Divergence in the development of public health insurance in Japan and the Republic of Korea: A multiple-payer versus a single-payer system

Abstract Japan and the Republic of Korea achieved universal health insurance coverage for their populations in 1961 and 1989, respectively. At present, Japan continues to operate a multiple-payer social health insurance system, while the Republic of Korea has moved to an integrated single-payer national health insurance structure. This article analyzes the influence of political economy in shaping the policy divergence found between these two Bismarckian health insurance systems. Issues addressed include differences in political power, the policy influence of business, the extent to which regional autonomy has developed and regional traits have been preserved, the level of political democratization, the form of political leadership, and the scale of development of the health insurance system. The article offers policy lessons derived from the two countries ’ experiences.issr_1428 51..7