Solidarity, labour, and institution: The politics of health insurance reform in Japan and South Korea

Why did South Korea integrate multiple health insurers into a single national health insurance in 2003 while Japan maintained its fragmented insurance system based on labour market status? Why did labour in South Korea support the integration of health insurance schemes whilst labour in Japan was opposed to it? The health insurance systems in Japan and South Korea were both based on the social insurance system and fragmented on the basis of occupation and labour market status. However, these two countries have taken different reform paths.
This thesis argues that the two self-undermining effects and ideas were interwined and these led to different policy coalitions. Firstly, workers’ support for the consolidation reform was dependent on the inclusivity of the decision-making process at company-level health insurance schemes. Labour in Korea was not able to take part in the decision-making process in company-based health insurance societies while Japanese workers were. The absence of self-governance in the Korean health insurance system reduced incentives for the labour unions to protect their health schemes. Secondly, the Korean government conferred small credibility to support for the municipal health insurance. The subsidy for municipal health schemes in Korea was provided at the discretion of the central government and local government had no legal responsibility for its municipal health funds. These regulations were in stark contrast to the Japanese regulations. It made the friction with the idea of universal health care in Korea. Thirdly, the socially oriented unionism and dense network between trade unions and reformers in Korea contributed to the integration of the health insurance system through creating intensive policy learning for solidarity inside labour movements. In contrast, the cooperative labour-management relationship and their strong networks in the Japanese healthcare policy arena led to the coalition to protect their occupational health funds.