The Evolution of Fragmented Systems of Welfare Provision: The National Health Care Systems of Japan, the Republic of Korea, and Taiwan

Abstract

The national health insurance systems in Japan, South Korea, and Taiwan are considered to have shown successful performance. These three countries achieved universal health coverage through systems with different degrees of integration and the unification of disparate schemes. Japan still maintains a fragmented system based on occupational and residential insurance schemes, while Taiwan and South Korea have achieved a unified system with single payers and are moving toward a more integrated system in terms of transfer across the different schemes within the system. By focusing on institutions, policies, and actors, this study highlights diverse forms of inter- and intra-sectoral integration mechanisms and pathways that have been used to achieve health equity in these countries. We show that the experiences of these three countries offer good cases for comparative research on how countries with rapid industrialization facing the task of developing their welfare systems have overcome fragmentation and unified their systems of welfare provision in equitable and sustainable ways.