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To whom do bureaucrats need to respond? Two faces of civil society in health policy


  • Lim, Seunghoo
  • Lee, Keon-Hyung
  • Suh, Hae Sun
  • Bae, Kwi-Hee


The South Korean government implemented a law that separates the dispensing and prescribing (SDP) of drugs in July 2000. It was one of the most controversial issues in the Korean healthcare delivery system. Drawing on the conflict-cycle view and stakeholder analysis, which was used to examine how multiple stakeholders influenced this policymaking process, this study examines 1) the role of Korean civil society (i.e., civic and special interest groups) in SDP reform and 2) why SDP reform led to unintended consequences. We argue that bureaucrats in the Ministry of Health and Welfare (MoHW) should have played a central role in accommodating the public interest. Because they failed to do so, civic groups assumed major mediating and moderating roles. Due to the civic groups' lack of technical knowledge and professional experience, however, they played a limited role. In finalizing the proposal, therefore, bureaucrats were captured by strong interest groups, leading to unintended consequences, such as the increased use of non-covered services and higher healthcare expenditures. To ensure that the government serves the authentic public interest rather than special interest groups, bureaucrats should be responsible to the public rather than these interest groups. Moreover, civic groups should be strengthened (in relation to strongly organized interest groups) and included systematically in creating health policy.

Suggested Citation

  • Lim, Seunghoo & Lee, Keon-Hyung & Suh, Hae Sun & Bae, Kwi-Hee, 2014. "To whom do bureaucrats need to respond? Two faces of civil society in health policy," Social Science & Medicine, Elsevier, vol. 123(C), pages 269-277.
  • Handle: RePEc:eee:socmed:v:123:y:2014:i:c:p:269-277
    DOI: 10.1016/j.socscimed.2014.10.025

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    References listed on IDEAS

    1. Kang, Hye-Young & Park, Chong Yon & Joong Kim, Han, 2002. "Public attitude and knowledge on a new health policy for pharmaceutical care in Korea," Health Policy, Elsevier, vol. 62(2), pages 195-209, November.
    2. Jeong, Hyoung-Sun, 2005. "Health care reform and change in public-private mix of financing: a Korean case," Health Policy, Elsevier, vol. 74(2), pages 133-145, October.
    3. Kwon, Soonman, 2003. "Pharmaceutical reform and physician strikes in Korea: separation of drug prescribing and dispensing," Social Science & Medicine, Elsevier, vol. 57(3), pages 529-538, August.
    4. Jeremy Hurst, 2010. "Effective Ways to Realise Policy Reforms in Health Systems," OECD Health Working Papers 51, OECD Publishing.
    5. Randall S. Jones, 2010. "Health-Care Reform in Korea," OECD Economics Department Working Papers 797, OECD Publishing.
    6. Reich, Michael R., 1995. "The politics of health sector reform in developing countries: three cases of pharmaceutical policy," Health Policy, Elsevier, vol. 32(1-3), pages 47-77.
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