Jordan Ellis
South Korea's healthcare system is based on the National Health Insurance Service, a public health insurance program to which South Koreans of sufficient income must pay contributions to insure themselves and their dependents. In 2015, South Korea ranked first in the OECD for healthcare access. The country also has the second-largest number of hospital beds per 1000 people in the OECD, with 9.56 beds, which is over triple that of Sweden, Canada, the UK, or the US. South Korea's universal healthcare system has led to a rapid increase in the number of hospitals and the country continues to invest in new medical equipment and technology.
| Characteristics | Values |
|---|---|
| Total number of medical personnel in hospitals in 2023 | 490,600 |
| Number of medical personnel in hospitals in Seoul in 2023 | 106,900 |
| Number of acute beds in 2011 | 20,000 more than the previous year |
| Number of hospital beds per 1000 people | 9.56 |
| Percentage of general hospitals, dental hospitals, and traditional medicine hospitals in urban areas | Higher than average |
| Percentage of acute bed utilization | Increasing |
| Number of long-term care hospitals | Rapidly increasing |
| Number of pediatric facilities in Seoul from 2018 to 2022 | 12.5% decrease |
| Number of psychiatry clinics from 2018 to 2022 | 76.8% increase |
| Number of anesthesiology centers from 2018 to 2022 | 41.2% increase |
| Number of hospital beds | Oversupply |
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What You'll Learn
South Korea's universal healthcare system
South Korea's healthcare system is based on the National Health Insurance Service (NHIS), a public health insurance programme run by the Ministry of Health and Welfare. South Koreans of sufficient income must pay contributions to insure themselves and their dependents. There is also the Medical Aid Program, a social welfare programme run by the central and local governments to insure those unable to pay National Health Insurance contributions.
South Korea's healthcare journey began after the Korean War ended in 1953, when the country's medical infrastructure and healthcare system needed attention. The Minnesota Project was launched in 1955 and ran until 1961, familiarising South Korean health professionals with medical methodology and cultivating a new wave of health leaders. It also increased public knowledge of proper sanitation and organised hospitals. In December 1963, South Korea implemented its first health insurance law: the Medical Insurance Act, which allowed companies to provide voluntary health insurance to employees. In 1977, health insurance became mandatory, and in 1989, national health insurance (NHI) extended to the entire country, providing universal healthcare for all citizens.
The NHI covers almost the entire South Korean population, with funding coming from employee and employer contributions, supplemented by government subsidies. Healthcare in South Korea is delivered through a combination of public and private institutions. University hospitals and large private hospitals offer high-quality tertiary care, while community health centres and private clinics provide primary and secondary care. The country also has a high number of hospital beds per 1000 people, with 9.56 beds, which is over triple that of Sweden, Canada, the UK, or the US.
South Korea's healthcare system is often cited as an example of efficiency and accessibility, combining universal coverage with modern medical infrastructure. It has achieved high rankings in healthcare access and efficiency, with Bloomberg rating it as the second most efficient healthcare system. However, the system also faces challenges, including a rapidly ageing population that increases the demand for long-term care and geriatric services, and regional disparities, with medical services concentrated in large cities, leaving some rural areas underserved.
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Hospitals in Seoul
Seoul, South Korea, is home to some of the world's best hospitals and medical centres. The country's universal healthcare system means that expats get the same quality of care as citizens. The public health system provides care to citizens, expats, and visitors to the country.
As Seoul welcomes travellers from across the globe, its hospitals are accustomed to caring for foreign visitors. International hospitals in metropolitan areas are counted among the best in the world, and Seoul's hospitals are no exception. Many hospitals in the city have English-speaking staff or translators available.
The quality of healthcare in South Korea is high, and the availability, quality, and quantity of basic equipment are good. The introduction of new medical equipment into the healthcare market has been rapid, and the utilisation of high-tech medical equipment such as MRI, CT, and PET scanners is common.
South Korea's universal healthcare system is funded through government subsidies, outside contributions, and taxes on tobacco products. While hospital stays are not free, out-of-pocket expenses are affordable and usually far less than in countries like the United States, Germany, Austria, Canada, and Ireland. Foreigners and expats living in South Korea are required to sign up with the National Health Insurance Service (NHIS) program after residing in the country for six months. This allows them to choose their healthcare providers, clinics, and hospitals in Seoul and across the country.
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Pediatric care challenges
South Korea has a universal health insurance system, which has resulted in an enormous increase in the demand for health services. The number of hospital beds has increased over the years, with acute beds being oversupplied. This is in contrast to other developed countries, where the number of acute beds per capita has decreased.
However, the South Korean healthcare system is currently facing significant challenges. The COVID-19 pandemic led to a substantial reduction in weekly patient visits to pediatric emergency departments. The pandemic also exacerbated the issue of staff turnover in intensive care units, with the increased burden contributing to intensivists and fellows leaving their positions.
One of the main challenges facing pediatric care in South Korea is the management of pediatric facial lacerations. Recent healthcare policy changes have impacted specialized services, and pediatric facial trauma care now faces significant systemic and financial barriers, as well as workforce shortages. There is a need for reforms in reimbursement policies and structured training programs to address these issues.
Another challenge is the declining interest in pediatrics among medical students and interns. While students recognize the importance of pediatrics, their interest tends to decrease as they progress in their education due to increased awareness of the specialty's challenges. These include legal risks, psychological burdens, and worries related to declining pediatric populations and interactions with patient guardians. There is a need for targeted interventions to improve the attractiveness of pediatrics and ensure a sustainable pediatric workforce for the future.
Additionally, pediatric nurses in South Korea experience moral distress and high turnover rates due to frequent experiences with patient death and limited pediatric palliative resources and support. There is a need for improved support and resources to address these issues.
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High cancer survival rates
South Korea has achieved high cancer survival rates, despite a 56.5% increase in cancer incidence from 2001 to 2021. The 5-year cancer survival rate from 2017 to 2021 increased by 17.9% compared to the period from 2001 to 2005. This improvement is evident across various cancer types, with some cancers showing outstanding advancements.
One notable example is stomach cancer, which has demonstrated significant improvements in survival rates over the years. In addition, cancers of the prostate, breast, and thyroid have consistently exhibited high survival rates. For instance, in 2019, the 5-year survival rate for thyroid cancer was 95.0% for men, while breast cancer had a 5-year survival rate of 93.6% for women. Similarly, prostate cancer in men had a 5-year survival rate of 94.4%, according to statistics from 2019.
However, it is important to acknowledge that cancer survival rates are influenced by socioeconomic status. Studies indicate that cancer survival rates tend to decline with lower socioeconomic status, and this trend is observed in both South Korea and other countries. For instance, in the United States, the mortality rate for cervical cancer was twice as high among low-income individuals compared to high-income individuals. Nevertheless, South Korea's universal health insurance, implemented in 1989, has contributed to increased access to acute hospital beds, which may help mitigate some socioeconomic disparities in cancer care.
While most cancers in South Korea have shown an increase in incidence with age, thyroid cancer and breast cancer are exceptions. These two types of cancer demonstrated the highest incidence in the 30-40s and 40-50s age groups, respectively. Furthermore, South Korea has witnessed a recent surge in lung cancer cases, surpassing stomach cancer to become the most prevalent cancer type in the country in 2019.
In conclusion, South Korea has made significant strides in improving cancer survival rates, particularly for cancers like stomach, thyroid, prostate, and breast. However, addressing socioeconomic disparities and focusing on age groups with higher cancer incidence can further enhance cancer care and survival outcomes in the country.
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Public hospitals' profitability issues
South Korea has a government-led health service system and does not allow the establishment of for-profit hospitals. There are 33 local public hospitals in South Korea, 11 of which have been operating for over 100 years. However, the Jinju Medical Centre, a 103-year-old hospital, was closed down in 2013 due to low efficiency and financial strain on the local government. This sparked a debate about the value of public hospitals, with proponents of a selective welfare system arguing that inefficient public hospitals should be replaced by the market. On the other hand, supporters of a universal welfare system contended that public hospitals should be preserved even if they are not profitable, as their inefficiency is due to the public good they provide to the socially disadvantaged.
Public hospitals in South Korea face the challenge of balancing public service with profitability. They are tasked with fulfilling a public mission, such as providing medical safety nets for low-income individuals and managing financially unsustainable facilities, while also being expected to operate as independent, self-sustaining entities that compete in the market. This dual mandate creates a conflict between serving the public interest and achieving profitability. The decline in inpatient revenue at local public hospitals can be attributed to low reimbursement rates, charitable care for low-income individuals, and the provision of low-revenue-generating services like obstetrics, gynaecology, and paediatrics in underserved areas.
The South Korean government has been criticised for failing to address healthcare disparities between urban and rural areas. Rural residents experience a higher prevalence of ageing-related health issues and have less access to private medical facilities. Additionally, there is a perception among the public that the introduction of health insurance has altered the traditional role of healthcare providers, with some believing that the government or insurance companies have replaced these providers.
The country's universal health insurance system, implemented in 1989, has led to an increase in the number of hospital beds, particularly acute care beds. This has resulted in an oversupply of acute beds, contrasting the trend in other developed countries where the number of acute beds per capita has decreased. The average length of stay in acute beds has been rising in South Korea, which can be attributed to providers having incentives to prolong patient stays in a context of rising acute bed supply.
South Korea has a high number of hospital beds per capita, with 10 beds per 1000 people compared to the OECD average of 5. 94% of hospitals and 88% of beds are privately owned, with private universities running 30 out of 43 tertiary hospitals. The fee-for-service payment system encourages hospitals to expand rather than focus on community services, and there is no direct government subsidy for hospitals. This has contributed to an imbalance in healthcare utilisation, with patients favouring large general hospitals and tertiary institutions over primary and secondary local hospitals.
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