South Korea’s National COVID-19 Policy
South Korean Health System Overview
Health System Rankings
Health System Outcomes
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.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm
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.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm
“South Korea has a compulsory National Health Insurance (NHI) system with universal coverage. This social health insurance system was established in 1977, when only 8.79% of the total population was covered. After 12 years of rapid coverage expansion, in 1989 the system covered the majority of the population, with the exception of a small portion (3–4%), who are now covered by an alternative welfare programme for the poor (the Medical Aid Programme, MAP). Until 2000, the NHI system operated as a multi-insurance fund system, with more than 370 insurers established on a regional or occupational basis. After nearly 20 years of discussion, these funds were integrated to form a single-payer system in July 2000.
“The Ministry for Health, Welfare and Family Affairs (MIHWFA) has overall responsibility for the health of the population and has a supervisory role in health insurance policy. The National Health Insurance Corporation (NHIC) is the single insurer, responsible for providing health care benefits to the population, as well as collecting contributions and reimbursing providers. The Health Insurance Review and Assessment Service (HIRA) reviews the cost of health care benefits and evaluates the reasonableness of health care services provided by medical institutions.”
Source: Chun C-B, Kim S-Y, Lee J-Y, Lee S-Y. Republic of Korea: Health system review. Health Systems in Transition, 2009; 11(7):1–184. http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/republic-of-korea-hit-2009
“Healthcare is financed through National Health Insurance covering the entire population. Other than some of very new and costly technologies, most health-care services, including medical check-ups and cancer screening, are included in the benefits package with relatively high cost-sharing. The role of voluntary health insurance (VHI) in health-care financing is increasing, and its role has been controversial.
“Out-of-pocket (OOP) payments still required in social insurance include co-payments for covered services and full payment for services not included in the benefits package. Patients pay 20% of the cost for insured services in inpatient care, and differential cost-sharing is applied for outpatient care, depending on the level of health provider. The poor are exempted from cost-sharing at the point of service, and vulnerable patient groups have access to discounted co-payment rates. There is a ceiling on OOP payments, with differential ceilings applied to different income groups, but the ceiling applies only to insured services. High OOP payments have been a serious concern and are increasingly driven by payments for uninsured services, most of which involve new technology and medicines with uncertain cost effectiveness.
“For employees, health insurance contributions are proportional to wage income and shared equally between the employee and employer. Health insurance contributions for the self-employed are based on both income and the value of property such as houses and vehicles. As a single payer system, health insurance has a uniform contribution formula and benefits coverage nationwide.
“Social health insurance is managed by quasi-public agencies: the National Health Insurance Service deals with premium collection, risk pooling, fund management, and reimbursement to providers, and Health Insurance Review and Assessment is responsible for claim review, assessment of appropriateness of health-care, technical support to benefit packages and the design of the provider payment system. Fees for services in the benefits package are negotiated annually between the NHIS and provider associations.
“Health-care providers are paid under the fee-for-service system, and due to the dominance of private providers, this has contributed to the rapid increase in health expenditure. Other payment methods include Diagnosis Related Group (DRG)-based prospective payments to acute care providers for seven disease categories and per-diem payments differentiated by 17 disease categories to long-term care hospitals.”
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
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Page last updated May 29, 2020 by Doug McVay, Senior Policy Analyst.