. 2019 Mar 29;11(1):41–56. doi: 10.1007/s41649-019-00079-1

Table 2.

Korea’s National Health Insurance System by components of Universal Health Coverage

Components of UHC	Concept	National Health Insurance System	Quantitative evaluation³
1. Target population	Who is covered? → Everyone (universality and equity)	∙Achieved National Health Insurance (NHI) in 1989, after introduction in 1977 ∙The insured under the NHI: 97.1% (including approximately 812,000 foreigners) and Medical Aid: 2.9% ∙Overseas Korean citizens and foreigners residing in Korea included	∙No reform occurs ∙Target population remains 100%	Population covered by healthcare 100% (as is)
2. Coverage of health services	Which services are covered? → Access to a good quality of needed services	∙63.4% of benefit coverage from total health services (75–90% for major illness)¹ ∙Diagnosis, test, drugs, medical materials, treatments, surgery, preventive care, rehabilitation, hospitalisation, nursing, and transportation ∙Negative list system for listed uninsured benefits, standard uninsured benefits, restricted uninsured benefits, selective uninsured benefits	∙Shifting listed uninsured benefit to insurance benefit ∙Abolishing selective treatment in regulated uninsured benefit, reduce burden in high-level wards, and nursing care services ∙Increasing insurance coverage by 70%	Health insurance coverage rate 63.4% (2015) → 70% (2023)
3. Financial protection	What do individuals have to pay out-of-pocket? → No one faces financial hardship or impoverishment by paying for necessary services	∙Out-of-pocket payments (OOPs) 36.8% (uninsured benefit 17.1%, OOPs 19.7%) in 2015 (OECD average 19.5%) ∙OOPs 20%, outpatient 30~60%, general drug 36.8%, severe drug 40~50% among total health expenses ∙Ceiling system of OOPs and benefit coverage extension of rare diseases ∙Experience rate of catastrophic health expenditure² 4.5%, 440,000 households fall from above middle-income to below middle-income	∙Keeping average premium rising rate of 3.2% ∙Changing all listed uninsured benefits and some standard uninsured benefits as insurance benefits ∙Reducing the burden of OOPs by adjusting the ceiling system of OOPs ∙Adopting a support system for catastrophic health expenditure	Total health expenses, rate of OOPs 36.8% (2015) → 30% (2023)

Components of UHC

Concept

National Health Insurance System

Quantitative evaluation³

Before reform

After reform
Moon Jae-in Care

1. Target population

Who is covered?

→ Everyone (universality and equity)

∙Achieved National Health Insurance (NHI) in 1989, after introduction in 1977

∙The insured under the NHI: 97.1% (including approximately 812,000 foreigners) and Medical Aid: 2.9%

∙Overseas Korean citizens and foreigners residing in Korea included

∙No reform occurs

∙Target population remains 100%

Population covered by healthcare

100% (as is)

2. Coverage of health services

Which services are covered?

→ Access to a good quality of needed services

∙63.4% of benefit coverage from total health services (75–90% for major illness)¹

∙Diagnosis, test, drugs, medical materials, treatments, surgery, preventive care, rehabilitation, hospitalisation, nursing, and transportation

∙Negative list system for listed uninsured benefits, standard uninsured benefits, restricted uninsured benefits, selective uninsured benefits

∙Shifting listed uninsured benefit to insurance benefit

∙Abolishing selective treatment in regulated uninsured benefit, reduce burden in high-level wards, and nursing care services

∙Increasing insurance coverage by 70%

Health insurance coverage rate

63.4% (2015) → 70% (2023)

3. Financial protection

What do individuals have to pay out-of-pocket?

→ No one faces financial hardship or impoverishment by paying for necessary services

∙Out-of-pocket payments (OOPs) 36.8% (uninsured benefit 17.1%, OOPs 19.7%) in 2015 (OECD average 19.5%)

∙OOPs 20%, outpatient 30~60%, general drug 36.8%, severe drug 40~50% among total health expenses

∙Ceiling system of OOPs and benefit coverage extension of rare diseases

∙Experience rate of catastrophic health expenditure² 4.5%, 440,000 households fall from above middle-income to below middle-income

∙Keeping average premium rising rate of 3.2%

∙Changing all listed uninsured benefits and some standard uninsured benefits as insurance benefits

∙Reducing the burden of OOPs by adjusting the ceiling system of OOPs

∙Adopting a support system for catastrophic health expenditure

Total health expenses, rate of OOPs

36.8% (2015) → 30% (2023)

¹The coverage rate of health insurance refers to the proportion of health insurance borne by all hospitals and clinics

²The experience rate of catastrophic expenditure is when more than 40% of a household’s income is spent on health care expenses

³Achieving UHC is more likely as the population under healthcare coverage and the health insurance coverage rate is closer to 100%, and the rate of OOPs in financial protection is closer to 0