I have two names. At school, my friends would call me over saying, “Hey Claire!” At home, I was “윤아야” or “Yuna,” my Korean name. I used to joke as a child that there were two separate versions of myself and I would “switch” between the two, going from Claire to Yuna and back again. As I grew older, I started hearing terms such as “Korean American,” “Asian American,” and gyopo (someone with Korean heritage but born outside of Korea). All of these labels sent my mind spiraling. I had always been either Claire or Yuna, so I had no idea how the two could coexist together.

Amidst this confusion, I applied for the Sejong Korea Scholars Program to explore my heritage and the country I’ve had such a complex relationship with. Each unit, my classmates and I analyzed textbook excerpts to news articles, sharing our thoughts through written assignments and discussion boards. We concluded with an end-of-unit virtual classroom, featuring expert historians and professors who generously shared their knowledge.

Spanning from the Joseon dynasty to post-colonial Korea to the Hallyu wave, this course took me on a journey throughout all chapters of Korean history. From the colonial independence movement to the post-war democratization protests, I continued to be in awe of the sheer grit and courage of the Korean people. As we delved deeper into modern Korean society by examining topics of education and nationalism, I was also able to contextualize my upbringing and the complexities of my Korean American identity.

Furthermore, the curriculum allowed us the freedom to lead our own learning. For my final paper, I analyzed the impacts of online feminist societies and gender violence on the prevalence of gender animosity in modern-day Korea. Taking this unique opportunity to explore my personal interests further fueled my passion for modern Korean history, social movements, as well as the ways the oppressed fight for a voice.

I would like to deeply thank Dr. HyoJung Jang for being an invaluable mentor throughout this course with her incredible expertise and dedication to learning for learning’s sake. I would also like to credit my talented classmates who inspired me with their insights and always pushed me to view the world from different perspectives.

This course challenged me in countless ways: as a learner, a Korean American, and a person. SKSP is a unique opportunity to learn with rigorous coursework and top-tier resources while exploring one’s own academic interests. I genuinely encourage students to apply, no matter their background, as anyone with a passion for knowledge will be wholeheartedly welcomed and rewarded.

SKSP has been pivotal in discovering my passion for East Asian and Korean studies, one that I wish to pursue both personally and in higher education. In terms of my personal journey, I am still navigating the complexities of my identity and will continue to do so throughout my life. But my SKSP experience has truly opened my eyes to all facets of my identity and their complex intersections. I know now that Claire and Yuna were never two separate people nor two separate parts of me. Rather, they are the ones who make each other whole. 

SKSP is one of several online courses offered by SPICE.

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As countries confront rising health care spending, policymakers everywhere face a key question: Who benefits from these spending increases?

Consider South Korea, a nation that has sharply increased its per capita health care spending over the past decade, delivering reasonable value in improving health outcomes as measured by rising life expectancy and a reduced overall disease burden. Yet, not all South Koreans reap equal rewards from the country’s health investments, according to a new study. Rather, adults in the lowest-income quintile receive the least health gains for every dollar spent on their care.

Published in the journal Health Affairs Scholar, the study reveals stark income-based disparities in the value of health care — defined as health gains relative to spending — among South Korean adults. The research systematically quantifies how efficiently health spending translates into longer, healthier lives across income groups in South Korea, providing insights into the distribution of health gains relative to health care spending.

“While earlier research often examined disparities in access, utilization, or outcomes separately, our analysis provides a more integrated assessment by jointly examining health care costs and health gains,” explains the research team, including Stanford health economist Karen Eggleston, the director of the Asia Health Policy Program (AHPP) at APARC. Eggleston’s co-authors are Sungchul Park, an associate professor in Korea University’s Department of Health Policy and Management; Young Kyung Do, a professor in Seoul National University’s Department of Health Policy and Management and AHPP’s inaugural postdoctoral fellow; and David Cutler, the Otto Eckstein Professor of Applied Economics at Harvard University. 

Their findings are sobering: between 2010 and 2018, South Korean adults in the lowest income quintile derived the least value from increased health spending compared to those in the middle- and higher income quintiles, suggesting a system that underserves the poorest population.

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Poorer Health, Smaller Gains

Between 2010 and 2019, per capita health care spending in Korea increased from $1,211 to $1,903, growing nearly 6 percent annually. During that decade, life expectancy climbed from 80.5 to 83.7 years, while disability-adjusted life years – expressed as the number of years lost due to ill-health – declined significantly. These measures seemingly suggest health spending has yielded solid returns in terms of improved health outcomes.

Yet stark income inequality persists in Korea. The country has both the highest old-age poverty rate and the largest share of out-of-pocket medical expenses among OECD countries. Does rising health spending benefit all segments of society equally?

To answer this question, the researchers analyzed trends in health spending and outcomes across income quintiles (excluding the bottom 10 percent of the household income distribution) from 2010 to 2018.

They measured health care spending as total medical expenditures, including costs for inpatient and outpatient services, emergency services, and prescription medications. All spending measures were adjusted for inflation and are reported in 2021 US dollars. To asses health outcomes, they used three indicators: (1) health-related quality of life, which relies on standard questionnaires to measure individuals’ perceived physical and mental health over time; (2) life expectancy, calculated using life table methods based on enrollment data from the national health insurance system; and (3) quality-adjusted life expectancy (QALE) at age 25, a measure that reflects both longevity and the quality of life during those years – an essential consideration when evaluating the effectiveness and equity of health care systems. To quantify the value of health care across income groups, the researchers applied statistical methods.

They found that adults in the lowest-income quintile experienced the smallest relative improvement in QALE over time: an increase of 0.7 years, compared with 1.4 years in the second and third quintiles, 1.3 years in the fourth, and 1.2 years in the highest quintile. Translated into a value estimate, adults in the lowest income quintile incurred $78,209 per QALE; in contrast, adults in the second through highest income quintiles achieved greater value estimates of $47,831, $46,905, $31,757, and $53,889, respectively. Thus, the most efficient gains in both longevity and quality of life were in the middle-income groups.

“We found that per capita spending was similar across income groups, but the lowest-income quintile experienced much smaller gains in QALE,” Eggleston and her collaborators write. 

Reflecting the principle of diminishing returns, “these findings highlight structural inequities in the South Korean health system and emphasize the need for targeted policies to promote equitable health care value.” 

Why Spending Does Not Equal Value

While the study did not identify causal pathways, secondary data suggest two plausible explanations for the results: poorer baseline health and greater unmet needs.

The data indicate that adults in the lowest-income quintile had significantly higher rates of chronic disease, disability, behavioral risk factors such as smoking and obesity rates, and mental health issues. These factors make it more difficult to achieve health gains.

Moreover, adults in the lowest-income quintile were less likely to receive preventive services, with markedly lower rates of medical checkups and cancer screenings. “Despite greater health needs, these adults faced persistent barriers to accessing care, particularly financial constraints,” the researchers say.

Notably, the highest value of health spending was not observed among adults in the highest-income group. One explanation is that this group may consume more low-value or marginally beneficial health services.

Policy Implications: Efficiency with Equity

Eggleston and her co-authors emphasize “the need for health policy in South Korea to prioritize both equity and value.” They highlight the following targeted strategies to improve efficiency and fairness:

• Invest in high-value services that link spending to meaningful health outcomes:
  • Improve access to high-value preventive and primary care services by expanding financial protections, particularly for lower-income groups.
  • Improve overall system efficiency by reducing the overuse of low-value health care services.
• Pair health care reform with broader social policies: Coordinate efforts to address upstream factors tied to health disparities, such as income inequality.
• Aim for improvements across the entire population: Implement evidence-based clinical appropriateness guidelines to ensure health care spending yields meaningful and equitable results.

While focused on South Korea, the study’s findings illuminate how income inequality interacts with health system designs and carry lessons for other countries.

“In countries with greater income inequality and fragmented health systems, such as the United States, disparities in health care value may be even more pronounced,” the co-authors write.

As South Korea and other countries continue to invest heavily in health care, the study highlights the urgency of improving the distribution and impact of that increased spending. Without focused reforms, it risks entrenching existing inequities rather than alleviating them.

I have always wished to learn more about Korea. Since I am only half Korean, my grandparents’ stories of Seoul made up the extent of my knowledge for much of my childhood. As I grew up and began to slot together my identity in a patchwork of personality and truths, my Korean identity simply did not fit. I could barely stomach the spice of bibimmyeon, my mother’s favorite Korean noodle dish. Wearing hanboks, the traditional Korean dress, never gave me the elegance my cousins seemed to embody. Speaking Korean didn’t come to me as easily as it did for my sister. What I did have were my grandparents’ firsthand stories, with rich history peeking through childhood anecdotes and accounts of war. Korean history always felt quite accessible to me, even if it didn’t make me feel Korean enough.

Accordingly, getting to participate in the Sejong Korea Scholars Program was a dream come true for me. I sensed that it would be a unique and incredible opportunity, and that perception was immediately confirmed by the first introductory meeting on Zoom. If anything, the online format made the focus of the program even clearer, and each virtual classroom felt just as grounded as any in-person class I’ve experienced.

It was especially exciting to be surrounded by 18 other like-minded and talented peers. We were all in pursuit of the same learning, the same deep dive into Korean history—and many were in the program for reasons similar to mine. There was a deep affinity for culture in the group, and not just for Korean culture. With so many Korean Americans in the group, it was fun to post or comment about our connections to Korea, and just as exciting to learn about Korean Americans from esteemed Professor Kyeyoung Park, who graciously answered all of our questions. I also must commend the students who weren’t Korean and simply were excited about Korean history; their passion was always quite inspiring.

Above all, what made SKSP so special was the historiography, which had long been a personal area of interest. Dr. HyoJung Jang, our extraordinary instructor, curated a diverse assortment of sources each week, ranging from U.S. government documents to articles to contemporary qualitative experiments. In between each virtual classroom, I pored over several sources, and reflected on the way they interacted with each other. As I worked on our biweekly writing assignment, I found myself making multiple connections for each source and forming my own mini arguments in the paragraphs. By the time we got to each lecture, I had stewed on my ideas long enough to get quite excited about the questions I wanted to ask.

Each lecturer gave a spectacular presentation and was quite generous with their time. In particular, I’ll highlight Professor Gi-Wook Shin and Professor Nancy Abelmann, who taught us about different facets of contemporary Korean society: nationalism and the education system, respectively. Their talks were grounded in Korean norms of filial piety, respect, and also patriarchal systems, a topic I intended to write my paper about.

At the time, however, my paper topic was, quite frankly, a mess. I knew I wanted to involve pop culture somehow into my discussion of ingrained misogyny in Korean society, but had written some incredibly vague topic proposal about sexist dating norms present in music and TV shows. Luckily, Dr. Jang gave some much-needed feedback about the large scope of my proposal. In the process of reading through academic papers around sexism, I came across digital feminist movements, and decided that the accessibility and weaponization of the internet was going to be my new focus. Of all the incredible experiences in the program, I think I’ll always remember writing my paper, how Dr. Jang was an especially important personal mentor, and the overwhelming feeling (as I was writing) that I was connected to my culture, somehow.

When I think back to the way I worried over my lack of a connection to Korea at the beginning of the year, I find my concerns a bit silly now. I now know that I have always been connected to my heritage through my history. Even if that didn’t feel like it was enough before, my scholarship and pursuit of Korean history through SKSP have now proven that to me. I will forever remember this program as a place where my writing became true to myself, and went beyond what I ever could have imagined. To all interested students, I urge you to apply without inhibition. You will surely find something you didn’t know you needed—whether it’s a reassurance about your culture, a reignited passion, or simply growth—in the Sejong Korea Scholars Program. 

SKSP is one of several online courses offered by SPICE.

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