From the Single Payer Health Insurance system achievement toward the Universal Health Coverage; Multiple streams framework in cases of three Asian countries

While many countries attempt health reforms for better coverage and efficient operation to achieve UNC, countries have different pathways toward the UHC and varying historical, political and cultural conditions. In this paper, we examine the policy changes and political patterns of such efforts in three Asian countries. Through Kingdon’s multiple streams approach, we explain how the problem, politics, and policy streams in each country converge or diverge throughout the process of achieving the UHC through a national health insurance system.

Our case analyses showed that the trajectory toward UHC in these three countries show some common features, and one of them is a political process driven by a range of social forces to generalise access to health care. Problem, policy, and politics streams converged at a critical moment, and created a policy window in each country. Especially, politics stream seems to be the most influential factor in all countries. There were also notable different characteristics among these three countries. Unlike South Korea and Taiwan which achieved single-payer national health insurance (NHI), in the case of Japan, few civil organizations participated in discussions about the potential organizational changes to the health insurance system. And relatively little attempt has been made to create a social movement to push forward the reform agenda. In contrast, civil organizations had a major impact on politics stream in both South Korea and Taiwan.

Notably, our analysis showed that Asian countries such as Japan, Korea, and Taiwan have a short history of adopting National Health Insurance and they do not show path dependency, which is a distinct experience from Europe countries. This application of Kingdon’s MSF to cases in three East Asian countries also showed that the analysis with the framework can provide valuable insights to other countries which strive to achieve universal health coverage.