College of Pharmacy, Ewha Womans University, Seoul, South Korea.
Department of Public Administration, College of Social Sciences, Ewha Womans University, Seoul, South Korea.
Health Syst Reform. 2024 Dec 16;10(1):2375101. doi: 10.1080/23288604.2024.2375101. Epub 2024 Aug 19.
South Korea is one of the few countries that has successfully consolidated its national risk pools into a single-payer health insurance system. This study analyzes national health insurance (NHI) consolidation in South Korea between 1980 and 2003, drawing lessons for countries seeking to consolidate their risk pools. The paper contextualizes the development of the South Korean national health insurance system and the consolidation of its risk pools in the changes in the political environment, particularly the processes of political democratization. It examines how these processes have affected the societal meanings and roles of the health insurance system. The paper focuses on two policy stages. During the agenda-setting stage, the government and employers emphasized the efficiency of the health insurance system. This emphasis contributed to the failure of a consolidation plan that emphasized equity over efficiency. However, as democratization expanded, the power of civil society movements and the popular demand for equity grew stronger. During the policy adoption phase, consolidation of health insurance trusts in South Korea was achieved through social and political processes that influenced public opinion, expanded civil society participation in decision-making, and worked with the government to integrate health insurance organizations and funds.
韩国是少数成功将国家风险池整合为单一支付者医疗保险制度的国家之一。本研究分析了韩国在 1980 年至 2003 年间的国家健康保险整合，为寻求整合风险池的国家提供了经验教训。本文将韩国国家健康保险制度的发展和风险池的整合置于政治环境的变化，特别是政治民主化进程中加以考察。本文探讨了这些进程如何影响健康保险制度的社会意义和作用。本文重点关注两个政策阶段。在议程设置阶段，政府和雇主强调医疗保险制度的效率。这种强调导致了一个强调公平而非效率的整合计划的失败。然而，随着民主化的扩大，公民社会运动的力量和公众对公平的需求变得更加强大。在政策采纳阶段，通过影响公众舆论、扩大公民社会参与决策以及与政府合作整合医疗保险组织和资金的社会和政治进程，实现了韩国健康保险信托的整合。
