Divergent trajectories: Healthcare insurance reforms in South Korea and Chile

This dissertation examines the trajectory of healthcare insurance reforms undertaken in South Korea and Chile during the late 1990s and early 2000s. Governments in both countries attempted to legislate more redistributive and solidaristic reforms to their healthcare systems. However, these efforts resulted in contrasting outcomes in the two cases. In South Korea, the pre-reform insurance system that consisted of hundreds of fragmented quasi-private insurers was consolidated into a government-operated single insurer system. The reform considerably improved equity between formal and informal sector workers and between higher-income and lower-income workers. In Chile, the government's efforts at introducing a more solidaristic financing mechanism to the healthcare insurance system failed to pass, although more targeted benefits aimed largely towards the lower income segments were incorporated.;I argue that middle class activism played a vital role in shaping these outcomes. In particular, I focus on the political capacities of white-collar workers, who were endowed with richer associational resources than lower middle or skilled manual classes. These associational resources facilitated their ability to organize civil society groups and mobilize political activity. The white-collar class in South Korea was motivated to build an alliance with the lower classes in favor of greater social insurance solidarity because these workers experienced increasingly precarious terms of employment, such as flexible or fixed-term contracts, that jeopardized their access to healthcare insurance. This recast their perceptions of the need for more protective social policy. In contrast, in Chile, white-collar workers were less exposed to labor market insecurity. Instead, the brunt of labor market insecurity was borne by the lower classes. Thus, white-collar workers shared less common ground with lower class workers that compelled them to seek more solidaristic social policy.;That changes in labor market security could motivate white-collar workers to mobilize suggests that the consequences of globalization potentially yield dual pressures on civil society activism. On one hand, the growing informality of the labor market exerted atomizing forces on workers, disarticulating them from associational networks. Yet, on the other hand, it stimulated a "compensation response" from those who also experienced the adverse consequences of deepened market integration but importantly possessed the density of associational resources to form organizations and respond effectively.