Comparative scholarship on health systems has largely relied on institutional approaches, based mainly on the public–private divide. This article argues that political dynamics are central to understanding the shaping and evolution of health systems. France offers a particularly instructive case due to the complexity of its system: intertwined public-private mix, changing modes of governance, persistence of historically rooted arrangements and institutional disjunctures. Drawing on policy tracing, with attention to critical realism, and conducting a contextual and historical analysis, the article shows how actor configurations, power resources, ideological conflicts and political crises have structured the French health system over time. The introduction presents the characteristics and paradoxes of the French system, which this article contributes to explain. The following two sections trace the separate institutionalisation of the two key policy actors: first, the nineteenth-century formation of the medical profession, structured as a national scientific elite, local political notability, and a corporatist organisation ; second, the belated and contingent construction of a national health insurance system, confronted with the resistance of organised medical liberalism. The third section analyses how the power relationship between the medical profession and the government have evolved after a major change of the political regime (Vth Republic) and pressure from economic and social challenges, such as modernizing hospital infrastructure, universalising access and containing expenditure. It shows growing government leadership, and yet limited statecraft over parts of health sector. The conclusion points to the interest of long-term policy tracing, as a method that allows to uncover underlying power structures and identify the causal factors of change, an approach applicable to other national cases.

A key structural characteristic of the Korean medical system is that the public share of total medical expenditure is low, and the provision of medical services relies primarily on the private sector. These structural characteristics emerged within the context of World War II, the end of the war, the Cold War system, and the expansion of global neoliberalism. Even amidst colonialism, authoritarian regimes, and the abuses of development-oriented governments, there were counter-movements that resisted through independence, democratization, and the strengthening of public services. In this process of co-evolution, specific policies related to the healthcare system often became the concrete manifestations of this struggle. The partial achievements attained by civil society and labor movements—such as the establishment of workers’ hospitals, the integration of health insurance, and the prevention of healthcare privatization—were made possible by progress in the broader context of independence and democratization. Currently, the Korean healthcare system is facing three major crises: (1) constant pressure for privatization and commercialization of healthcare services, (2) sustainability of the healthcare system amid rapid aging, and (3) explosive growth of science and technology driven by artificial intelligence (AI) and the resulting weakening of civil, labor, and social rights. The outcome of the new crisis currently facing South Korea’s healthcare system will also be determined by the multilayered political dynamics between dominant and countervailing forces at the global, national, and collective levels. The history of co-evolution between politics and the healthcare system that South Korean society has built thus far will provide useful insights not only for Korea but also for other nations facing similar situations in their efforts to establish better healthcare systems.

Citations

• Health Systems as Contested Ground
  Haejoo Chung, Carles Muntaner
  Health Politics.2026; 1(2): e006.     CrossRef