National health insurance in Korea, commonly referred to as health insurance, stands as a cornerstone within Korea's social insurance systems, constituting a vital component of public health care. However, like any system, it is not without its drawbacks.

Despite its imperfections, this system extends substantial benefits to the populace, solidifying its position as a prominent social security initiative that continues to capture attention.

The underpinning legislation governing its implementation is the National Health Insurance Act. Functioning under the auspices of the Ministry of Health and Welfare, the system is managed by two key entities—the National Health Insurance Corporation and the Health Insurance Review and Assessment Service (HIRA). The former oversees the financial aspects, managing health insurance premium payments and expenditures, while the latter, HIRA, assumes responsibility for the oversight of medical institutions and the review of medical expenses.

Notably, the original functions of the erstwhile medical insurance union have been absorbed by the integrated National Health Insurance Corporation, while the review authority, once held by the Korea Federation of Medical Insurance Associations, has been inherited by the Review and Assessment Service.

As of 2023, the determination of medical fees adheres to a fee-for-service system, complemented by the incorporation of a comprehensive fee structure. This evolution in fee determination reflects ongoing efforts to enhance the efficiency and effectiveness of the National Health Insurance system.

South Korea's National Health Insurance (NHI) is a fundamental component of the country's healthcare system, providing residents, including expatriates, access to a wide range of medical services. For foreigners residing in South Korea, understanding the intricacies of the NHI is essential for ensuring comprehensive healthcare coverage. Here's a detailed guide to navigating the National Health Insurance system:

1. Mandatory Enrollment: Foreigners planning to stay in South Korea for more than six months are required to enroll in the National Health Insurance. This ensures that they have access to affordable and high-quality healthcare services during their stay.

The Employed Insured:

1. Overview: Foreigners and overseas Koreans residing and working at an insured company are compulsorily subscribed to the National Health Insurance. However, it is possible to apply for exclusion if they are secured with medical care equivalent to health insurance benefits as per foreign regulations, insurance, or a contract with the employer.

2. Subject: The following individuals are subject to mandatory subscription:

Self-employed individuals employing foreign workers must submit a report to the NHIS for the acquisition of employee insured eligibility, including workplace and user details (both employer and employee).

3. Exclusion of Health Insurance Application by Overseas-based Koreans and Foreigners:

The Self-employed Insured:

1. Overview:

2. Subject:

Available Types of Visa:

2. Enrollment Process: Enrollment in the NHI is typically an automatic process for foreigners with residency status. However, expatriates should verify their enrollment status to avoid any complications when seeking medical services. This can be done by checking with the local National Health Insurance office or through the online services provided.

3. Benefits and Coverage: The NHI offers extensive coverage, encompassing a broad spectrum of medical services. Expatriates can benefit from routine check-ups, vaccinations, emergency care, hospitalization, and various specialist consultations. Understanding the scope of coverage is crucial for making informed decisions about healthcare options.

Co-Payment Structure:

4. Costs and Premiums: National Health Insurance premiums for expatriates are reasonable compared to many other countries. Premiums are typically based on income, and individuals may need to cover a portion of their medical expenses through co-payments. It's important to familiarize oneself with the cost structure, including out-of-pocket expenses for specific services.

Employee Insured: The contribution for the employee insured is calculated by multiplying the monthly wage by the contribution rate:

{Monthly Contribution} = {Monthly Wage} times {Contribution Rate}

This contribution is shared equally between the employee (50%) and the employer (50%). It is deducted from the salary through withholding tax and is applied retroactively at the time of employment.

Self-Employed Insured: For the self-employed insured, the contribution is calculated as follows:

{Contribution} = {Contribution Score} times {Value per Score (KRW)}

The method mirrors that of local residents. If the calculated insurance fee is less than the average fee, the average insurance fee is levied.

Applicable Visa Types: Contributions apply to various visa types, including but not limited to D-1 to D-10, E-1 to E-10, H-1, H-2, G-1, F-1 to F-4, and overseas Koreans permanently residing in the country. The calculation method for contribution remains consistent with that of local residents.

Reduction of Insurance Fee: Certain visa holders may be eligible for a reduction in insurance fees based on their visa type and duration. Reduction rates vary, with specific reductions applicable to visa holders such as D-6, G-1-6, G-1-12, F-4, Korean National students, and others.

For example:

However, households consisting solely of minors are excluded from the reduction policy.

Special Considerations: Reduction rates also apply to individuals living on islands, remote areas, farming/fishing villages, or quasi-farming/fishing villages as defined by the Minister of Health and Welfare. Farmers and fishermen residing in such villages may receive a 28% reduction. D-2, D-4, and F-4 visa holders are subject to specific contribution rate discount rates.

Family Contributions: If you wish to pay the monthly contribution as a family unit, submit documents proving family relations (e.g., marriage certificate) and request the National Health Insurance Service (NHIS) to issue a collective monthly contribution bill for all family members.

For households, the following criteria must be met:

In the annals of South Korea's healthcare history, the journey towards a comprehensive medical insurance system has been a nuanced tale of trials, adjustments, and ultimately, success.

In 1963, a significant stride was made with the initiation of a medical insurance combination system rooted in voluntary subscriptions under the Medical Insurance Act. However, this early attempt encountered a formidable challenge in the form of adverse selection, hindering its effective operation. The Blue Cross Medical Insurance Association, despite substantial investments from local governments and national budgets, could not overcome these hurdles, leading to a system that struggled to function optimally.

A pivotal shift occurred in 1977 when a medical insurance combination system, this time based on compulsory subscription, was launched for a targeted population. This marked the beginning of a phased expansion, incorporating considerations such as region, occupation, and workplace. Over time, this approach sought to address the limitations of its predecessor and cater to a broader demographic.

In 1989, a significant milestone was reached with the fulfillment of a presidential election promise made during the Roh Tae-woo administration – the establishment of medical insurance covering all citizens. However, this promising development faced an unexpected setback when President Roh Tae-woo vetoed the integration of health insurance unions. Despite initial momentum, the motion for integration was canceled, necessitating a shift in strategy.

Following the veto, the system pivoted to operate as an individual medical insurance cooperative. Notably, during the Kim Dae-jung administration in 2000, efforts were made to streamline and fortify the healthcare financing structure. This led to the integration of health insurance cooperatives, culminating in the establishment of the present framework embodied by the National Health Insurance Corporation.

The establishment of the national health insurance system was not a solitary endeavor. Throughout the process, dedicated contributions from government officials, healthcare professionals, and civil society organizations played a pivotal role. It is imperative to recognize that conglomerates, as highlighted in the Newstapa link, shouldered a significant portion of the initial financial burden. The ability to secure financial resources during the 1960s and 1970s was intricately tied to the remarkable economic development of the nation during that period.

The evolution of South Korea's medical insurance system reflects a continuous journey of adaptation, overcoming challenges, and a commitment to providing comprehensive healthcare coverage. The financial intricacies and collaborative efforts involved underscore the significance of a robust and sustainable healthcare infrastructure.

The genesis of South Korea's medical insurance landscape traces back to its early post-war years, marred by the Korean War's disruptive influence in 1950. In its infancy, the focus was primarily on disaster relief, sidelining discussions about medical insurance.

The first flicker of a medical insurance concept surfaced at Busan Labor Hospital, structured as an incorporated association. Operating like a union, it issued membership cards upon fee payment, granting access to medical treatment. However, an inherent flaw, known as adverse selection, emerged as individuals paid fees when ill but abstained when healthy. This endeavor marked Korea's inaugural venture into private medical insurance, driven by Nodong Hospital.

In 1959, discussions on a comprehensive medical insurance system for all citizens gained momentum. Initiated by the "Research Group for the Introduction of the Health Insurance System," the focus was on addressing prevailing healthcare deficiencies. In 1961, Professor Jae-mo Yang of Yonsei University College of Medicine proposed Korea's first concrete medical insurance plan, drawing inspiration from European models. Unfortunately, political upheavals prevented its implementation.

The 1960s witnessed diverse attempts at medical insurance associations, with a notable example being the Central Medical Insurance Association in 1965. However, these endeavors encountered financial challenges, subscriber reluctance, and organizational issues, leading to limited success and eventual dissolution.

In 1968, the Blue Cross Medical Insurance Association emerged in Busan under the stewardship of Dr. Jang Ki-ryeo. Operating as a voluntary association, it pioneered a capitation system, adapting to challenges like adverse selection. The success of Busan's Blue Cross inspired a nationwide movement, albeit with varying degrees of success, providing crucial healthcare coverage until the advent of national health insurance.

1977 marked a turning point with the introduction of compulsory employee medical insurance, initially for large companies. Despite attempts at implementing comprehensive medical insurance, challenges arose due to fee systems, customary practices, and economic constraints.

Regional medical insurance pilots in 1980 faced setbacks, notably due to low premium collection rates. The 1986 preparation for national health insurance expansion encountered financial constraints and management controversies.

A comprehensive plan for national health insurance unfolded in 1986, aiming for gradual implementation in rural and urban areas. However, a proposed integration plan in 1988 faced substantial opposition, leading to President Roh Tae-woo's veto in 1989. Consequently, medical insurance persisted in regional and workplace-based associations.

In summary, South Korea's journey toward a comprehensive medical insurance system has been marked by experimentation, challenges, and persistent efforts to bridge gaps in healthcare coverage. The evolution from voluntary associations to the ambitious goals of national health insurance reflects the nation's commitment to providing accessible and inclusive healthcare for its citizens.

In the wake of South Korea's escalating national income and improved living standards driven by sustained economic growth, the evolution of its medical services paradigm reflects a shift from addressing fundamental healthcare needs to a broader recognition of the necessity for practical medical services. This transformative journey entails enhancing systems to ensure individuals can access appropriate benefits with commensurate burdens, particularly in the context of a low-burden, low-wage framework.

Advancements in Medical Benefits Under the initial Medical Insurance Act, the stipulated medical care benefit period for the same ailment was 180 days. Over time, responsive adjustments were made to align with changing healthcare needs. By 1985, this period extended to 180 days per year. In 1988, the system further evolved, allowing benefits even beyond 180 days if the annual amount remained below 300,000 won. Subsequent enhancements raised this cap to 450,000 won in 1991 and 550,000 won in 1993. Notably, these increments were paralleled by corresponding increases in insurance benefits.

Transition from Regional and Workplace Medical Insurance to National Health Insurance The early landscape saw a division between regional medical insurance and workplace medical insurance. Myriad local governments and workplaces formed their own insurance associations, leading to a fragmented structure. Challenges emerged, such as smaller associations struggling to cover medical expenses, resulting in insurance suspensions for union members. Recognizing these inefficiencies, the Kim Dae-jung government pursued a comprehensive integration effort. In 1998, a major reorganization united medical insurance for public officials, private school teachers, and regional medical insurance associations under the umbrella of the 'National Health Insurance' system. The final merger took place in 2000, with the incorporation of the last remaining workplace medical insurance association into the National Health Insurance Management Corporation, culminating in the establishment of the National Health Insurance Corporation on July 1, 2000.

This consolidation endowed the National Health Insurance Corporation with significant authority, ushering in an era where it held a predominant position over medical institutions. Notably, the National Health Insurance Act, once established, mandated that doctors could only practice if registered with the Corporation.

Universalization of Mandatory Medical Insurance Currently, South Korea implements a compulsory medical insurance designation system, requiring children to be enrolled upon birth registration. Refusal to comply could result in consequences, including potential expulsion from the country and a temporary entry ban. This mandate extends to foreigners, irrespective of nationality, with residency status holders automatically enrolled in medical insurance, except for those on diplomatic or official missions. Short-term stays, such as tourism, remain an exception, lasting less than six months.

Claims Review and Evaluation With the National Health Insurance Corporation assuming a pivotal role in managing medical expenses, it oversees the review, dismissal, reduction, or approval of claims submitted by hospitals and medical institutions. However, recognizing concerns about fairness, a separate entity, the Review and Assessment Service, was established to handle these critical evaluations independently.

In the wake of the profound impact of aging, the landscape of health insurance premiums is poised for a notable transformation. Forecasts indicate a surge, with premiums projected to elevate to 350,000 won by 2030, escalating further to 710,000 won in 2040 and reaching 950,000 won by 2050. This anticipated trajectory underscores the imperative for a proactive response to the challenges posed by a rapidly aging population.

Acknowledging the limitations of the existing health care framework, discussions are underway regarding the necessity for a more adaptable and responsive reconstruction. The rigidity of the current system may prove inadequate in effectively addressing the multifaceted demands that accompany the demographic shift towards an older population. As stakeholders engage in dialogue, the exploration of flexible restructuring becomes paramount to ensure the sustained efficacy and inclusivity of the health care system in the face of evolving demographic dynamics.

The impact of national health insurance in South Korea is deeply ingrained in the collective consciousness, a testament to the collaborative efforts of citizens and healthcare professionals. Individually, its significance resonates profoundly as it mitigates the financial burden on individuals seeking medical care. The government, specifically the National Health Insurance Corporation, shoulders a significant portion of medical expenses, leaving patients responsible for only a fraction.

Remarkably, the total medical costs, around 70% of the OECD average, position South Korea favorably even when excluding countries with more complex healthcare structures. The existence of national health insurance simplifies hospital visits, enabling swift treatment for common ailments at a minimal cost, often as low as 10,000 won from hospitals to pharmacies. Notably, the dedication of Korean doctors has led to a rapid increase in average life expectancy, surpassing that of the United States in 2003.

Presently, the prospect of individuals succumbing to illness due to financial constraints is rare in Korea. Economic barriers to healthcare access, as per the 2013 National Health Statistics, affect only a marginal percentage of the population. While some argue that the coverage, scope, and reimbursement of national health insurance are relatively lower compared to private insurance, a substantial portion of the economically empowered and those with chronic illnesses, necessitating frequent hospital visits, complement their national coverage with private insurance.

Critics of Korea's medical insurance system exist, citing concerns such as low medical fees and a broad spectrum of non-reimbursement targets. The contention revolves around health insurance premiums being perceived as too modest, potentially jeopardizing the sustainability of the medical system. However, the resounding satisfaction with national health insurance stems from its efficiency in providing prompt treatment—a luxury often lacking in countries advocating free medical care.

Drawing comparisons, the waiting times for medical treatment in countries like Canada and the United States exemplify the disparities. Korea, dubbed a medical paradise by some, contrasts starkly with prolonged waiting periods in other nations. The competitive environment in the United States, while technologically advanced, has elevated costs and resulted in the lowest life expectancy among developed countries.

Anecdotal evidence highlights the significant cost disparity, with Korea's "medical shopping" trend gaining attention. Foreigners, especially English teachers, often commend the affordability of hospital fees in Korea, surpassing the cost-effectiveness even when factoring in travel expenses. It's essential to note that cost variations exist depending on the nature of the ailment.

Examining other healthcare systems, Hong Kong, operating under a British model, boasts a functional government hospital system despite higher medical fees. Private hospitals thrive, primarily catering to wealthy individuals, including many from mainland China. While countries like the UK, France, Hong Kong, Japan, Australia, and the United States excel in medical expertise, the prohibitive cost in some of these nations poses a significant barrier to healthcare access for the general populace.

The crux of the matter lies in balancing quality and accessibility. The suggestion of a separate government hospital system akin to the NHS in the UK and Hong Kong or designating regional emergency centers with government subsidies is proposed as a potential long-term solution. However, this entails a trade-off, requiring a willingness to pay more for equitable access to medical services. In essence, the South Korean healthcare landscape stands as a unique blend of affordability, efficiency, and the ongoing pursuit of an optimal healthcare model.

Medical institutions are bound by law to charge fees determined by regulations. Any deviation from these prescribed amounts is deemed illegal. Consequently, if a medical institution suggests reducing the price, it is akin to engaging in unlawful practices. Beyond the standard fees, patients are required to shoulder a portion of the cost associated with nursing care benefits provided by the health insurance system.

The financial burden on patients varies, contingent on factors such as the type of disease and the specific medical institution administering treatment. Notably, a percentage of the consultation fees is collected as co-payment. In some instances, doctors or hospitals may provide vague responses when queried about treatment fees, as the co-payment is a nuanced calculation based on various elements. The intricacies involve rounding off amounts to the nearest ten won, with variations for first visits, follow-up visits, nighttime consultations, and those on public holidays. The co-payment, representing 10%, 30%, or other specified percentages, can often amount to a fractional unit. It's not uncommon for amounts to drop to a single won. In practice, many medical institutions might forgo amounts less than 10 won, which, while seemingly negligible, collectively amounts to tens of billions of won in losses for these institutions.

However, there are scenarios where the entire amount remains constant, irrespective of the medical institution chosen for treatment. This includes instances where individuals deviate from prescribed care benefit procedures, cases involving short-term service personnel (such as military sergeants, soldiers, or officer candidates) receiving treatment outside designated institutions, individuals with salary restrictions due to unpaid insurance premiums, and emergency medical management fees for patients not covered by the calculation standards for transport treatment and emergency medical fees when transported to an emergency medical institution via ambulance. In these specific cases, the financial obligations for medical services are standardized, providing clarity and consistency for patients incurring these particular circumstances.

Designed to alleviate the financial strain on patients enduring extended hospital stays due to severe illnesses, the out-of-pocket limit is a crucial component of the health insurance framework. It aims to offset the income loss experienced by the patient's household during such challenging times, representing a form of financial support rather than covering treatment expenses.

Since 2014, the out-of-pocket limit system has evolved, expanding its coverage from a minimum of 1 million won to a maximum of 5 million won. This system operates through two mechanisms: pre-application and post-refund.

In the pre-application method, if the hospital fee surpasses 5 million won for admission to the same hospital, the medical institution refrains from billing the patient for the excess amount. For instance, if the insured hospital fee amounts to 8 million won, the patient pays only 5 million won upfront, with the remaining cost left unpaid. Subsequently, after one year, a refund of up to 4 million won is possible, contingent on the individual's income level and health insurance premium payments.

The post-refund approach involves reimbursing the excess amount after one year (January to December) to patients incurring high insurance-covered medical expenses. This includes scenarios like obtaining costly new drugs as outpatients. For patients spending 1 million won in medical expenses, any expenditure beyond 5 million won becomes subject to a refund of 1 million won per month, starting six months later. Once the settlement is concluded, individuals can receive a refund of up to 4 million won based on their income level. Applications for post-refund payment are conveniently facilitated through mail, phone, in-person visits to the Corporation, or online platforms such as THE Health Insurance app or the National Health Insurance Corporation website.

It's important to note that non-benefit items, such as special treatments, are excluded from the upper limit. For those with an annual income less than 1 million won, a minimal monthly contribution of 13,100 won suffices, providing an essential safety net for those facing economic constraints.

Insurance benefits, though available to eligible individuals, may be subject to limitations or suspension under specific circumstances:

Insurance benefits may be suspended under the following circumstances:

Note: If a person falling under items 3 and 4 receives medical care benefits from a medical institution, insurance benefits become available, subject to the deposited amount. It's essential to clarify that the term "No way" signifies a definitive suspension of benefits in these scenarios.

1. Immediate Suspension upon Leaving the Country:

2. Returning from Abroad without Notification:

3. Expedited Suspension Release:

Note: Failure to lift the suspension before seeking medical attention results in 100% self-payment. Once the suspension is resolved, retrospective settlements can be made. To avoid inconveniences, it's crucial to ensure timely communication with the National Health Insurance Corporation regarding international travels and return.

Non-Benefit Eligibility Criteria:

Prescription Drug Coverage:

Challenges and Ambiguities:

Impact on Medical Professionals:

The National Health Insurance Corporation administers health insurance premiums for both employers and local subscribers. The income assessment involves data from the National Tax Service and direct employee surveys. However, similar to tax evasion challenges faced by the National Tax Service, accurately gauging local subscribers' income proves complex.

For local subscribers, premiums factor in both assets and income, resulting in relatively high costs, a source of considerable discontent. Criticism arises when individuals with low income but assets like houses or cars are subject to premiums. This issue sparks numerous complaints, reaching around 60 million annually (as of 2015) to the National Health Insurance Corporation. Those without homes or cars experience comparatively lower premiums, though it remains a relative term, not necessarily implying affordability. Furthermore, the non-payment of health insurance premiums among local subscribers contributes to various social problems, amplifying the need for systemic adjustments.

Employee subscribers enjoy several benefits, with their companies covering half of the insurance premium, resulting in relatively low payments. The company considers salaries and health insurance premiums as labor costs. For civil servants, the government covers half, and for private school teachers, the school corporation pays 30%, and the government pays 20%. The upper limit for monthly insurance premiums is 7,822,560 won as of 2023.

Upon becoming an employee subscriber, individuals cease being local subscribers, while remaining family members may continue as local subscribers or register as dependents. Upon retirement, a transition to a local subscriber can be delayed for up to three years through the voluntary continuous subscriber system, offering a 50% discount on the monthly premium. However, those with post-retirement incomes exceeding 20 million won per year face separate monthly premiums.

Until 2000, employed subscribers had no premium settlement system, requiring monthly checks and deductions from salaries. Health insurance settlements present challenges due to individual burdens, necessitating deposits and year-end tax settlements. Unlike other insurances, the national pension lacks a settlement system. Health insurance settlements for employee subscribers frequently occur, affecting the overall income.

The settlement process for employee subscribers involves calculating the monthly compensation and months worked from the annual total compensation. The average monthly compensation is multiplied by 3.06%, and the long-term care insurance premium is calculated at 6.55%. The total monthly insurance premium is then determined. Employees working overseas receive full or half reductions, but benefits are void if they are in Korea or receive health insurance benefits. Since 2016, monthly compensation reporting mandates have facilitated monthly premium settlements for employed subscribers.

Unlike employer subscribers, local subscribers bear the full cost of insurance premiums. The calculation involves multiplying the premium levy point by the amount per point, determined based on factors like income, assets, and automobile ownership. The premium is then adjusted based on the household's annual income.

For income insurance premium levy points:

For property insurance premium points: