Analyzing the Historical Development and Transition of the Korean Health Care System

OBJECTIVES: Many economically advanced countries have attempted to minimize public expenditures and pursue privatization based on the principles of neo-liberalism. However, Korea has moved contrary to this global trend. This study examines why and how the Korean health care system was formed, developed, and transformed into an integrated, single-insurer, National Health Insurance (NHI) system. METHODS: We describe the transition in the Korean health care system using an analytical framework that incorporates such critical variables as government economic development strategies and the relationships among social forces, state autonomy, and state power. This study focuses on how the relationships among social forces can change as a nation’s economic development or governing strategy changes in response to changes in international circumstances such as globalization. RESULTS: The corporatist Social Health Insurance (SHI) system (multiple insurers) introduced in 1977 was transformed into the single-insurer NHI in July 2000. These changes were influenced externally by globalization and internally by political democratization, keeping Korea’s private-dominant health care provision system unchanged over several decades. CONCLUSION: Major changes such as integration reform occurred, when high levels of state autonomy were ensured. The state’s power (its policy capability), based on health care infrastructures, acts to limit the direction of any change in the health care system because it is very difficult to build the infrastructure for a health care system in a short timeframe.

Unmet dental care needs according to employment status / 대한구강보건학회지

OBJECTIVES: This study aimed to investigate differences in unmet dental care needs according to employment status and if factors have relevance to unmet dental care needs due to "economic burden" and "no time to spare for visiting". METHODS: Multivariate logistic regression analysis was performed to examine the factors that affected the prevalence of unmet dental care needs due to "economic burden" and "no time to spare for visiting" in an economically active population comprised of subjects aged 20-64 years. RESULTS: Compared to regular workers, part-time workers experienced 1.28-times more unmet dental care needs, while students experienced 0.64-times fewer unmet dental care needs. With regard to reasons related to "economic burden", the rate of experiencing unmet dental care needs was 1.37-times higher for part-time workers than for regular workers. Regarding reasons related to "no time to spare for visiting", the rate of experiencing unmet dental care needs was 0.51-times lower in part-time workers compared with regular workers. In economically inactive people, these values were 0.51-times lower in the unemployed, 0.37-times lower in students, 0.23-times lower in house workers, 0.20-times lower in subjects with disease and injury, and 0.20-times lower in early retirees compared to regular workers. CONCLUSIONS: Part-time workers experienced more unmet dental care needs compared with regular workers. With regard to "economic burden", a significant difference in unmet dental care needs was observed between regular workers and part-time workers. Additionally, regarding "no time to spare for visiting", people who were economically inactive because of unemployment, student or house-worker status, diseases and injury, and retirement experienced fewer unmet dental care needs compared with regular workers.