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.

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.

Fast Forward: Uncertainties, Risks and Opportunities of Rapid Aging in China, Japan, and Korea will be an innovative, invitation-only scenario planning exercise. Our goal is to develop a broader understanding of how population aging could affect the social, cultural, economic, and security futures of Asia over the next ten to twenty years. We’ve invited a select group of leaders from business, government, and academia with an interest in various aspects of Asia’s growth to identify key uncertainties and assess possible outcomes. This highly interactive session will be moderated by the Global Business Network, the world’s leading scenario consultancy.

This scenario planning workshop is part of a two-day conference at Stanford, Aging Asia: Economic and Social Implications of Rapid Demographic Change in China, Japan, and Korea. The first day, Aging in Asia Today: What the Experts Know, will feature keynote presentations and academic panels on the impacts of rapid aging in these countries, focused on four topics: economic growth, social insurance programs, long-term care, and health care.

This conference, sponsored by the Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center and the Global Aging Program of Stanford Center on Longevity, explored the impact of rapid aging on economic growth, labor markets, social insurance financing, long term care, and health care in China, Japan, and Korea.