Health Systems in East Asia : What Can Developing Countries Learn from Japan and the Asian Tigers?

The health systems of Japan and the Asian Tigers--Hong Kong (China), the Republic of Korea, Singapore, and Taiwan (China)--and the recent reforms to them provide many potentially valuable lessons to East Asia's developing countries. All five systems have managed to keep a check on health spendi...

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Main Author:	Wagstaff, Adam
Format:	Policy Research Working Paper
Language:	English
Published:	World Bank, Washington, DC 2012
Subjects:	ABILITY TO PAY AMBULATORY CARE CLINICAL LABORATORY CLINICS CONTRIBUTION RATES COST CONTROL DELIVERY OF HEALTH CARE DELIVERY SYSTEM DIAGNOSIS DIAGNOSTIC TESTS DOCTORS DRUGS EXPENDITURE CONTROL EXPOSURE FEE SCHEDULE FEE-FOR-SERVICE FINANCE OF HEALTH CARE FINANCIAL INCENTIVES FINANCING OF HEALTH CARE GENERAL PRACTICE GENERAL PRACTITIONERS HEALTH AFFAIRS HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE FINANCE HEALTH CARE MANAGEMENT HEALTH DATA HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FINANCE HEALTH FINANCING HEALTH INSURANCE HEALTH INSURANCE PLANS HEALTH PROVIDERS HEALTH SECTOR HEALTH SERVICES HEALTH SPENDING HEALTH SYSTEM HEALTH SYSTEMS HOSPITAL ADMISSION HOSPITAL ADMISSIONS HOSPITAL BEDS HOSPITAL CARE HOSPITAL COSTS HOSPITAL SECTOR HOSPITAL SETTING HOSPITALS INCOME GROUPS INFORMATION ASYMMETRY INPATIENT CARE INSURANCE COVERAGE INSURERS MEDICAL ASSOCIATION MEDICAL CARE MEDICAL FEES MEDICAL SAVINGS ACCOUNTS MEDICAL SERVICES MEDICINES NATIONAL HEALTH NATIONAL HEALTH EXPENDITURES OUTPATIENT CARE PATIENT PATIENTS PAYMENTS FOR HEALTH CARE PHARMACISTS PHYSICIANS POCKET PAYMENTS POLICY RESEARCH PRIMARY CARE PRIVATE INSURANCE PRIVATE SECTOR PRIVATE SECTORS PUBLIC HOSPITALS PUBLIC INSURANCE PUBLIC SECTOR RISK OF COST SOCIAL INSURANCE SOCIAL INSURANCE CONTRIBUTIONS SOCIAL INSURANCE SYSTEMS VISITS WORKERS
Online Access:	http://documents.worldbank.org/curated/en/2005/12/6460304/health-systems-east-asia-can-developing-countries-learn-japan-asian-tigers http://hdl.handle.net/10986/8539

id	okr-10986-8539
recordtype	oai_dc
spelling	okr-10986-85392021-04-23T14:02:43Z Health Systems in East Asia : What Can Developing Countries Learn from Japan and the Asian Tigers? Wagstaff, Adam ABILITY TO PAY AMBULATORY CARE CLINICAL LABORATORY CLINICS CONTRIBUTION RATES COST CONTROL DELIVERY OF HEALTH CARE DELIVERY SYSTEM DIAGNOSIS DIAGNOSTIC TESTS DOCTORS DRUGS EXPENDITURE CONTROL EXPOSURE FEE SCHEDULE FEE-FOR-SERVICE FINANCE OF HEALTH CARE FINANCIAL INCENTIVES FINANCING OF HEALTH CARE GENERAL PRACTICE GENERAL PRACTITIONERS HEALTH AFFAIRS HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE FINANCE HEALTH CARE MANAGEMENT HEALTH DATA HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FINANCE HEALTH FINANCING HEALTH INSURANCE HEALTH INSURANCE PLANS HEALTH PROVIDERS HEALTH SECTOR HEALTH SERVICES HEALTH SPENDING HEALTH SYSTEM HEALTH SYSTEMS HOSPITAL ADMISSION HOSPITAL ADMISSIONS HOSPITAL BEDS HOSPITAL CARE HOSPITAL COSTS HOSPITAL SECTOR HOSPITAL SETTING HOSPITALS INCOME GROUPS INFORMATION ASYMMETRY INPATIENT CARE INSURANCE COVERAGE INSURERS MEDICAL ASSOCIATION MEDICAL CARE MEDICAL FEES MEDICAL SAVINGS ACCOUNTS MEDICAL SERVICES MEDICINES NATIONAL HEALTH NATIONAL HEALTH EXPENDITURES OUTPATIENT CARE PATIENT PATIENTS PAYMENTS FOR HEALTH CARE PHARMACISTS PHYSICIANS POCKET PAYMENTS POLICY RESEARCH PRIMARY CARE PRIVATE INSURANCE PRIVATE SECTOR PRIVATE SECTORS PUBLIC HOSPITALS PUBLIC INSURANCE PUBLIC SECTOR RISK OF COST SOCIAL INSURANCE SOCIAL INSURANCE CONTRIBUTIONS SOCIAL INSURANCE SYSTEMS VISITS WORKERS The health systems of Japan and the Asian Tigers--Hong Kong (China), the Republic of Korea, Singapore, and Taiwan (China)--and the recent reforms to them provide many potentially valuable lessons to East Asia's developing countries. All five systems have managed to keep a check on health spending despite their different approaches to financing and delivery. These differences are reflected in the progressivity of health finance, but the precise degree of progressivity of individual sources and the extent to which households are vulnerable to catastrophic health payments depend too on the design features of the system-the height of any ceilings on social insurance contributions, the fraction of health spending covered by the benefit package, the extent to which the poor face reduced copayments, whether there are caps on copayments, and so on. On the delivery side, too, Japan and the Tigers offer some interesting lessons. Singapore's experience with corporatizing public hospitals-rapid cost and price inflation, a race for the best technology, and so on-shows the difficulties of corporatization. Korea's experience with a narrow benefit package shows the danger of providers shifting demand from insured services with regulated prices to uninsured services with unregulated prices. Japan, in its approach to rate-setting for insured services, has managed to combine careful cost control with fine-tuning of profit margins on different types of care. Experiences with diagnosis-related groups in Korea and Taiwan (China) point to cost-savings but also to possible knock-on effects on service volume and total health spending. Korea and Taiwan (China) both offer important lessons for the separation of prescribing and dispensing, including the risks of compensation costs outweighing the cost savings caused by more "rational" prescribing, and cost-savings never being realized because of other concessions to providers, such as allowing them to have onsite pharmacists. 2012-06-20T18:06:49Z 2012-06-20T18:06:49Z 2005-12 http://documents.worldbank.org/curated/en/2005/12/6460304/health-systems-east-asia-can-developing-countries-learn-japan-asian-tigers http://hdl.handle.net/10986/8539 English Policy Research Working Paper; No. 3790 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank World Bank, Washington, DC Publications & Research :: Policy Research Working Paper Publications & Research East Asia and Pacific Japan Taiwan China Korea, Republic of Singapore China Hong Kong
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	English
topic	ABILITY TO PAY AMBULATORY CARE CLINICAL LABORATORY CLINICS CONTRIBUTION RATES COST CONTROL DELIVERY OF HEALTH CARE DELIVERY SYSTEM DIAGNOSIS DIAGNOSTIC TESTS DOCTORS DRUGS EXPENDITURE CONTROL EXPOSURE FEE SCHEDULE FEE-FOR-SERVICE FINANCE OF HEALTH CARE FINANCIAL INCENTIVES FINANCING OF HEALTH CARE GENERAL PRACTICE GENERAL PRACTITIONERS HEALTH AFFAIRS HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE FINANCE HEALTH CARE MANAGEMENT HEALTH DATA HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FINANCE HEALTH FINANCING HEALTH INSURANCE HEALTH INSURANCE PLANS HEALTH PROVIDERS HEALTH SECTOR HEALTH SERVICES HEALTH SPENDING HEALTH SYSTEM HEALTH SYSTEMS HOSPITAL ADMISSION HOSPITAL ADMISSIONS HOSPITAL BEDS HOSPITAL CARE HOSPITAL COSTS HOSPITAL SECTOR HOSPITAL SETTING HOSPITALS INCOME GROUPS INFORMATION ASYMMETRY INPATIENT CARE INSURANCE COVERAGE INSURERS MEDICAL ASSOCIATION MEDICAL CARE MEDICAL FEES MEDICAL SAVINGS ACCOUNTS MEDICAL SERVICES MEDICINES NATIONAL HEALTH NATIONAL HEALTH EXPENDITURES OUTPATIENT CARE PATIENT PATIENTS PAYMENTS FOR HEALTH CARE PHARMACISTS PHYSICIANS POCKET PAYMENTS POLICY RESEARCH PRIMARY CARE PRIVATE INSURANCE PRIVATE SECTOR PRIVATE SECTORS PUBLIC HOSPITALS PUBLIC INSURANCE PUBLIC SECTOR RISK OF COST SOCIAL INSURANCE SOCIAL INSURANCE CONTRIBUTIONS SOCIAL INSURANCE SYSTEMS VISITS WORKERS
spellingShingle	ABILITY TO PAY AMBULATORY CARE CLINICAL LABORATORY CLINICS CONTRIBUTION RATES COST CONTROL DELIVERY OF HEALTH CARE DELIVERY SYSTEM DIAGNOSIS DIAGNOSTIC TESTS DOCTORS DRUGS EXPENDITURE CONTROL EXPOSURE FEE SCHEDULE FEE-FOR-SERVICE FINANCE OF HEALTH CARE FINANCIAL INCENTIVES FINANCING OF HEALTH CARE GENERAL PRACTICE GENERAL PRACTITIONERS HEALTH AFFAIRS HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE FINANCE HEALTH CARE MANAGEMENT HEALTH DATA HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FINANCE HEALTH FINANCING HEALTH INSURANCE HEALTH INSURANCE PLANS HEALTH PROVIDERS HEALTH SECTOR HEALTH SERVICES HEALTH SPENDING HEALTH SYSTEM HEALTH SYSTEMS HOSPITAL ADMISSION HOSPITAL ADMISSIONS HOSPITAL BEDS HOSPITAL CARE HOSPITAL COSTS HOSPITAL SECTOR HOSPITAL SETTING HOSPITALS INCOME GROUPS INFORMATION ASYMMETRY INPATIENT CARE INSURANCE COVERAGE INSURERS MEDICAL ASSOCIATION MEDICAL CARE MEDICAL FEES MEDICAL SAVINGS ACCOUNTS MEDICAL SERVICES MEDICINES NATIONAL HEALTH NATIONAL HEALTH EXPENDITURES OUTPATIENT CARE PATIENT PATIENTS PAYMENTS FOR HEALTH CARE PHARMACISTS PHYSICIANS POCKET PAYMENTS POLICY RESEARCH PRIMARY CARE PRIVATE INSURANCE PRIVATE SECTOR PRIVATE SECTORS PUBLIC HOSPITALS PUBLIC INSURANCE PUBLIC SECTOR RISK OF COST SOCIAL INSURANCE SOCIAL INSURANCE CONTRIBUTIONS SOCIAL INSURANCE SYSTEMS VISITS WORKERS Wagstaff, Adam Health Systems in East Asia : What Can Developing Countries Learn from Japan and the Asian Tigers?
geographic_facet	East Asia and Pacific Japan Taiwan China Korea, Republic of Singapore China Hong Kong
relation	Policy Research Working Paper; No. 3790
description	The health systems of Japan and the Asian Tigers--Hong Kong (China), the Republic of Korea, Singapore, and Taiwan (China)--and the recent reforms to them provide many potentially valuable lessons to East Asia's developing countries. All five systems have managed to keep a check on health spending despite their different approaches to financing and delivery. These differences are reflected in the progressivity of health finance, but the precise degree of progressivity of individual sources and the extent to which households are vulnerable to catastrophic health payments depend too on the design features of the system-the height of any ceilings on social insurance contributions, the fraction of health spending covered by the benefit package, the extent to which the poor face reduced copayments, whether there are caps on copayments, and so on. On the delivery side, too, Japan and the Tigers offer some interesting lessons. Singapore's experience with corporatizing public hospitals-rapid cost and price inflation, a race for the best technology, and so on-shows the difficulties of corporatization. Korea's experience with a narrow benefit package shows the danger of providers shifting demand from insured services with regulated prices to uninsured services with unregulated prices. Japan, in its approach to rate-setting for insured services, has managed to combine careful cost control with fine-tuning of profit margins on different types of care. Experiences with diagnosis-related groups in Korea and Taiwan (China) point to cost-savings but also to possible knock-on effects on service volume and total health spending. Korea and Taiwan (China) both offer important lessons for the separation of prescribing and dispensing, including the risks of compensation costs outweighing the cost savings caused by more "rational" prescribing, and cost-savings never being realized because of other concessions to providers, such as allowing them to have onsite pharmacists.
format	Publications & Research :: Policy Research Working Paper
author	Wagstaff, Adam
author_facet	Wagstaff, Adam
author_sort	Wagstaff, Adam
title	Health Systems in East Asia : What Can Developing Countries Learn from Japan and the Asian Tigers?
title_short	Health Systems in East Asia : What Can Developing Countries Learn from Japan and the Asian Tigers?
title_full	Health Systems in East Asia : What Can Developing Countries Learn from Japan and the Asian Tigers?
title_fullStr	Health Systems in East Asia : What Can Developing Countries Learn from Japan and the Asian Tigers?
title_full_unstemmed	Health Systems in East Asia : What Can Developing Countries Learn from Japan and the Asian Tigers?
title_sort	health systems in east asia : what can developing countries learn from japan and the asian tigers?
publisher	World Bank, Washington, DC
publishDate	2012
url	http://documents.worldbank.org/curated/en/2005/12/6460304/health-systems-east-asia-can-developing-countries-learn-japan-asian-tigers http://hdl.handle.net/10986/8539
_version_	1764408064069337088

Health Systems in East Asia : What Can Developing Countries Learn from Japan and the Asian Tigers?

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