the principle of equity and efficiency with a view to promoting public health and satisfying the demand for treatment of diseases”. Based on the definition and general perception, the content of this book is divided into three categories as follows. First, the overall public healthcare system in Korea has been reviewed. Second, in terms of healthcare policies implemented under this system, data and materials on health insurance, separation of dispensary from medical practice and healthcare industry have been reviewed. Third, data and materials on management of infectious disease in terms of prevention and disease management have been reviewed. However, all policies, projects, and institutions were not planned or implemented as a single, isolated policy or project, and all of these were executed or implemented in an organic and interdependent relationship. Therefore, Chapters 2 and 3 provide detailed information on the respective aspect, but in order to understand the relationship between these contents in a broader framework, it would be helpful to look into the overall historical flow from the viewpoint of healthcare policy considering the time of the milestone events in understanding the changes in healthcare system in Korea. In this context, this book provides an account on various projects, policies and institutions related to healthcare system of Korea in light of the change of the times with historical perspectives.

In order to share these valuable experiences and cases of healthcare policy in the international community, we are publishing an English of healthcare policy history.

This work is part of the Health and Medical Education Competency Enhancement Project of the University of Health & Allied Science (UHAS) in Ghana, which is facilitated by the Ministry of Education and supported by the National Research Foundation (NRF) of Korea.

The goal of this project is to make the UHAS experience a new leap forward as a health-specialized higher education institution in Ghana while strengthening the capabilities of community health education at UHAS’s medical school, nursing school, and health school.

The aim is to help UHAS cultivate differentiated healthcare professionals in the health sector who can then help improve the health standards in Ghana and other countries in Africa.

Therefore, we are preparing to provide a practical reference textbook that can provide information on building, changing, and implementing healthcare’s strategies so that professors and students can appropriately apply them in the field of healthcare in each stage of economic growth.

Further, we hope that this book will help establish realistic, affordable, and effective healthcare delivery systems and policy that are tailored to the economic and cultural level of each developing communities that still lack access to essential services for healthcare policy.

We sincerely appreciate the co?authors, editorial board members, researchers for helping us with this tedious and continuous work. We would like to thank to Dr. Yunhong Noh, Prof. Dong?hyun LEE, Prof. Sunjoo Kang, Prof. Yuri Lee, Prof. Sangsook Beck, and Dr. Siwoo Kim and the researchers, Ms. Hyojung Sea(saina), Ms. Dasol Jessica Ro and Ms. Jiwon Park for their invaluable assistance in participating in the project and helping write and edit this book. We also appreciate professional proofreading given by Editage.

Lastly, we would like to express our gratitude to the researchers who made efforts to publish this book while participating in the project, as well as the National Research Foundation of Korea(NRF) who supported the production of this book. We would also like to thank Parkyoung Publishing & Company for their guidance throughout this publishing process.

Dr. Myongsei SOHN

Chairman, RIGHT Fund

Former President, HIRA

Emeritus Professor, Yonsei University

Prof. So Yoon Kim

Yonsei University College of Medicine

Director, Asian Institute for Bioethics and Health Law

About the Representative Authors

Myongsei SOHN

MD, MPH, PhD, is a Chairman of RIGHT Fund and Executive Council member of Council for International Organization of Medical Sciences (CIOMS).

Now, he is working as a Executive Director, Institute for Global Engagement & Empowerment(IGEE), Yonsei University and Emeritus Professor of Department of Preventive Medicine and Public Health, Yonsei University College of Medicine in Korea. And he is Former President of Health Insurance Review and Assessment Service (HIRA) and Asia Pacific Academic Consortium for Public Health (APACPH). Also, he is Former Vice Chairperson of Executive Board for World Health Organization (WHO) and Former Member of International Bioethics Committee for United Nations Educational, Scientific and Cultural Organization (UNESCO).

So Yoon Kim

MD, MPH, PhD, is a Professor of Division of Medical Law and Ethics, Department of Humanities and Social Medicine, Yonsei University College of Medicine in Korea.

Now, she is working as a director of the Asian Institute for Bioethics and Health Law (WHO Collaborating Center for Health Law & Bioethics) and Division of International Health Science, Graduate School of Public Health, Yonsei University. And she is President of Korean Association of Medical Law and Asia Pacific Academic Consortium for Public Health (APACPH). Also, she is serving as editor-in-chief of the Journal of Global Health Science (JGHS) in the Korean Society of Global Health.

About the Co-Author Members

Yunhong Noh

PhD, is a Chairman of Korea Pharmaceutical and Bio-Pharma Manufacturers Association (KPBMA). He served as a Senior secretary to the President for employment and welfare and Commisioner of Korea Food and Drug Administration (KFDA).

Dong-hyun LEE

PhD. in public health. His PhD. thesis is “Improvement of Payment System for Chronic Disease Management; A Comparative and institutional study on the Case of USA and Japan.” He is a research professor at the Department of Global Health Science, the School of Public Health, Yonsei University. He majored in Health Administration at Yonsei University. His research interest is Global Health Science, Public Health Policy, Public Health Education and Quality Improvement of Health care Service Payment System.

Sunjoo Kang

PhD. in Law and Nursing, is a research professor at the Graduate School of Public Health, Yonsei University. With 13 years of experience as a nursing faculty member, she joined the university in 2019. She served as a nursing officer in the Korean Army and has actively participated in diverse global health projects since 2012. Sunjoo is an associate editor for the Frontiers in Public Health Journal and is recognized as a global nursing leader trained by the International Council of Nurses.

Yuri Lee

RN, MPH, MSc, PhD, is an Assistant Professor at the Department of Health and Medical Information at Myongji College in Korea. She has served as the Director of General Affairs of the Korean Society of Global Health. Also, she is a member of the Editorial Board of the Journal of Global Health Science.

Sang Sook Beck

MPH, PhD, is a Research Professor at the Graduate School of Public Health, Yonsei University in Korea. She also works as Secretary General of the Korea Golden Age Forum.

Siwoo Kim

RDH, PhD, is a senior researcher at SNU Medical Research Center, Institute of Environmental Medicine, Seoul National University in Korea. She studied in Yonsei University and participated in various ODA (Official Development Assistance) projects related to health.

Hyojung Sea (saina)

RN, MPH, is a Researcher of Asian Institute for Bioethics and Health Law of Yonsei University (WHO Collaborating Centre for Health Law & Bioethics) and Doctoral Program in Medical Law and Ethics, Yonsei University. She is a nurse with over 17 years of clinical experience, served as the team leader of the Slioam International Center for the Disabled People and participated the ODA projects such as international development cooperation, global health, and for international disabled.

About the Editorial Board

* Editor-In-Chief : So Yoon Kim

MD, MPH, PhD, is a Professor of Division of Medical Law and Ethics, Department of Humanities and Social Medicine, Yonsei University College of Medicine in Korea.

Now, she is working as a director of the Asian Institute for Bioethics and Health Law (WHO Collaborating Center for Health Law & Bioethics) and Division of International Health Science, Graduate School of Public Health, Yonsei University. And she is President of Korean Association of Medical Law and Asia Pacific Academic Consortium for Public Health (APACPH). Also, she is serving as editor-in-chief of the Journal of Global Health Science (JGHS) in the Korean Society of Global Health.

* Editorial Board Member

Yumi SON

MPH, is a Researcher of Asian Institute for Bioethics and Health Law of Yonsei University (WHO Collaborating Centre for Health Law & Bioethics) and Doctoral Program in Medical Law and Ethics, Yonsei University.

Jong Hyuk Lee

Consultant, World Health Organization Regional Office for the Western Pacific.

Dasol Jessica Ro

MBA, ia a Researcher of Asian Institute for Bioethics and Health Law of Yonsei University (WHO Collaborating Centre for Health Law & Bioethics) and Doctoral Program in Medical Law and Ethics, Yonsei University.

Jiwon Park

Researcher, Asian Institute for Bioethics and Health Law of Yonsei University (WHO Collaborating Centre for Health Law & Bioethics)

Eric Osei

PhD, Motivated faculty with over 19 years of progressive experience in Public Health practice and teaching. His area of expertise is community health and infectious disease control. At the moment, he holds a Ph.D in Public Health, specialising in epidemiology.

Prince Kubi Appiah

PhD. He is a Public Health Ethicist and Nutritionist, 26 years of continuous experience in Public Health Practice and Teaching and a Lecturer in the Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho - Ghana. He holds PhD in Medical Law and Ethics from Yonsei University, Seoul, South Korea, a Master of Public Health and a Bachelor’s degree from the University of Ghana, Legon.

Agani Afaya

He is a nurse with over seven years of clinical experience and a faculty member at the Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana.

Kennedy Diema Konlan

He is a faculty with the Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences. He has over nine years of working experience in primary health care and clinical care nursing in Ghana’s urban and rural communities.

Abdullatif Ghafary

Researcher, Asian Institute for Bioethics and Health Law of Yonsei University (WHO Collaborating Centre for Health Law & Bioethics)

Preface ⅲ

Chapter 1.

Overview of History of Healthcare Policy in Korea

Section 1. Before 1945; Historical Background of Healthcare Policy 3

Section 2. From 1945 to 1960s; Birth of Healthcare Policy 9

Section 3. From 1970s to 1980s; Expanding Healthcare Policies 13

Section 4. From 1990s to 2000s; Ongoing Efforts to Improve the
Quality of Life for the Public 19

Chapter 2.

Changes in policies for providing medical services in Korea

Section 1. Establishment of Public Health System 29

Section 2. Current Status and Future Development of Healthcare
Resources 35

Section 3. Changes in Health Care Organizations and the Present 45

Section 4. Aspects of the Development of Changes in the Health
Insurance System 57

Section 5. Changes in Drugs and the Pharmaceutical Industry 65

Section 6. Changes in Health Promotion Policies 81

Section 7. Promotion of Maternal and Child Health and
Implementation of Family Planning 89

Section 8. Changes in Policies for Disease Control and Eradication 101

Chapter 3.

Discussion of major issues with respect to changes in healthcare policy

Section 1. Beginning of the Debate on Bioethics and Safety
and the Transition Process 115

Section 2. Discussion on the institution of induced abortion 125

Section 3. Attempts to Introduce For-Profit Medical Corporations 135

Section 4. Conflicts of Various Issues Following Separation of
Prescribing and Dispending 147

Section 5. Traditional Korean Medicine Policy and Conflict between
Traditional Korean Medicine Doctors and Pharmacists 161

Section 6. Response to New Infectious Diseases and Public
Health Crisis 173

Reference 193

Table

<Table 1> Annual Trends of Public Health Centers and Community
Health Posts 30

<Table 2> Maternal and child health projects by life cycle 98

<Table 3> Main areas of debate on inclusion in the Bioethics Act 118

<Table 4> Types of medical corporation 138

<Table 5> Comparison between for-profit and nonprofit medical
corporations 139

Figure

<Figure 1> Health Care System from Medical Insurance Act 16

<Figure 2> Development objectives of Korea’s health industry
in stages 21

<Figure 3> Number of outpatients visits per capita (2018) 22

<Figure 4> Public Health Delivery System 31

<Figure 5> Medical insurance system (July 1977–November 1998) 60

<Figure 6> The first Western-style hospital, Jejungwon 66