3 But again it is Korea and Taiwan (China) that are making the fastest progress on the issue. Most systems in the region have opted for some form of universal coverage, or aspire to achieve it. Korea introduced universal health insurance (UHI) in 1989, six years ahead of Taiwan (China) despite being poorer than Taiwan (China), and despite being poorer than Japan was when it introduced UHI (1961). China, The Philippines, Thailand and Vietnam are all currently taking major steps towards universal coverage, and on present trends look set to achieve it well before they reach even the per capita income Korea had when it did so.

In short, despite the wide income differences within the Japan-Tiger grouping and between that grouping and the developing economies of East Asia, the opportunities for lessonlearning in the health sector would seem to be considerable. This paper provides an analytical overview of the health systems of Japan and the Asian Tigers, and suggests some lessons for the developing countries of the region. The focus is not on describing the five systems, but rather on linking their policies and institutional arrangements to outcomes of interest, such as health spending, unit costs, and use of services. The paper tries to pull out lessons both from looking across the systems, and from looking at the impacts of reforms within the various systems. Over the last few years, the availability of quality comparable data across the systems has improved. The efforts by OECD<sup>1</sup> and WHO<sup>2</sup> on health spending and sources of financing have helped improved comparability of data for Japan, Korea and Singapore, and Hong Kong (China)<sup>*</sup> and Taiwan (China)<sup>3</sup> have complemented this work with their own health accounts. And four of the five systems—Singapore is the exception—have also been represented in a multi-system Asian comparative study on equity in health care finance and delivery, known as the Equitap project.<sup>†</sup> In addition, the last few years have seen several interesting policy reforms in the systems, some of which have been the subject of careful evaluation. These evaluations, as well as the data emerging from the health accounts and Equitap project, constitute the evidence base for this paper.

The paper begins in section II with the financing of health care, comparing the shares of GDP spent by the different systems on health care, and the revenue sources used in the financing of it. Also reviewed is evidence on the progressivity of health financing in the different systems, and the extent to which households—especially poor ones—are protected from catastrophic health expenses. The results are interpreted in the light of schemes aimed at cushioning the poor from copayments. The paper then turns in section III to the delivery and use of health services, reviewing the roles of the public and private sectors, and the ways providers are paid and their influence on provider organization. Also reviewed are recent reforms concerning provider payments, and the separation of drug prescribing and dispensing. The paper reviews in the light of this the evidence on utilization rates, comparing rates to OECD averages, and the extent of inequalities across income groups in use of different types of services. The final section—section IV—contains the conclusions.

> * Hong Kong (China)’s ‘domestic’ health accounts are available at http://www.hwfb.gov.hk/statistics/en/dha.htm. † The project’s homepage is at <u>http://www.equitap.org/.</u>