사회보험수급권의 범위는 법령상 규정과는 달리 운용 면에서는 그 인적, 물적, 비용 및 접근 범위가 실질적으로 축소 내지 보장제외 되는 엄연한 현실로 존재함을 알 수 있다. 그 전형적 경우로는 비정규근로자의 낮은 보험가입률(40%)과 국민연금 지역 가입자 납부예외자의 높은 비율(57%), 국민연금급여 소득대체율의 실질적 저하(40%), 건강보험급여 일부부담금문제와 의료전달체계에서 종합병원의 대도시집중(45%)을 꼽을 수 있을 것이다. 이로 미루어보면 정규근로자와 비정규근로자, 사업장가입자와 지역가입자, 대도시와 농어촌 사이에 엄연한 불평등구조가 잠재되어 있음이 자명하게 드러난다. 첫째, 그 인적 적용범위는 단기간의 임시적 불안정근로자의 직장(사업장)가입자의 적용제외, 비정규근로자의 낮은 보험가입률, 국민연금의 납부예외와 보험료미납으로 인한 사실상의 비 가입상태, 국외여행자 등에 대한 국민건강급여정지, 보험료체납에 의한 수급자격 상실로 인하여 사실상 감축되고 있는 실정이다. 둘째, 그 물적 범위는 건강보험급여의 비 급여대상항목, 국민연금급여의 소득대체비율의 실질적 저하, 사회통합에 미흡한 실업급여의 종류 등으로 인하여 사회보험 본래 취지의 급여충족을 제대로 실현하지 못하고 있는 상황이다. 셋째, 그 비용 및 접근범위에서 건강보험급여 일부부담금과 본인부담상한선의 허구화가능성, 종합병원의 대도시 집중으로 인한 의료전달체계의 편중성, 고용보험 전달체계구축의 미비 등으로 인하여 계층과 지역사이에 현저한 불공평성이 존재하고 있는 현실임을 부인할 수 없다. 사회보험제도의 실질적 정착화를 위하여 앞으로 꾸준한 제도개선이 필요하겠지만 그 기본방향은 각 보험제도의 원리적 조화측면에서 모색되어야 하리라고 본다. 건강보험은 건강보장의 공익성과 의료기관의 영리성, 연금보험은 사회적 부양성과 개인적 형평성, 산재보험은 재해근로자의 생활보장과 보험재정의 안정, 고용보험은 고용조정성과 실업급여의 사회통합성을 슬기롭게 조화하는 균형적 사회보험정책을 펼쳐야 될 것이다.

This Article attempts to reexamine the gap between the legal provisons of Korean Social Insurance System (KSIS) and the actual operation of it, since the first study on that in 1990. Nowadays, with respect to the range of entitlement to social insurance benefits, it might be found out that, unlike the statutory regulations, the actual social insurance coverage of beneficiary or benefits and access are reduced and even limited in some categories in reality. Typical examples includes these: 1) the low rate of atypical workers in the policyholder of KSIS (40%); 2) a high percentage of the local area-based insured person exempted from the national pension program (57%); 3) a substantial decrease of the earning-replacement rate of the national pension benefits; 4) the problem of individual co-payment of beneficiaries in the health care insurance; and 5) the gravitation of the general hospitals to big cities in the health care delivery system (45%). These current circumstances clearly reveal the stark inequalities between regular employees and atypical workers or workplace-based insured person and local area-based insured person, and metropolitan and rural areas. More specifically, firstly, the coverage of beneficiary in KSIS is decreased in reality because of these: 1) short-term temporary workers are excluded from the workplace-based insured person; 2) the participant rate of atypical workers in the policyholder of KSIS is very low; 3) the national pension benefits will be unavailable in effect, if the future recipient is exempted from pension contributions due to the statutory regulations, or does not pay the contributions on time; 4) a recipient travelling or working abroad is unable to receive the health care insurance benefits for the duration of being abroad; and 5) the arrears of contributions result in disqualification of the entitlement to the health care and the national pension benefits. Secondly, the range of benefits in KSIS is unlikely to realize the core spirit of the social insurance due to these: 1) the numerous non-covered items in the health care insurance scheme; 2) the substantial decrease of the earnings-replacement rate of the national pension benefits; and 3) the shortcomings of unemployment benefits to achieve social integration. Thirdly, with respect to the scope of cost and access in KSIS, the existence of a remarkable unfairness between classes and regional disparity can not be denied. It is as a consequence of these: 1) individual co-payment of beneficiaries and the possibility of its false upper limit in the health care insurance scheme; 2) inequality in the health care delivery system due to the gravitation of the general hospitals to big cities; and 3) lack of infrastructure of the employment insurance delivery system. In conclusion, in order to develop KSIS, it is essential to strike the balance between conflicting principles in each social insurance regime as well as reform the system continuously. Therefore the equitable social insurance policy should be wisely carried out to ensure the balance between these: 1) the characteristics of the health care coverage as a public interest and that of medical institution as a profit-making enterprise in the health care insurance; 2) individual equity and social adequacy in the national pension insurance; 3) guarantee of living safety of injured workers and financial stability of insurance fund in the industrial injury compensation insurance; and 4) adequate unemployment benefits for social integration and the employment adjustment in the employment insurance.