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Democratic transitions, health institutions, and financial protection in the emerging economies: insights from Asia

Published online by Cambridge University Press:  14 November 2016

Eduardo J. Gómez
Eduardo J. Gómez*
Affiliation:
Senior Lecturer (Associate Professor), School of Global Affairs, Department of International Development, King’s College London, Strand Campus, London, UK
*
*Correspondence to: Eduardo J. Gómez, Senior Lecturer (Associate Professor), School of Global Affairs, International Development Institute, King’s College London, Strand Campus, London, WC2R 2LS UK. Email: [email protected]
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Abstract

In recent years, several emerging economies have introduced national health insurance programs ensuring access to health care while offering financial protection from out-of-pocket and catastrophic expenses. Nevertheless, in several nations these expenses continue to increase. While recent research has emphasized the lack of funding, poor policy design and corruption as the main culprits, little is known about the politics of establishing federal regulatory agencies ensuring that state governments adhere to national insurance reimbursement and coverage procedures. This article fills in this lacuna by providing an alternative perspective, one that accounts for differences between nations in the creation of regulatory institutions, with an emphasis instead on governing elite strategies to campaign on access to health care during transitions to democracy, civil societal mobilization, constitutional constraints and the national electoral incentives to overcome ineffective decentralization processes. The cases of Indonesia and China are introduced as examples of how and why their differences in this political process accounted for Indonesia’s success and China’s failure to ensure financial protection.

Type
Perspectives
Information
Health Economics, Policy and Law , Volume 12 , Issue 3 , July 2017 , pp. 309 - 323
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Copyright
© Cambridge University Press 2016 

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References

Acemoglue, D. and Robinson, J. (1999), A Theory of Political Transitions, Discussion Paper No. 2277, Centre for Economic Policy Research, London: UK.Google Scholar
Asia Law (2010), ‘Improving Indonesia’s healthcare system – New Hospital Law’, 10 February.Google Scholar
Bangura, Y. (ed.) (2007), Democracy and Social Policy, New York: Palgrave/Macmillan.Google Scholar
Barber, S. and Yao, L. (2010), Health Insurance Systems in China, Background Paper 37, Geneva: WHO.Google Scholar
Bitran, R. (2012), ‘Universal health coverage reforms: patterns of income, spending and coverage in four developing countries’, Results for Development Institute, Working Paper, August.Google Scholar
Brancati, D. (2014), ‘Democratic authoritarianism: origins and effects’, Annual Review of Political Science, 17: 313–326.Google Scholar
Briston, N. (2014), Global Action Towards Universal Health Coverage, Washington DC: Center for Strategic and International Studies.Google Scholar
Brown, R., Píriz, D., Liu, Y. and Moore, J. (2012), ‘Reforming health care in China: historical, economic, and comparative perspectives’, PubPol, 716: 1–26.Google Scholar
Bueno de Mesquita, B., Morrow, D., Siverson, R. and Smith, A. (2005), Political Institutions, Policy Choice, and the Survival of Leaders, unpublished manuscript, Yale University.Google Scholar
Carrie, C. (2009), Health Systems Policy, Finance, and Organization, Oxford: Academic Press.Google Scholar
Carrin, G, Mathauer, I., Xu, K. and Evans, D. (2016), ‘Universal coverage of health services: tailoring its implementation’, Bulletin of the World Health Organization, 86: 817–908.Google Scholar
Cornelius-Schecter, A. (2016), ‘Correcting distorted incentives in China’s healthcare system’, The Yale Review of International Studies. Available at http://yris.yira.org/essays/1235 Google Scholar
Daemmrich, A. (2013), ‘The political economy of healthcare reform in China: negotiating public and private’, Springerplus, 2: 448.CrossRefGoogle Scholar
Duckett, J. (2011), ‘‘Challenging the economic reform paradigm: policy and politics in the early 1980s’ collapse of the rural co-operative medical system’, The China Quarterly, 205: 80–95.CrossRefGoogle Scholar
Eggleton, K. (2012), ‘Healthcare for 1.3 Billion: An Overview of China’s Health System’, Working Paper 20, Walter H. Shorenstein Asia-Pacific Research Centre, Stanford University.Google Scholar
Esping-Andersen, G. (1990), Three Worlds of Welfare Capitalism, Princeton, NJ: Princeton University Press.Google Scholar
Esthey, J. (2014), ‘Key lessons learned from Jamkesmas to achieve universal health care in Indonesia’, World Bank News, http://www.worldbank.org/en/news/feature/2014/01/30/improving-jamkesmas-to-achieve-universal-health-care-in-indonesia[4 May 2016].Google Scholar
Forrat, N. (2013), ‘Why do we need the theory of authoritarian social policy in comparative perspective’, Paper prepared for presentation at the Annual Meeting of the American Political Science Association, 13 August, Chicago, IL.Google Scholar
Gandhi, J. (2008), Political Institutions under Dictatorship, New York, NY: Cambridge University Press.CrossRefGoogle Scholar
Gauri, V. and Khaleghian, P. (2002), ‘Immunization in developing countries: its political and organizational determinants’, World Development, 30: 2109–2132.Google Scholar
Gómez, E. (2015), Health Spending and Inequalities in Emerging Economies, Oxford: Oxfam GB.Google Scholar
Haggard, S. and Kaufman, R. (1995), The Political Economy of Democratic Transitions, Princeton: Princeton University Press.Google Scholar
Haggard, S. and Kaufman, R. (2008), Development, Democracy, and Social Welfare States, Princeton: Princeton University Press.Google Scholar
Halabi, S. (2013), ‘Participation and the right to health: lessons from Indonesia’, Health and Human Rights, 11: 49–59.Google Scholar
Hesketh, T. and Wei, X. (1997), ‘Health in China: from Mao to market reform’, British Medical Journal, 314: 153.Google Scholar
Heywood, P and Harahap, N. (2009), ‘Public funding of health at the district level in Indonesia after decentralization – sources, flows, and contradictions’, Health Research, Policy, and Systems, 7: 1–14.CrossRefGoogle ScholarPubMed
Hort, K., Djasri, H. and Utarini, A. (2013), Regulating the Quality of Health Care: Lessons from Hospital Accreditation in Australia and Indonesia, The Nossal Institute for Global Health, Number 26, University of Melbourne.Google Scholar
Huang, Y. (2013), Governing Health in Contemporary China, Oxfordshire: Routledge Press.Google Scholar
Huber, E. and Stephens, J. D. (2001), Development and crisis of the Welfare State: Parties and Policies in Global Markets, Chicago, IL: The University of Chicago Press.Google Scholar
Kaufman, J. (2006), ‘China’s health care system and avian influenza preparedness’, Journal of Infectious Disease, 197: S7–S13.Google Scholar
Kaufman, J. (2008), ‘China’s health care system and Avian influenza preparedness’, Journal of Infectious Diseases, 197: S7–S13.CrossRefGoogle ScholarPubMed
Keping, Y. (2009), Democracy is a Good Thing: Essays on Politics, Society, and Culture in Contemporary China, Washington DC: Brookings Institution Press.Google Scholar
Lee, W. and Shaw, I. (2014), ‘The impact of out-of-pocket payments on health care inequality: the case of national health insurance in South Korea’, International Journal of Environmental Research and Public Health, 11: 7304–7318.Google Scholar
Li, Y., Quenching, W., Lui, C., Man, Z., Die, X., Yin, H., Joao, M., Lui, G., Yao, Y. and Ning, N. (2014), ‘‘Catastrophic health expenditure and rural household impoverishment in China: what role dos the new cooperative health insurance scheme play?’, PLoS One, 9: 1–9.Google Scholar
Long, Q., Ling, X., Bekedam, H. and Tang, S. (2013), ‘Changes in health expenditures in China in 2000s: has the health system reform improved affordability’, International Journal for Equity in Health, 12: 1–8.Google Scholar
Mares, I. (2005), ‘Social protection around the world: external insecurity, state capacity, and domestic political cleavages’, Comparative Political Studies, 38: 623–651.Google Scholar
Masiye, F., Kaonga, O. and Kirigia, J. (2015), ‘Does user fee removal policy provide financial protection from catastrophic health care payments? Evidence from Zambia’, PLOSOne, DOI:10.1371.Google Scholar
Masiye, F., Kaonga, O. and Kirigia, J. (2016), ‘Does user fee removal policy provide financial protection from catastrophic health care payments? Evidence from Zambia’, PLoS One, 11: e0146508.Google Scholar
McGuire, J. (2010), Health, Wealth and Democracy, New York: Cambridge University Press.Google Scholar
Mkandawire, T. (2004), ‘Disempowering new democracies and the persistence of poverty’, in M. Spoor (ed.) Globalization, Poverty and Conflict, Dordrecht: Kluwer Academic Publishers, 117–153.Google Scholar
Mujani, S. and Liddle, R. (2010), ‘Voters and the new Indonesia Democracy’, in E. Aspinall and M. Mietzner (eds), Problems of Democratization in Indonesia: Elections, Institutions, and Society. Singapore: ISEAS Publishing, 75–99.Google Scholar
Mulligan, C., Gil, R. and Sala-i-Martin, X. (2004), ‘Do democracies have different public policies than non-democracies’, Journal of Economic Perspectives, 18: 51–74.CrossRefGoogle Scholar
Pisani, E. (2014), ‘Indonesia in pieces: the downside of decentralization’, Foreign Affairs, July/August.Google Scholar
Pitriyan, P. (2013), ‘Health inequity in Indonesia: is it declining?’, Working Paper, Department of Economics, Padjadjaran University.Google Scholar
Ragin, C. (1987), The Comparative Method: Moving Beyond Qualitative and Quantitative Studies, Berkeley, CA: University of California Press.Google Scholar
Rudra, N. and Haggard, S. (2005), ‘Globalization, democracy, and effective welfare spending in the developing world’, Comparative Political Studies, 38, 1015–1049.Google Scholar
Rueschemeyer, D., Stephens, E. H. and Stephens, J. D. (1992), Capitalist Development and Democracy, Chicago, IL: University of Chicago Press.Google Scholar
Saksena, P, HSD, J. and Evans, D. (2014), ‘Financial risk protection and universal health coverage: evidence and measurement challenges’, PLoS Med, 11: e1001701.Google Scholar
Savedoff, W. (2012), Transitions in Health Financing and Policies for Universal Health Coverage, Washington, DC: Results for Development.Google Scholar
Shahrawat, R. and Rao, K. (2012), ‘Insured yet vulnerable: out-of-pocket payments and India’s poor’, Health Policy & Planning, 27: 1–9.Google Scholar
Stokes, S. (2001), Mandates and Democracy: Neoliberalism by Surprise in Latin America, Cambridge: Cambridge University Press.Google Scholar
The Economist (2010), Old Problems, Fresh Solutions: Indonesia’s Health Regime, London: The Economist.Google Scholar
Van Minh, H., Phoun, N., Saksena, P., James, C. and Xu, K. (2013), ‘Financial burden of household out-of-pocket health expenditure in Viet Nam: findings from the National Living Standard Survey 2002–2010’, Social Science & Medicine, 96: 258–263.Google Scholar
Vian, T., Domente, S., Negnuta, A., Matei, A. and Habicht, J. (2015), ‘Barriers to universal health coverage in the Republic of Maldova: a policy analysis of formal and informal out-of-pocket payments’, BMC Health Services Research, 15(319): 1–15.Google Scholar
Vos, T., C. Murray and C. Allen (2015), ‘Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013’, The Lancet, 386: 743–800.Google Scholar
Wang, L., Wang, Y., Yang, G., Ma, J., Wang, L. and Qi, X. (N/D), China Information System for Disease Control and Prevention (CISDCP), Seattle, Washington: Centre for Health and Aging, National Bureau of Asian Research, 1–7.Google Scholar
Wintrobe, R. (1988), The Political Economy of Dictatorship, New York: Cambridge University Press.Google Scholar
WHO (2008a), Delivering on the Global Partnerships for Achieving the Millennium Development Goals, Geneva: WHO.Google Scholar
WHO (2008b), Indonesia: WHO Country Cooperation Strategy, 2007–2011, Geneva: WHO.Google Scholar
WHO (2013), Global Nutrition Policy Review, Geneva: WHO.Google Scholar
Wong, V. and Chiu, S. (1997), ‘Health-care reforms in the People's Republic of China’, International Journal of Public Sector Management, 10: 76–92.Google Scholar
Xiangqian, G. (2012), ‘Chinese NGOs and Global Health Governance: from the perspective of International Law’, Working Paper #27, Research Center for Chinese Politics and Business, Indiana University.Google Scholar
Xu, K., Evans, D., Carrin, G. and Mylena, A. (2005), Designing Health Financing Systems to Reduce Catastrophic Health Expenditure, Technical Briefs for Policy-Makers, Geneva: World Health Organization.Google Scholar
Yip, W. and Hsiao, W. (2015), ‘What drove the cycles of Chinese health system reform?’, Health Systems and Reform, 1: 52–61.CrossRefGoogle Scholar
Yip, W., Hsiao, W., Chen, W., Hi, S., Ma, J. and Maynard, A. (2012), ‘Early appraisal of China’s huge and complex health-care reforms’, The Lancet, 379: 833–842.Google Scholar
Yu, H. (2015), ‘Universal health insurance coverage for 1.3 billion people: what accounts for China’s success?’, Health Policy, 119: 1145–1152.Google Scholar