Recommended reading
Health systems in East Asia: what can developing countries learn from Japan and the Asian Tigers?
A review of financing mechanisms and health care provision amongst East Asian industrialised economies
Authors:
A. Wagstaff
Publisher:
World Bank, 2005
The health systems of Japan and the Asian Tigers (Hong Kong, South Korea, Singapore and Taiwan), and the recent reforms to them, provide many potentially valuable lessons to East Asia’s developing countries. This World Bank working paper provides an overview of the health systems in these countries/territories. It compares the shares of GDP spent on health care, and the revenue sources used in the financing of it. It also reviews evidence on the progressivity of health financing, and the extent to which households – especially poor ones – are protected from catastrophic health expenses. Finally, the paper reviews the roles of the public and private sectors, the way providers are paid and their influence on provider organisation.
The paper concludes that there is no evidence of excessive or runaway health expenditures in any of the health systems evaluated. Financing systems range from the tax-financed system in Hong Kong, through to the social insurance systems in Japan, and Singapore’s largely privately financed system. Tax financed systems are the most progressive, however the degree of progressivity and the extent to which households are vulnerable to catastrophic health payments depends on the specific features of each system. These include the emphasis on direct versus indirect taxes, the degree to which luxury goods are taxed at a higher rate, and whether the poor are exempt from social insurance contributions.
