Table 3.

Snapshot of health-care systems in selected Asian countries

		Hong Kong	Taiwan	Singapore	Japan	South Korea
General description		Two-tiered system with the government directly funding public hospitals or clinics and the private sector financed by a mix of direct out-of-pocket payment and private insurance and primarily serving the higher-income and middle-income groups. A hospital sector dominated by public providers and a primary care sector dominated by private clinics creates a barrier for service integration. Quality of care in the private sector is poorly regulated and highly variable	The National Health Insurance (NHI) covers 100% of the population with comprehensive service coverage. As a single-payer system, it is quite effective in controlling of health expenditure growth and assurance of equal access, however, there are quality and efficiency weaknesses in service delivery	Covers all citizens through Medisave (an individual savings account), MediShield, Medisave-Approved Integrated Shield Plans, and Medifund; this system is inequitable because Medisave does not provide risk pooling. Medisave creates disincentives to use primary care because it can only pay for inpatient services and chronic disease related outpatient services	NHI covers 100% of the population with comprehensive service coverage. It uses a nationally uniform fee schedule and claims review to control cost. Professional governance and accountability are relatively weak in the service, and delivery and quality can be variable	NHI covers 100% of the population. Service coverage has been increased, although coinsurance is high. Fees-for services provide hospital with incentives to oversupply services that might not be clinically necessary, leading to expenditure growth and high out-of-pocket spending
Total health expenditure as % of GDP		5·1%87	6·6%88	4·7%89	10·1%89	7·5%89
Financing
	Sources of financing (note: private includes out-of-pocket and private insurance)	Government 48·7%, private 51·3%87	Government 5·88%, NHI 52·24% (Government vs individual vs employer: 25·5% vs 38·0% vs 36·5%), private 36·74%, other 5·14%88	Government 37·60%, private 62·40%90	Government 10·18%, -NHI 71·92%, -private 17·90%91	Government 11·17%, -NHI 43·26%, -private: 45·57%91
	Risk pooling	One risk pool for government financing; no risk pooling for private financing	One risk pool for NHI	One risk pool for Medishield; one risk pool for Medifund; no risk pooling for Medisave	Several risk pools for NHI but all use the same benefit package and fee schedule	One risk pool for NHI
Provision
	Public–private hospital share (beds)	Public 87·59%, private (mix of for-profit and not-for-profit): 12·41%87	Public 33·74%, private (mix of for profit and not for profit): 66·26%88	Public 85·59%, private (mainly for profit): 14·41%92	Public 26·34%, private (mainly not for profit): 73·66%91	Public 12·44%, private (not for profit by law, but for profit in behaviour) 87·56%91
	Public–private competition	Public and private hospitals compete on the margin on personal aspects of quality—eg, waiting time, choice of doctors, and hotel services	NHI purchases care from public and private sectors on equal terms	Public hospitals have three classes of ward with differentiated government subsidies. Private ward has no subsidy and compete directly with private hospitals. Patients have free choice of wards	NHI purchases care from public and private sectors on equal terms	NHI purchases care from public and private sectors on equal terms
	Governance of public hospitals	Corporatised and managed by the Hospital Authority	Public hospitals are becoming more autonomous in planning and delivery of services, although approval is needed from the Department of Health; public hospitals can manage their own staff except for civil servants	Public hospitals are corporatised and managed autonomously. They are managed similarly to not-for-profit organisations and subject to broad policy guidance by the Government through the Ministry of Health	Mostly managed by municipal governments with some autonomy given to hospital directors	Most public hospitals have been corporatised. Ministry of Health and Welfare has taken the lead to streamline the governance structure of public hospitals by putting most under their jurisdiction
	Primary health care	Mostly provided by private doctors in individual practices (80%) with some limited government outpatient clinics targeting low-income neighbourhoods (20%). Low or non-existent gatekeeping	Most care is provided by privately operated clinics; the government also operates some health stations in the mountain and island areas. A family doctor plan was launched in March, 2003, to promote integrated primary care with referrals for more specialised treatment when needed	Primary health care is provided in government outpatient polyclinics (20%) and private medical practitioner's clinics (80%)	Clinics, mainly owned by physicians or medical corporations (and some by the national and local governments), provide primary care and specialist care	No clear demarcation between primary and secondary care and most clinical practitioners are also specialists who often do not do the functions of what might conventionally be viewed as primary-care practice. Low or non-existent gatekeeping
Provider payment methods		Public: direct government budgets make up the bulk (>80%) of revenue, user fees (heavily subsidised at 80–90%) make up the rest. Private: fee-for-service with providers setting their own fees	Fee-for-service with global budgets, supplemented by diagnosis-related groups and pay-for-performance for selected number of conditions	Public: direct government budgets and charging fees; fees for private wards are not subsidised, whereas fees for open wards are subsidised at about 80%. Private: fee-for-service with providers setting their own fees	Fee-for-service, with all the different insurance schemes following one fee schedule set nationally	Predominantly fee-for-service with one national fee schedule, with intention to move towards diagnosis-related groups and capitation, but progress has been slow

GDP=gross domestic product. NHI=national health insurance.