Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-05T06:53:49.680Z Has data issue: false hasContentIssue false
  • English
  • Français

Health Policy in East Asia: Objectives, Priorities and Performance

Published online by Cambridge University Press:  03 September 2020

Gyu-Jin Hwang
Gyu-Jin Hwang*
Affiliation:
Department of Sociology and Social Policy, School of Social and Political Sciences, University of Sydney, Australia E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

This article aims to identify how the economies that do not necessarily prioritise social rights in their social policy arrangements fare in achieving various healthcare objectives. The big five of East Asian countries – China, Japan, South Korea, Taiwan, Singapore plus Hong Kong – are considered as such cases. It first highlights a wide range of variations in their healthcare offerings. It then shows that, contrary to the common belief, they constitute a surprisingly high level of redistributive elements in them. Deviating from their overall welfare regime characteristics, each healthcare system presents a unique combination of policy objectives in social, medical, economic and political terms, raising a question of the utility of social rights as a central conceptual lens to understand the world of welfare capitalism.

Keywords

East Asiahealth policypolicy objectivescomparative welfare state
Type
Article
Information
Social Policy and Society , Volume 20 , Issue 4 , October 2021 , pp. 599 - 621
Copyright
© Cambridge University Press 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bambra, C. (2005a) ‘Worlds of welfare and the health care discrepancy’, Social Policy and Society, 4, 1, 31-41.CrossRefGoogle Scholar
Bambra, C. (2005b) ‘Cash versus services: worlds of welfare and the decommodification of cash benefits and health care services’, Journal of Social Policy, 34, 2, 195-213.CrossRefGoogle Scholar
Bloor, K., Hendry, V. and Maynard, A. (2006) ‘Do we need more doctors?’ Journal of the Royal Society of Medicine, 99, 6, 281-87.CrossRefGoogle ScholarPubMed
Census and Statistics Department (2017) Thematic Household Survey Report No. 63, Hong Kong.Google Scholar
Chan, E. (2018) ‘Interview with Ms. Elain Chan, Hong Kong Actuaries’, Actuarial Society of Hong Kong’s Newsletter, volume 2, August.CrossRefGoogle Scholar
Cheng, T-M. (2015a) ‘Reflections on the 20th anniversary of Taiwan’s single-payer national health insurance system’, Health Affairs, 34, 3, 502-510.CrossRefGoogle ScholarPubMed
Cheng, T-M. (2015b) ‘Taiwan’s health care system: the next 20 years’, Brookings, 14 May, https://www.brookings.edu/opinions/taiwans-health-care-system-the-next-20-years/ [accessed 08.04.2017].Google Scholar
Chisholm, D. and Evans, D. B. (2010) Improving Health System Efficiency as a Means of Moving towards Universal Coverage, World Health Report 2010, Background Paper, 28, WHO.Google Scholar
Department of Health (2016) Hong Kong: The Facts, Government of Hong Kong, https://www.gov.hk/en/about/abouthk/factsheets/docs/public_health.pdf [accessed 21.07.2018].Google Scholar
Department of Health (2017) Health Facts of Hong Kong, 2017 Edition, Government of Hong Kong, https://www.dh.gov.hk/english/statistics/statistics_hs/files/Health_Statistics_pamphlet_E.pdf [accessed 21.07.2018].Google Scholar
Department of Statistics, Singapore (2019) Report on the Household Expenditure Survey, 2017/18, https://www.singstat.gov.sg/-/media/files/publications/households/hes201718.pdf [accessed 20.07.2020].Google Scholar
Esping-Andersen, G. (1990) The Three Worlds of Welfare Capitalism, Cambridge: Polity Press.Google Scholar
Food and Health Bureau, Hong Kong (2017) Infant Mortality Rate, Food and Health Bureau, Hong Kong, https://www.fhb.gov.hk/statistics/en/health_statistics.htm [accessed 20.07.2020].Google Scholar
Food and Health Bureau, Hong Kong (2018) Domestic Health Accounts, Food and Health Bureau, Hong Kong, https://www.fhb.gov.hk/statistics/en/dha/dha_summary_report.htm [accessed 21.07.2018].Google Scholar
Freeman, R. and Frisina, L. (2010) ‘Health care systems and the problem of classification’, Journal of Comparative Policy Analysis: Research and Practice, 12, 1-2, 163-78.Google Scholar
Ginsburg, P. B. and Koretz, D. M. (1983) ‘Bed availability and hospital utilization: estimates of the “Roemer Effect”’, Health Care Financing Review, 5, 1, 87-92.Google ScholarPubMed
Goodin, R., Headey, B. and Muffels, R. (1999) The Real Worlds of Welfare Capitalism, Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Hankook Ilbo (2017) ‘3,500 employees pay the national health insurance contribution ceiling’, 7 September, https://www.hankookilbo.com/News/Read/201709070823773298 [accessed 20.04.2018] (In Korean).Google Scholar
Haseltine, W. A. (2013) Affordable Excellence: The Singapore Healthcare Story, Washington, D.C.: Brookings Institution Press.Google Scholar
He, A. J. (2017) ‘Introducing voluntary private health insurance in a mixed medical economy: are Hong Kong citizens willing to subscribe?’, BMC Health Services Research, 17, 603, 1-10.CrossRefGoogle Scholar
He, A. J. (2018) ‘Public satisfaction with the health system and popular support for state involvement in an East Asian welfare regime: health policy legitimacy of Hong Kong’, Social Policy and Administration, 52, 3, 750-70.CrossRefGoogle Scholar
He, A. J. and Wu, S. (2017) ‘Towards universal health coverage via social health insurance in China: systemic fragmentation, reform imperatives, and policy alternatives’, Applied Health Economics and Health Policy, 15, 6, 707-16.CrossRefGoogle ScholarPubMed
Holliday, I. (2000) ‘Productivist welfare capitalism: social policy in East Asia’, Political Studies, 48, 4, 706-23.CrossRefGoogle Scholar
Hospital Authority, Hong Kong (2020) Fees and Charges, Hospital Authority, Hong Kong, https://www.ha.org.hk/visitor/ha_visitor_index.asp?Content_ID=10045&Lang=ENG# [accessed 6 February 2020].Google Scholar
Hsiao, W., Yip, W., Rannan-Eliya, R., Kwok, A., Bir, A., Cao, Z., Eggleston, K., Fitzner, K., Jakab, M., Liao, C., Neoh, K., Shen, Y., Somanathan, A., Vryonides, D. and Yaracaris, P. (1999) Improving Hong Kong’s Health Care System: Why and For Whom? Printing Government: Hong Kong SAR.Google Scholar
Hudson, J., Kühner, S. and Lowe, S. (2008) The Short Guide to Social Policy, Bristol: The Policy Press.Google Scholar
Hussey, P. and Anderson, G. F. (2003) ‘A comparison of single- and multi-payer health insurance systems and options for reform’, Health Policy, 66, 3, 215-28.CrossRefGoogle ScholarPubMed
Hwang, G. (2015) ‘Welfare modelling business in the East Asian welfare state debate’, in Irving, Z., Fenger, M. and Hudson, J. (eds.), Social Policy Review, 27: Analysis and Debate in Social Policy, Bristol: Policy Press, 225-45.CrossRefGoogle Scholar
Kasza, G. J. (2002) ‘The illusion of welfare “regimes”’, Journal of Social Policy, 31, 2, 271-87.CrossRefGoogle Scholar
Kwon, S. (2009) ‘Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage’, Health Policy and Planning, 24, 1, 63-71.CrossRefGoogle ScholarPubMed
Kwon, S., Lee, T-J. and Kim, C-Y. (2015) Republic of Korea: health system review, Health Systems in Transition, 5, 4, 1-102.Google Scholar
Kyodo News (2018) ‘Japan’s population decline to 127 mil., aging continue in 2017’, 13 April, https://english.kyodonews.net/news/2018/04/1fc13074ea8a-japans-population-decline-aging-continue-in-2017.html [accessed 20. 07. 2020].Google Scholar
Langenbrunner, J. C. and Somanathan, A. (2011) Financing Health Care in East Asia and the Pacific: Best Practices and Remaining Challenges, Washington D.C.: World Bank.Google Scholar
Lasswell, H. D. (1936) Politics: Who Gets What, When, How, New York: Whittlesey House.Google Scholar
Liang, L. and Langenbrunner, J. C. (2013) The Long March to Universal Coverage: Lessons from China, UNICO Study Series 9, Washington DC: World Bank.Google Scholar
Lim, J. (2017) ‘Sustainable health care financing: the Singapore experience’, Global Policy, 8, S2, 103-09.CrossRefGoogle Scholar
Liu, X., Wong, H., and Liu, K. (2016) ‘Outcome-based health equity across different social health insurance schemes for the elderly in China’, BMC Health Services Research, 16, 9, 1-12.Google ScholarPubMed
Lu, J. R. (2014) Universal Health Coverage Assessment: Taiwan, Global Network for Health Equity (GNHE).Google Scholar
Marshall, T. H. (1950) Citizenship and Social Class, Cambridge: Cambridge University Press.Google Scholar
McGranahan, D. (1972) ‘Development indicators and development models’, The Journal of Development Studies, 8, 3, 91-102.CrossRefGoogle Scholar
Ministry of Health and Welfare, Taiwan (2013) Statistics of General Health and Welfare, Ministry of Health and Welfare, Taiwan Government, https://www.mohw.gov.tw/lp-3570-2.html [accessed 20.07.2018].Google Scholar
Ministry of Health and Welfare, Taiwan (2015) Statistics of General Health and Welfare, Ministry of Health and Welfare, Taiwan Government, https://www.mohw.gov.tw/lp-3570-2.html [accessed 20.07.2018].Google Scholar
Ministry of Health and Welfare, Taiwan (2016) Public Satisfaction of National Health Insurance, MoHW: Taiwan.Google Scholar
Ministry of Health, Singapore (2015) Patient Satisfaction Survey 2015, MoH: Singapore.Google Scholar
Ministry of Health, Singapore (2018) ‘Health Facilities’, https://www.moh.gov.sg/resources-statistics/singapore-health-facts/health-facilities [accessed 20.07.2018].Google Scholar
Ministry of Health, Singapore (n.d.) Beds in Inpatient Facilities and Places in Non-Residential Long-Term Care Facilities, https://www.moh.gov.sg/resources-statistics/singapore-health-facts/beds-in-inpatient-facilities-and-places-in-non-residential-long-term-care-facilities [accessed 06.02.2020].Google Scholar
Mosley, H. and Mayer, A. (1999) Benchmarking National Labour Market Performance: A Radar Chart Approach, WZB Discussion Paper, No. FS 99-202.Google Scholar
Munro, N. and Duckett, J. (2016) ‘Explaining public satisfaction with healthcare systems: findings from a nationwide survey in China’, Health Expectations, 19, 3, 654-66.CrossRefGoogle ScholarPubMed
Murata, H. and Aramaki, H. (2015) Why Japanese are not Satisfied with their Health Care System: From the ISSP Survey on Health and Health Care, NHK Broadcasting Culture Research Institute.Google Scholar
National Institute of Population and Social Security Research (2014) Social Security in Japan, NIPSSR, ISSN 2186-0297.Google Scholar
National Statistics, Republic of China (n.d.) ‘Principal figures’, https://eng.stat.gov.tw/ct.asp?xItem=37408&CtNode=5347&mp=5 [accessed 31.03.2017]Google Scholar
O’Donnell, O., van Doorslaer, E., Rannan-Eliya, R. P., Somanathan, A., Adhikari, S. R., Akkazieva, B., Harbianto, D., Garg, C. C., Hanvoravongchai, P., Herrin, A. N., Huq, M. N., Ibragimova, S., Karan, A., Kwon, S-M., Leung, G. M., Lu, J. R., Ohkusa, Y., Pande, B. R., Racelis, R., Tin, K., Tisayaticom, K., Trisnantoro, L., Wan, Q., Yang, B-M. and Zhao, Y. (2008) ‘Who pays for health care in Asia’, Journal of Health Economics, 27, 2, 460-75.CrossRefGoogle ScholarPubMed
OECD Stat (n.d.) OECD Health Statistics, http://www.oecd.org/els/health-systems/health-data.htm [accessed 17.07.2017].Google Scholar
OECD Tax Database (n.d.) OECD Tax Database, https://www.oecd.org/tax/tax-policy/tax-database/ [accessed 17.07.2017].Google Scholar
Palier, B. (2005) The Health Care Policies Quadrilemma, Paper presented at the ESPANET Conference, 22-24 September, Fribourg, Switzerland.Google Scholar
Pavolini, E., Palier, B. and Guillén, A. M. (2013) ‘The health care policy quadrilemma and comparative institutional reforms’, in Pavolini, E. and Guillén, A. M. (eds.), Health Care Systems in Europe under Austerity: Institutional Reforms and Performance, London: Palgrave Macmillan, 193-221.CrossRefGoogle Scholar
Pierson, P. (1994) Dismantling the Welfare State? Regan, Thatcher, and the Politics of Retrenchment, Cambridge: Cambridge University Press.Google Scholar
Piven, F. F. and Cloward, R. A. (1971) Regulating the Poor: The Functions of Public Welfare, New York: Pantheon Books.Google Scholar
Phua, K. H. (2003) ‘Attacking hospital performance on two fronts: network corporatization and financing reforms in Singapore’, in Preker, A. S. and Harding, A. (eds.), Innovations in Health Services Delivery: The Corporatization of Public Hospitals, Washington, DC: The World Bank, 451-84.Google Scholar
Ramesh, M. (2004) Social Policy in East and Southeast Asia: Education, Health, Housing, and Income Maintenance, London: RoutledgeCurzon.CrossRefGoogle Scholar
Ramesh, M. (2008) ‘Autonomy and control in public hospital reforms in Singapore’, American Review of Public Administration, 38, 1, 62-79.CrossRefGoogle Scholar
Ramesh, M., Wu, X. and He, A. J. (2014) ‘Health governance and healthcare reforms in China’, Health Policy and Planning, 29, 6, 663-72.CrossRefGoogle ScholarPubMed
Regidor, E. (2004) ‘Measures of health inequalities: Part 1’, Journal of Epidemiol Community Health, 58, 10, 858-61.CrossRefGoogle ScholarPubMed
Reid, T. R. (2010) The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care, London: Penguin Books.Google Scholar
Research Office of Legislative Council Secretariat (2016/17) Health Services Statistical Highlights, ISSH03/16-17.Google Scholar
Richardson, J., Wildman, J. and Robertson, I. K. (2003) ‘A critique of the World Health Organisation’s evaluation of health system performance’, Health Economics, 12, 5, 355-66.CrossRefGoogle ScholarPubMed
SingHealth (2018) Day Surgery Ward Charges, Singapore General Hospital, https://www.sgh.com.sg/patient-services/charges-payment/pages/types-wards.aspx [accessed 20.07.2018].Google Scholar
South China Morning Post (2015) ‘Hong Kong public hospital patients must wait up to two and a half years to see a specialist, new data reveals’, 25 September, https://www.scmp.com/news/hong-kong/health-environment/article/1861195/hong-kong-public-hospital-patients-must-wait-two [accessed 30.10.2019].Google Scholar
South China Morning Post (2019) ‘Former Hong Kong health chief slams medical voucher scheme for the elderly as lax, flawed and ‘not cost-effective”, 12 March, https://www.scmp.com/news/hong-kong/health-environment/article/3001151/former-hong-kong-health-chief-slams-medical [accessed 30.10.2019].Google Scholar
The Government of the Hong Kong Special Administrative Region (2019) Health Care Voucher, https://www.hcv.gov.hk/eng/pub_background.htm [accessed 24.10.2019].Google Scholar
The Japan Times (2017) ‘Japan’s health care is far from free, and ballooning costs could mean higher premiums’, 11 August https://www.japantimes.co.jp/news/2017/08/11/business/japans-health-care-far-free-ballooning-costs-mean-higher-premiums/ [accessed 19.08.2020]Google Scholar
Tin, K. Y. K., Song, W., Tsoi, P. K. O., Lee, Y. H., Chong, D. S. Y., Lam, D. W. S., Yeung, A. Y. T., Ma, E. S. K. and Maw, C. K. C. (2016) ‘Hong Kong domestic health spending: financial years 1989/90 to 2012/13’, Hong Kong Medical Journal, 22, 3, 2-23.Google ScholarPubMed
Toth, F. (2016) ‘Classification of healthcare systems: can we go further?’ Health Policy, 120, 5, 535-43.CrossRefGoogle ScholarPubMed
Uchida, Y. (2012) ‘The health care system in Japan’, in Aspalter, C., Uchida, Y. and Gauld, R. (eds.), Healthcare Systems in Europe and Asia, New York: Routledge, 81-102.Google Scholar
Wagstaff, A. (2007) ‘Health systems in East Asia: what can developing countries learn from Japan and the Asian tigers?’ Health Economics, 16, 5, 441-56.CrossRefGoogle ScholarPubMed
Wei, X., Yin, J., Wong, S. Y. S., Griffiths, S. M., Zou, G. and Shi, L. (2017) ‘Private ownership of primary care providers associated with patient perceived quality of care’, Medicine, 96, 1, 1-8.CrossRefGoogle ScholarPubMed
Wendt, C., Frisina, L. and Rothgang, H. (2009) ‘Health system types: a conceptual framework for comparison’, Social Policy and Administration, 43, 1, 70-90.CrossRefGoogle Scholar
Wendt, C., Kohl, J., Mischke, M. and Pfeifer, M. (2010) ‘How do Europeans perceive their healthcare system? Patterns of satisfaction and preference for state involvement in the field of healthcare’, European Sociological Review, 26, 2, 177-92.CrossRefGoogle Scholar
Wilding, P. (2008) ‘Is the East Asian welfare model still productive?’ Journal of Asian Public Policy, 1, 1, 18-31.CrossRefGoogle Scholar
Wong, C. N. and Tin, K. Y. K. (2015) Universal Health Coverage Assessment: Hong Kong, Global Network for Health Equity (GNHE).Google Scholar
World Bank (2017) World Development Indicators, http://data.worldbank.org/indicator/SP.DYN.IMRT.IN [accessed 06.04. 2017].Google Scholar
World Health Organisation (2000) The World Health Report 2000 – Health Systems: Improving Performance, Geneva: WHO.Google Scholar
World Health Organisation (2017) Global Health Database Health Expenditure, http://apps.who.int/nha/database/Select/Indicators/en [accessed 31.03. 2017].Google Scholar
Xinhuanews (2019) ‘China to further unify rural, urban medical insurance schemes’, 13 May, http://www.xinhuanet.com/english/2019-05/13/c_138055225.htm, [accessed 06. 02. 2020].Google Scholar
Xu, K., Soucat, A., Kutzin, J., Brindley, C., Maele, N. V., Toure, H., Aranguren Garcia, M., Li, D., Barroy, H., Flores Saint-Germain, G., Roubal, T., Indikadahena, C. and Cherilova, V. (2018) Public Spending on Health: a Closer Look at Global Trends, WHO/HIS/HGF/HFWorkingPaper/18.3, Geneva: World Health Organisation.Google Scholar
Yeung, R. and Wai-Sum, C. (2006) ‘Health financing in Hong Kong: the current status’, in Leung, G. M. and Bacon-Shone, J. (eds.), Hong Kong’s Health System: Reflections, Perspectives and Visions, Hong Kong: Hong Kong University Press, 435-46.Google Scholar
Yin, J. D-C. and He, A. J. (2018) ‘Health insurance reforms in Singapore and Hong Kong: how the two ageing Asian tigers respond to health financing challenges?’ Health Policy, 122, 7, 693-97.CrossRefGoogle ScholarPubMed
Yu, H. (2015) ‘Universal health insurance coverage for 1.3 billion people: what accounts for China’s success?’ Health Policy, 119, 9, 1145-52.CrossRefGoogle ScholarPubMed
Yu, S. (2012) ‘Contribution of health care decommodification index to the analysis of the marginalisation of East Asian countries in comparative welfare studies, Development and Society, 41, 2, 253-70.Google Scholar
Yu, S. (2014) ‘Studying the health care systems in seven East Asian countries by the cluster analysis’, Development and Society, 43, 1, 81-107.Google Scholar
Zhu, K., Zhang, L., Yuan, S., Zhang, X. and Zhang, Z. (2017) ‘Health financing and integration of urban and rural residents’ basic medical insurance systems in China’, International Journal for Equity in Health, 16, 194, 1-8.CrossRefGoogle Scholar