State Interests and Welfare Policymaking: Four Major Phases in the Development of the Korean Health Insurance Program

Abstract

This study examines how state interests and welfare policymaking is interrelated in the development of the Korean health insurance program. The main argument of this article is that welfare provisions can be employed at a given historical juncture by an autonomous state willing to pursue its own specific interests independent of an actual resource base or societal demands. By analyzing four major phases in the historical trajectory of the health insurance program in Korea, we argue that economic considerations and the need to respond to a political legitimacy crisis, or both of these factors combined, are the main influence on the timing and main contents of the relevant legislation. State bureaucrats, key policymakers, and presidents in particular, have identified a health insurance program as key objective for policy goals, even without pressure emanating from the public, and have been highly autonomous in designing actual legislation. With regards to the future study of Korean welfare provisions, our view is that the changes in the state‐society relationship in Korea which have taken place since the late 1980s have ushered in a new theoretical task, that of ascertaining whether the “major” theoretical perspectives in welfare state research can be applied to the Korean case.