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.

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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.

China's Harmonious Society colloquium series

co-sponsored by the Stanford China Program and the Center for East Asian Studies

Since 2006, the official doctrine of China's Communist Party calls for the creation of a "harmonious society" (HeXieSheHui). This policy, identified with the Hu Jintao leadership, acknowledges the new problems that have emerged as China continues its amazing economic growth. The economy is booming but so are tensions from rising inequality, environmental damage, health problems, diverse ethnicities, and attempts to break the "iron rice bowl." In this series of colloquia, leading authorities will discuss the causes of these tensions, their seriousness, and China's ability to solve these challenges.

Nancy Shulman's talk topic will be posted soon.

Nancy Shulman conducts laboratory and clinical research in the area of HIV therapeutics, with focus on antiretroviral resistance and treatment strategies of experienced patients, the impact of antiretroviral treatment on HIV co-receptor utilization, and HIV in China. she received her MD from Kansas University Medical School and holds a BA in biochemistry from University of Texas, Austin. She is a doctor specializing in internal medicine, pediatrics, and infectious diseases.

"Healthcare Coverage for 1.3 Billion: China's Odyssey"

Karen Eggleston

Media coverage as well as the academic literature give conflicting appraisals of China's reality: Is China's healthcare system on the verge of collapse? Why is healthcare so expensive and difficult to access in contemporary China? Have reforms 'marketizing' healthcare drastically undermined progress in assuring affordable access for all? Or do hospitals and other providers constitute a last bastion of state control and bureaucratized monopoly in the name of equal access? Chinese analysts and policy advisers have engaged in a sometimes acrimonious debate; some champion a government-led, National Health Service-like model, while others passionately argue that market forces should play a greater role. In this talk, Karen Eggleston will present a brief overview of China's health system reforms and current developments.

Karen Eggleston focuses her research on comparative healthcare systems during economic development and transition from central planning to market-based economies. Her interests include the impact of payment incentives on healthcare insurer and provider behavior; chronic disease management; and incentives surrounding health behaviors such as the spread of HIV/AIDS and tuberculosis, overuse of antibiotics, and smoking. She earned her PhD in public policy from Harvard University and has MA degrees in economics and Asian studies from the University of Hawaii.