Korean Health Insurance System
U.S. Healthcare Delivery System
Terri Rouse, RHIA
March 5, 2014
According to National Health Insurance Service’s website (http://www.nhis.or.kr), National Health Insurance in Korea's history dates back to 1966. Medical insurance was instituted in 1966, but enforcement was held in 1977, and the medical insurance system to target large companies with 500 or more employees was implemented. The medical insurance had been expanded gradually since then. Finally, the health insurance system had been conducted in 1989 for all the people who have been to apply health insurance. In 1998, 227 regional health insurance unions and health care industries of officials and teacher medical insurance were integrated into the National Medical Insurance Management Corporation. In July 2000, National Health Insurance Management Corporation and employee medical insurance associations (139 societies) were integrated. 30th anniversary of the National Health Insurance Service (NHIS) in 2007 and integrated National Health Insurance in 2010 were celebrated. Korean national health insurance is one of the most exemplary models in the world because the national health insurance system is the shortest period of time to expand health insurance for all citizens, and hundreds of health insurance industries were integrated into the a single insurance corporation. Efficiency of management by integrated national health insurance is dramatically improved, and assurance of public health insurance has been enhanced. The structure of the Korea Medical Insurance System
Except in some public hospitals in South Korea, personal physician owned hospitals. The national health insurance finances through general taxes, all Koreans must be insured mandatorily. Private insurances supplement a part of insurance payment not covered by the national health insurance (balance bill). The core of this system, the National Health Insurance Service is owned by the government. As mentioned above, all Koreans living in Korea is insured automatically. The only exception is people who are protected by the government, and they are supported by complete welfare system and don’t pay additional taxes. Those people are very poor, refugees, child-headed and holder of important intangible cultural heritage and national merits. All people who are insured are required to pay extra taxes. There are two options to pay such taxes in which are employees who have health insurance are deducted from their salary and the company such as premium and people who are not in career pay directly to NHIS. The health insurance premiums through two paths are exactly the same, but not nearly the same amount. Medical insurance amount is determined in the same manner as taxes, a high income earner pay much more than low earner. The most important function of NHIS is that allocates all costs of the health care process by the law. Excluding the cost of specific surgery or costs, because all medical procedures must be specified by the law, its works are very broad. In particular, because NHIS determines the cost of prescription drugs, the drug costs are incredibly low. How is Koran healthcare service operated? Patients go to see a doctor. After diagnosis, the patient has to pay the remaining low portion of the medical fee, excluding the deducted fee from NHIS, and then receive a prescription. Then physicians and pharmacists should claim to NHIS for the medical service fee and the total amount of drug costs. Although many parts of medical related are covered by health insurance, also private health insurance companies exist in Korea. Despite the covering, certain diseases such as cancer and chronic diseases are still a costly burden to middle-class in Korea because those diseases include the selective surgery, and request long LOS while the patient is not working. Therefore, many people have private health insurance for not...
References: History of National Health Insurance Service in Korea. Retrieved February 11, 2014 from
Korean Institute for Health and Social Affairs. (2009, p.2). The health insurance cost in
Korean compared to OECD countries.
Kim, S. (2007). Europe, America, and Korea’s medical insurance comparison. Retrieved
February 15, 2014 from http://grands.egloos.com/1189992.
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