ABSTRACT
This chapter uses a revised version of the multiple-streams framework to examine integration reform in the Republic of Korea (ROK). It shows that changes in the political leadership and the 1997 Asian financial crisis created a window of opportunity to push forward the administrative and financial integration of all health insurance societies into a single-managed health insurer. The alliance between President Kim Dae-jung and progressive labor and civic organizations helped to enhance the legitimacy of the regime and win broader societal support for integration reform, while the formation of a legislative coalition by President Kim ensured the passage of the integration reform bill in February 1999. But a series of anti-integration actions following the passage of the integration reform bill and electoral concerns delayed the administrative and financial integration. The current single-payer system has yet to solve the problems of high out-of-pocket expenses, high spending per capita, and a deterioration of quality care in the country. Low economic growth and a shrinking workforce also led to increasing concern over the financial sustainability of the single-payer system. The government can consider developing a stronger community-based primary care system to lower healthcare costs.
