BACKGROUND: The aim of this study is to analyze determinants of welfare attitudes toward healthcare services in South Korea, using three main theories: self-interest (positive welfare attitudes if the policy fulfills people's personal interests), symbolic attitudes (positive welfare attitudes if the person is politically progressive or egalitarian), and sociotropic perception (positive welfare attitudes if the person experienced positive aggregated collective experiences of societal events and trends regarding the policy). Although the definition of the welfare attitude is rather ambiguous in literatures, in this investigation, we operationalize the concept as the ‘willingness to pay higher taxes to improve the level of health care services for all people in Korea' which shows individuals’ actional propensity. METHODS: We used the health module from the International Social Survey Program 2011 for the analysis (N=1,391). Five logistic regression models were built successively using two variables for each theory to measure key concepts of self-interest, symbolic attitudes, and sociotropic perceptions as independent variables. RESULTS: The result showed self-interest and symbolic attitudes factors to be strong determinants of welfare attitudes towards healthcare services in South Korea, whereas sociotropic perception factors have inconsistent effects. CONCLUSION: For a more politically elaborated healthcare reform in South Korea and elsewhere, there needs to be further research on various dimensions and determinants of welfare attitudes to understand popular basis of welfare expansion, especially in the era of inequality.
Delivery of Health Care ; Health Care Reform ; Health Status ; Humans ; Korea ; Logistic Models ; Socioeconomic Factors ; Taxes

Currently, the South Korean Government does not provide sickness benefits from the National Health Insurance, which is different from most other Organization for Economic Cooperation and Development countries. The sickness benefit guarantees a part of lost income due to injuries or diseases. The purpose of this study is to propose a sickness benefit scheme for South Korea. To this end, we compare health care systems, sickness benefit schemes, and delivery systems of those in Germany, Japan, and Sweden, focusing on the seven categories: management authority, object, level of payment, duration of payment, qualification requirements, connection with paid sick leave of workplace, and financial resources, and as to delivery system, the six categories: the number of procedures, transferring document between institutions, whether or not utilizing electronic reporting system, applicant, and administrative convenience. Based on the implications derived from the case study, we propose the sickness benefit scheme and its delivery pathway and other details for South Korea. This study is first to propose the sickness benefit for health insurance in Korea with its level of details. More studies should follow with case studies of other countries, as well as productive debates to build a feasible and sustainable sickness benefit system in South Korea.
Delivery of Health Care ; Germany ; Insurance, Health ; Japan ; Korea ; National Health Programs ; Organisation for Economic Co-Operation and Development ; Sick Leave ; Sweden

In 2019, the Seoul metropolitan government established its own ‘Seoul-type paid sick leave project’. Although the central government had to introduce such a system, which is also called sickness benefits, it was not implemented. In order to understand the process by which the Seoul government has implemented such a policy, this study used Kingdon’s multiple streams framework. As a result, in the problem stream, it was found that the economic burden of sickness has been considered only in terms of medical expenses in the past of Korea. Then Songpa’s three women and Middle East respiratory syndrome incidents raised awareness of the necessity of the sickness benefit system in 2014 and 2015. In the political stream, several social affairs such as national health insurance huge surpluses and the 2017 presidential election opened policy window. At that time, Seoul Mayor actively promoted sickness benefits as a policy entrepreneur. In the policy stream, the sickness benefit system has gained new attention through political events. To summary, these three streams flowed separately and then they assembled around huge political affairs. As a result, it was confirmed that Kingdon’s model is the most effective theory than any other models in analyzing the health care policy decision process in Korea.

The study seeks to widen the discussion from healthcare oriented ‘health publicness’ to human security oriented ‘health publicness’. The shortcomings of previous literatures on health publicness are as follows: (1) the studies have confined the range of discussions to healthcare system, (2) lacked arguments from political perspectives, and (3) failed to provide actionable pathways to achieve the goal. Thereby, we suggest ‘health publicness’ based on the concept of human security to solve multidimensional healthcare problems. The health publicness based on human security, which aims to secure everybody's freedom from want and fear, enables not only to expand the scope of health problems that can be discussed but also to propose the procedures to achieve health publicness. More specifically, it consists of substantive and procedural health publicness. The former is about ‘health security’-protecting, maintaining, and promoting individual's health-whereas, the latter is about ‘social dialogue’ guaranteeing participation of citizens, government, employers, and worker representatives. In conclusion, this study proposes the ‘Regional Healthcare Quadripartite’ as the incarnation of health publicness involving a variety of actors within and across the healthcare system.
Delivery of Health Care ; Freedom ; Humans