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The Special Case,

The Achievement of Universal

Health Coverage in Korea
SOHN, Myongsei MD PhD
Executive Director, Institute for Global Engagement and Empowerment

Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily
reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments
they represent ADB does not guarantee the accuracy of the data included in this paper and accepts no
responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB
official terms.
Organization and Governance of Health care
A. National Health Insurance (NHI)
1. Universal Coverage
- NHI covers 95% of population
- Medical Care Assistant (MCA) covers the rest (the poorest 5%)
- Private health insurance is only supplementary.
B. Single insurer with two organizations
1. National Health Insurance Corporation (NHIC)
- premium collection, fund management, reimbursement to providers
2. Health Insurance Review and Assessment (HIRA)
- claim review, assessment of appropriateness of health care
C. Two categories in NHI
1. Employee insurance
- employee and their dependents
- contribution rate: fixed percentage of wage
2. Self-employed insurance
- people who are not eligible for employee insurance
Organization and governance
Three strengths
• A real-time based monitoring and analysis of national health
insurance expenditure by HIRA
• A free health market system
• Health care service is mostly provided and supported by the private
Introduction of Western Medicine to Korea
• In 1885 by the 26th King of Chosun Dynasty, King Gojong
• American missionary physician saved King’s brother-in-law from life-
threatening stab injury
• Co-existence of Korean/Eastern (Oriental) and Western medicine.
Modern Korea
• 1950’s and 1960’s
• Intense planning and building for the future development and
• Expansion of medical and nursing schools as well as hospitals
• Introduction of health insurance program (1963)
• Family Planning
• Funded by international organizations
Incremental Approach to Universal Coverage
• 1970’s – 1980’s
In 1977, firms with > 500 employees
In 1979, public employees and teachers, and firms with > 300 employees
In 1981, pilot program for the self-employed in 3 rural areas
In 1982, pilot program for 1 urban and 2 rural areas
In 1983, firms with > 16 employees
In 1988, all rural self-employed
In 1989, all urban self-employed (Universal Coverage)
Investment on health care infrastructure
• 1980’s and 1990’s
• Resource mobilization
• Foreign loans (from Japan and IDRD) and grant
• Investment from private sector in Korea
• As a result, private providers explains 90% of health care expenditure
Reform in 2000’s
• Merging of hundreds of health insurance insurer entities into a single
insurer/payer system
• Inception of an independent expenditure management agency (HIRA)
• Implementing a separate and independent system for prescribing and
dispensing all medications to the insured
• Reimbursement reform
Information and Communication Technology
• Importance of ICT in health care
Current reform plans and challenges ahead