Abstract:

One of the key objectives of introducing a compulsory health insurance is to provide citizens, regardless of socioeconomic status, with financial risk protection against unexpected catastrophic expenditures in the face of illness.  South Korea and Taiwan achieved universal health coverage (UHC) through mandatory social insurance schemes in 1989 and 1995, respectively.  Despite both countries' efforts to achieve the goal of financial risk protection for more than two decades, past research has demonstrated that household out-of-pocket (OOP) payment still accounts for more than one-third of total health expenditures in both countries.  When OOP payment represents a significant share of financial sources for health care, one should be particularly concerned about the distribution of such payments, in particular, catastrophic health expenditures, across households of differing economic levels.  This talk sets out to examine the change in the incidence and distribution of catastrophic health expenditures before and after the introduction of the National Health Insurance programs in South Korea and Taiwan.

Given similarity in the health and National Health Insurance (NHI) system characteristics observed in South Korea and Taiwan, substantial variation in the distribution of catastrophic payment among households was noted. The rich are more likely to incur catastrophic payment in South Korea, but the opposite trend is noted in Taiwan.  Further assessment on the impact of universal health coverage (UHC) on reducing catastrophic headcount (defined as the proportion of households incurring catastrophic health payment) is observed in Taiwan, but not in South Korea.  We found that when South Korea introduced the NHI program with a limited benefit package and high copayment, it produced little effect (if not none) in reducing financial burden in terms of proportion of catastrophic headcount. On the contrary, the impact of universal health coverage on catastrophic headcount ranged from -1.82% to -4.08% for Taiwan, due to the provision of a rather comprehensive benefit package with modest copayment. While UHC is a well-lauded policy goal and may be a magic word for many countries striving for the achievement, it is definitely not a panacea to resolve the incidence of catastrophic payment and potential medical impoverishment.  To provide sufficient financial protection against unexpected medical expenses, the design of the benefit coverage and risk sharing mechanism is key to the success of effectively achieving UHC. 

Bio

Jui-fen Rachel Lu, Sc.D., is the Fulbright Visiting Scholar at Center for East Asian Studies, Stanford University, and a Professor at Chang Gung University (CGU) in Taiwan, where she teaches comparative health systems, health economics, and health care financing and has served as department chair (2000-2004), Associate Dean (2009-2010) and Dean of College of Management (2010-2013).  She earned her B.S. from National Taiwan University, and her M.S. and Sc.D. from Harvard University, and she was also a Takemi Fellow at Harvard (2004-2005).  Prof. Lu is currently the President of Taiwan Society of Health Economics (TaiSHE) and an Honorary Professor at Hong Kong University (2007-2017).  Dr. Lu was also the recipient of IBM Faculty Award in 2009.   

Her research focuses on 1) the equity issues of the health care system; 2) impact of the NHI program on health care market and household consumption patterns; 3) comparative health systems in Asia-Pacific region.  She is a long-time and active member of Equitap (Equity in Asia-Pacific Health Systems) research network and was the coordinator for the catastrophic payment component of Equitap II research project which involved 21 country teams and was jointly funded by IDRC, AusAID, and ADB.  Professor Lu has also been appointed to serve as a member on various government committees dealing with health care issues in Taiwan.  

Abstract

Under Secretary Sewall will deliver remarks on Countering Violent Extremism, the U.S. Government’s comprehensive approach for preventing the spread of ISIL and emergence of new terrorist threats. The Under Secretary will describe how the evolution of violent extremism since the 9/11 attacks necessitates a “whole of society” approach to prevent people from aligning with terrorist movements and ideologies in the first place. Drawing on recent travel to Indonesia, India, and Egypt, the Under Secretary will describe the vital role of actors outside government in this approach, including women, youth, religious leaders, businesses, and researchers. She will also elaborate on new steps the U.S. Government is taking to intensify its CVE efforts around the world. The Under Secretary will also take questions from the audience.

Speaker bio

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Dr. Sarah Sewall is the Under Secretary for Civilian Security, Democracy, and Human Rights at the U.S. State Department, and is a longtime advocate for advancing civilian security and human rights around the world. Dr. Sewall was sworn in on February 20, 2014. She serves concurrently as the Special Coordinator for Tibetan Issues. Over the previous decade, Dr. Sewall taught at the Harvard Kennedy School of Government, where she served as Director of the Carr Center for Human Rights Policy and directed the Program on National Security and Human Rights.

Dr. Sewall has extensive experience partnering with the U.S. armed forces around civilian security. At the Kennedy School, she launched the MARO (Mass Atrocities Response Operations Project) to assist the U.S. military with contingency planning to protect civilians from large-scale violence. She was a member of the Defense Policy Board and served as the Minerva Chair at the Naval War College in 2012. She also led several research studies of U.S. military operations for the Department of Defense and served as the inaugural Deputy Assistant Secretary of Defense for Peacekeeping and Humanitarian Assistance in the Clinton Administration. Prior joining the executive branch, Dr. Sewall served for six years as the Senior Foreign Policy Advisor to U.S. Senate Majority Leader George J. Mitchell and earned a Ph.D at Oxford University, where she was a Rhodes Scholar.

This event is co-sponsored by Stanford in Government and CISAC. 

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This event is co-sponsored by NHK WORLD, Global Agenda, and the Center on Democracy, Development, and the Rule of Law.

About NHK and Global Agenda

NHK WORLD is NHK's international broadcast service. NHK is Japan’s national public broadcasting corporation and operates international television, radio, and internet services; together, they are known as NHK WORLD.

The aims of NHK WORLD are:

• To provide both domestic and international news to the world accurately and promptly
• To present information on Asia from various perspectives, making the best use of NHK's global network
• To serve as a vital information lifeline in the event of major accidents and natural disasters
• To present broadcasts with great accuracy and speed on many aspects of Japanese culture and lifestyles, recent developments in society and politics, the latest scientific and industrial trends, and Japan's role and opinions regarding important global issues
• To foster mutual understanding between Japan and other countries and promote friendship and cultural exchange

“Global Agenda” is a new program within NHK WORLD TV where world opinion leaders discuss various issues facing Japan and the rest of the world today.

Symposium Overview

Innovation is essential for economic growth, especially in advanced economies. As the catch-up phase of economic growth is ending or has ended for many Asian economies, they face the challenge of transforming their economic systems to ones that encourage innovations and use those as the most important source for growth. The panel will discuss various issues surrounding the economic system that is favorable for innovations. Silicon Valley, where Stanford University is located, has an ecosystem that is conducive to innovations. The panel will pay special attention to implications for Japan and other Asian economies.

Panelists

William Barnnett, Professor of Business Leadership, Strategy, and Organizations, Stanford Graduate School of Business

Francis Fukuyama, Director, Center on Democracy, Development, and the Rule of Law, Freeman Spogli Insititute for International Studies

Takeo Hoshi, Director, Japan Program, Shorenstein Asia-Pacific Research Center

Kenji Kushida, Research Associate, Japan Program, Shorenstein Asia-Pacific Research Center

Note

This event will be recorded and broadcast worldwide. By registering to attend you hereby grant Stanford University and NHK World permission to use encode, digitize, copy, edit, excerpt, transmit, and display the audio or videotape of your participation in this event as well as use your name, voice, likeness, biographic information, and ancillary material in connection with such audio or videotape. You understand that this event will be broadcast worldwide, which will be available to the general public. This event may also be webcast over one or more websites. By registering to attend you grant, without limitations, perpetual rights for the use and transmission and display of audio or videotape of this event. This permission is irrevocable and royalty free, and you understand that the University and NHK will act in reliance on this permission.

RSVP

RSVP for this event is mandatory as seating is limited. Doors will open at 3:00pm and the event will begin promptly at 3:30pm. Since the event is being recorded, we ask that participants arrive on time.