This seminar will feature two presentations: an attempt to evaluate the impact of health policy under a decade of progressive governments in Korea; and an investigation into the health and economic well-being of the elderly in Korea. The presenters will be Dr. Byongho Tchoe, a 2008-09 visiting scholar at Stanford University, and Dr. Young Kyung Do, the inaugural postdoctoral fellow in the Asia Health Policy Program at Stanford.

Korea achieved universal health care coverage in 1989 only twelve years after the introduction of social health insurance under an authoritarian government. In 1992 a civil government won the presidential election. Consistent with a conservative ideology oriented toward market principles and globalization, that government emphasized competitive principles in health care policy. However, at the end of 1997 in the face of economic crisis, the progressive party won the Korean presidential election; their health emphasized strengthening equity, redistribution, and regulation of providers’ rent seeking behavior. Under successive progressive governments from 1998 to 2007, ambitious health policy reforms integrated insurers, separated prescribing from dispensing, reformed provider payment, expanded benefits coverage, increased medical-aid enrollees, and increased the role of government providers in the health care market. But in the election of 2007, they were defeated by a conservative party, which insists that competition among insurers and providers will enhance efficiency and quality in health care, and stresses consumer choice and responsibility.

Dr. Tchoe's talk will attempt to evaluate impact of health care policy under a decade of progressive governments in Korea. Although equity in both access to care and financial responsibility appear to be enhanced, there is controversy about whether the policies were cost-effective or improved health, and what will happen as the new government repeals regulations in the health care market. The return of economic crisis also brings renewed urgency to debates of economic and social policy.

Byongho Tchoe is a 2008-09 visiting scholar at Stanford University. After working at the Korea Development Institute from 1983 to 1995, he took up his current post with the Korea Institute for Health and Social Affairs. He has been influential in formulating health and social policy in Korea, having served as an advisor to the minister of health and social welfare and participated in many task forces and committees. In 2007, he was awarded a National Medal in honor of 30 years achievement related to Korea’s National Health Insurance. He has published many articles and books and served as president of the Korean Association of Health Economics and Policy and as vice president of the Korea Association of Social Security. He holds a master’s degree in public policy from Seoul National University and a Ph.D. in economics from the University of Georgia.

Young Kyung Do is the inaugural Postdoctoral Fellow in Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center. He completed his Ph.D. in health policy and administration at the University of North Carolina at Chapel Hill School of Public Health in August 2008. He has also earned M.D. and Master of Public Health degrees from Seoul National University (in 1997 and 2003, respectively). He earned board certification in preventive medicine from the Korean Medical Association in 2004. He received the First Prize Award in the Graduate Student Paper Competition in the Korea Labor and Income Panel Study Conference in 2007. He also is the recipient of the Harry T. Phillips Award for Outstanding Teaching by a Doctoral Student from the UNC Department of Health Policy and Administration in 2007. In May 2008, he was selected as a New Investigator in Global Health by the Global Health Council.

Why do community-based education and social persuasion programs for promoting healthy lifestyle and preventing chronic disease sometimes fall short of our expectations? Why are population effects so difficult to engineer and why are they so ephemeral? This research carried out at USC, the Claremont Graduate University, and collaborating institutions in China integrates across social, behavioral, and neurocognitive sciences to address those questions.

We conclude tentatively that the answer to each of the questions may lie in individual and context variability relative to program response, and that in order to more fully address the question of prevention program response variability requires engagement and integration across several levels of science to consider the roles of social groupings, environmental selection and design, social influence processes, and brain biology. What works in one social, cultural or organizational setting may not be so effective in another. What works for persons with certain genetic and experiential backgrounds may be totally ineffective for persons with different dispositional or personality characteristics. In a series of community/school based prevention trials carried out in markedly different southern California and central China settings, we have uncovered domains of consistent response, and other domains of substantial environment- and disposition-based response variability. A social influences based smoking prevention program framed in collectivist values and objectives worked to prevent smoking in one cultural setting but not another. And an individualist framed social influences program worked in the setting where the collectivist program did not. But the characteristics of the particular settings which defined program success or failure were different from what conventional (e.g., cultural psychology) wisdom would have led us to expect. Furthermore, both within and across cultural settings, the same individual dispositional characteristics moderated or determined program effectiveness, again in ways not predicted by the common cultural and behavioral science wisdom. In recent studies carried out both in China and the U.S. we have found affective decision deficits, with known neural underpinnings, to account for rapid progression to regular smoking and binge drinking. These deficits are akin to the dispositional characteristics found earlier to moderate prevention program effects. Subsequent brain imaging studies confirm the hypothesized regions of neural involvement. Together these findings hold promise for more effective – situation and phenotype specific – approaches to engendering and sustaining more optimal individual and population health behavior.

Korea introduced three major health-care reforms: in financing (1999), pharmaceuticals (2000), and provider payment (2001). In these three reforms, new government policies merged more than 350 health insurance societies into a single payer, separated drug prescribing by physicians from dispensing by pharmacists, and attempted to introduce a new prospective payment system. The change of government, the president’s keen interest in health policy, and democratization in public policy process toward a more pluralist context opened a policy window for reform. Civic groups played an active role in the policy process by shaping the proposals for reform —a major change from the previous policy process that was dominated by government bureaucrats. However, more pluralistic policy process also allowed key interest groups to intervene at critical points in implementation (sometimes in support, sometimes in opposition), with smaller political costs than previously.

Strong support by the rural population and labor unions contributed to the financing reform. In the pharmaceutical reform, which was a big threat to physician income, the president and civic groups succeeded in quickly setting the reform agenda; the medical profession was unable to block the adoption of the reform but their strikes influenced the content of the reform during implementation. Physician strikes also helped them block the implementation of the payment reform. Future reform efforts in Korea will need to consider the political management of vested interest groups and the design of strategies for both scope and sequencing of policy reforms.

Soonman Kwon is Professor of Health Economics and Policy, and Director of the BK (Brain Korea) Center for Aging and Health Policy in Seoul National University, South Korea. After he received his Ph.D. from the Wharton School of the University of Pennsylvania, he was assistant professor of public policy at the University of Southern California in 1993-96. Prof. Kwon has held visiting positions at Harvard School of Public Health (Fulbright Scholar and Tekemi Fellow), London School of Economics (Chevening Scholar), Univ. of Trier of Germany (DAAD Scholar), and Univ of Toronto. He is on the editorial boards of Social Science and Medicine (Elsevier), Health Economics Policy and Law (Cambridge U Press), and Health Systems in Transition (HiT, European Observatory). He has occasionally worked as a short-term consultant of WHO, ILO, and GTZ (German Technical Cooperation) on health financing and policy in China, Cambodia, Lao PDR, Malaysia, Mongolia, Pakistan, Philippines, and Vietnam. He has also been a consultant of Korean government for the evaluation of its development aid programs in North Korea, Ecuador, Fiji, Mexico and Peru.

Secondhand smoke (SHS) is a known cause of cancer, heart disease, respiratory disease, and other ailments. However, these diseases have a multiplicity of causes. Defendants claim SHS exposures are "low" and other sources created the illness. Plaintiffs claim "high" exposures to SHS caused their disease. In the world of toxic torts litigation involving allegations of injury from secondhand smoke, how does the expert witness use multidisciplinary science and technology in the investigation and establishment of facts and evidence in a court of law? Cases have been brought on behalf of railroad conductors, casino dealers, flight attendants, laborers, nurses, barbers, bartenders, prisoners, office workers, and even condo owners. How have they fared in high stakes litigation, and what does it take to prove a case?

James Repace, MSc., is a biophysicist and an international secondhand smoke consultant who has published 83 scientific papers, 70 of which concern the hazard, exposure, dose, risk, and control of secondhand smoke. He has received numerous national honours, including the Flight Attendant Medical Research Institute Distinguished Professor Award, the Robert Wood Johnson Foundation Innovator Award, the Surgeon General's Medallion, and a Lifetime Achievement Award from the American Public Health Association. He holds an appointment as a Visiting Assistant Clinical Professor at the Tufts University School of Medicine, and is a consultant to Stanford doing research on secondhand smoke in casinos. He is a former senior policy analyst and scientist with the U.S. Environmental Protection Agency, serving on both the Air Policy and Indoor Air Staffs, Office of Air and Radiation, and in the Exposure Analysis Division, Office of Research and Development. He served as a consultant to the Occupational Safety and Health Administration, U.S. Department of Labor, on its proposed rule to regulate secondhand smoke and indoor air quality. He was also a research physicist at the Naval Research Laboratory in the Ocean Sciences and Electronics Divisions. His degrees are from the Polytechnic University of New York; he has also pursued post-masters' studies at the Catholic University of America in Washington DC.

Abstract:  In this era of catastrophic terrorism and heightened concerns about pandemic influenza and other emerging diseases, unprecedented resources have been allocated to improving medical and public health emergency preparedness.  Investments in such preparedness, however, can impose significant opportunity costs, particularly when the investments are focused on improving consequence management capabilities.  Enhancing preparedness and response capabilities in economically efficient, proportionate, and politically sustainable ways thus becomes a critical component of any longterm effort to address the threats we face.  Dr. Hatchett will speak about the challenges of developing medical countermeasure for CBRN threats and preparing communities for infectious disease emergencies, using these examples to raise more general issues about the relative benefits of specific v. "broad-spectrum" strategies and countermeasures, decision-making under conditions of uncertainty, and our efforts to "get ready" for nuclear terrorism and pandemic influenza.

Dr. Hatchett is Associate Director for Radiation Countermeasures Research and Emergency Preparedness at the National Institute for Allergy and Infectious Disease, overseeing a program that develops drugs and devices to prevent or mitigate the effects of radiation exposure. 

In 2005-06, he served as Director for Biodefense Policy at the White House Homeland Security Council, where he was a principal author of the Implementation Plan for the National Strategy for Pandemic Influenza and helped set policy and devise strategies to mitigate the consequences of a pandemic.  Dr. Hatchett previously served as Senior Medical Adviser in the U.S. Department of Health and Human Services (HHS) Office of Public Health Emergency Preparedness, where he worked on a wide range of biodefense issues, including the delivery of mass prophylaxis to urban populations, the development of disease containment strategies, and the role of modeling in the formulation of public health policy. 

Dr. Hatchett completed his undergraduate and medical educations at Vanderbilt University, an internship and residency in Internal Medicine at New York Hospital - Cornell Medical Center, and a fellowship in Medical Oncology at the Duke University Medical Center.