Health Regimes in Korea and Thailand

Abstract

Prior to their reforms of the 2000s, South Korea and Thailand already had in place health insurance programs that promised, at least on the books, universal coverage to their citizens. Considering that these countries began addressing in earnest the issue of health care provisioning only in the 1970s, the programs in place showcased the considerable progress their governments made in extending coverage across their large populations. The achievements notwithstanding, however, health insurance systems in both countries were dogged by systemic inequity. In Thailand, 30 percent of the population still lacked health coverage in 1999. Moreover, health insurance systems of both countries were burdened by low risk and income pooling and high levels of out-of-pocket (OOP) spending that especially penalized lower-income groups. In Thailand and Korea, fragmented insurance schemes impeded redistribution of income and risk from the healthy and rich to the sick and poor. At the same time, citizens incurred high levels of direct payments for health services, reflected in substantial OOP spending, which represented the most regressive form of health financing (WHO 2007, 64). In Korea, OOP expenditures accounted for nearly 46 percent of total health expenditures (THEs) in 2000, while in Thailand, they made up 34 percent. Accordingly, total private financing comprised a significant proportion of THE—52 percent and 45 percent—in Korea and Thailand, respectively, and indicated that citizens’ access to health care still relied heavily upon individuals’ ability to pay.¹