OUR APOLOGIES: THIS WORKING PAPER HAS BEEN TEMPORARILY REMOVED PENDING PEER REVIEW FOR PUBLICATION.

In this study, we discuss the historical and policy background of expanded private health insurance in South Korea. Looking at the public-private mix of health care financing and its impacts, we conduct a comparative study of 30 member countries of the Organisation for Economic Co-operation and Development (OECD) over the period 1980–2007 to ask whether private health insurance can counterbalance limited government financing, high out-of-pocket payments, and the persistent financial deficit of South Korea’s National Health Insurance system. The panel analyses of OECD Health Data 2009 suggest that private health insurance financing is unlikely to reduce government spending on health care and social security. Also we find little evidence that out-of-pocket payments will be replaced by private health insurance payments. Private health insurance payments, however, are found to have a statistically significant positive association with total spending on health care, which indicates that the coverage effect of private health insurance—in addition to national health insurance—may exceed the efficiency gain through the market competition that private insurers may deliver to the health care sector. These findings leave it unclear whether private initiatives in health care financing will be as effective as the policy advocates hope for, in dealing with the challenges of national health insurance in South Korea. Further studies of how public and private insurers, and providers and consumers interplay in response to  a given structure of private-public mix in financing are warranted to decide the right balance between private coverage and publicly provided universal coverage.

Published: Shin, Jaeun. "Private health insurance in South Korea: An international comparison." Health Policy 108.1 (2012): 76-85.

According to hitherto available data, health expenditures in Pakistan are relatively low in international comparison. Data1F published by the World Health Organization (WHO) for the year 2005 shows a lack of Pakistani health expenditures in most indicators, compared to other low-income countries (LIC). To answer the question whether these results reflect the real situation in Pakistan or whether they exist due to statistical problems, Pakistan, for the first time, developed its National Health Accounts (NHA) in 2009. Only the availability of good estimates of health expenditures allows for evidence-based policymaking and therefore good governance.

The results clearly indicate that the situation in Pakistan is better than what was earlier estimated; however, the total health expenditure (THE) is still low compared to neighboring countries and other LIC. As a result, it is clear that the WHO health expenditure figures for Pakistan are understated, because they mainly comprise public and household out-of-pocket expenditures on health. Expenditures of many other entities, like military, cantonment boards, autonomous bodies, private hospitals, and so on, have not been taken into account in earlier estimations. Therefore, expenditure figures of NHA Pakistan are higher than those of WHO. Overall, the official NHA results show that THE is 27 percent higher than the WHO figure.

Furthermore, this paper cross-checks NHA results with other already available data sources on household expenditure. This comparison includes preliminary results of the Family Budget Survey (FBS), which also includes health items as well as National Accounts (NA) data. In line with this comparison, we calculate a raising factor that can be used for the adjustment of NHA results according to NA. The raised NHA result shows 102 percent higher out-of-pocket (OOP) spending on health; this would result in OOP health expenditures of $25.15 USD per capita (compared to only $12.45 USD per capita in the NHA estimation). This result, based on the NA figure with $33 USD THE per capita, leads to a different evaluation in international comparison, since it nearly reaches the level of India, with $37.5 USD and more than the average of all LIC with $27 USD.

China is transforming itself, and the world is adapting in response. Profound forces have reshaped the country's socioeconomic and political landscapes, but they have also brought challenges—growing pains—that China must face if it is to continue its upward trajectory.

Despite its successes, China is experiencing sharp growing pains. Rising levels of protest have accompanied the country's wrenching structural transformation. Corruption has prompted some observers to claim that the Chinese government is nothing short of a "predatory state." Legal reform continues to languish. Given that such challenges remain, can it be said that China's structural changes have succeeded? Or is the country trapped in transition?

"Growing Pains deserves the attention of every scholar interested in contemporary China." -Scott Kennedy, Indiana University

Growing Pains contains new analytical and empirical research from preeminent scholars working on contemporary China. These scholars identify which of the many problems thought to threaten China's reforms are not as serious as some interpreters claim, as well as those that have already been solved. Further, they point to other high-profile challenges, some of which truly are serious and loom on the horizon. With thoughtful, nuanced analysis, the contributors tackle thorny issues in China's ongoing reforms—employment, land policy, village elections, family planning, health care, social inequality, and environmental degradation—and use rich survey data and on-the-ground observation to assess the severity of the problems and the likelihood of near-term solutions.

Moving beyond the hype and hysteria that often characterize conversations about contemporary China, Growing Pains seeks to present not an optimistic or pessimistic perspective but rather an objective, empirically based view of the country's transition.

Examination copies: Desk, examination, or review copies can be requested through Stanford University Press.

Objective: To show the pattern of patient satisfaction with top-level delivery organizations (Level 2 and Level 3 hospitals), and using neo-institutionalism approach to explain the relatively low satisfaction and to explore the limitations with top providers, focusing on how to improve the competence of Level 2 and Level 3 hospitals at both the individual hospital level and the whole delivery system level.

Data Sources/Study Setting: The household survey by the National Bureau of Statistics in China in 2008; China Health Statistics Yearbooks.

Data Collection/Extraction Methods: The analysis uses a 2008 sample medical experiences of 5,036 residents from 17 provinces collected in a household survey by the National Bureau of Statistics in China. The linear regression model, the structural difference regression model, and the ordered probit model are used in our framework.

Principal Findings: The imbalance between the needs of patients and the limited competence of top-level providers, and the conflict between the business expansion and the limited competence of those providers are deeply and widely influenced by patterns of patient needs, the top providers’ expansion, and the institutional environment.

Conclusions: In order to effectively respond to patient needs, top and lower level providers need to set their own individual priorities. The government needs to improve institutional arrangements to respond to patient needs with the development of a fair and appropriate reimbursement and compensation pricing mechanism, and with further evaluation of top level providers’ advanced and limited health services.