Manuscript Title

Comparative Analysis of Health Insurance Systems in the United States and South Korea

Abstract

This paper uses a case study design to compare the U.S. health insurance system with that of South Korea, analyzing the effects of the two countries’ cultural value systems, political institutions, and stakeholders on the historical development and current status of national health insurance policy. The authors find that in the United States, a value system characterized by anti-statism, anti-elitism, individualism, liberalism, and a laissez-faire philosophy has acted, in combination with a decentralized democratic political system and strong, well-organized interest groups opposed to publicly-funded healthcare, to significantly limit the possibility of national health insurance reform on anything but an incremental basis. In contrast, South Korea’s value system has been characterized by statism, elitism, groupism, and a philosophy of nobles oblige, which has interacted with autocratic but health insurance reform-minded regimes, in a weak civil society (with particularly weak organizations representing anti-health reform interests) where formal lobbying activities were illegal, to produce a policy environment particularly favorable to comprehensive health insurance reform from the 1960s through the 1980s. The study demonstrates that each country has not only different political institutions and laws governing interest groups, but also significantly different cultures and medical traditions, which must be considered if policy reforms in either country, or indeed for any country considering health insurance reform, are to be implemented successfully. The paper concludes with a brief discussion of implications of these findings on health insurance reforms in both countries, with particular consideration of the reform plans of the Obama administration in the United States.