This chapter documents health policy problems that exist in South Korea, the policy tools that are used to address them, and the outcomes they produce. We see that the Korean government has gone to great lengths to establish mechanisms to provide health care to all while containing financial burden on both households and the government. The root cause of the high out-of-pocket payments in Korea is the fee for service (FFS) mode of paying providers which incentivizes over-supply of services that generate higher returns for providers. Unable to replace FFS with capped payments due to political opposition, the government has had to resort to controlling fees and volume of services and requires co-payments from patients. Korea has also established a detailed decision and monitoring processes to curb over-supply and over-charging which have shown only limited success. The financing and payment arrangements and weak regulations coupled with political power of the vested interests make it very difficult to reduce the burden of out of pocket expenditures on households without shifting the burden to the government, a burden that the latter is unwilling to shoulder.

This introductory chapter conceptualises the absence of universal health care as a policy problem which requires a problem-solving approach if it is to be addressed. It develops the theoretical framing of the book: a policy design approach to health care. The chapter presents five challenges (governance; provision; financing; payment; and setting standards) that governments need to meet in their efforts to achieve universal health care, and the types of policy tools (stewardship and coordination; ownership and management; risk pooling; retrospective and prospective payments; and regulations) available to them. The chapter summarises the core argument around the importance of ownership and management of public hospitals, and the need for regulatory frameworks to manage private providers.

The aim of this chapter is to explain Singapore's health care performance, and the types of policy tools deployed to achieve universal coverage. The chapter argues that Singapore has pursued the goals of affordable health care through a range of policy tools targeting specific problems that work in tandem and are fine-tuned constantly. The island state has an inordinately complex health system comprising a broad range of policy tools and it is their combined working, and not that of any one tool, that explains the system-level performance. By focussing on simply one tool, such as Medical Savings Account (Medisave), observers miss the bigger picture as well as the details of the health care system in the country. And yet, as we shall see, policy makers in Singapore are stymied by blind spots that leave crucial problems insufficiently addressed.

After decades neglect, the Indian government has turned its attention to strengthening the health care system and the country is amidst implementing its most ambitious health care program. The Pradhan Mantri Jan Arogya Yojana (PM-JAY) rolled out in 2019 aims to provide health care coverage to half a billion Indian citizens and offers hope that it will reduce the population’s financial sufferings caused by illness. The chapter assesses the evolution of the health care system in India and examines the policy tools in use to understand the country’s preparation for achieving its goal. In this chapter, we see that health care system continues to be handicapped by a weak public sector and an inadequately regulated private sector which together form an inhospitable context for publicly financed programs to succeed.

This chapter synthesizes social, economic and demographic trends over the past three decades in the countries studied in this book. It argues that health policy is affected by and affects these trends. The chapter synthesizes data on economic and demogrphic trends as well as key health system input and outcomes. The chapter records impressive economic growth rates, decline in poverty, and prudent public finances in the region. It shows that all countries except India enjoy some of the best health status in the world, and that these were achieved at relatively low costs. However, rapid population ageing and rising incomes and expectations present serious health policy challenges that governments must meet.

Hong Kong has one of the best health care systems in the world, noted for its low costs and high equity. It is a rather simple system, with hierarchical governance structures and sparse policy tools centred on public ownership and financing that have undergone only minimal changes since the 1960s. The purpose of the chapter is to describe the development and functioning of the health care system in Hong Kong and examine the policy tools that underlie it. The case shows that it is possible to achieve universal health care through traditional organizational and fiscal policy tools. The case also serves as a cautionary lesson for health policy and international consultants proposing complex mix of policy tools in health care when simpler tools used effectively can achieve universal health care. This vital lesson is lost on the Hong Kong government itself as it promotes privately financed and provided health care to complement the public system.

This chapter presents a comparative portrait of the policy tools employed in health care in Asia, the effects they trigger, and how they affect the achievement of universal health coverage. It examines the design and implementation of key health policy tools in China, Hong Kong, India, Korea, Singapore, and Thailand shows improvements along all main dimensions of health policy design. It also points out the continued under-emphasis on regulation of private providers, which is especially vital in health systems dominated by private provision and financing.

Thailand is widely acknowledged as a successful case of achieving universal heath care at modest costs. In this chapter we show that the success is based on a simple system under strong government stewardship: most health services are provided at publicly owned and operated hospitals, and paid for by the government through tax revenues. Layered to the combination of public ownership and funding, is a purchaser-provider split and frequent changes in policy settings based on data on utilisation and costs. The combination of these tools enable the government to monitor quality of services while maintaining a watchful eye on costs. The only tool that Thailand does not use extensively is regulation which, as we will see in this chapter, is not necessarily damaging due to the other tools in place. Public ownership and funding offers sufficient levers to the government to create incentives for healthcare providers to control costs, promote responsiveness, and improve quality of services without the need for extensive regulations.

This chapter discusses the dismantling and rebuilding of the Chinese health care system in recent decades. It shows that China’s reforms over the past decade have focussed on (i) reiterating the role of the government as steward; (ii) promoting policy coordination of various agencies in the sector; (iii) improving the performance public hospitals; (iv) making healthcare providers more responsive to patients’ needs. It will argue that despite these reforms, regulations controlling the quality and safety of drugs and behaviour of providers remain weak and undermine public trust.

The purpose of this chapter is to reflect on the main trajectories of change that have characterized the health systems of OECD countries in the last three decades, from the fall of the Berlin Wall to the present day. For this purpose, it is possible to identify five major "reform themes" which traveled transversally through countries generating processes of emulation and policy transfer. The five major reform themes are as follows: (1) stimulation of greater competition; (2) promotion of integration (both in terms of financing and provision); (3) decentralization; (4) strengthening the rights of the patient; (5) extension of insurance coverage. For most of these five themes it is possible to identify a reform that has acted as a forerunner, which other countries have subsequently been inspired by and followed.

Consumer law and policy generally envisages that consumer interests are best advanced by prohibiting abusive marketplace practices and promoting competition. This chapter proposes the framework be sophisticated for the provision of professional health services. Arguably, universal access to health services is a basic human right. Thus, the consumer interest is best understood within a human rights and a marketplace framework. These two frameworks do not always sit comfortably together, as illustrated in this chapter. The chapter explores the impacts of ASEAN’s market liberalisation strategies upon the delivery of professional health services. One strategy involves regional mutual recognition of health qualifications. This could enhance consumer interests by increased movement of medical practitioners to areas of regional need. Conversely, it could lead them to shift from low-income countries where universal access needs are acute to countries where practitioners receive higher incomes. The chapter concludes with an examination of how ‘health tourism’ is being promoted by some ASEAN members for economic benefit. However, these apparent benefits maybe somewhat illusory.