Abstract
This thesis explores the health policy process and its organisational response to epidemics/pandemics in South Korea. South Korea has been considered a prime example of a country that has institutionally learned from its past epidemics. The research aims to answer how the health policy decision-making found in epidemic management during the five years 2015–2020 (MERS and COVID-19) in South Korea can best be characterised.The research utilised various theories: health policy process, network governance, professional dominance, and bureaucracy/hierarchy in crisis management. Policy learning, national culture theory, and the entrepreneurial state with a knowledge-based economy are the literature topics inductively reviewed after the findings.
The study adopted a case study design with a longitudinal and comparative element to examine the five-year health policy process in South Korea. Three sub-cases were selected and analysed: the MERS response (2015); the post-MERS period (2015‒2020); and the initial COVID-19 response (2020). Qualitative research methods were employed to collect diverse data on the health policy process from multiple sources. More than 50 documents were reviewed (e.g. government reports, white papers, and news articles) and 43 semi-structured interviews were conducted (with respondents from Ministries, healthcare professionals, medical doctors, NGOs, and the media). Thematic analysis and Gioia’s grounded theory were used to analyse the documents and interviews.
This study’s findings uncovered three parts. First, diverse health policy participants were observed, but government, healthcare professionals, and industry were found to be more influential and powerful than local governments, media, and NGOs. Second, a modified health policy process was drawn out. The stages model of the health policy process was applied over two policy cycles with two epidemics (MERS and COVID-19) where different stages showed different governance structures: command-and-control, network governance, or a mixed structure. Third, changing roles of policy participants were found in the organisational response to epidemics: although governments and medical professionals are at the core of the health decision-making process, NGOs/citizen groups, the media, and local government are growing and considered important in the policy community. Lastly, new themes such as policy learning, cultural aspects, and the business of healthcare have inductively emerged, found as the factors that influenced the response to the COVID-19 pandemic. Lessons learned from past epidemics, reflecting on policy learning, and culture and social values, especially Confucian values, communitarianism, collectivism, and social stigma, played a key role. The government’s business-oriented policy with information and communication technology (ICT) and biotech firms in crisis response resulted in a fragmented triple helix model. The government’s role has shifted from a developmental state to a more entrepreneurial state in the economy and society.
This study contributes to public policy and management theories: the novel finding of the stages model in crisis management combined with governance structures; the core (inner) and outer policy actors in the health policy arena; and revisiting policy learning, cultural theories, and business theories in the context of epidemics. The study provides practical implications for public managers to note the importance of past epidemic experience and including scientific advisors in health policy making, while considering cultural aspects when dealing with epidemics. This study also provides insights and lessons to enable other countries to prepare for future pandemics.
| Date of Award | 1 Apr 2024 |
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| Original language | English |
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| Supervisor | Ewan Ferlie (Supervisor), Susan Trenholm (Supervisor) & Alec Fraser (Supervisor) |