발간사
요 약 ······························································································································1
제1장 서 론··············································································································5
제2장 일차의료의 개념과 역할, 개혁 어젠다로서의 성과·····························8
제1절 개념과 정의 ····························································································8
제2절 각국의 실제 일차의료 형태 ··································································10
제3절 일차의료의 성과에 관한 경험 연구 ·······················································14
1. 일차의료 성과에 관한 마이크로 분석 ···················································16
2. 일차의료가 구현된 정도를 수치화하여 시스템의 성과를 측정하거나
시스템 간을 비교하는 매크로 분석 ·······················································17
3. 비용에 미친 영향 분석 ·········································································19
제4절 개혁 어젠다로서의 일차의료 ································································19
제3장 일차의료 이슈의 부상: 고령화로 인한 만성질환 관리
필요성 증가와 사회적 배제 해소···························································26
제1절 사회통합 필요성의 증가 ·······································································26
제2절 고령화로 인한 만성질환 관리와 의료서비스 조율기능의 중요성 증가 ··28
제4장 한국 의료시스템 속에서의 일차의료·····················································31
제1절 지표를 통한 우리나라 일차의료의 개괄적 평가 ····································31
제2절 결과 측면에서 본 일차의료 기능의 후진성 ···········································33
1. 만성질환 관련 의료이용의 격차 ···························································34
2. 취약한 정책 인프라와 조율기능 부재 ···················································41
제3절 우리나라 일차의료 낙후현상의 이해 ·····················································43
1. 의료시스템 발전과정의 특성 ································································43
2. 일차의료와 관련되는 근래 시도들 ························································46
제4절 성과연동지불제도와 일차의료 지식기반(knowledge base) ·················49
1. 의료시스템 변화수단으로서의 성과연동지불 ········································50
2. 일차의료의 성과연동지불 사례 ····························································51
3. 우리나라의 성과연동지불제도 ······························································53
4. 정책수단으로서의 성과연동지불에 대한 관점과 과제 ···························54
제5장 일차의료 발전을 위한 제안······································································57
참고문헌 ··························································································································64
ABSTRACT ······················································································································76