South Korea: Health System Coverage and Costs for Consumers

Population Insurance Coverage For A Core Set Of Healthcare Services* (%) (2017):
Public Coverage: 100%; Primary Private Health Coverage: 0%; Total: 100%

*“Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is country-specific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. Financing is linked to ability-to-pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population.”

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

Annual household out-of-pocket payment, current USD per capita (2017): $769

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed Jan. 10, 2020.
http://apps.who.int/nha/database/

Out-of-Pocket Spending as Share of Final Household Consumption (%) (2017): 5.6%

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

“Under the Infectious Disease Prevention Act, the South Korean government is covering all costs related to testing, quarantine, and treatment for COVID-19. More specifically, the cost is shared by the National Health Insurance Service (NHIC), the state, and local governments.”

Source: Park Da-hae, staff reporter, “S. Korean government covers costs for testing for and treating coronavirus infections,” The Hankyoreh, Feb. 13, 2020.
http://english.hani.co.kr/arti/english_edition/e_national/928120.html

“A 20% co-payment is required for inpatient care services included in the benefit package, but this ranges from 30% to 60% for outpatient care, depending on the level of provider. The poor are exempted from cost-sharing at the point of service, and vulnerable patient groups (e.g., the elderly, patients with catastrophic conditions such as cancer) have access to discounted co-payment rates. There is a ceiling on OOP payments for each six months, with differential ceilings applied to different income groups.”

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.
https://apps.who.int/iris/handle/10665/208215

“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).”

“For employees, health insurance premiums are proportional to wage income and shared equally between the employee and employer. The contribution rate is uniform for all employees and has increased from 4.21% of wage income in 2004 to 5.64% in 2011. There is a salary ceiling for the contribution assessment, but it is very high (a monthly wage of about US$ 70 000), and only a limited number of people are in that category. As the reliability of information about the income of the selfemployed is doubtful, health insurance premiums for the self employed are based on both income and property value (house, vehicle). The NHIS as the single health insurance agency collects the premium. The poorest 3–4% of the population do not pay contributions and are managed through the Medical Aid Program,which is financed by the general revenue of the central and local governments but administered (including payments to providers) through the health insurance system.

“In the past, wage income was the predominant source of income for households. However, the source of household income has diversified into rents, interest, investment income and beyond. If insurance premiums are charged only on wage income, it is not only inequitable but also distorts (discourages) labour participation. In the near future, health insurance contributions will need to be assessed against all types of income to improve the efficiency and equity of the health financing system.”

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Dec. 4, 2020 by Doug McVay, Editor.