Korea: Health System Coverage and Access

Universal Health Coverage: Service coverage index, 2021: ≥80

Source: World health statistics 2025: monitoring health for the SDGs, Sustainable Development Goals. Tables of health statistics by country and area, WHO region and globally. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.

Population coverage for a core set of services, 2021
– Total public coverage: 100%

Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.

“Republic of Korea (hereafter, Korea) has introduced a national health insurance (NHI) scheme that includes the compulsory coverage of 97% of the population, except those recipients of Medical Aid that protect the accessibility of care for the poor [5]. However, the benefit coverage of NHI is rather low, indicating that the proportion of out-of-pocket (OOP) payments, including copayments for services that have been insured and full payments for uncovered services, is approximately 32.2% of the health expenditure in 2018. This metric is relatively higher than those of Japan (13%), Germany (12.6%), the UK (15.9%), and France (10.2%) [6]. If OOP payments increase excessively, catastrophic consequences for households and the economy may ensue [7]. The World Health Organization (WHO) [8] states that if the ratio of OOP expenses to a household’s ability to pay exceeds a specific threshold, it is considered as “catastrophic health expenditures (CHE),” and this has been adopted as a measure of fairness in financial contribution indicators [8, 9]. Consequently, many studies on CHE have been conducted in Korea for more than a decade, and almost all of these studies have criticized the financial functioning of the Korean NHI scheme, which barely protects households from high OOP expenses [10–12].

“The pricing system of the health care service market in Korea is based on a fee-for-service scheme and NHI is a third-party payer that covers some proportion of medical fees. There are many services in the medical market, most of which are “covered” services managed by NHI, and other “non-covered” services. Notably, NHI covers some proportion of medical costs for services that are covered according to the coinsurance rates, and the rest of the expenses become statutory copayments of patients [13]. At the same time, the patients must make full payments for services such as dental prosthetics, vision correction surgery, manual therapy, and other treatments or medicine based on new health technologies. These uncovered services may have clinical evidence for their treatment effects. However, the NHI does not pay for them due to low economic efficiency or the existence of other alternative medical services.”

Source: Jung, H.W., Kwon, Y.D. & Noh, JW. How public and private health insurance coverage mitigates catastrophic health expenditures in Republic of Korea. BMC Health Serv Res 22, 1042 (2022). https://doi.org/10.1186/s12913-022-08405-4

“Many Koreans additionally purchase PHI [Private Health Insurance] plans, a supplementary scheme covering services not covered by NHI [National Health Insurance]. Although some variations exist, depending on research data, it has been reported that approximately 65–80% of households have PHI plans [10, 15, 16]. Moreover, PHI premiums have averaged US$ 184.9 per household with PHI per month, which is 2.1 times higher than NHI contributions (US$ 89.9 per month) [16]. Given this difference in premiums, it would be reasonable for households insured with PHI to be able to significantly reduce their OOP expenses. Furthermore, NHI benefits (benefit-in-cash and benefit-in-kind) are the amounts that NHI pays for medical services according to coinsurance rates; PHI reimbursements are a part of the OOP expenses reimbursed by PHI.”

“Population coverage has been given higher priority than the scope and depth of service coverage in the development of health insurance in the Republic of Korea. The benefits are explicitly defined and mainly in the areas of curative services such as diagnosis, treatment, traditional medical care, emergency care, pharmaceuticals and dental care. They also include biannual health check-ups, such as cancer screening for those over 40 years old. Thanks to the single payer system, all insured have access to an identical benefits package. Cash benefits are available for limited areas such as maternity benefits and funeral benefits.

“Cost-effectiveness criteria were formally applied to benefits package decisions for new medicines and technology in 2006. For medical services, various criteria are considered, including clinical effectiveness, cost-effectiveness, financial burden on patients and fiscal impact on health insurance. Technical reviews of benefit decisions are provided by relevant committees in the health insurance agency. Based on these reviews, the final decision is made by Health Insurance Policy Deliberation Committee.

“The Health Insurance Policy Deliberation Committee makes major decisions such as premium contributions, benefit packages, cost sharing, and pricing of medical care and pharmaceuticals. The Committee has 25 members with the Vice Minister of Health and Welfare as the chair. It is a tripartite committee consisting of representatives of payers, providers and expert/governments. Eight members represent payers (labour unions, employer associations, civic groups, etc.), eight come from health-care providers (physicians, hospitals, dentists, pharmacists, nurses, etc.) and eight are experts and public agencies representatives (Ministry of Health and Welfare, Ministry of Strategy and Finance, National Health Insurance Service, Health Insurance Review and Assessment, and four experts).”

Source: World Health Organization. Regional Office for the Western Pacific. (‎2015)‎. Republic of Korea health system review. Manila: WHO Regional Office for the Western Pacific.

South Korea: Health System Coverage - Healthcare - coverage, access, private - National Policies - World Health Systems Facts

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Page last updated October 20, 2025 by Doug McVay, Editor.