Regulation of the pharmaceutical market in the South Korean National Health Insurance

This thesis explores the implications of democratisation on the regulation of health care providers. It examines the reforms in relation to two regulatory policies in the pharmaceutical market of the National Health Insurance (NHI) in South Korea – the separation of prescribing and dispensing (SPD) and the pharmaceutical pricing policy – conducted in two periods – the 1980s under the authoritarian regime and the 1990s under the democratised regime. The misuse and overuse of drugs had long been recognised as a problem for the NHI, and the tight regulation of the SPD and pharmaceutical pricing as potential solutions.Democratisation seems unlikely to tighten the government’s regulation of the SPD and pharmaceutical prices. On the one hand, the Korean authoritarian regime was known as being capable of conducting top-down regulation of societal groups, and democratisation as having liberalised the government-society relationship. On the other, pharmaceutical regulation is a sophisticated and detached issue, which restricts the ability of laypeople to mobilise and exert bottom-up pressure for regulation. Nevertheless, the authoritarian government failed to tighten, and even loosened these regulations, whereas the democratised government tightened them.This thesis explains this puzzle by focusing on the features of the agenda-setting process and the articulation of policy issues therein. In the 1980s, the SPD and the pharmaceutical reimbursement pricing policy were administrative issues, discussed exclusively between bureaucrats and the central associations of health care providers, which resulted in loose regulation. In contrast, in the 1990s, reform-oriented professionals and NGOs raised these issues and put them on the political agenda, which motivated the government to conduct tighter regulation.This thesis suggests some general implications of democratisation on the politics of regulation. The hierarchical and exclusive authoritarian policy network aims to realise policy goals set by ruling elites; however, for other policy issues, societal partners can utilise this network to promote their preferred policies. Democratisation, which promotes competitive elections and political rights, allows previously excluded policy actors to participate in policy-making networks. These new actors include professionals and activists who are able to understand regulatory issues and articulate them in ways that are salient to politicians and the general public, which will motivate the government to tighten the regulation governing its traditional policy partners.