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Opinion
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A sickness benefit for all, leaving no one behind
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Daseul Moon, Hongjo Choi
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Ann Occup Environ Med 2025;37:e25. Published online July 28, 2025
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DOI: https://doi.org/10.35371/aoem.2025.37.e25
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 Abstract
Abstract in Korean
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- South Korea’s pilot sickness benefit program, launched in 2022 across six regions and currently operating in 14 regions as of 2025, represents a critical juncture in the country’s social protection development. While ostensibly designed with inclusive eligibility criteria, the program reveals fundamental paradoxes that illuminate deeper structural inequalities within Korea's dualized labor market. This opinion piece examines how current design choices risk undermining universal health coverage goals by systematically excluding the most precarious workers. The program’s design features—including low replacement rates (60% of the minimum wage) and extended waiting periods—created perverse incentives where the most vulnerable workers accepted the least favorable conditions. This pattern exemplifies what Korpi and Palme termed the “paradox of redistribution,” where targeted approaches ultimately prove less effective than universal ones, with the second phase’s restriction to the bottom 50% income bracket threatening to exacerbate this paradox. Successful implementation will depend on integrating equity, people-centered design, and gender-transformative perspectives into every phase—design, operation, evaluation, and reform. In doing so, South Korea has the opportunity to offer a model of sickness protection that does not simply patch gaps, but actively reshapes the structures that produce health and economic inequalities in the first place.
- 모두를 위한 상병수당의 과제
2022년 6개 지역에서 시작되어 2025년 현재 14개 지역에서 시행되고 있는 한국형 상병수당 시범사업은 한국 사회보장의 제도적 발전에 있어 중요한 전환점을 나타낸다. 시범사업은 기존 제도와 비교해 보다 포용적인 자격 기준으로 설계되었지만, 한국의 이중화된 노동시장과 결합한 구조적 불평등을 드러내는 근본적 역설들을 보여주고 있다. 본 논문은 현재의 제도적 설계가 한국의 불안정한 노동자들을 체계적으로 배제하며, 이것이 보편적 건강보장 목표 달성에 장벽으로 작동한다는 점을 분석한다. 1차 시범사업 신청 현황 분석 결과, 낮은 소득대체율(최저임금의 60%)과 긴 대기기간을 포함한 프로그램의 설계 특징들은 가장 취약한 노동자들이 가장 불리한 조건을 받아들이는 역설적 유인을 만들어냈다. 이러한 패턴은 재분배의 역설을 반영하며, 2단계에서 소득 하위 50%로 대상을 제한한 것은 이러한 역설을 심화할 것으로 예상된다. 상병수당 제도의 성공적인 실행은 설계, 운영, 평가, 개혁의 모든 단계에서 형평성, 사람 중심 설계, 젠더 변혁적 관점을 통합하는 데 달려 있다. 이를 통해 건강과 경제적 불평등을 생산하는 구조를 재편하는 제도로서 상병수당을 기대할 수 있을 것이다.
Special Issue
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The impacts of working time flexibilization on occupational safety and health: an expert survey
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Daseul Moon, Hyunjoo Kim
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Ann Occup Environ Med 2023;35:e20. Published online July 20, 2023
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DOI: https://doi.org/10.35371/aoem.2023.35.e20
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Abstract
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 Supplementary Material
The policy proposal by the current Korean government that proposes flexible overtime rules is causing social controversy. This study has explored the 612 experts’ opinions on the occupational safety and health impacts of the policy using an online self-report survey. They expected short-term overwork (87.25%), overwork inequality (86.44%), irregular working hours (84.31%), chronic overwork (84.15%), long working hours (83.66%), and unpredictability of working hours (81.86%) as a result of the policy change. They also responded that the policy change would increase industrial accident deaths (87.25%), mental illnesses (87.09%), deaths due to overwork or cardiovascular diseases (83.84%), and accidents (83.33%). They disagreed that the government’s flexibilization policy, while agreeing that the necessity of policies on regulating night work (94.77%), guaranteeing wages to eliminate overtime (90.36%), establishing working time regulations for the bogus self-employed (82.84%), and applying the 52-hour workweek system to all workplaces (76.47%). These expert opinions are consistent with previous research on the health effects of working hours.
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Citations
Citations to this article as recorded by  - Association between long working hours and engagement in preventive healthcare services in Korean workers: Findings from the Korean National Health and Nutrition Examination Survey
Seong-Uk Baek, Yu-Min Lee, Jin-Ha Yoon
Preventive Medicine.2024; 180: 107849. CrossRef - Effect of long working hours on psychological distress among young workers in different types of occupation
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Preventive Medicine.2024; 179: 107829. CrossRef - Association between long working hours and diet quality and patterns: A latent profile analysis of a nationally representative sample of Korean workers
Seong-Uk Baek, Jong-Uk Won, Yu-Min Lee, Jin-Ha Yoon
Preventive Medicine.2024; 180: 107890. CrossRef - Association of precarious employment with depressive symptoms and suicidal ideation among female workers: Findings from a nationwide longitudinal study in Korea
Seong-Uk Baek, Yu-Min Lee, Jin-Ha Yoon
Journal of Affective Disorders.2024; 351: 931. CrossRef - Association between long working hours and metabolic dysfunction–associated steatotic liver disease: a nationwide population-based study in Korea
S.-U. Baek, J.-U. Won, Y.-M. Lee, J.-H. Yoon
Public Health.2024; 232: 188. CrossRef - Association between long working hours and the development of suicidal ideation among female workers: An 8-year population-based study using the Korean Longitudinal Survey of Women & Family (2012–2020)
Seong-Uk Baek, Yu-Min Lee, Jin-Ha Yoon
Psychiatry Research.2024; 333: 115731. CrossRef - Association of low-quality employment with the development of suicidal thought and suicide planning in workers: A longitudinal study in Korea
Seong-Uk Baek, Jin-Ha Yoon, Yu-Min Lee, Jong-Uk Won
Social Science & Medicine.2024; 358: 117219. CrossRef - Long working hours and preventive oral health behaviors: a nationwide study in Korea (2007–2021)
Seong-Uk Baek, Jin-Ha Yoon, Yu-Min Lee, Jong-Uk Won
Environmental Health and Preventive Medicine.2024; 29: 48. CrossRef - Special Series I: Working hours as a social determinant of workers’ health
Kyunghee Jung-Choi, Tae-Won Jang, Mo-Yeol Kang, Jungwon Kim, Eun-A Kim
Annals of Occupational and Environmental Medicine.2023;[Epub] CrossRef
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