Erased Alternatives, Locked-in Path: The Contestation of Medical Workforce Supply Policy in Authoritarian South Korea, 1961-1988.

Abstract

This article traces how physician supply policy was formulated and implemented during Korea's authoritarian era (1961-1988), spanning the military regime of Park Chung-hee and the New Military regime of Chun Doo-hwan. It examines several questions that have hitherto gone unexplained: the circumstances behind the initiation (1965), suspension (1971), and resumption (1978) of the founding of new medical schools; why most of these newly established schools were private; and the range of alternatives explored in lieu of building medical schools. The founding of medical schools that began in the mid-1960s was halted in 1971 amid opposition from physicians' organizations and fiscal constraints. The government then turned to familiar alternatives-qualifying examinations and four-year medical colleges-but neither bore fruit. The Community Health Practitioner system, an adaptation of MEDEX, was successfully institutionalized, yet it remained constrained by persistent skepticism toward non-physician personnel and by its inability to address the growing demand for care in cities. After these alternatives had foundered one by one, the government reverted in 1978 to expanding medical schools. Coupled with a guiding principle of minimizing state investment, this reversion culminated in a model of physician training centered on private medical schools. In short, the 1960s and 1970s were at once a period in which a policy imagination for mobilizing other kinds of personnel took shape and a critical juncture at which that imagination was erased and a single path became entrenched. By showing that today's prevailing assumption-that expanding the medical supply must mean founding new medical schools-is not inevitable but the product of a particular historical trajectory, this article draws out the significance this past holds for a present in which regional healthcare has once again become a contested issue.