Financial Crisis and Structural Risk in Korean National Health Insurance - A History of Health Care Policy Perspective -

Abstract

To examine why and how financial crisis occurred in 2001 in Korean National Health Insurance (NHI), I take a ’history of health care policy’-oriented approach to the research topic. Instead of following the conventional policy approach that explains policy problems and proposes the alternative solution, my paper explores the dynamic relationship between actors and structure in the making of NHI from a historical perspective. It analytical focus is on the process in which NHI-related risk factors that may be recognized as separate elements have been structured to cause the fiscal crisis in 2001.

First, the current health insurance regime in which the state must be fully responsible for financing the NHI is more likely to deteriorate rather than stabilize risk factors. Since employment-based insurance societies has been unified with regional ones as the National Health Insurance Corporation in 1999, risk factors managed as separate ones has become conglomerated rather than minimized.

Second, as social solidarity in the NHI has less to do with the increase in the insured than with public sector of the health care resources, the unified NHI has little consolidated the solidarity, The NHI has worked independently of the health care delivery system during the last thirty years. Its dual characteristic of the Korean health care system has contributed to the structuring of risk factors, The solidarity must be exposed to the structural risk in the private sector-centered Korean health care system.

In conclusion, I argue that a history of health care perspective can go beyond policy positivism-based disciplines such as health care administration and economics, medical sociology, and health policy to grip with the whole picture of risk structure in the NHI.