ABSTRACT
Introduction This chapter compares healthcare reforms in China, South Korea, Singapore and Thailand with the purpose of drawing useable lessons about the appropriate role of the state in the sector. It argues that healthcare reforms in China and Korea offer many negative lessons for healthcare reformers, while Singapore and Thai land offer positive lessons that may be considered for emulation elsewhere. The fundamental lesson to emerge from the successful reform experiences is that a large and active state role in various aspects of healthcare provision and financ ing is essential for containing expenditures and maintaining access. Public own ership of providers and prospective payments are particularly effective in controlling expenditures, while direct government financing promotes equitable access. The cases also show that political economy matters: the Singapore and Thai states’ strong presence in the healthcare sector is a vital reason for their superior performance. Many governments in the region are finally realizing that their healthcare reforms are on the wrong track. While trying to reign in expenditures, they have not only created other problems, but have also, ironically, accelerated expend iture growth in the process. Far too often, policymakers are trapped in a line of thinking that offers little reason that governments will be able to effectively reform their ailing healthcare systems. Fortunately, there are countries in Asia that offer rich lessons for policy reformers. The purpose of this chapter is, there fore, to examine healthcare policy reforms in a select group of countries – China, Korea, Singapore and Thailand – for drawing useable reform ideas, both negat ive and positive. In this chapter I argue that healthcare reforms in China and Korea offer many negative lessons for healthcare reformers, while Singapore and Thailand offer positive lessons that may be considered for emulation elsewhere. Chinese reforms are textbook examples of what reformers elsewhere should avoid: fee forservice (FFS) payment system for providers without appropriate controls over them. The case of Korea shows the potential pitfalls of comprehensive national health insurance in the context of FFS payment to providers. The experience in Singapore, on the other hand, suggests the need for government
control over providers for reigning in expenditures and the limitations of savings-based financing. Thailand’s experiment with government-financed uni versal healthcare offers yet another lesson: it is possible for governments in developing countries to deliver healthcare of reasonable quality to all citizens through changes in the financing and payment systems. However, for govern ments to devise and implement healthcare policies that serve the general rather than sectional interests, it is essential that the state is strong and has access to strong instruments for controlling providers. The fundamental lesson to emerge from the successful reform experiences in Asia is that a large and active state role in various aspects of healthcare provision and financing is essential for con taining expenditures and maintaining access.
