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Health insurance and the growth of the private health sector in the Republic of Korea

This paper analyzes the efficacy of the national health insurance (NHI) system in the Republic of Korea, and the role played by the private sector in the provision of health care services. It identifies four main problems: 1) lack of access to the system for low-income households, because of high co-payments, and insurance premia, thereby leading to a two-tier system; 2) high administrative costs caused by the existence of a large number of small insurers; 3) excessive use of high technology brought about, in part, by the lack of a gatekeeper, and referral system, and in part, by the freedom granted to private health care providers, to collect special treatment charges which are not covered; and, 4) low priority given to primary health care. The Korean example suggests that while private sector participation in NHI is important, appropriate institutional mechanisms should be put in place, to control system costs, and to provide affordable access to low-income groups.