Divergent Trajectories: Healthcare Insurance Reforms in East Asia ...

Illan Nam, Colgate University, Feb 2011Draft in progress, please do not quote or citeKOREAIn 2000, the South Korean National Assembly passed legislation that integratedthe country’s fragmented corporatist healthcare insurance societies into a nationaluniversal single-payer health insurance system managed by the state. The “IntegrationReform” represented the culmination of a series of changes to the healthcare system thatsignificantly expanded coverage and increased the system’s mechanisms ofredistribution. Between 1987 – the year of democratic transition – and 2001, coverageexpanded from 41% of the population to 97%. At the time of transition, only formalsector workers who were employed by firms larger than 100 workers – were guaranteedinsurance through their employers. In a succession of measures, the first democraticallyelected government of Roh Tae-woo expanded coverage to the rural and informal sectors.In 1987, farmers were handed out healthcare insurance cards. Two years later, a programto cover the self-employed was implemented. These extensions were achieved throughthe incremental establishment of quasi-private insurers that pooled workers by workplaceor geographic location. As a result, South Korea’s health insurance system came toresemble a corporatist system that was composed of hundreds of quasi-private insurers,each of which offered different benefits packages and charged different premiums todifferent pools of workers. The system generated considerable inequity between largecompanyand small-company employees and between urban and rural workers, asworkers at large companies paid lower premiums and received better benefits while theself-employed/informal and rural workers paid higher premiums for poorer services. By8