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A Tale of Two Systems: The Impact of Universal Health Coverage on Financial Risk Protection in Taiwan and South Korea
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Abstract:
One of the key objectives of introducing a compulsory health insurance is to provide citizens, regardless of socioeconomic status, with financial risk protection against unexpected catastrophic expenditures in the face of illness. South Korea and Taiwan achieved universal health coverage (UHC) through mandatory social insurance schemes in 1989 and 1995, respectively. Despite both countries' efforts to achieve the goal of financial risk protection for more than two decades, past research has demonstrated that household out-of-pocket (OOP) payment still accounts for more than one-third of total health expenditures in both countries. When OOP payment represents a significant share of financial sources for health care, one should be particularly concerned about the distribution of such payments, in particular, catastrophic health expenditures, across households of differing economic levels. This talk sets out to examine the change in the incidence and distribution of catastrophic health expenditures before and after the introduction of the National Health Insurance programs in South Korea and Taiwan.
Given similarity in the health and National Health Insurance (NHI) system characteristics observed in South Korea and Taiwan, substantial variation in the distribution of catastrophic payment among households was noted. The rich are more likely to incur catastrophic payment in South Korea, but the opposite trend is noted in Taiwan. Further assessment on the impact of universal health coverage (UHC) on reducing catastrophic headcount (defined as the proportion of households incurring catastrophic health payment) is observed in Taiwan, but not in South Korea. We found that when South Korea introduced the NHI program with a limited benefit package and high copayment, it produced little effect (if not none) in reducing financial burden in terms of proportion of catastrophic headcount. On the contrary, the impact of universal health coverage on catastrophic headcount ranged from -1.82% to -4.08% for Taiwan, due to the provision of a rather comprehensive benefit package with modest copayment. While UHC is a well-lauded policy goal and may be a magic word for many countries striving for the achievement, it is definitely not a panacea to resolve the incidence of catastrophic payment and potential medical impoverishment. To provide sufficient financial protection against unexpected medical expenses, the design of the benefit coverage and risk sharing mechanism is key to the success of effectively achieving UHC.
Bio
Jui-fen Rachel Lu, Sc.D., is the Fulbright Visiting Scholar at Center for East Asian Studies, Stanford University, and a Professor at Chang Gung University (CGU) in Taiwan, where she teaches comparative health systems, health economics, and health care financing and has served as department chair (2000-2004), Associate Dean (2009-2010) and Dean of College of Management (2010-2013). She earned her B.S. from National Taiwan University, and her M.S. and Sc.D. from Harvard University, and she was also a Takemi Fellow at Harvard (2004-2005). Prof. Lu is currently the President of Taiwan Society of Health Economics (TaiSHE) and an Honorary Professor at Hong Kong University (2007-2017). Dr. Lu was also the recipient of IBM Faculty Award in 2009.
Her research focuses on 1) the equity issues of the health care system; 2) impact of the NHI program on health care market and household consumption patterns; 3) comparative health systems in Asia-Pacific region. She is a long-time and active member of Equitap (Equity in Asia-Pacific Health Systems) research network and was the coordinator for the catastrophic payment component of Equitap II research project which involved 21 country teams and was jointly funded by IDRC, AusAID, and ADB. Professor Lu has also been appointed to serve as a member on various government committees dealing with health care issues in Taiwan.
Okimoto Conference Room, Encina Hall 3rd Floor, East Wing
Rachel Jui-fen Lu
Visiting Scholar, Center for East Asian Studies
Stanford University
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Repression and Foreign Aid in Autocracies: Exploiting Debt Relief Negotiations in Post-Cold War Africa
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Does dependence on development aid from Western sources constrain the use of repression among autocrats? To answer this question, I employ a novel dataset of Africa's post-Cold War autocracies in which the unit of analysis is the country-day rather than the country-year. This day-level dataset enables me to address three potential sources of bias that obscure the relationship between Western aid dependence and repression. The evidence suggests that, when the threat of nancial sanction is credible, Western donors have reduced the daily odds of repression in Africa's post-Cold War autocracies by a factor of 10. Western aid dependence is constraining even during election seasons, when rates of protest and repression are high relative to other times of year. Most broadly, these results suggest that modern autocrats who rely on Western donors for nancial support lack the easy recourse to repression enjoyed by their Cold War era predecessors.
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CDDRL Working Papers
Election Ethics: Fair Play & Due Process
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The Anatomy of Authoritarianism in the Arab World
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Abstract
In this talk Joseph Sassoon discusses his recently released book Anatomy of Authoritarianism in the Arab Republics (Cambridge University Press, 2016). By examining the system of authoritarianism in eight Arab republics, the book portrays life under these regimes and explores the mechanisms underpinning their resilience. How did the leadership in these countries create such enduring systems? What was the economic system that prolonged the regimes’ longevity, but simultaneously led to their collapse? Why did these seemingly stable regimes begin to falter? This book seeks to answer these questions by utilizing the Iraqi archives and memoirs of those who were embedded in these republics: political leaders, ministers, generals, security agency chiefs, party members, and business people. Taking a thematic approach, the book begins in 1952 with the Egyptian Revolution and ends with the Arab uprisings of 2011. It seeks to deepen our understanding of the authoritarianism and coercive systems that prevailed in these countries and the difficult process of transition from authoritarianism that began after 2011.
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Joseph Sassoon is an Associate Professor at Georgetown University’s School of Foreign Service and the Sheikh Sabah Al Salem Al Sabah Chair at Georgetown’s Center for Contemporary Arab Studies. His work focuses on the history, politics, and political economy of the Arab world, and he has published extensively on Iraq and its economy. Sassoon’s book Saddam Hussein’s Ba`h Party: Inside an Authoritarian Regime (Cambridge University Press, 2013) won the British-Kuwait Prize for the best book on the Middle East. His previous publications include The Iraqi Refugees: The New Crisis in the Middle East (London, I.B. Tauris, 2009). He was a fellow at the Woodrow Wilson Center for International Scholars during the 2014-15 academic year. Born in Baghdad, Sassoon completed his PhD at St Antony’s College, University of Oxford.
Philippines Conference Room
Encina Hall, 3rd Floor Central
616 Serra St
Stanford, CA 94305
Joseph Sassoon
Associate Professor
Georgetown University
Seminars
Oil and Urban Life in Kuwait
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Abstract
In this talk Farah Al-Nakib will discuss her recently released book Kuwait Transformed: A History of Oil and Urban Life (Stanford University Press, 2016), in which she traces the relationships between the urban landscape, patterns and practices of everyday life, and social behaviors and relations in Kuwait, from its settlement in 1716 through the bridge of oil discovery to the twenty-first century. The history that emerges reveals how decades of urban planning, suburbanization, and privatization have eroded an open, tolerant society and given rise to the insularity, xenophobia, and divisiveness that characterize Kuwaiti social relations today. However, over the past decade several social forces and youth-based movements—from political protesters to architects and small entrepreneurs—have been staking claims to the city and demanding a different kind of urban experience. Beyond simply reviving the declined urban center, Al-Nakib argues, their efforts have the potential to restore Kuwaiti society’s lost urbanity.
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Farah Al-Nakib is Assistant Professor of History and Director of the Center for Gulf Studies at the American University of Kuwait. She obtained her PhD (2011) and MA (2006) in history from the School of Oriental and African Studies in London. Her research primarily focuses on the urban history of Kuwait City before and after oil, on which she has written her first book. She also writes about memory and forgetting in relation to the built environment. Her latest research analyzes the 1990-91 Iraqi invasion and occupation of Kuwait from a social historical perspective. Al-Nakib is currently a Carnegie Centennial Fellow at American University in Washington, DC. She is also a co-editor of Jadaliyya’s Cities Page.
Reuben Hills Conference Room
2nd Floor East Wing E207
Encina Hall
616 Serra Street
Stanford, California 94305
Farah Al-Nakib
Assistant Professor
American University of Kuwait
Seminars
Bassam Haddad Analyzes the Root Causes and Dynamics of the Syrian Uprising [VIDEO]
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As part of the Program on Arab Reform and Democracy's speaker series, George Mason University scholar Bassam Haddad explained the roots and dynamics of the tragic Syrian uprising, with particular attention to its background and to the recent Russian intervention, in a talk dated January 22, 2016. After nearly five years since the start of the uprising, Syria finds itself divided and embattled, with no end in sight. More significantly, more than half of the Syrian population is displaced and the death toll surpassed 300,000 by all counts. The Syrian tragedy persists and, more than any other case of mass uprising in the region, continues to be shrouded in political power-plays and contradictions at the local, regional, and international levels, Haddad explained.
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Tunisia’s Pathway to Democracy
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After having witnessed the beginning of the Arab Spring in December 2010, and the ouster of former President Zine El Abidine Ben Ali in January 2011, Tunisia went through a period of intense political turbulence, including a rapid succession of governments and a paralyzing political gridlock in the summer of 2013. The Tunisian national dialogue quartet, which represented the major stakeholders in civil society and is the recipient of the 2015 Nobel Peace Prize, paved the way for a technocratic government that helped bring the country’s democratic transition back on track. After discussing the conditions that led to these developments, this presentation will focus on how the technocratic government managed the challenges of organizing the country’s first fully democratic presidential and legislative elections, re-establishing security, and restoring economic fundamentals. Finally, the presentation will discuss the prospects for democratic and economic development in Tunisia, one year after the appointment of the government that resulted from the 2014 elections.
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CISAC Central Conference Room
Encina Hall, 2nd Floor
616 Serra St
Stanford, CA 94305
Kamel Ben Naceur
Director for Sustainability, Technology, and Outlooks
International Energy Agency
Seminars
Traveling the world to train policy reformers
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News
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The Leadership Academy for Development (LAD) is an innovative program at Stanford’s Center on Democracy, Development and the Rule of Law that trains mid-level government officials and business leaders to be more effective in promoting policy changes in developing countries.
In order to accomplish this goal, LAD teaches weeklong courses with partner institutions located in Africa, Asia, Latin America, and the Former Soviet Union. The most recent workshop was held in Tbilisi, Georgia in partnership with a leading Georgian think tank.
LAD’s programs attract leaders from the private and public sector who are driving public policy in countries that are transitioning to democracy and strengthening their public institutions. Since LAD’s launch in 2010, the Program has trained over 400 students hailing from nations as diverse as Timor-Leste, Zimbabwe, and the United Kingdom.
The LAD teaching team is composed of faculty from Stanford, Johns Hopkins’s School of Advanced International Studies, Georgetown University, and Texas A&M.
At the core of LAD’s curriculum is a set of case studies that encourage students to think critically about the best methods for solving a policy problem. LAD’s case studies are developed by Stanford faculty and students, and are grounded in real-world scenarios drawn from many of the countries where the program is taught. Case studies reframe policy problems based on various scenarios that invite students to contribute their own perspectives and experience.
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As described by LAD co-founder and CDDRL Director Francis Fukuyama, "The Leadership Academy for Development is unique in that by utilizing the case study method, it provides students with a hands-on, interactive framework for problem solving.” Fukuyama continued, “Students must put themselves in the shoes of the case study's protagonist and then devise a solution to the dilemma presented in the text."
Case study authors are sent to the field where they conduct original interviews and research topics ranging from the funding of a vaccination program in Bangladesh to the challenge of administrative decentralization in Peru. To date, LAD has grown its case study library to over 20 cases that are publically available online for wider use and dissemination.
Michael Goldfien, an alumnus of Stanford’s International Policy Studies master’s program, researched and wrote three case studies for LAD over the course of a year.
“While I was writing a case about wine export promotion in the Republic of Georgia, speaking with current and former government officials helped put the challenges facing the Georgian wine industry in a broader domestic and international political context, said Goldfien.”
Goldfien continued, “Researching and writing a LAD case study is about more than simply establishing the facts of a specific policy initiative, it’s about putting things in context and mapping out the constellation of stakeholders who stand to gain or lose from a particular reform to understand the political landscape that a would-be reformer must navigate to effect change.”
One of LAD’s more commonly employed case studies is Gifford Pinchot and Sustainable Forest Management, which introduces the student to Gifford Pinchot, who served as the chief forester in the US at the turn of
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the 20th century. Grounded in the political history during this period, Pinchot faces the moral dilemma of whether he should expose the corrupt political patronage practices reaching all the way up to the office of President Taft, or keep his job and continue to fight for the relevance of the fledgling U.S. Forest Bureau. This case study exposes students to pivotal leadership decisions that they may have to face in their own professional careers.
Farai Maguwu, a prominent civil society leader in Zimbabwe who participated in the LAD workshop in Kenya last year summarized his experience, “The case study method was very effective as it made it easy for us to understand that Public-Private Partnerships (PPP’s) are a viable option if there is political will.” Maguwu continued, “For instance, we saw evidence of PPP in practice in one particular case that clearly demonstrated how the private sector could make a public park both beautiful and profitable.”
To learn more about the LAD program and access the case study library, please click here.
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CDDRL Director Francis Fukuyama leads a lecture during the Leadership Academy for Development workshop in Tblisi, Georgia. January 2016.
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