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TransKorea    [Video] Sick Around the World 세계의 의료보험 제도 (1/5) 영국

우리나라의 의료보험 제도에 대한 논의가 계속되고 있습니다.
정부는 계속해서 현재의 제도를 어떤 방향으로 바꿔야 하는지 고민하고 있고
국민들은 혹시나 정부가 "의료산업의 선진화"란 이름으로
대다수 국민들에게는 혜택을 줄이고
부유층에게는 고급 서비스를 제공하는
"의료 서비스의 양극화"를 초래하는 정책으로 바꾸지 않을까 걱정하고 있습니다.

미국도 의료보험 제도로 심각하게 고민하는 나라 중 하나입니다. 미국은 선진국 중 가장 비효율적인 의료보험 제도를 운영하는 것으로 알려져 있고 차기 대통령 후보들은 나름대로 대안을 가지고 선거 공약으로 내세우고 있습니다.

이에 미국의 공영방송인 PBS에서 5개 선진국(영국, 일본, 독일, 대만, 스위스)의 의료보험 제도에 대해서 취재했습니다.

과연 대한민국의 의료보험 제도는 어떻게 개선해야 하는지 고민하고 있는 우리에게도 좋은 참고 자료가 될 것 같습니다.

Sick Around the World

Tonight on FRONTLINE: American health care is in big trouble. It's the world's most expensive medical system, yet it leaves 47 million people without coverage and drives hundreds of thousands into bankruptcy each year.

I believe the problem is not that folks are trying to avoid getting health care. The problem is they can't afford it.

We are approaching a perfect storm of problems that if not addressed by the next president, will cause our health care system to implode.

I am not running for president to put band-aids on our problems. I want to get to universal health care for every single American.

In the middle of our national debate, Washington Post reporter T.R. Reid journeys to five countries--

Have you ever paid a medical bill?

No, never.

--and finds out how other rich free-market democracies provide health care for all.

How many people in Switzerland go bankrupt because of medical bills?

Nobody. It doesn't happen. It would be a huge scandal if it happens.

Tonight on FRONTLINE, what it's like to be Sick Around the World.

That's the capitol of the richest, most powerful nation in history. But when it comes to providing health care for people, that great country, our country, is a fourth-rate power. The World Health Organization says the U.S. health care system rates 37th in the world in terms of quality and fairness. All the other rich countries do better than we do, and yet they spend a heck of a lot less. How do they do it? That's what this film is about. We're going to go around the world to see what lessons we can learn to fix America's sick, sick health care system.

I've covered the world as a foreign correspondent, and right now, I'm writing a book about health care systems overseas. First stop on my tour is Great Britain, where our family lived for five years. Even though the U.K. is our closest European ally, its health care solution -- that is, the government-run National Health Service -- may seem too close to socialism for most Americans.

Still, we can learn something here. For about half of what we pay per person, the NHS covers everybody and has somewhat better health statistics-- longer life expectancy, lower infant mortality.

Britain's National Health Service is dedicated to the proposition that you should never have to pay a medical bill. In the NHS, there's no insurance premium, no co-pay, no fee at all. The system covers everybody. And you know, when we lived here, my family got really good care from the NHS, although we often had to wait to see a doctor. And yet the newspapers here are full of NHS horror stories-- rationing, waiting lists, terrible mistakes. So I've come to London to see this NHS. Is it an answer for the U.S. or just some horrible socialist nanny state?

The Brits pay for health care out of tax revenue, so the government owns the hospitals, like this one, the Whittington Hospital in North London. The doctors who work here are salaried government employees. Does that sound like socialized medicine?

(영국의 과감한(?) 사회주의적인 의료제도 – 대부분의 병원은 국가의 공공기관이고 의사는 공무원 – 는 이 나라가 국민건강과 보편적인 의료 서비스를 어떻게 생각하고 있는지 알게 해준다.)

Well, according to the hospital CEO, David Sloman, the Brits like it that way.

I think people are proud of it. Ninety percent of people who use the NHS think it's good or excellent, so people think very, very highly of it. People who don't use it don't think so well of it, actually.

Would you say most British people go their whole lives and never get a medical bill?

Every single person who's born in the U.K. will use the NHS at one point in their lives. The majority of people will use it as the only provider of their medical care, and none of them will be presented a bill at any point during that time.

No medical bills. Sounds sweet to me. And here's something else that's different. There's no medical bankruptcy.

This is Jeremy Cadle. His son, Tom, is being treated for leukemia at the Whittington. At least he doesn't have to worry about going broke.

He's had eight weeks in hospital. Apart from the times when he needs chemotherapy, we've got community health care that comes in on a weekly basis to take his blood. Hasn't cost us a penny. You know, it's astonishing the care you can get.

Of course, it's not free. The Brits pay much higher taxes than we do to cover health care. But even so, does it sound a bit too good to be true? To find out, I sought out a long-time NHS watcher, Nigel Hawkes of The Times, for a more critical perspective.

Look, this all sounds really sweet. Does it work?

It works in some respects. I think primary care, the family doctor service, is pretty good. And emergency care works quite well. Where I think it can fall down is on elective care-- hip replacements, heart operations, this kind of thing. It used to be on the order of 18 months to get a new hip. That's been greatly reduced by the current government over the last 10 years. It's down to certainly less than 6 months, and for most people about 2 or 3.

(이런 문제점은 당연히 있으리라 본다. 대다수의 국민이 동등한 대우를 받으며 의료 서비스를 받는 상황에서는 고가의 치료를 받으려면 그만큼 기다려야 할 것이다. 이것은 돈의 문제가 아니다. 물론 돈이 많은 사람은 기다리지 않고 외국으로 가서 치료를 받고 올 수 있겠지만 적어도 영국 내에서는 누구나 평등하게 기다려야 한다.)

There are 400,000 fewer people on waiting lists than in 1997. Waiting times--

In the last decade in Britain, Tony Blair and other politicians have reduced the waiting lists. They did it by spending more money and by bringing some market mechanisms into a government-run system. Today, government-owned hospitals like the Whittington compete against each other for government money. In today's NHS, patients can choose which hospital to go to.

Oh, of course, we compete. You know, we do on our Web site-- you book in, we'll make sure you can book into our place as least as quick as all the other places around here. But we're all competing around what I think are now respectable margins, whereas previously, you know, it was 6 months or 7 months. Now in some specialties, I could proceed tomorrow.

It's easy to see why choice might suit patients. But what do government-run hospitals get out of it?

We don't understand why people would compete when you can't make more money. In America, people compete to make profit.

Yes. That's a very fair point. I mean, here you would compete in order to survive because if you start losing patients to another hospital, your services are going to be under threat.

(아주 중요한 문제이다. 이익을 내지 못하는데 무엇을 위해 경쟁하는가? 그들은 생존하려고 경쟁한다고 한다. 그렇다. 경쟁이라는 것이 꼭 이익 추구가 전제되는 것은 아니다. 우리나라에도 지방자치단체들, 비영리 단체들이 서로 좋은 서비스를 제공하려고 건전하게 경쟁하는 것을 어렵지 않게 볼 수 있다.

현재 우리나라도 의료법인은 영리를 추구하지 못하게 되어있다. 병원 운영에서 이익이 발생하면 해당 병원에 투자해야 한다. 그런데 만약 병원이 일반 기업과 마찬가지로 이익을 얻어 주주들에게 배당하기 위해서 운영된다면 어떤 상황이 발생할까. 아마도 현재 미국의 의료산업이 보이고 있는 빈익빈 부익부의 상태와 크게 달라지지 않을 것이다.)

What we've seen over the past 10 years is a move away from Bevin's ideal of a NHS for all. We've seen the creeping privatization of services--

When I was in London, I stumbled on this rally in Trafalgar Square, and I discovered that many NHS staffers are angry about these new trends that could close some of the less popular hospitals. They were also protesting government plans to privatize some NHS services.

You're probably 50, or even more than that. Have you ever paid a medical bill? Have you ever paid a medical bill?


No, never.

Will you ever pay a medical bill in your life?

Not Likely.

I hope not.

We don't want to.

This is why we're doing this. We don't want to. And even in 10 years' time, if we're not around, we don't want our kids to do it, either.

While the hospitals struggle with reforms, the GPs have embraced them. I went to visit one who practices in the West London neighborhood of Shepherds Bush. In Britain, health care starts here. Nobody can to go directly to a specialist. First you have to go to a gatekeeper like Dr Ahmed Badat.

He's a family doctor, a general practitioner. GPs hold down costs for the system and give people what the Brits call a medical home. My family had one just down the street, and we liked it. GPs are paid a fixed amount based on the number of patients they have. The average list is 1,800 people.

(우리나라도 이 family doctor/gatekeeper 제도를 심각하게 검토해 보아야 한다. 현재 우리나라에도 1/2/3차 진료 기관의 제도가 있지만 효율적으로 운영되지 않는 것이 사실이고 많은 사람들이 아직도 무작정 처음부터 유명 대형 병원으로 가서 기다리고 있다. 해결되어야 할 문제이다.)

And get this. They make a bonus for keeping their patients healthy. So when Dr. Badat does a good job of caring for patients with diabetes and heart disease, he gets paid more. How much more?

It works out about 90,000 pounds.

So that's increasing your salary by $180,000 a year. That's not bad.

Yes. [laughs]

(아주 중요한 이슈이다. 의료비용을 줄이는 가장 효과적인 방법 중의 하나는 적극정인 예방을 통해서이다. 그런데 우리나라는 이러한 부분들이 아직 매우 취약하다. 단적인 예가 치과의 스케일링이다. 스케일링은 건강한 치아를 유지하기 위한 1차적이고 가장 일반적인 예방책인데도 불구하고 의료보험이 적용되지 않는다. 아주 잘못된 것이다. )

I'm reading the newspaper. It says docs are doing well here.

I can't complain.

Dr. Badat has had personal experience with U.S. medicine. He had a heart attack while on vacation in Las Vegas and was rushed to the county hospital.

The treatment was absolutely fantastic. But you know, I was there eight days. The total bill came to $67,000. I mean, that is preposterous.

Critics say Britain has the opposite problem: Care costs the patients too little here.

Do you have patients who come twice a week or something?

Yes. There's always like that.

Are they sick, or--

No. I think they're just lonely people, they are, so just want somebody to chat to. But then there are people I never see at all. And they come and register, I don't see them for three years, five years.

(예상될 수 있는 문제이다. 의사를 만나는데 돈이 한 푼도 들지 않으니 동네에서 외로운 어르신들은 어디가 조금만 이상하더라도 의사를 방문하여 대화를 나누려고 할 것이다. 하지만 인터뷰에서 영국 family doctor가 말하듯이 모든 사람이 그런 것은 아니다. 다시 말해서 이런 문제가 제도 전체에 치명적인 결함을 가져다 주는 것은 절대 아니라는 것이다.)

With access this easy, the doctor and the system have a strong incentive to keep people healthy. The result, Britain has become a world leader in preventive medicine. Just look at all these services GPs here aggressively promote and talk to their patients about.

To sum up then, there's a lot to like in Britain-- no bills, NHS waiting lists are getting shorter, there's excellent preventive medicine. But there's probably still too much government here for American tastes, even if the NHS is trying to be more market-savvy.

영국의 제도에 대해서 어느 정도 이해가 되시나요? 다음 segment는 일본입니다.