Online Program

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

Tuesday, November 3, 2015

Green Bae, Bioethics policy studies, Ewha Womans Univeristy, Seoul, Korea, Republic of (South)
Minah Kang, Department of Public Administration, College of Social Sciences, Ewha Womans University, Seoul, Korea, Republic of (South)
Reich Michael, Department of Global Health & Population, Harvard T.H CHAN School of Public Health,, Boston
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.

Learning Areas:

Public health administration or related administration
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Compare and identify the health insurance payment policy changes and politicla patterns in three Asian countries.

Keyword(s): International Health, Health Systems Transformation

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the co-researcher of Social Science Korea(SSK)funding in South Korean National Research foundation.Especially, I have been doing research the health policy related to health system. Among health system, health insurance system is my main interest for promote public health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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