Política pública; Salut pública; Actuacions ; Política publica; Salud pública; Actuaciones ; Public policy; Public health; Actions ; Documento de bases del Plan interdepartamental de salud pública (PINSAP). Incluye una primera parte que ilustra la influencia de los determinantes sobre la salud de las personas y las poblaciones y resume los antecedentes y los planteamientos sobre los que se basa el modelo de intervención que se propone, que, junto con los propósitos y objetivos, constituye el segundo apartado del documento. El documento recoge aportaciones y consideraciones sobre cada una de las áreas de actuación identificadas por el Grupo de Trabajo del Departamento de Salud a partir de una adaptación del modelo de determinantes de Dahlgren y Whitehead referidos a las condiciones de vida y trabajo y que tienen que ver con el entorno, el urbanismo y vivienda, la movilidad, la educación, el empleo, el sistema sanitario y la alimentación. Dada la importancia que tiene el tiempo libre, sobre todo en algunas edades, se ha añadido al modelo un apartado al respecto, en el que se han incluido los aspectos relacionados con la cultura. Finalmente, se incluyen propuestas del ámbito de las políticas sociales. En cada apartado se reflejan posibles líneas prioritarias de intervención para mejorar estas condiciones, promover la equidad y disminuir las desigualdades sociales que las afectan, y de esta manera reducir las desigualdades en salud que son injustas y evitables. En este capítulo también hay una selección necesariamente incompleta de buenas prácticas en marcha que pueden servir para promover nuevas actuaciones. ; Document de bases del Pla interdepartamental de salut pública (PINSAP). Inclou una primera part que il·lustra la influència dels determinants sobre la salut de les persones i les poblacions i resumeix els antecedents i els plantejaments sobre els quals es basa el model d'intervenció que s'hi proposa, que, juntament amb els propòsits i objectius, constitueix el segon apartat del document. El document recull aportacions i consideracions sobre cadascuna de les àrees d'actuació identificades pel Grup de Treball del Departament de Salut a partir d'una adaptació del model de determinants de Dahlgren i Whitehead referits a les condicions de vida i treball i que tenen a veure amb l'entorn, l'urbanisme i habitatge, la mobilitat, l'educació, l'ocupació, el sistema sanitari i l'alimentació. Donada la importància que hi té el lleure, sobretot en algunes edats, s'ha afegit al model un apartat sobre això, en el qual s'han inclòs els aspectes relacionats amb la cultura. Finalment, s'hi inclouen propostes de l'àmbit de les politiques socials. En cada apartat s'hi reflecteixen possibles línies prioritàries d'intervenció per tal de millorar aquestes condicions, promoure l'equitat i disminuir les desigualtats socials que les afecten, i d'aquesta manera reduir les desigualtats en salut que són injustes i evitables. En aquest capítol també hi ha una selecció necessàriament incompleta de bones pràctiques en marxa que poden servir per promoure noves actuacions.
본 논문은 대외정책 분야에서 드러나는 미국 대통령제의 운용원칙인 권력분립을 미국식 민주주의의 사각지대로 접근하는 시각을 제시하여 선행연구와 차별성을 추구한다. 구체적으로 헌법이 천명하는 권력분립 원칙에도 불구하고 오히려 그 권력분립의 기제인 상호간 독자적 선거제에 의해 미국의 유권자 전체가 선출한 대통령은 각 지역구에서 선출된 입법부 구성원이 내세우는 집합적 통치 위임과 확연하게 구별되는 유일한 공공리더십(public leadership)을 정책결정과정에서 독점할 수 있다는 점을 주시하고자 한다. 결국 미국 대통령제의 과제는 미국식 민주주의의 주요 통치원칙인 권력분립을 중시하는 동시에 성공적 통치를 위해 권한공유의 묘(妙)를 찾는 부단한 노력을 경주해야만 가능하다는데 있다. 특히 국내정책 분야보다 대외정책 분야에서 이 난제의 해법을 모색하는데 있어서 법제도적 및 정치적 장애물이 가로막혀 있다. 게다가 선거결과와 무관하게 통치 위임을 생성하는 정치의 사법화가 입헌 대통령제의 근간을 흔들 수 있는 위험성을 목격했다. 이에 본 논문은 대외정책 분야의 미국 대통령제에 대한 평가를 권력분립의 양면성, 즉 권력분립은 권력공유를 전제로 한다는 패러독스에 중점을 두고 대통령의 우위에 대한 주장을 가능하게 하는 헌법적 및 정치적 근거를 대조하면서 미국식 민주주의의 사각지대를 재조명하고자 한다. ; In this paper, I argue that the principle of separation of power in foreign policy under presidentialism invites a blind spot in American democracy. Although the Constitution specifies separation of power both in the conduct of domestic and foreign affairs, independent elections of President and legislators differentiate the kind of collective mandates on Capitol Hill from the unitary mandate bestowed upon President, thus prompting him to proclaim public leadership. The key to a successful governing, then, lies in the art of pursuing "separated institutions sharing powers" persistently. However, the realm of foreign affairs poses a more challenging task, both constitutionally and politically, than its counterpart in domestic policy. Furthermore, we came to witness a modern presidency whose relentless claim on mandate, or what is dubbed as judicialization of politics, was found irrelevant to the electoral outcome itself, thus creating a peril in constitutional presidency. In this paper, I explore this paradox in American democracy by comparing across constitutional and political sources of such claims. ; 이 논문은 2010년도 정부재원(교육과학기술부 학술연구조성사업비)으로 한국연구재단의 지원을 받아 연구되었음(NRF-2010-327-B00027). ; OAIID:oai:osos.snu.ac.kr:snu2010-01/102/0000040203/1 ; SEQ:1 ; PERF_CD:SNU2010-01 ; EVAL_ITEM_CD:102 ; USER_ID:0000040203 ; ADJUST_YN:Y ; EMP_ID:A076716 ; DEPT_CD:216 ; CITE_RATE:0 ; FILENAME:미국학논집4202.pdf ; DEPT_NM:정치외교학부 ; EMAIL:okyeonh@snu.ac.kr ; SCOPUS_YN:N ; CONFIRM:Y
The municipal social services must give precedence to or regain the main role of citizens in taking social decisions at a municipal level, by providing innovative mechanisms to express and coordinate, thus allowing for greater participation fromcitizens and social entities. The article analyses the contributions and opportunities for civic participation, and goes deeper into the democratisation of public policies in the municipal sphere. A systematic and reflexive assessment of the contexts, objectives, dimensions, opportunities and mechanisms aimed at incorporating civic participation into social services management. In addition, results and conclusions are presented from recent empirical research into participation in municipal social policies, comparing the reality and trends in studies and experiences, both nationally and internationally. ; Els Serveis Socials municipals ha de prioritzar/recuperar el protagonisme ciutadà en les decisions socials municipals mitjançant la innovació en l'articulació i coordinació de mecanismes que permetin una més gran participació dels ciutadans i de les entitats socials. L'article realitza una anàlisi de les contribucions i oportunitats de la participació ciutadana per aprofundir en la democratització de les polítiques públiques en l'àmbit municipal. Una avaluació sistemàtica i reflexiva dels contextos, objectius, dimensions, oportunitats i mecanismes orientats a incorporar la participació ciutadana en la gestió de serveis socials. Es presenten, a més, resultats i conclusions d'una recent investigació empírica sobre la participació en l'àmbit de les polítiques socials municipals, tot comparant realitats i tendències en estudis i experiències d'àmbit nacional i internacional. ; Los Servicios Sociales municipales deben primar/recuperar el protagonismo ciudadano en las decisiones sociales municipales mediante la innovación en la articulación y coordinación de mecanismos que permitan una mayor participación de los ciudadanos y de las entidades sociales. El artículo realiza un análisis de las contribuciones y oportunidades de la participación ciudadana para profundizar en la democratización de las políticas públicas en el ámbito municipal. Una evaluación sistemática y reflexiva de los contextos, objetivos, dimensiones, oportunidades y mecanismos orientados a incorporar la participación ciudadana en la gestión de servicios sociales. Se presentan, además, resultados y conclusiones de una reciente investigación empírica sobre la participación en el ámbito de las políticas sociales municipales, comparando realidades y tendencias en estudios y experiencias de ámbito nacional e internacional.
In contemporary democratic societies most administrations manage their competences by means of programmes of government action, i.e. using public policies. These aim to resolve publicly identified situations or conflicts, as well as design strategies and / or implementation tools by means of action programmes derived from political - public administration agreements that have the objective of resolving these collective problems. Within this framework it is necessary to evaluate these processes so as to identify if the programmes established by the governments have been adequate, and if they have been capable of solving the various problems and of reaching the target groups in order to satisfy their needs and improve the situation of the final beneficiaries. This research proposes the analysis and measurement of cultural events, understood as acts of implementing a public policy, in order to later discover if evaluating a policy by means of the proposed analysis of the impacts is possible. Therefore the challenge of this research is found in the process of analysing cultural impacts so as to be able to observe if this analysis process can be adapted to the effectiveness analysis of a public policy. ; En les societats democràtiques contemporànies, la majoria de les administracions gestionen les seves competències per mitjà de programes d'acció governamental, és a dir, les polítiques públiques, destinades a resoldre situacions identificades públicament. Així doncs les estratègies i/o eines d'implementació per mitjà dels programes d'acció - acords de l'administració pública- tenen l'objectiu de resoldre aquests problemes col•lectius. Dins d'aquest marc, cal avaluar aquests processos, per tal de determinar si els programes establerts pels governs han estat suficients, si han estat capaços de resoldre els diversos problemes i si han arribat als grups objectiu per tal de satisfer les seves necessitats, millorant la situació dels beneficiaris finals. Aquesta investigació proposa l'anàlisi i la mesura dels esdeveniments ...
Background: Bankrupted households have recently been increased due to excessive medical expenditure in Korea. They have not been protected from economic risk when household's member has severe diseases that need a lot of money for treatment. Purpose of this study examines policy effect by comparing unmet needs' change of policy object households and non-object groups. Methods: We used Korea Health panel 2nd 4th data collected by Korea Institute for Health and Social Affairs and National Health Insurance Service. Analysis subjects were 381 households (pre-policy) and 393 households (post-policy) that had cancer and cardiovascular and cerebrovascular diseases. Since it was major concern that estimates benefit strengthening policy started by certain time, we setup comparing households which had diabetes, hypertension disease. Comparison subjects were 393,247 households, respectively and we evaluated policy effect using difference in difference (DID) model. Results: Although unmet needs of policy object households were higher than non-object groups, policy execution variable affected negative direction. But interaction-term which shows pure effect of policy was not statistically significant. We utilized multi-DID model to examine factors affecting unmet needs causes. Copayment assistance policy did not significantly affect households that responded to 'economic reason,' and 'no have time to visit' for unmet needs causes. Conclusion: The second copayment assistance policy did not significantly give positive effect to beneficiary households than non-beneficiary groups. When we consider that primary purpose of public insurance guarantee high medical expenditure occurred by unexpected events, it needs to deliberate on switch of benefit strengthening policy that can assist vulnerable people. Also, we suggest that government forward a policy covering non-reimbursable medical expenses as well as switch of benefit strengthening direction because benefit policy do not affect non-covered medical cost which accounts for quarter of total health expenditure. ; open
학위논문(박사)--서울대학교 대학원 :의과대학 의학과,2020. 2. 강영호. ; 1. Background Low-quality services of emergency medical institutions, unclear function of institution classification, and overcrowding of emergency departments (ED) of regional emergency medical centers (regional centers) have been major problems in the Korean emergency medical services system (EMSS). In 2015, the Middle East Respiratory Syndrome (MERS) outbreak spread from patients waiting for hospitalization in the overcrowded ED. The MERS outbreak was an event that revealed the vulnerability of EMSS and opened the policy window to solve the problem of EMSS in Korea. Several policies for EMSS improvement were implemented after the 2015 MERS outbreak focusing the improvement of emergency medical services (EMS) delivery system and ED infection control. This study investigates the policy processes for improving emergency EMSS and infection control program after the MERS outbreak. The purpose of this study was to examine the policy processes regarding EMSS from the view of policy actors and draw lessons for improving the EMSS in Korea. 2. Methods A mixed method was utilized to identify and explain the complex subject of the policy processes of Korean EMSS during and after the MERS outbreak in 2015. As a quantitative study, changes in EMSS after MERS were investigated according to the WHO's model of a national health system infrastructure. Literature review and data analysis of Korean Health Insurance Service (NHIS) database were conducted. In Korea, the NHIS covers all citizens. A quantitative analysis was performed on 16,965,755 cases using ED during 2014-2016. In-depth interviews were conducted on 30 experts, who were involved in the emergency medical policy process, including clinicians, policy experts, and hospital management experts. The total interview time was 55 hours and 4 minutes. Changes in EMSS and the policy process after the MERS outbreak were evaluated from the view of policy actors. In this study, quantitative data was interpreted qualitatively, and independent qualitative evaluation was conducted, as well. Therefore, this research is a mixed-methods study focusing on qualitative research. SAS version 9.4 was used for the quantitative analysis and NVivo 12.0 was used for the qualitative analysis. 3. Results The quantitative analysis results showed that in the area of EMS delivery system, the human resource of ED and number of regional centers have been increased and facility, equipment, and manpower standards have been revised in order to expand emergency medical resources. As a result, the number of medical personnel and emergency intensive care units in regional centers increased and profitability of ED improved as well. The number of monthly ED visits temporarily decreased during the MERS outbreak but then recovered afterward. As ED overcrowding indicators were emphasized in the evaluation of EMS institutions, monthly mean ED length of stay of regional centers was decreased. However, despite the emphasis on providing critical care, transfer rate of severe emergency patients was not decreased. In the policy processes of EMS, experts evaluated that EMS delivery system was set up as a pseudo-agenda and exploration and comparison of policy alternatives were not sufficiently carried out. As a result, the physicians did not comply with the policy implementation and policy goals were not achieved. In the area of ED infection control program, the human resources for infection control and the number of isolation unit of ED were increased. Budgets for emerging infectious disease management were increased and profitability of infection control was also improved. The EMS Act was revised to respond to emerging infectious diseases and indicators related to infection control were strengthened in evaluation of EMS institutions. In the qualitative research, experts said that since the ED infection control program was such an intuitive and obvious problem, it was easy to become a policy-agenda. Despite the resistance of small hospitals, ED infection control program was implemented by powerful policy measures such as the revision of the Law. As a result, policy goals of expanding the infection control resources and improving the infection management environment were able to be achieved. From results of observing EMS policy process, the following characteristics of policy actors were found. First, there was difference of opinions within the physician subgroup as well as between government and medical professionals. ED staff, other department staff, and hospital executives, who have different views on policy alternatives could have all served as veto points in the policy process. Second, while the EMSS expert organization, which was an unofficial participant in the emergency medical policy process, could have played both roles of cause group and sectional group in the policy process, their sectional position has been emphasized, thereby weakening their insider status during policy process. Third, policy actors understood the publicness of EMS differently in terms of its ownership and function. The ED staff insisted that government support is needed because emergency medical care is based on public interest, however, some staffs were unwilling to provide less profitable cares, leading to conflict. Main characteristics of the emergency medical policy process that made it difficult to successfully implement are as follows: First, there was lack of consideration regarding variation of EMSS in Korea, such as distribution of medical resources among different regions, incentives to hospitals, and understanding of functional variations in ED. Second, the problem of the EMS delivery system was a problem of the low quality of emergency medical care. Third, the lack of professionalism in some physicians has lowered the capacity of emergency medical care, as well as trust between patient and doctor, therefore made the problem more difficult to solve. 4. Discussion Based on the analysis of the policy processes of the EMSS after the MERS outbreak in Korea, following lessons are suggested. First, setting the goals of EMS from the perspectives of citizen is warranted. The final performance goal should focus on improving health status of citizen and satisfaction with emergency medical care. Second, to close the gaps among policy actors in understanding policy content and policy process, actors should work together to explore the root causes of the problems and establish a policy agenda together. Third, a policy alternative should be causal in solving the problems in EMSS considering variation of EMS. Fourth, compliance with policies could be secured by internal persuasion among policy actors with proper incentives and reasonable punishment, especially EMSS expert organization. Fifth, policy outcomes should be evaluated based on both policy output and side effects together to identify policy impact. Sixth, policy governance regarding EMSS should be established and the roles of EMSS expert organization should be strengthened as the cause group rather than sectional group. This study examined the emergency medical policy processes from the view of policy actors through the 2015 MERS outbreak in Korea. The improvement of EMSS should be based on understanding of the emergency medical policy process and policy actors. ; 1. 서론 응급의료기관의 응급환자 진료 역량부족과 불명확한 종별 기능 구분, 일부 응급실의 과밀화는 한국 응급의료체계(emergency medical services system, EMSS)의 고질적인 문제였다. 2015년 과밀화된 상급종합병원 응급실에서 입원대기 중이던 환자로부터 메르스(Middle East Respiratory Syndrome, MERS) 유행이 확산되었다. 메르스 유행은 우리나라 응급의료체계의 취약성이 드러난 사건이자 응급의료 문제를 해결할 수 있는 정책의 창이 열린 사건이었다. 정부는 메르스 유행 이후 여러 가지 응급의료 개선정책을 추진하였다. 이 연구는 취약한 응급의료 전달체계 하에서 응급환자 감염관리의 실패로 인해 메르스 유행이 발생했다는 점에 문제의식을 두었다. 그래서 응급의료 전달체계와 응급환자 감염관리 영역에서 메르스 유행 이후 이루어진 정책과정과 그로 인한 변화를 분석하였다. 응급의료 정책행위자의 관점에서 정책과정과 정책결과를 분석함으로써, 향후 응급의료 개선을 위한 정책과정에서 고려해야 할 점을 도출하는 것이 이 연구의 목적이다. 2. 연구방법 메르스 유행 이후 응급의료 정책과정 분석이라는 복잡한 주제를 파악하고 설명하기 위하여 혼합연구방법(Mixed methods research)을 사용하였다. 양적연구로 문헌고찰과 국민건강보험공단 자료 분석을 통해 메르스 유행 이후 응급의료체계의 변화를 보건의료체계의 구성요소별로 조사하였다. 한국은 1989년 전국민 의료보험제도를 도입하여 전 국민이 국민건강보험에 가입되어 있는 국가이다. 메르스 유행 전후 응급실 이용 변화를 조사하기 위하여 국민건강보험공단 DB의 2014-2016년 응급실 이용 진료건 16,965,755건을 분석하였다. 질적연구로 응급실 의료진, 정책 전문가, 병원 경영진 등 응급의료 정책과정의 관련 전문가 30명을 대상으로 심층면접을 수행하였다 전체 심층면접 분량은 55시간 4분이었다. 심층면접을 통해 정책 행위자의 관점에서 메르스 이후 이루어진 응급의료 정책과정을 고찰하고, 응급의료체계의 변화를 조사하였다. 양적연구 결과를 질적연구로 해석하고 질적연구로 독자적인 분석을 수행하여, 이 연구는 질적연구가 중심이 된 혼합연구로 볼 수 있다. 양적연구의 분석에는 SAS version 9.4를 사용하였고, 질적연구 분석은 NVivo 12.0을 사용하였다. 3. 연구결과 응급의료 전달체계 영역에서 응급의료 자원을 확대하기 위해 권역응급의료센터(권역센터)가 확대되고 시설·장비·인력기준과 관련 수가가 개정되었다. 그 결과 권역센터의 의료인력과 응급중환자실 병상 수가 증가하고 수익성이 개선되었다. 달빛어린이병원 사업을 확장한 결과 달빛어린이병원 수도 증가하였다. 응급실 과밀화를 완화하기 위해 응급의료기관 평가에 재실시간 지표를 수가연동지표로 도입하고 응급의료에 관한 법률에 응급의료센터 24시간 이상 재실환자 관리 규정을 넣었다. 그 결과 응급실 월별 방문환자 수는 2015년 메르스 유행 당시 일시적으로 감소한 후 지속 증가 추세이나, 권역센터 응급환자의 월별 재실시간 평균은 2014-2016년 기간 동안 감소 추세를 보였다. 응급의료기관의 응급환자 진료역량을 강화하기 위해 응급의료기관 평가에 중증해당환자 최종치료 제공 관련 지표를 강화하였으나 2017-2018년 기간 중증응급환자의 전원율은 개선되지 않았다. 전문가들은 응급의료 전달체계 개선은 위장의제(pseudo agenda)로 설정되어 정책대안 탐색과 비교평가가 충분히 이루어지지 않았으며 점중주의적으로 쓰레기통 모형의 정책결정이 이루어졌다고 평가하였다. 그 결과 정책대상집단인 의사들은 정책집행에 순응하지 않았고, 정책은 집행 후에도 정책목표를 달성하지 못했다. 응급환자의 감염관리 영역에서 권역센터 시설·장비·인력기준과 감염관리실 설치기준 및 인력기준이 개정되어 응급실 감염관리 자원이 확대되었다. 정부는 응급실 방문객 관리를 도입하고, 감염예방관리료 등 감염관리 관련 건강보험 수가를 신설하였으며, 신종감염병 대응 관련 법률 등 감염관리 관련 법률을 개정하여 응급실 감염관리 여건을 개선하였다. 전문가들은 응급환자 감염관리는 직관적이고 명확한 문제라는 특성이 있어 병원 내 감염관리 강화로 의제화되기 쉬웠다고 평가하였다. 감염관리 개선정책은 보호적 성격을 가진 규제정책으로 집행 과정에서 중소병원을 중심으로 일부 병원의 반발이 있었다. 그러나 응급의료에 관한 법률 개정과 같은 강력한 정책수단을 사용하여 집행된 결과, 응급실 감염관리 자원확대와 감염관리 환경개선이라는 정책목표를 달성하였다. 응급의료 정책행위자들의 관점에서 응급의료 정책과정을 관찰한 결과 다음과 같은 정책행위자의 특징을 발견하였다. 첫번째, 정부 전문가와 의료진 전문가 사이뿐 아니라 의사 하위집단 내에서도 견해 차이가 존재하였다. 정책대안에 대해 다른 견해를 가지고 있는 응급실 의료진, 배후진료과 의료진, 병원 경영진은 정책과정에서 모두 거부점(veto point)으로 작용할 수 있었다. 두번째, 응급의료 정책과정의 비공식적 참여자인 응급의료 관련 전문학회는 정책과정에서 대의집단이자 파벌집단의 역할을 동시에 수행할 수 있으나, 정책과정에서 파벌집단의 역할이 강조됨으로써 내부자의 지위가 약화되었다. 세번째, 응급의료의 공공성에 대하여 소유주체 기준에 따른 공공성과 기능에 따른 공공성 개념이 혼재되어 사용되며 서로 다른 공공성 개념에 따른 정책행위자간 갈등이 발생하였다. 응급실 의료진은 응급의료가 공공의 이익을 실현하는 의료영역이므로 정부 지원이 필요하다고 주장했으나 일부 의료진은 수익성이 낮은 진료를 기피하는 모습을 보여 정부 전문가와 의견 차이를 보였다. 응급의료 정책과정의 성공적 추진을 어렵게 한 정책과정의 특징은 다음과 같다. 첫번째, 응급의료 정책과정에서 지역간 의료자원 분포, 병원에 작용하는 유인, 병원 내 응급실의 역할과 같은 응급의료에 존재하는 변이에 대한 고려가 부족했다. 두번째, 응급의료 전달체계 문제는 곧 응급의료기관의 취약한 응급환자 진료 역량의 문제였다. 세번째, 일부 의사들의 전문직업성(professionalism) 부족이 응급의료기관의 응급환자 진료 역량을 취약하게 하고, 환자-의사 사이 신뢰를 저하시켜 대형병원 쏠림현상을 악화시켰다. 4. 고찰 메르스 유행 이후 이루어진 응급의료 개선정책의 정책결과 분석과 정책과정에 대한 연구 결과를 근거로 하여 향후 응급의료 정책과정에 대하여 다음과 같이 제언한다. 첫번째, 국민의 관점에서 응급의료체계의 개선목표를 설정할 필요가 있다. 건강수준 향상과 응급의료 서비스에 대한 만족도 향상이라는 최종 성과목표가 개선정책의 목표로 설정되어야 한다. 두번째, 정책행위자의 인식 차이를 좁히기 위하여 여러 행위자가 함께 문제의 원인을 탐구하고 정책의제를 설정하는 과정이 필요하다. 세번째, 문제 해결에 인과성 있는 정책대안이 결정되어야 한다. 인과성 없는 정책대안은 정책이 집행되어도 정책문제를 해결하지 못한다. 네번째, 정책대상자의 순응을 확보할 필요가 있다. 유인과 처벌 이전에 전문가이자 정책대상자인 의사들에 대한 내면적 설득 과정이 필요하다. 다섯번째, 정책산물과 부수작용을 포괄하는 정책결과 평가가 필요하다. 여섯번째, 응급의료 정책 거버넌스를 확립하고 응급의료 관련 전문학회를 정책과정에 참여시켜 대의집단의 성격을 강화할 필요가 있다. 이 연구는 2015년 메르스 유행이라는 사건을 통해 응급의료 정책행위자들의 관점에서 우리나라 응급의료 정책과정을 고찰하였다. 응급의료 정책과정과 정책행위자에 대한 이해를 바탕으로 응급의료체계 개선을 추진해나가야 한다. ; I. 서 론 1 1. 연구 배경과 필요성 1 1) 한국 응급의료체계의 문제 1 2) 2015년 메르스 유행과 응급의료체계 4 3) 연구의 필요성 6 2. 연구 목적 10 II. 이론적 배경 12 1. 보건의료체계의 평가 12 1) WHO 보건의료체계의 구성요소 12 2) 보건의료체계 개혁을 위한 조종손잡이 14 2. 정책론 18 1) 정책과정의 이해 18 2) 응급의료 정책과정의 이해 25 III. 연구방법 35 1. 혼합방법 연구설계 35 2. 양적연구 방법 43 1) 양적 연구의 자료 수집 43 2) 양적 연구의 자료 분석 46 3. 질적연구 방법 54 1) 연구팀 구성 54 2) 심층면접 설계 55 3) 분석 방법 67 4. 혼합방법 연구의 통합 70 IV. 연구 결과 72 1. 양적연구 결과 72 1) 응급의료 전달체계 72 2) 응급환자의 감염관리 121 2. 질적연구 결과 134 1) 심층면접 참여자의 특성 134 2) 응급의료 전달체계 137 3) 응급환자의 감염관리 249 3. 연구결과의 종합 297 1) 2015 메르스 유행의 응급의료체계에 대한 의의 297 2) 메르스 유행 이후 응급의료 정책과정 분석 298 3) 응급의료 정책과정의 특징 340 V. 논의 363 1. 응급의료 정책과정 고찰 363 2. 연구의 한계 380 3. 연구의 의의 383 1) 방법론적 의의 383 2) 정책적 의의 384 4. 연구의 결론 385 1) 메르스 유행 이후 응급의료 전달체계와 응급환자 감염관리의 변화 385 2) 응급의료 정책과정 고찰 386 3) 응급의료체계 개선을 위한 정책과정에의 시사점 388 VI. 참고문헌 390 ; Doctor
La televisió local s'ha vist en els darrers anys com una indústria emergent vinculada a projectes de clústers audiovisuals. A través d'entrevistes amb els actors implicats, aquest article desmunta el discurs optimista generat entorn de la capacitat de la televisió local per actuar com a tractor de la indústria audiovisual, i estableix que no contribueix a desenvolupar uns clústers audiovisuals locals, que s'han multiplicat sense control per la falta d'una política nacional de clústers per l'audiovisual. La inacció de l'Administració autonòmica ha provocat problemes com l'excés de competència o la falta de coordinació. ; La televisión local se ha visto en los últimos años como una industria emergente vinculada a proyectos de clústeres audiovisuales. A través de entrevistas con los actores implicados, el presente artículo desmonta el discurso optimista generado en torno a la capacidad de la televisión local para actuar como tractor de la industria audiovisual, y establece que no contribuye a desarrollar unos clústeres audiovisuales locales, que se han multiplicado sin control por la falta de una política nacional de clústeres para el audiovisual. La inacción de la Administración autonómica ha provocado problemas como el exceso de competencia o la falta de coordinación. ; In the last years, local television has been seen as an emerging industry linked to projects of audiovisual clustering. Through interviews with some of the actors implied in these processes, this article takes to pieces the discourse generated around the capacity of local television to act as a driver of the audiovisual industry; it cannot contribute to develop local audiovisual clusters, which have grown without control because of the lack of a national cluster policy for the audiovisual sector. The inactivity of the regional government has generated problems such as an excessive competence or a lack of coordination
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A partir de 2011 se ha reforzado el gobierno económico de la UE a través de seis instrumentos legislativos, el llamado Six Pack, que supone fundamentalmente una reforma de la supervisión de la política presupuestaria de los Estados miembros. Más recientemente el Tratado de estabilidad, coordinación y gobernanza de UE de marzo de 2012 (TECGUE) establece un conjunto de normas destinadas a promover la disciplina presupuestaria a través de un pacto presupuestario a reforzar la coordinación de sus políticas económicas y a mejorar la gobernanza de la zona del euro. En el presente trabajo se analiza si este modelo basado en una estricta disciplina presupuestaria es compatible con los postulados del Estado social, y más concretamente con los principios de justicia del gasto público. En efecto, a partir de la reforma del art. 135 de la Constitución Española, el principio de estabilidad presupuestaria debe ser interpretado coordinadamente con otros principios constitucionales que en el momento presente están plenamente vigentes y pueden adquirir una nueva función: la de actuar como límite y medida del objetivo de estabilidad presupuestaria. Del mismo modo se analizan los principios de coordinación entre las políticas presupuestarias y de endeudamiento de los Estados miembros en un Estado con una pluralidad de Haciendas, como es el caso español. ; From 2011 onwards, the Economic Governance of the EU on the Member States has been strengthened through six main instruments of legislation, the so-called Six Pack, which is primarily a supervision reform of the Member States budgetary policy. More recently Treaty on Stability, Coordination and Governance of EU from March 2012 (TECGUE) establishes a set of rules aimed to promote the budgetary discipline through a fiscal pact, to strengthen the coordination of their economic policies and to improve governance within the euro area. In this paper we analyze whether this model based on a strict budgetary discipline is well-matched with the tenets of the welfare state, and more specifically with the public spending principles of justice. Indeed, since the reform of art. 135 of the Spanish Constitution, the principle of budgetary stability should be interpreted in coordination with other constitutional principles which at present are in full force and can acquire a new role: to operate as a boundary and a extent of the budgetary stability objective. Similarly, principles of coordination between the General Government Debt and Budgetary Policies of the Member States within a state with a plurality of Public Finances, such as the Spanish case, have been also analyzed.
Las políticas culturales se han institucionalizado sobre la idea de la cultura como sustantivo, como objeto, incluso como esencia de un grupo o colectivo. Si bien el modelo de democratización de la cultura continúa como núcleo de las políticas culturales, se vuelve evidente la caducidad de buena parte de los principios de una política centrada en el acceso a la oferta cultural. Los problemas a los que las políticas públicas se enfrentan resultan cada vez más complejos, inciertos y con más riesgos incorporados. Suponen un nuevo reto para la legitimidad de las instituciones culturales en su rol de intermediación tradicional. En este contexto, los bienes comunes (commons) emergen no sólo como concepto analítico sino como herramientas de acción política, social y legal. Los bienes comunes no son simplemente objetos o espacios, sino complejos sistemas de gestión de recursos con comunidades y normas que permiten su sostenibilidad. Este artículo plantea como hipótesis la posibilidad de que las políticas culturales reconozcan la cultura no sólo como sustantivo sino también como adjetivo (lo cultural). ¿Qué implica concebir las políticas culturales como políticas de los bienes comunes? ¿Cuáles son las diferencias principales en lo que se refiere al modelo de políticas de acceso a la cultura? ¿Puede un cambio de modelo derivar en la desresponsabilización de las políticas públicas en el ámbito de la cultura? ; Les polítiques culturals s'han institucionalitzat sobre la idea de la cultura com a substantiu, com a objecte, fins i tot com a essència d'un grup o col·lectiu. Tot i que el model de democratització de la cultura continua com a nucli de les polítiques culturals, es torna evident la caducitat de bona part dels principis d'una política centrada a l'accés a l'oferta cultural. Els problemes a què les polítiques públiques s'enfronten resulten cada vegada més complexos, incerts i amb més riscos incorporats. Suposen un nou repte per a la legitimitat de les institucions culturals en el seu rol d'intermediació tradicional. En aquest context, els béns comuns (commons) emergeixen no sols com a concepte analític sinó com a eines d'acció política, social i legal. Els béns comuns no són simplement objectes o espais sinó complexos sistemes de gestió de recursos amb comunitats i normes que permeten la seua sostenibilitat. Aquest article planteja com a hipòtesi la possibilitat que les polítiques culturals reconeguen la cultura no sols com a substantiu sinó també com a adjectiu (allò cultural). Què implica concebre les polítiques culturals com a polítiques dels béns comuns? Quines són les diferències principals en relació al model de polítiques d'accés a la cultura? Pot un canvi de model derivar en la desresponsabilització de les polítiques públiques en l'àmbit de la cultura? ; Cultural policies have been institutionalised around the idea of culture as a noun, as an object, and even as the essence of a group or collective. While the model of the democratisation of culture remains at the heart of cultural policies, the temporary nature of many of the principles of a policy focused on access to cultural activities is becoming apparent. The problems faced by public policies are increasingly complex, uncertain and involve more and more risks. They pose a new challenge to the legitimacy of cultural institutions in their traditional role of intermediation. In this context, the commons are not merely an analytical concept, but are also tools for political, social and legal action. They are not just objects or spaces, but also complex systems for resource management with communities and rules that allow their sustainability. This article considers the hypothesis of the possibility of cultural policies recognising culture not only as a noun but as an adjective (the cultural). What does conceiving of cultural policies in terms of policies of the commons entail? What are the main differences in the model of policies for access to culture? Can a change of model lead to the removal of responsibility from public policies in the field of culture?
학위논문 (석사)-- 서울대학교 대학원 : 환경계획학과, 2012. 2. 전상인. ; 경주지역의 고도보존법 개정과정 사례는 사회구조의 변화에 따른 문제점과 갈등의 원인을 공공부문과 시민들이 함께 인식하고, 다양한 이해관계자들이 참여와 협력을 통한 상호작용으로 합의를 도출한 협력적 계획사례로 평가할 수 있다. 따라서 경주사례를 협력적 계획의 구성요소를 통해 분석해 보는 과정은, 지방 환경에서 협력적 계획이론의 적합성과 현실에서의 적용에 있어 발생하는 문제들을 어떻게 개선하여 보완해야 하는지에 대하여 시사점을 제공한다. 협력적 계획이론에 대한 탐구를 바탕으로, 협력적 계획의 네 가지 구성요소들인 '제도적 맥락', '상호작용의 장', '사회적 학습', '참여 및 합의형성'을 도출하였고, 그중 제도적 맥락을 중심으로 분석을 진행하였다. 경주지역 고도보존법 개정과정에는 공공부문과 시민부문을 중심으로 하는 다양한 이해관계자들이 네트워크를 형성하고 있으며, 공유된 이해에 따라 네트워크는 변화하는 양상을 나타냈다. 개정과정의 이해관계자들은 공청회와 주민설명회를 중심으로 하는 상호작용의 장에서 유통되는 정보를 바탕으로 사회적 학습을 하고 있었으며, 이를 바탕으로 계획과정에 참여하여 개정안의 도출이라는 합의를 형성하였다. 분석의 결과를 종합하면, 경주의 사례는 협력적 계획의 외형은 갖추어져 있다고 평가할 수 있지만, 실제 과정에 있어서는 공공부문의 제한적인 정보공개 범위와 접근성의 문제, 참여자의 대표성과 권력의 비차별성이 부족, 상호작용의 장에서 공동학습이 이루어지기보다 소통의 방향이 일방적이라는 문제점을 가지고 있었다. 제도적 맥락으로 종합하면, 경주지역에 있어 위 문제들은 이해관계자들 간 신뢰저하의 원인으로 작용하였다. 경주지역의 이해관계자들은 정책의 목표달성을 위해 표면적으로 협력하고 있지만 서로를 신뢰하지 않았다. 지방환경에서 발생하는 공공부문과 시민들 간의 신뢰의 문제는 지속적인 합의형성의 학습에서 그 해답을 구할 수 있기에, 정책적 제언을 통해 제도적 보완과 사유재산권 제한에 대한 해법을 모색하고자 하였다. ; Gyeongju-city's preservation law revision process is evaluated as collaborative planning practices. On this case, first the public sector and citizens recognize social problem and conflicts, then various stakeholders are produced agreement with participation and interaction. Therefore, this analysis of cooperative Gyeongju case through the components of the collaborative planning theory provides implications for suitability of collaborative planning theory. It also provides the application of local environment and how to improve and supplement in real life problems. To precede the analysis, first I studied on collaborative planning theory and then derived four components of the collaborative planning theory that 'institutional context', 'field of interaction', 'social learning', 'participation and consensus-building'. Among these components, analysis was performed mainly on the institutional context. Various stakeholders to form a network and a shared understanding of the network showed a changing pattern in this revision process. Stakeholders are conducting social learning, based on the information that delivered by public-hearings and presentations around field of interaction. Based on this information, they involved in the planning process and derived the agreement. In sum, this case evaluated as collaborative planning case superficially. But there are some problems in process that information, participation and mutual understanding. Problem that listed above acts as the cause of deterioration of trust between stakeholders. On the surface, to achieve the goals of the policy is working, but stakeholders are did not trust each other. Through policy proposal, I tried to seek a solution on deterioration of trust problem. Continuous learning on public consensus is encouraging a social capital, such as trust. Study institutional complements on regional commission and find solution in private property limitation problem, are able to derive consensus making. ; Master
Objectiu: presentem una iniciativa per a l'alfabetització mediàtica i digital de la ciutadania, concretament de les comunitats educatives, tant en espais formals com informals. Partint de l'àmbit de la comunicació i de l'anàlisi de les formes de participació ciutadana en l'entorn digital, duem a terme una primera exploració en una línia de recerca en la qual convergeixen les ciències de la comunicació i les pedagogies més innovadores en procés de desenvolupament en les ciències de l'educació. Metodologia: plantegem una anàlisi de l'ecosistema mediàtic actual, marcat per la digitalització, així com de les subjectivitats i les formes de socialització. Entorn de la metàfora de l'alimentació i la dietètica introduïm els estudis crítics sobre mitjans de comunicació, en general, i Internet, en particular, i proposem una alfabetització per a una ciutadania conscient, crítica i activa. Contrastem aquesta proposta amb el Marc Comú de Competència Digital Docent, desenvolupat per la Unió Europea i aplicat pel Ministerio de Educación y Formación Profesional, per a homologar-la amb treballs previs i actuals. Resultats: proposem una àrea de competència digital complementària a les plantejades en el Marc Comú de Competència Digital Docent enfocada a la intervenció en la proposta, l'elaboració i la vigilància ciutadanes de les polítiques digitals. ; Objetivo: presentamos una iniciativa para la alfabetización mediática y digital de la ciudadanía, concretamente de las comunidades educativas, tanto en espacios formales como informales. Partiendo del ámbito de la comunicación y del análisis de las formas de participación ciudadana en el entorno digital, realizamos una primera exploración a una línea de investigación en la que convergen las ciencias de la comunicación y las pedagogías más innovadoras en desarrollo en las ciencias de la educación. Metodología: planteamos un análisis del ecosistema mediático actual, marcado por la digitalización, así como de las subjetividades y las formas de socialización. En torno a la metáfora de la alimentación y la "dietética" introducimos los estudios críticos sobre medios de comunicación, en general, e Internet, en particular, y proponemos una alfabetización para una ciudadanía consciente, crítica y activa. Contrastamos esta propuesta con el Marco Común de Competencia Digital Docente, desarrollado por la Unión Europea y aplicado por el Ministerio de Educación y Formación Profesional, para homologarla con trabajos previos y actuales. Resultados: proponemos un área de competencia digital complementaria a las planteadas en el Marco Común de Competencia Digital Docente enfocada a la intervención en la propuesta, elaboración y vigilancia ciudadana de las políticas digitales. ; Objective: We describe a project for enhancing the media and digital literacy of the general public, or more specically of the educational community, in both formal and informal settings. Starting from the eld of communication and the analysis of different forms of citizen participation in the digital environment, we present an initial examination inside a line of research in which the sciences of communication and education converge. Methodology: We propose an analysis of the current media ecosystem dominated by digitization, subjective approaches, and forms of socialization. Around the metaphor of food and diet we introduce critical studies on media in general and the Internet in particular, and propose ways of enhancing media literacy for a conscious, critical and active public. We compare this proposal with the European Union's Framework for Developing and Understanding Digital Competence, applied by the Spanish Ministry of Education and Vocational Training, in order to bring it into line with previous and current work. Results: We propose an area of digital competence complementary to those outlined in the Framework for Developing and Understanding Digital Competence, focusing on intervention in the proposal, elaboration and assessment of digital policies by the general public.
