This seminar will feature two presentations: an attempt to evaluate the impact of health policy under a decade of progressive governments in Korea; and an investigation into the health and economic well-being of the elderly in Korea. The presenters will be Dr. Byongho Tchoe, a 2008-09 visiting scholar at Stanford University, and Dr. Young Kyung Do, the inaugural postdoctoral fellow in the Asia Health Policy Program at Stanford.

Korea achieved universal health care coverage in 1989 only twelve years after the introduction of social health insurance under an authoritarian government. In 1992 a civil government won the presidential election. Consistent with a conservative ideology oriented toward market principles and globalization, that government emphasized competitive principles in health care policy. However, at the end of 1997 in the face of economic crisis, the progressive party won the Korean presidential election; their health emphasized strengthening equity, redistribution, and regulation of providers’ rent seeking behavior. Under successive progressive governments from 1998 to 2007, ambitious health policy reforms integrated insurers, separated prescribing from dispensing, reformed provider payment, expanded benefits coverage, increased medical-aid enrollees, and increased the role of government providers in the health care market. But in the election of 2007, they were defeated by a conservative party, which insists that competition among insurers and providers will enhance efficiency and quality in health care, and stresses consumer choice and responsibility.

Dr. Tchoe's talk will attempt to evaluate impact of health care policy under a decade of progressive governments in Korea. Although equity in both access to care and financial responsibility appear to be enhanced, there is controversy about whether the policies were cost-effective or improved health, and what will happen as the new government repeals regulations in the health care market. The return of economic crisis also brings renewed urgency to debates of economic and social policy.

Byongho Tchoe is a 2008-09 visiting scholar at Stanford University. After working at the Korea Development Institute from 1983 to 1995, he took up his current post with the Korea Institute for Health and Social Affairs. He has been influential in formulating health and social policy in Korea, having served as an advisor to the minister of health and social welfare and participated in many task forces and committees. In 2007, he was awarded a National Medal in honor of 30 years achievement related to Korea’s National Health Insurance. He has published many articles and books and served as president of the Korean Association of Health Economics and Policy and as vice president of the Korea Association of Social Security. He holds a master’s degree in public policy from Seoul National University and a Ph.D. in economics from the University of Georgia.

Young Kyung Do is the inaugural Postdoctoral Fellow in Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center. He completed his Ph.D. in health policy and administration at the University of North Carolina at Chapel Hill School of Public Health in August 2008. He has also earned M.D. and Master of Public Health degrees from Seoul National University (in 1997 and 2003, respectively). He earned board certification in preventive medicine from the Korean Medical Association in 2004. He received the First Prize Award in the Graduate Student Paper Competition in the Korea Labor and Income Panel Study Conference in 2007. He also is the recipient of the Harry T. Phillips Award for Outstanding Teaching by a Doctoral Student from the UNC Department of Health Policy and Administration in 2007. In May 2008, he was selected as a New Investigator in Global Health by the Global Health Council.

Why do community-based education and social persuasion programs for promoting healthy lifestyle and preventing chronic disease sometimes fall short of our expectations? Why are population effects so difficult to engineer and why are they so ephemeral? This research carried out at USC, the Claremont Graduate University, and collaborating institutions in China integrates across social, behavioral, and neurocognitive sciences to address those questions.

We conclude tentatively that the answer to each of the questions may lie in individual and context variability relative to program response, and that in order to more fully address the question of prevention program response variability requires engagement and integration across several levels of science to consider the roles of social groupings, environmental selection and design, social influence processes, and brain biology. What works in one social, cultural or organizational setting may not be so effective in another. What works for persons with certain genetic and experiential backgrounds may be totally ineffective for persons with different dispositional or personality characteristics. In a series of community/school based prevention trials carried out in markedly different southern California and central China settings, we have uncovered domains of consistent response, and other domains of substantial environment- and disposition-based response variability. A social influences based smoking prevention program framed in collectivist values and objectives worked to prevent smoking in one cultural setting but not another. And an individualist framed social influences program worked in the setting where the collectivist program did not. But the characteristics of the particular settings which defined program success or failure were different from what conventional (e.g., cultural psychology) wisdom would have led us to expect. Furthermore, both within and across cultural settings, the same individual dispositional characteristics moderated or determined program effectiveness, again in ways not predicted by the common cultural and behavioral science wisdom. In recent studies carried out both in China and the U.S. we have found affective decision deficits, with known neural underpinnings, to account for rapid progression to regular smoking and binge drinking. These deficits are akin to the dispositional characteristics found earlier to moderate prevention program effects. Subsequent brain imaging studies confirm the hypothesized regions of neural involvement. Together these findings hold promise for more effective – situation and phenotype specific – approaches to engendering and sustaining more optimal individual and population health behavior.

Korea introduced three major health-care reforms: in financing (1999), pharmaceuticals (2000), and provider payment (2001). In these three reforms, new government policies merged more than 350 health insurance societies into a single payer, separated drug prescribing by physicians from dispensing by pharmacists, and attempted to introduce a new prospective payment system. The change of government, the president’s keen interest in health policy, and democratization in public policy process toward a more pluralist context opened a policy window for reform. Civic groups played an active role in the policy process by shaping the proposals for reform —a major change from the previous policy process that was dominated by government bureaucrats. However, more pluralistic policy process also allowed key interest groups to intervene at critical points in implementation (sometimes in support, sometimes in opposition), with smaller political costs than previously.

Strong support by the rural population and labor unions contributed to the financing reform. In the pharmaceutical reform, which was a big threat to physician income, the president and civic groups succeeded in quickly setting the reform agenda; the medical profession was unable to block the adoption of the reform but their strikes influenced the content of the reform during implementation. Physician strikes also helped them block the implementation of the payment reform. Future reform efforts in Korea will need to consider the political management of vested interest groups and the design of strategies for both scope and sequencing of policy reforms.

Soonman Kwon is Professor of Health Economics and Policy, and Director of the BK (Brain Korea) Center for Aging and Health Policy in Seoul National University, South Korea. After he received his Ph.D. from the Wharton School of the University of Pennsylvania, he was assistant professor of public policy at the University of Southern California in 1993-96. Prof. Kwon has held visiting positions at Harvard School of Public Health (Fulbright Scholar and Tekemi Fellow), London School of Economics (Chevening Scholar), Univ. of Trier of Germany (DAAD Scholar), and Univ of Toronto. He is on the editorial boards of Social Science and Medicine (Elsevier), Health Economics Policy and Law (Cambridge U Press), and Health Systems in Transition (HiT, European Observatory). He has occasionally worked as a short-term consultant of WHO, ILO, and GTZ (German Technical Cooperation) on health financing and policy in China, Cambodia, Lao PDR, Malaysia, Mongolia, Pakistan, Philippines, and Vietnam. He has also been a consultant of Korean government for the evaluation of its development aid programs in North Korea, Ecuador, Fiji, Mexico and Peru.

Dr. Forsberg will present findings from studies in China and Vietnam and put those findings into a broader comparative perspective regarding the future role of the private sector in improving health service delivery and population health.

Birger Carl Forsberg is a public health specialist and lecturer in International Health at the Karolinska Institute in Stockholm, Sweden from where he holds an MD and a PhD. He is also trained in economics and has health economics as one of his areas of work. Dr Forsberg has more than 20 years experience from international health from around 25 low- and middle-income countries as an adviser to bilateral donors and international organisations. Since 2002 he has been a consultant to the World Bank on public private sector collaboration in health. He is also coordinator since 2002 of a joint Harvard-Karolinska research programme called Private Sector Programme in Health (PSP). The programme has coordinated studies of the private health sector in five countries in Asia and Africa. In his talk Dr Forsberg will present findings from PSP studies in China and Vietnam and put those findings into a broader perspective on the future role of the private sector in health service delivery for increased access to health services and improved health.

Teh-wei Hu is a Professor Emeritus of health economics at the University of California, Berkeley.  At Berkeley, he served as associate dean (1999-2002) and department chair (1990-1993) in the School of Public Health.  He received his PhD in Economics from the University of Wisconsin.  

During the past 40 years, Professor Hu has been teaching and conducting research in health economics, particularly in healthcare financing and the economics of tobacco control.  Hu was a Fulbright scholar in China. He has served as consultant or advisor to the World Bank, the World Health Organization, the National Institutes of Health, the Institute of Medicine, the Rand Corporation, the Ministry of Health in the People's Republic of China, Department of Health and Welfare in Hong Kong, Department of Health in the Republic of China (Taiwan), and many private research institutions and foundations. 

Professor Hu will speak to us immediately after an April trip to China, sharing his research and perspectives on the economics of tobacco control and the debate about healthcare system reforms in China (including a possible link between the two through financing expansions in coverage through increased tobacco taxation).

Rapid population aging in many Asian countries poses an increased burden of care for elderly people with disabilities. Traditionally, care for the disabled elderly was provided by family members co-residing or living nearby. However, declining fertility rates, eroding social norms, and growing rates of labor force participation among females have changed the overall picture of informal care. 

One important policy question is whether informal caregiving affects caregivers' labor force participation. This question is particularly relevant for rapidly developing economies including newly industrialized countries, because a shrinking working-age population is another major concern with population aging. Providing different answers to this question leads to different policy implications for long-term care policy and labor market policy. 

Most of the existing literature on this issue comes from the United States and Europe. Using data from the first wave of the "Korean Longitudinal Study of Aging", Do's research not only provides results from a less-studied Asian society, but also takes into account different patterns of living arrangements and labor force participation. His talk will deal with the methodological issue of endogeneity between informal caregiving and labor force participation, and explore gender and age group differences.

Young Kyung Do is currently completing his PhD in health policy and administration at the University of North Carolina at Chapel Hill School of Public Health. He has also earned both an MD and a master of public health degrees from Seoul National University (in 1997 and 2003, respectively). Young earned board certification in preventive medicine from the Korean Medical Association in 2004.

Migration and health are two areas that have each received significant amounts of attention in sociology. However, only recently have researchers begun to examine the links between these two population processes. There is growing yet incomplete evidence that migration and the health are intertwined in complex ways. Health itself can impact the decision to move, and migration may affect the health of those who move, those who stay, and those who host migrants. Using high quality longitudinal data from Indonesia, Lu's research makes a serious attempt to tackle important questions about the association between migration and health in the Indonesian context. In particular, she examines both how health may affect migration decisions, and how changing socioeconomic conditions associated with migration may have implications for the health of various populations involved, including not only migrants but also people left behind in sending communities. Lu will also discuss research underway on migration and health in China, including a new national survey with data to study that topic in the Chinese context.

Yao Lu is a Ph.D. candidate of Sociology, M.S. candidate of Public Health, and student affiliate at the California Center for Population Research at UCLA. She has a BS from Fudan University in China. Her research focuses on studying the causes and consequences of internal migration in developing countries, and modeling socioeconomic and behavioral factors as determinants of health. Her papers include studies based on data from China, Indonesia, and South Africa. She has a paper forthcoming in the American Sociological Review, and has received dissertation fellowships from the AAUW foundation and the Asia Institute at UCLA. She is currently completing her dissertation on the relationship between labor migration and health in Indonesia, while working on a national survey project on internal migration and health in China.