급부행정 영역의 민영화와 공공의료에 관한 공법적 연구 - 한국과 일본의 지방의료원 체계와 지방의료원 개혁 비교를 중심으로 -

Abstract This paper begins by questioning the case of the United States, which has the highest number of infections and deaths in the world, despite having many hospitals and advanced medical technology during the COVID-19 pandemic. One of the reasons for the severe COVID-19 damage in the United States is that the proportion of public hospitals has decreased as public hospitals have been actively privatized since the 1980s. Focusing on the impact of the privatization of public hospitals in the United States upon COVID-19 response system, this paper compares public hospital reforms by using public hospital privatization in Korea and Japan to verify how the privatization of public hospitals affected local public hospitals. The local medical center legislation in Korea and Japan has something in common in that it has changed its management form from being subject to the Act on the Establishment and Management of Local Medical Centers to a special corporation through enactment and amendment of local medical center-related laws, which are part of the reform of local medical centers. However, there is a difference that Japan applies various management forms based on various underlying laws rather than Korea. The reform of local medical centers, which was the basis of the current legislation of local medical centers in Korea and Japan, was promoted to solve the chronic fiscal deficit that had been raised so far by reducing the size of local medical centers through privatization. However, there are some differences in the specific method of reforming local medical centers. In the case of Korea, incorporation and contracting out were partially utilized. In contrast, Japan is using corporationization, sale, and consignment to the private sector for reform of local medical centers. Although there are some differences in the methods of reforming local medical centers in the two countries, the reduction in the size of local medical centers appears to be a common result. In addition, the reduction of local medical centers negatively affected the crisis response system such as COVID-19, as shown in the cases of both countries. Privatization, which reduces the size of public hospitals, needs to be avoided because it weakens the crisis response system, and I would like propose to improve the public hospital legislation to actively utilize public-private cooperation that allows the state to actively intervene in case of emergency.