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Democratic transitions, health institutions, and financial protection in the emerging economies: insights from Asia

  • Eduardo J. Gómez (a1)

In recent years, several emerging economies have introduced national health insurance programs ensuring access to health care while offering financial protection from out-of-pocket and catastrophic expenses. Nevertheless, in several nations these expenses continue to increase. While recent research has emphasized the lack of funding, poor policy design and corruption as the main culprits, little is known about the politics of establishing federal regulatory agencies ensuring that state governments adhere to national insurance reimbursement and coverage procedures. This article fills in this lacuna by providing an alternative perspective, one that accounts for differences between nations in the creation of regulatory institutions, with an emphasis instead on governing elite strategies to campaign on access to health care during transitions to democracy, civil societal mobilization, constitutional constraints and the national electoral incentives to overcome ineffective decentralization processes. The cases of Indonesia and China are introduced as examples of how and why their differences in this political process accounted for Indonesia’s success and China’s failure to ensure financial protection.

Corresponding author
*Correspondence to: Eduardo J. Gómez, Senior Lecturer (Associate Professor), School of Global Affairs, International Development Institute, King’s College London, Strand Campus, London, WC2R 2LS UK. Email:
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D. Brancati (2014), ‘Democratic authoritarianism: origins and effects’, Annual Review of Political Science, 17: 313326.

A. Daemmrich (2013), ‘The political economy of healthcare reform in China: negotiating public and private’, Springerplus, 2: 448.

J. Duckett (2011), ‘‘Challenging the economic reform paradigm: policy and politics in the early 1980s’ collapse of the rural co-operative medical system’, The China Quarterly, 205: 8095.

J. Gandhi (2008), Political Institutions under Dictatorship, New York, NY: Cambridge University Press.

V. Gauri and P. Khaleghian (2002), ‘Immunization in developing countries: its political and organizational determinants’, World Development, 30: 21092132.

S. Halabi (2013), ‘Participation and the right to health: lessons from Indonesia’, Health and Human Rights, 11: 4959.

T. Hesketh and X. Wei (1997), ‘Health in China: from Mao to market reform’, British Medical Journal, 314: 153.

P Heywood and N. Harahap (2009), ‘Public funding of health at the district level in Indonesia after decentralization – sources, flows, and contradictions’, Health Research, Policy, and Systems, 7: 114.

E. Huber and J. D. Stephens (2001), Development and crisis of the Welfare State: Parties and Policies in Global Markets, Chicago, IL: The University of Chicago Press.

J. Kaufman (2006), ‘China’s health care system and avian influenza preparedness’, Journal of Infectious Disease, 197: S7S13.

J. Kaufman (2008), ‘China’s health care system and Avian influenza preparedness’, Journal of Infectious Diseases, 197: S7S13.

W. Lee and I. Shaw (2014), ‘The impact of out-of-pocket payments on health care inequality: the case of national health insurance in South Korea’, International Journal of Environmental Research and Public Health, 11: 73047318.

Q. Long , X. Ling , H. Bekedam and S. Tang (2013), ‘Changes in health expenditures in China in 2000s: has the health system reform improved affordability’, International Journal for Equity in Health, 12: 18.

I. Mares (2005), ‘Social protection around the world: external insecurity, state capacity, and domestic political cleavages’, Comparative Political Studies, 38: 623651.

F. Masiye , O. Kaonga and J. Kirigia (2016), ‘Does user fee removal policy provide financial protection from catastrophic health care payments? Evidence from Zambia’, PLoS One, 11: e0146508.

C. Mulligan , R. Gil and X. Sala-i-Martin (2004), ‘Do democracies have different public policies than non-democracies’, Journal of Economic Perspectives, 18: 5174.

N. Rudra and S. Haggard (2005), ‘Globalization, democracy, and effective welfare spending in the developing world’, Comparative Political Studies, 38, 1015–1049.

P Saksena , J. HSD and D. Evans (2014), ‘Financial risk protection and universal health coverage: evidence and measurement challenges’, PLoS Med, 11: e1001701.

R. Shahrawat and K. Rao (2012), ‘Insured yet vulnerable: out-of-pocket payments and India’s poor’, Health Policy & Planning, 27: 19.

S. Stokes (2001), Mandates and Democracy: Neoliberalism by Surprise in Latin America, Cambridge: Cambridge University Press.

H. Van Minh , N. Phoun , P. Saksena , C. James and K. Xu (2013), ‘Financial burden of household out-of-pocket health expenditure in Viet Nam: findings from the National Living Standard Survey 2002–2010’, Social Science & Medicine, 96: 258263.

T. Vian , S. Domente , A. Negnuta , A. Matei and J. Habicht (2015), ‘Barriers to universal health coverage in the Republic of Maldova: a policy analysis of formal and informal out-of-pocket payments’, BMC Health Services Research, 15(319): 115.

Vos, T., C. Murray and C. Allen (2015), ‘Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013’, The Lancet, 386: 743800.

V. Wong and S. Chiu (1997), ‘Health-care reforms in the People's Republic of China’, International Journal of Public Sector Management, 10: 7692.

W. Yip and W. Hsiao (2015), ‘What drove the cycles of Chinese health system reform?’, Health Systems and Reform, 1: 5261.

W. Yip , W. Hsiao , W. Chen , S. Hi , J. Ma and A. Maynard (2012), ‘Early appraisal of China’s huge and complex health-care reforms’, The Lancet, 379: 833842.

H. Yu (2015), ‘Universal health insurance coverage for 1.3 billion people: what accounts for China’s success?’, Health Policy, 119: 11451152.

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Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
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