Thursday, January 07, 2010

Healthcare System in Korea?

Dear Korean,

I came across you blog from a reference to your "Fan Death is Real" post (which I LOVED btw, thanks for putting us expats in our place a little bit). I was wondering if you could explain how the Korean healthcare system works. It's amazing, efficient and dirt-cheap. I'm a Canadian, who avoids hospitals and clinics like the plague because back home you will sit and wait in an emergency room for 4 hours unless you are bleeding profusely from a major artery and have to wait at least 3 months to get an appointment with your doctor, never mind how long you have to wait for a specialist. Never mind how much everybody talks about how great our free health care system is. It is great believe me, to not have to give up your university career because you've been sidelined by appendicitis or a tonsillectomy. But it's completely backlogged, and all our nurses and doctors are overworked and medicine is ridiculously expensive. Since living in Korea, I've been amazed by the medical system here. Today I walked into an EMPTY throat specialist’s office with tonsillitis. Within 15 minutes I was out the door with a prescription in hand for less than 3500 won [= $3.50] and on top of that my medication cost all of 3200 won [= $3.20]! How? How does that happen? How does all the medical equipment, office space, staff and doctors salaries get paid for and still charge so little to the patient? Same goes for pharmacies. In Canada and America, it insanely expensive to get medication. How do the Koreans do it???

Lisa
Suncheon, Jeollanamdo, South Korea


Dear Lisa,

Very smart question strategy – you praise a post near and dear to the Korean’s heart (i.e. the reality of Fan Death) and then ask a current events topic. That’s the way to jump the line at AAK!

First, a caveat: the Korean has not been following the details of America’s healthcare debate at all, so he does not have a solid grasp of how the proposed Obamacare is supposed to work out.

Sorry Mr. President, the Korean just doesn't care.

Part of the reason why the Korean did not follow the debate was because the entire thing was so moronic: to the Korean, it is obvious that a country should guarantee its citizens a health insurance, and the cheapest way to achieve that is a single-payer system like Korea’s. Scores of advanced and semi-advanced countries in the world manage to do this without turning their country into Russia. (Unless, of course, if their country is Russia.) There is no point in watching a debate where the other side is arguing the sky isn’t blue.

Another caveat is that the Korean does not know much about how precisely European/Canadian healthcare systems work either, other than some broad-stroke knowledge. (Here is a tip for aspiring writers – write only about what you know. That way, you end up looking like you know everything.) So while the Korean knows that Korea’s healthcare system basically has the same structure as Canada’s, he can’t really talk about which details in Korea’s healthcare system that makes it stand out. All he knows is what he already knew plus some research.

At any rate, Korea’s healthcare system is absolutely beautiful. Basically, everyone is covered for everything (with some amount of deductible) as long as the procedure is not elective. As Lisa noted, the wait time is short and everything is dirt-cheap. It has been this way since 1989. The Korean works in the U.S. for a large company that provides top-rated health insurance, and it still sucks compared to the national health insurance in Korea. “Best healthcare in the world” his ass – what kind of best healthcare in the world makes the patient, half dead from crippling coughs and chills, call ahead to make sure that the doctor’s office nearest from the patient takes his health insurance? Stupid, just stupid.

Structure of Healthcare System in Korea

In Korea, doctor’s offices and hospitals are privately owned, except a small number of community hospitals. There is a national health insurance, funded by nationally levied tax, in which everyone must enroll. Private health insurance exists to cover expenses that the national health insurance does not cover.

The centerpiece of this structure is the national health insurance, governed by National Health Insurance Act. As the Korean mentioned earlier, every Korean citizen living in Korea (and a few others) are automatically enrolled in the health insurance. The only exception is those who receive “medical protection,” which is an out-and-out welfare system – essentially, everything is paid for and there is no premium. This is reserved for the extremely poor, refugees, children of independence fighters and other significant contributors to Korea, possessors of important intangible cultural products (e.g. artisans of very rare traditional ceramics,) and so on.

Everyone who is enrolled in the insurance must pay a premium. There are two avenues through which payments are made. Those who have a job pay half of the premium deducted out of their paycheck, and the employing company pays the other half. Those who do not have a job pay their premium directly to the death panel National Health Insurance Corporation, a government-owned corporation that administers the insurance. The two types of premium are roughly the same in amount, but not identical. The amount of the premium is determined like tax -- the more you earn, the more you pay. In 2009, on average, each family in Korea paid around $8,000 a year for the premium.

The NHIC is run by a number of committees, whose members usually are representatives of the medical community, taxpayers, the government, etc. For example, the board of directors that governs the entire corporation has 18 members, which is broken down as follows: the chairman is appointed by the president based on the recommendation from the Minister of Health, Welfare and Family; the chairman in turn appoints five members; heads of related governmental agencies take up four positions; unions, employer associations, consumer organizations, fishing/agricultural associations can each appoint two.

Under this leadership, the biggest function of the NHIC is to set the cost of every single medical procedure that the law covers. This is a big range, since the law requires coverage of all medical procedures except electives and certain other expenses, such as an upgrade to a nicer hospital room or food. Significantly, this covers medicine – which makes prescription medicine extremely cheap. [Updated with commenter Brett's point:] NHIC insurance also covers traditional medicine (herbal remedies, acupuncture, etc.) and other semi-medical practitioners, like chiropractors.

The Korean had pneumonia when he was a kid, and spent about a month in one of these rooms.

So this is how the whole machinery works, in a very simplified form. A patient visits a doctor. After diagnosis, the patient pays a small amount of deductible – usually a small percentage of the cost set by NHIC (which varies from the type of treatment and the type of doctors one visits) – to obtain a prescription. The patient takes the prescription to a pharmacy, where again she pays a small amount of deductible to get her medicine. Then the doctor and the pharmacist claim the full cost (which is pre-set by NHIC) of the visit to the NHIC. The NHIC pays the doctor and the pharmacist, out of the premium that every Korean has paid.

Although the national health insurance covers a lot, private health insurance companies still exist in Korea. Even with the national health insurance coverage, certain disease or chronic conditions – for example, cancer – can still be very costly for middle class Koreans, because the treatments for those diseases include many options that are considered elective, and the treatments tend to get drawn out while rendering the patients unable to work. Therefore, many Koreans also join a private health insurance that covers what the national health insurance does not cover, such as deductibles (which can get high, since it’s a percentage of the NHIC-set cost rather than an absolute amount,) lost wages, etc.

The Good

The benefits of this system are obvious. First, everyone gets affordable healthcare. This is huge, and cannot be stated with enough emphasis -- in Korea, everyone can visit just about any doctor for anything for less than $5 [fixed because of overstatement] relatively small amount of money. Koreans very frequently visit the doctor's office for any common cold. Often, this leads to early detection/treatment of a more serious illness.

Also, Korean patients almost never have to deal with any bureaucracy, since main exchange of paperwork happens between the doctor and the NHIC. As long as the patients can pay the deductibles, they can visit any doctor in Korea. Given that nearly every corner in the country can be traveled under three hours on a high-speed train, it is very easy to visit the best doctor in the country (who would likely be in Seoul) if anyone wants to.

On top of that, the whole system is really cheap. No one likes taxes, and Koreans grumble on the national health insurance fee as much as anyone. But Koreans on the whole spend about 6.3 percent of its GDP on healthcare, which is lower than Europe/Canada (which is around 10 percent) and a lot lower than America (which spends appalling 15 percent.) The low cost is partly achieved by having a single-payer system, which significantly lowers the administrative cost.

The Bad

But there is no such thing as free lunch. If the system is cheap, it means that it is squeezing savings from someone or something. Then where are the savings coming from (other than the single-payer administrative cost)?

First, the coverage under the Korean national health insurance is not as good as the European countries, especially when it comes to more expensive diseases. Given that Koreans generally pay less for premium compared Europeans/Canadians, NHIC tends to be more conservative on what type of procedure counts as covered. This is not a big deal with primary care where a procedure for common cold, for example, is straightforward. But this could pose a problem when it comes to a chronic condition or a complex disease like cancer where there are many extra tests, etc. that the national health insurance does not cover. (Which this makes cancer insurance a good idea for many Koreans.) It also does not help that these diseases/conditions drag on for years.

The end result is that while European/Canadian national health insurance pays up to 90 percent of the total medical cost, Korea’s national health insurance ends up paying around 55 percent of the total cost. While Korea does not have too many cases of a middle class family receiving treatment all the way to bankruptcy as happens in America, there are definitely cases where lower-middle class families do not invest in a private health insurance and later get bowled over by cancer treatment expenses. (Which is a popular recurring theme in Korean dramas.)

Second, doctors just don’t earn a whole lot of money. Korean doctors are well-off compared to the rest of the society, but they earn about half of European and Japanese doctors, and about a quarter of American doctors in PPP-controlled income. This is because even if you are the best doctor in the country, you still have to charge the NHIC-set price – and the NHIC price, compared to the rest of the developed world, is pretty low. There is some differentiation in the NHIC price that factors in the doctor’s expertise, the hospital’s facilities, etc., but that difference is not big. For each of the same medical procedure, Korean doctors can only charge one-eighth of what American doctors charge or one quarter of what European/Japanese doctors charge.

Doctors and pharmacists have some influence over the NHIC price through their representatives on the NHIC committees, and they actively lobby every year to raise the price. But they cannot be too vigorous in asking for a raise, since it does not look good for them in the eyes of the public given that they are still in a relatively high-earning profession.

This has real effects on healthcare. Think about it from the doctor’s perspective – if the price is fixed, how can they earn money? Broadly, there are three ways: (1) see more patients; (2) perform treatments that have a higher NHIC price or are not covered by NHIC; (3) find another way to get paid.

Pity us, we got a family to feed. 

Because Korean doctors are incentivized to see more patients, they often cram in as many patients as they can, in a practice derisively called “five-minute diagnosis.” As of 2005, each Korean doctor sees three to four times more outpatients than doctors in other OECD countries. Many Korean patients complain about this practice, as they do not feel adequately cared for.

Korean doctors are also incentivized to over-treat a patient or recommend more expensive treatment. For example, Korea is the world leader in caesarian delivery – a whopping 43 percent of all births – partly because doctors are more likely to recommend a c-section, which has the higher NHIC price. Korea also has more hospital beds, CT scanners and MRI machines than OECD average, partly because hospital stay and advanced scanning has the higher NHIC price. Koreans have longer hospital stays than the OECD average, for the same reason. One can argue under this system, patients who do not require extended hospital stay are wasting resources. Also, to avoid the grip of the NHIC price, top medical students often adopt a specialty that the NHIC generally does not cover, like plastic surgery or dermatology.

Doctors also look for other ways to get paid under this system, and the most common way is to receive kickbacks from pharmaceutical companies for prescribing their medicine. This practice sometimes leads to a pattern of over-prescription that has a direct consequence on the national health. For example, Korean patients are notorious for having high immunity against antibiotics, because very strong antibiotics are over-prescribed partly due to doctors’ profit motives. It is also somewhat common for doctors to form an alliance with certain neighborhood pharmacies and receive some amount of fee for referring to patients there to pick up their prescription, which can be considered an unfair business practice.

Lastly, because the patients can visit any doctor in the country, they often opt to visit the best doctor in the country for any petty ailment. So the best hospitals in Korea – like Seoul National University Hospital, Yonsei Severance Hospital, National Cancer Center, etc. – often have a significant waiting time not unlike the horror stories one hears about other socialized medicine countries.

Seoul National University Hospital, arguably the best hospital in Korea.

The Good, Again

While Korean healthcare system is far from perfect, the Korean thinks that its benefits easily outweigh the cost. This is especially so because even some of its perceived costs are, in fact, benefits when the national health is considered as a whole.

First, the complaint of “five minute diagnosis” is hardly a real, dire problem. By incentivizing doctors to see many patients at a primary care level, Korean health insurance is most likely preventing a more serious and more expensive disease down the road. Indeed, a “five minute diagnosis” that costs around $ 3 is a problem that 45 million uninsured people in America will gladly take. Same with the “crowded top hospitals” problem – the uninsured of America will gladly take a cheap visit to the nation’s finest hospitals even if the wait takes a few months.

Korea’s other problems are no worse than any other country’s. In fact, because there is a single entity in charge of overseeing the entire healthcare system, it is much easier for Korea to provide a systematic solution for a systematic problem.

Some may consider the fact that Korean national health insurance only covers around 55 percent of the total healthcare cost to be problematic. This may be true if one takes the idea of guaranteed socialized medicine seriously. But for fiscal conservatives with some measure of compassion for the plight of the uninsured, this could be an attractive balance. While corruption is definitely still a problem with Korean government, the NHIC is surprisingly efficient and well-run. It does a great job squeezing out maximum value out of the tax it receives. What’s not to like?

Got a question or a comment for the Korean? Email away at askakorean@hotmail.com.

-EDIT 1/11/2010- Two articles that show the limitations of Korea's healthcare system. First, a report that automobile accidents in Korea are a cause of poverty, partly because of the healthcare cost among other things. Second, Korea's intensive care unit rates very poorly even compared to countries like Indonesia or Malaysia.

75 comments:

  1. If the system is cheap, it means that it is squeezing savings from someone or something.

    Yes and no. Sometimes the question to ask is not why something is cheap but why something else is expensive. Among the reasons that US health care takes up such a huge portion of GDP is the inefficient bureaucracy you mentioned, vis-à-vis Korea and some other countries, as well as the way the per-visit deductible works to keep people out of hospitals unless they feel a need. Imagine if Korean medical care were free, then you'd get some people going in for just about anything, and the demand would cause prices to increase. (This is one reason so-called "Cadillac plans" and gap-covering secondary insurance plans cause price increases for those who don't have them.)

    Korea's system is good, but not perfect. In fact, with its heavy emphasis on private doctors and hospitals, it would have been a good model for Republicans to look at if they were truly serious about insuring everyone.

    Anyway, nice post. Very well researched. Kudos.

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  2. One other nice thing that I have found about the Korean Health Care system is that it also covers things like Traditional medicines, chiropractors etc.

    That is something that in Australia you must have a private insurance for.

    Personally I have had only good experiences with doctors in Korea so far.

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  3. in Korea, everyone can visit just about any doctor for anything for less than $5.

    This has absolutely not been my experience in Korea, especially since I have a young child. When I take my son to the hospital, I have to pay before I see the doctor. The visit usually costs 16,000 won, plus some change (not much less than the cost of my deductible under private insurance in the USA). I wait at least a half hour to see my pediatrician usually. Before I am even through talking to her, the next customers are rushed in. On the plus side, prescription drugs are fairly cheap - I usually pay less than 5,000 won for antibiotics together with other medications when my son is ill. He has been ill a lot lately, unfortunately.

    Not all international clinics and OBGYNs take NHIC, either. There are a number of practitioners who are popular amongst expats for prenatal care and delivery who are also quite expensive. Korean doctors also like to perform frequent ultrasounds, and the costs add up.

    Also, a number of standard, routine vaccinations in the USA are elective in Korea and are also quite costly. You can get free compulsory vaccinations at district community health centers in Korea, but the facilities and tools are not very technologically up-to-date as they are in hospitals, where even compulsory vaccinations are charged for.

    This year I got a bad flu and the Tamiflu plus appointment fees for myself and my son set me back over 100,000 won.

    When I was in the United States, I got free ultrasounds during my pregnancy, and my son's well-child visits and vaccinations were deductible-free. My birth cost me a mere $200 deductible, and if I would have given birth at a different hospital, it would have been deductible-free, also. The monthly premium for my family about $200 - chump change compared to what I saved on the $10,000 birth of my son. It may sound weird to some, but I miss my health care that I had back in the USA - I wish everyone could have the insurance I had. It was an amazing deal.

    I think my favorite thing about health care in Korea is that, even without insurance, it is still very cheap. I took my son to the hospital when we first arrived in Korea and I only paid probably 20~25,000 won for a doctor visit and a little less than that for a prescription. Now that he is covered, it's only a little bit cheaper!

    My main discovery: when you have a toddler, it's easy to drop quite a bit of cash on doctor visits because they get sick all the time. We have been in Korea 5.5 months now, and I would say I have easily spent 400~500,000 won on doctor visits and prescription medication for my family, and we are all covered under NHIC. While that still might be less than the premium + deductible I used to pay, it's still a lot more than $5per visit.

    That said, I still think I have had quite a positive experience with Korean health care, despite the unexpected cost.

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  4. Kushibo's point is a good one...

    For two reasons off of the top of my head...

    1) Less bureaucracy to pay for in Korean hospitals and certainly way less paperwork

    2) Less ability for price-gouging because the prices are set (now, price-setting can obviously be a bad thing when it leads to inneficiencies, but I haven't really seen that yet)

    Lolimahro may well be right, but if you are going to International Clinics, you are going because you require a different level of care (even if that is as simple as English speakers) so you will pay more. As TK noted, specialized demands do require specialized payment. For sure, I also miss the health care I had back in the States. Because I was in PERS I was covered for virtually anything and everything, and particularly well for catastrophic events and prescriptions ;-) - but some of my friends were covered for nothing. It's a bit of a trade off.

    Finally, to be completely anecdotal, when my lovely fiancee first came to Korea she fell and dislocated and broke her elbow. This was *before* she had insurance. I was paralyzed with fear.

    Total - under 500,000 won, in and out with relocation, x-rays and cast, as well as the check up two weeks later.

    My deductible in the US would probably have been for more than that. ;-)

    At my age I suppose I need to look into supplemental insurance for cancer, long-term heart trouble, etc.. but the basic insurance here is, to me, a triumph of Korean "socialized" (in the Confucian sense) government.

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  5. Thanks for following up so quickly on this Korean! Like you said, there are plusses and minuses to the system, but I would say that the GOOD definitely outweighs the BAD. Since all the small stuff gets treated quickly and effectiently, it doesn't back things up and make it tougher on people who do need more care/treatment for serious illnesses. I don't pay anything when I go to a hospital in Canada, but I would DEFINITELY pay $5 (or heck, even $25 *gasp*) to see a doctor quickly when I've got a flu or busted ankle, rather than wait for hours in an emergency room. Many, MANY people in Canada simply never go to see a doctor unless they are seriously ill. This leads to quite a culture clash in Korea. Many EFL teachers get confused or annoyed when they're co-teacher suggest "You should go to the hospital" for a common cold. But if you could get it checked and get a perscription for your symptoms so easily (and inexpensively) why wouldn't you? And you make a good point - because of this, more serious illnesses are caught early on.

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    1. Totally Agreed. As a Korean-born Univ student now living in N.S. I would not attempt to compare Canadian Medicare system with Korean healthcare and other conditions such as doctors' availability. You pointed out well Annalisa. Although Korean National Healthcare covers 55% (I newly learned in this thread), it makes doctors and specialists (Koreans just call "doctors", because they can walk-in to see specialists: how awesome!) more driven to compete each other, and this as a whole makes an environment for better and more skilful doctors. I have two friends, who are native Canadians, do not go (cannot go) to see doctors yet because waiting list is too long. I feel very very sad when I hear them say they are still waiting.

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    2. I also knew several very bright, highly ambitious and motivated Korean medical professionals who left Korea to go to Canada or the USA for the better pay so there's a bit of a brain drain inherent in the Korean system compared to the US system. Their loss is North America's gain.

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    3. For Canada I think it depends on where you live. I've lived in three provinces: Manitoba, Alberta, and British Columbia, which is where I currently reside. I have never had an issue with seeing a specialist almost immediately for a serious problem.

      In Canada health care is provincial jurisdiction. In BC the province is divided into health regions of which each gets a budget. BC charges a monthly fee for for those earning over $22K, and is scaled according to what one earns. The maximum fee is lass than $130 per month, which is often paid by the one's employer. It is nevertheless a taxable benefit. Some employers also offer additional health and dental insurance and for this one can sometimes choose the level of coverage they desire: the more benefits one wants, the more one pays. The more expensive plans have smaller co-pays, so one ends up spending more on the premium but less on the co-pay. BC also has a "Fair Pharmacare" system, which, after spending a certain amount (determined by income) on medications, will cover the full cost of medications.

      As to long waits at hospitals, or lack of doctors, it's a case of how much the provincial government contributes to health care. Alberta, being a richer province with its oil, pays its doctors more, and as a result doctors will move there before going to a lesser paying province. To avoid the long emergency room waits one can also go to a walk-in clinic, but for more serious illnesses the doctor may dispatch one to the emergency room anyway. A bad dose of tonsillitis, for example, might just need a prescription, and that can be handled by the walk-in clinic.

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  6. I should have clarified that when I spoke of OBGYNs and and pregnancy-related care in Korea, it's true that foreigners generally use International clinics and actively seek out doctors that favor natural childbirth, have low c-section rates, and also look for midwives and doctors who are available for homebirths. These would definitely fall under specialized care.

    However, when I go to the hospital or take my son to see his doctor, I go to the regular hospital in my neighborhood (it doesn't have an international clinic) and I make my appointments in Korean. My son's pediatrician speaks English but generally I make the appointments myself filling out the forms and using the ATM machines in Korean. My son's pediatrician works in the general pediatrics department and is seen by Koreans and non-Koreans alike.

    My Korean language abilities are pretty bad for the amount of time I studied Korean in college, but with the amount of times I've been to my local hospital (lol) I've got the appointment system pretty much down. That said, perhaps I am still getting charged extra fees of which I am unaware. I sure hope not. Perhaps I should ask my doctor at my next appointment.

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  7. Responding to Lolimahro, I would agree with his/her critiques of what The Korean wrote. Visits are not $5, but closer to $12 or $15. That is actually part of the point of how they keep prices low: they discourage frivolous use by making each visit costly enough for people to not waltz in there any time but also not at all prohibitively expensive.

    Right now I live in Hawaii, which is rare in that it has mandated "universal" coverage (which covers only 97%, incidentally), and I have to pay about $10 per visit as a deductible.

    Most routine things are covered, but if you end up going for a major illness, like cancer, even the deductibles can add up (and care possibly run out?), which is the reason for supplemental insurance for targeted illnesses like cancer, heart disease, etc.

    ---

    As for the international clinics, it is my opinion that their refusal to accept NHIC insurance is illegal. But I want to note that this is by no means all of them that do that; in fact, it might be few of them. The first time I went to Samsung Med Center, I went to the International Clinic because I thought it would be easier to have someone translate for me than doing it myself. When they said they don't take NHIC, I walked to the main part of the clinic, where I saw the same doctors I would have seen if someone from the int'l clinic had walked me through.

    Hyundai's Asan does accept NHIC, as does Yonsei Severance (where I got my appendix taken out).

    Since I'm in a public health field, and there's an increasing likelihood I'll be dealing, at least partly, with international residents' health care issues in Korea, this is something I want to see dealt with. To me, it's discriminatory and possibly illegal for Samsung Med Center to do (or have done?) that.

    Yes, this is one of those rare cases where you'll see me saying that some Korean institution is being discriminatory by not providing adequate language services in health care in order to give the same level of service (including acceptance of NHIC) that a Korean speaker would get.

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  8. Great post.
    I am always shocked at how many Americans believe that their health care system is the best in the world (when it actually ranks 37th).

    Tragically, I will admit that I am biased on this issue though.
    My Mum's friend from University a few years ago got cancer. Now, this would have been fine except from several years before she'd had a Baby. The Baby was on life support for six months before it died. The cost of their health insurance sky rocked. They weren't exactually poor but they couldn't afford it.
    When she eventually went to the doctor after feeling unwell she was
    diagnosed with cancer. She died shortly afterward.
    Now some people may say that is an extremely rare example (I would disagree) the fact was that it happened. Not through a mistake in the system but exactually as the system was meant to work. And she died. How is that morally right? Please try and explain that to me?

    Me, on the other hand, is a recipient of the fantastic UK NHS (the reason why Northern Ireland never joined Ireland, if you really want to go into history). As I normally detest my country this is quite a rare occurrence to find something I actually like about it. The NHS remains in the view of most people here the countries greatest achievement.
    I happen to use the NHS a lot actually (the Hospital is practically our second home) being a member of the family with possibly the worst health in the Universe.
    My Mum has had cancer twice (which means none of the American insurance companies will insure her, We've tried, which sucks because I've been trying to get her to move to the US for ages). She has received excellent care through out the original surgery and the follow up surgery.
    The NHS has (unfortunately) saved my Dad's life. He has a rare blood disease and is on countless (expensive) drugs. I highly doubt insurance companies would want him.
    I am partly deaf. This means I use hearing aids. I get new one whenever there's an upgrade. Also my personal 'coping with hearing aids' person tells me that I can claim up to £3000 ($6000) per a year of specialized equipment to help me when I start work. If you didn't know hearing aids cost several thousands of dollars (money I'm afraid I just don't have lying around). But even better I get to pick what colour they are!
    Now all this I get for free. Why? Because the health system gets it cheaper. In America the drug companies set the prices but in the UK (and every other developed country on the 'axis of evil 'socialized' health care' - all of them actually, oh actually sorry, apart from America) the (absolutely useless stupid illegal) government does. That is part of the reason (I suspect) why prices are so expensive in America.

    http://swampland.blogs.time.com/2009/11/02/how-much-does-health-care-cost/

    If you just set the prices half the problem would be solved.

    Sorry if turned out too long but I just needed to rant for a bit. I wanted to show that scary evil 'socialized' medicine isn't so bad. I would much rather be with my 'socialized' 17th best health care in the world then America's 37th.
    Although this fact makes it very difficult to move to America where my Family lives (curse you Mum for moving to the UK, why couldn't I be American?) to look after my Grandparents.

    About Korea's health care system: I heard many reports that it is excellent but why does it come 58th in the world then? I read somewhere that because the military budget has to be so large that it lacks more investment or something. Probably wrong or something.

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  9. Lo que escribe en su blog es interesante, salud pèublica en Corea, en realdiad me interesa todo lo que tenga que ver con pais Corea.
    Seguire leyendo tu blog.

    Gracias por compartir.

    Chio.

    Saludos de Perú

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  10. 1 France
    2 Italy
    3 San Marino
    4 Andorra
    5 Malta
    6 Singapore
    7 Spain
    8 Oman
    9 Austria
    10 Japan
    11 Norway
    12 Portugal
    13 Monaco
    14 Greece
    15 Iceland
    16 Luxembourg
    17 Netherlands
    18 United Kingdom
    19 Ireland
    20 Switzerland
    21 Belgium
    22 Colombia
    23 Sweden
    24 Cyprus
    25 Germany
    26 Saudi Arabia
    27 United Arab Emirates
    28 Israel
    29 Morocco
    30 Canada
    31 Finland
    32 Australia
    33 Chile
    34 Denmark
    35 Dominica
    36 Costa Rica
    37 United States of America
    38 Slovenia
    39 Cuba
    40 Brunei
    41 New Zealand
    42 Bahrain
    43 Croatia
    44 Qatar
    45 Kuwait
    46 Barbados
    47 Thailand
    48 Czech Republic
    49 Malaysia
    50 Poland
    51 Dominican Republic
    52 Tunisia
    53 Jamaica
    54 Venezuela
    55 Albania
    56 Seychelles
    57 Paraguay
    58 South Korea

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  11. Skeptico, source?

    South Korea's wouldn't likely measure in the top ten or possibly even the top twenty because it's not free. It costs money, but the fact that it costs money is one reason individual procedures stay so relatively cheap and health care's share of GDP stays so relatively small.

    There's no such thing as a kongtcha chŏmshim.

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  12. One interesting thing about the Korean health system, to me, is the proliferation of small private clinics. They're everywhere, even in small cities. I haven't researched this, but I would bet there are many more of them per capita than in the US.

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  13. That would be an interesting thing to look into, Nathan. I hold out the possibility, however, that while there is probably a greater geographic concentration of clinics in South Korea, that wouldn't necessarily translate into a population-based concentration.

    Like all the bad stuff, the good stuff also seems like it's more simply because of the far greater concentration of people in almost any given city.

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  14. In my area the poor and illegal aliens gets free health care. Unfortunately the hospital is closing now because it is not receiving enough revenue. The low end middle class are the real victims of not having health care.

    In my opinion, government regulation caused the health care to be expensive. According to CNN today, insurance companies only make about 6% profit. Health Insurance companies are not allowed to sell across state lines and government regulations caused so much paper work. My doctor will not accept insurance in 2010 because it cost too much to process the insurance claims. I would like to see insurance companies sell across state lines

    I see both sides of the health insurance debate. My brother has a small business and the insurance premiums are so high that his employees are on their spouses plan from a different company. I do not want to see my health insurance weaken because of a bad implementation of the national plan. The US has the best care in world as long as you can pay the bill. If that is not true, why do so many people from other countries come to the USA for treatment from a specialist? I guess the specialist left countries like Canada because of the low payment for services. Our health care has a bad rating because it does not cover everyone.

    My Senator supports a national health care plan and he is a republican. He agrees with me that there should be a health care “Bill of Rights” where you will not be turn down because of pre-existing condition, you will not be turn down because of age, and the doctor has the final say about your treatment.

    I see both parties failing on how to pay for the heath care. For starters all government officials including Senators and the President should be on the same national health care insurance plan. Also if you elect to be on the national system, your company should pay for their part as they would on the private health insurance plan. For example my health care cost about $3,000 a year. The company pays about $2,000 and I pay about $1,000 per year. So if I decide to be on the national health insurance plan, my company would pay $2,000 on my part to the national plan.

    If the national health insurance plan is implemented, there would be no need for Medicare and VA hospitals. The government should get a cost per person on what it takes to cover everyone on the national plan. Once the government gets the national cost per person, it would allow the insurance companies to sell private insurance at the rate of the national cost per person. It does not make sense for one company’s employees to pay more or less on health insurance than another company’s employees.

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  15. Tennessee tried to give public health care to the poor through TennCare. The TennCare program nearly bankrupted the state. A lot of doctors in Tennessee are not accepting TennCare, because it takes over a year to pay and does not pay enough for some services. I believe the public plan may work, but I am very skeptical because of the failure of TennCare in Tennessee.

    TennCare cost Tennessee 2.7 billion in 1994. If every state had the same cost as Tennessee, the public health care plan would cost more than 135 billion a year to cover less than 25%. 37% of Tenncare costs were Administrative costs. I do not understand why TennCare paid Congressman Ford 10 million dollars to do a feasibility study. Paying our elected officials money to do studies is why the administrative costs are high.

    http://wizbangblog.com/content/2009/...s-tenncare.php

    http://cnsnews.com/Public/content/ar...x?RsrcID=51238

    http://nashville.bizjournals.com/nas...ditorial1.html

    http://www.state.tn.us/tenncare/

    http://en.wikipedia.org/wiki/TennCare

    http://www.realclearpolitics.com/art...orm_97570.html

    http://healthecon.memphis.edu/Docume...line_Chang.pdf

    http://www.outsidethebeltway.com/arc...what_happened/

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  16. ZtraderX,

    The Korean appreciates your comments, but please keep them on topic. (The Korean thinks your first comment tiptoed the line of being on topic, and the second comment stepped over.)

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  17. Having said that...

    Brett, the post is updated with your point. Thank you for that.

    Lolimahro, the sentence you pointed out WAS an overstatement. It is now fixed. Thanks.

    Amy B., you need to keep it on topic as well.

    Skeptico, a link would be much appreciated. But the Korean thinks it's fair to say any list that puts Morocco ahead of Korea -- except perhaps for the number of camels per capita -- is somewhat suspect.

    Nathan S., the Korean does not know about the number of small clinics, but Korea actually has less number of doctors per capita than the U.S. -- Korea has 1.6 per 1000 people, U.S. has 2.4 per 1000 people. This is mentioned in one of the sources the Korean linked.

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  18. My MD friends all graduated from med school with huge debts that they struggled for years to pay off, even with the relatively high income of US doctors. This has made them especially wary of any program that looks like it would reduce doctors' incomes. What about med school in Korea? Is it subsidised or do Korean MDs face a similar problem when they graduate?

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  19. I am sorry, I was bad. Cost and corruption was mentioned in the article. So I was just trying to show the administration cost and corruption of universal care for the poor in Tennessee. I posted the cost in Tennessee because I was hoping that someone would post costs for South Korea. I really cannot see the cost when it is stated as a percentage of GDP or 55% of total healthcare.

    Could cost be low in South Korea because the Doctors do not get sued for every stupid thing like in the US?

    Did I read this correctly from the article? “In 2009, each family in Korea paid around $8,000 a year for the premium.” Is that US currency! If so, not many people in the US will pay for health insurance.

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  20. If you consider the World Health Organization suspect...then yes.

    http://www.photius.com/rankings/healthranks.html

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  21. I'd like to mention that the high rate of C-sections has much to do with many Koreans wanting to have their children born at a certain date/time. Usually this is because elders in a family will go to a fortuneteller type person who will give them a time/date that corresponds with a good future (I think the Korean covered superstition and fortunetelling some time ago), and then in order for the child to be born into that future the child must be born within that timeslot, which obviously is hard to control with natural childbirth and so a C-section is performed.

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  22. "Imagine if Korean medical care were free, then you'd get some people going in for just about anything" / "they discourage frivolous use by making each visit costly enough for people to not waltz in there any time but also not at all prohibitively expensive."

    You've got to be kidding. They DO go in for just about anything and the Korean system is BUILT on frivolous use, and the low costs are a big part of that. Korean mothers are notorious for dragging their kids to the hospital or the local clinic for every little scratch, cough, or runny nose.

    The 5-minute diagnosis exists partly because of the incentive for doctors to cram as many patients as possible into every day, but also because the overly paranoid public does their part by going to the doctor for common colds, flu, headaches, and all kinds of other crap that usually requires no medical attention at all.

    Have you ever talked to a Korean doctor? I had several friends that were doctors in Korea and they saw 250-300 patients per day, and they freely admitted actively soliciting unnecessary follow-ups and scaring Korean mothers to keep them coming back regularly.

    Anyone with a Korean mother (or mother-in-law) can attest to this.

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  23. Skeptico wrote:
    You've got to be kidding. They DO go in for just about anything and the Korean system is BUILT on frivolous use, and the low costs are a big part of that. Korean mothers are notorious for dragging their kids to the hospital or the local clinic for every little scratch, cough, or runny nose.

    Indeed. And imagine how often they'd go if it were free.

    There is a tendency toward overuse by a certain segment of the population (counterbalanced by another segment that is deathly afraid of doctors and clinics), but they are tempered somewhat by the 12K won (or so) per visit cost.

    There are people like my mŏn halmŏni who, turned the neighborhood clinic and pharmacy into a social gathering place. If she were able, she'd get medical treatment every day in order to justify her multiple visits every week. She'd be using up medical resources that she didn't need. The modest charge puts the brakes on that kind of thing without discouraging those in real need of services.

    It's not a perfect system, and it's a sound use of the economic function of deductibles.

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  24. I hate to be the one to break it to you kushibo, but there is no such thing as "free" health care anywhere in the world.

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  25. 지수, if natural child birth cost 2-3X as much as c-sections do, you would see Korea with one of the highest rates of natural child birth in the world, no question.

    http://joongangdaily.joins.com/article/view.asp?aid=2049603

    http://joongangdaily.joins.com/article/view.asp?aid=1905862

    http://english.chosun.com/site/data/html_dir/2002/07/09/2002070961037.html

    http://english.chosun.com/site/data/html_dir/2000/07/07/2000070761420.html

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  26. Last two links got cut off.

    Just for clarification, my view on the Korean system is that yes, it's inexpensive and works reasonably well for all kinds of basic care for a large majority of the population.

    But you get what you pay for. Go for a hospital stay of more than a night at any average hospital, and you'll realize that the facilities, rooms, and standard of care are well below what you'll find in most western countries. You'll always share rooms with 2+ other people, and the nurses quite frankly don't do shit outside of essential medical care. Family memebers are expected to do most of the cleaning, hygiene, feeding, bedpan duty, and other stuff of that nature.

    In order to get care that cheap, corners are cut everywhere.

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  27. "One other nice thing that I have found about the Korean Health Care system is that it also covers things like Traditional medicines, chiropractors etc."

    @Brett
    Could you clarify what "traditional medicines" you're talking about? You may be right about chiropractors and even physical therapy, but I saw a doctor Kyung Hee University believing the same thing and was pretty shocked to find out my completely natural "prescriptions" were going to be well over 200,000 won!

    I even asked the doctor if there was something less expensive he could suggest to which he replied, "You don't have a credit card?" (Dude was a bit of a prick anyhow.) The nurse told me that Korean folks are often surprised at the price of traditional medicines and when I recounted the story to a Korean coworker, she said the price sounded about right. She said the traditional stuff's not covered and it's pricey.

    On the other hand, the doctor's visit itself wasn't any more than 15,000.

    As Lolimahro pointed out, some basic OB/GYN isn't completely covered (paid about 100,000 for an annual) and the last place I went also rolled out a crazy price list for STD testing. I'm thinking, wait, so people actually pay $200 plus to get basic STD tests done? Or do they? (I'm thinking they don't.)

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  28. Skeptico. I followed your link and I saw this up towards the top.

    The World Health Organization's ranking of the world's health systems was last produced in 2000, and the WHO no longer produces such a ranking table, because of the complexity of the task

    Do you have something more current?

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  29. I found this interesting.

    http://blogs.wsj.com/numbersguy/the-trouble-with-ranking-national-health-care-systems-819/

    The points made in the second paragraph hits the nail right on the head.

    Hey Korean, do you know how South korea handles medical malpractice claims? I ask because I read that South Korea wants to have medical tourism.

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  31. Nice article question. I learned in my statistics class that statistics are meaningless unless you know how the numbers were derived. I learned how to tell a story with numbers.

    I always wonder about the data behind the WHO’s health system ranking. The two links below kind of explains the numbers.

    Question; I think medical tourism is already happening. My mom and her friends went to South Korea to get dental work and other stuff done.

    http://smartgirlnation.com/2009/06/popular-ranking-unfairly-misrepresents-the-us-health-care-system/

    http://www.who.int/whr/2000/media_centre/press_release/en/index.html

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  34. Skeptico,
    I'm sure the cost has a lot to do with the high rate of C-sections, but I still do believe that the want for a certain birthdate/time is also a factor. I work at a university hospital in Korea and I see this happening a lot. I'd like to add that a university hospital is different from private practices in that doctors' pay is not directly influenced by the amount of money an indivisual doctor generates like in a private practice setting - therefore doctors are less inclined to perform C-sections for the money alone. At the end of the day the doctor would be paid the same amount whether he/she delivered babies naturally or through C-sections.

    (Excuse my cancelling and re-posting, please.)

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  35. question, the text you quoted answers your question. The WHO no longer compiles rankings so the 2000 version is the most recent one available, and I agree with their stated reason for not doing so any longer.

    The WSJ article is a reasonable one, and identifies why its inherently difficult to rank health care systems, which is the valuation required on different elements for which there are no easily identifiable or universal valuations. Cost vs quality vs wait times vs access are all valued differently in different parts of the world, and for that reason the rankings are inherently flawed.

    They do provide some value in just getting a general view, granted you understand how the rankings were formulated and how they valued the criteria, and that's the only reason I posted them.

    지수, I understand that trying to time the birth for some archaic, ridiculous reasons do drive some c-section decisions. But clearly, that is not a legitimate medical reason to perform a c-section, and any doctor that intentionally increases the risk of harm to their patient in the name of superstition should never be practicing medicine in the first place. Any REAL physician that gets a request from a patient for a medically unnecessary c-section so that the mother can time the birth, would simply refuse.

    Let's face facts, the 40% rate of c-sections in Korea is an absolute disgrace to the reputation of the health system, whether the reasons are profit-driven or astrology-related, there's simply no excuse for endangering millions of women's lives unnecessarily in the name of either.

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  36. bjr, Korean med students' tuition is definitely lower -- around $20K a year or so. But because educational loan system is very underdeveloped in Korea, the parents are pretty much expected to pay for everything. So the debt is, surprisingly, less of an issue -- because the parents paid everything.

    ZtraderX, lack of very high cost malpractice litigation definite lowers the cost of healthcare in Korea, for sure. And the $8000 premium amount is on average, not that every family in Korea pays $8000.

    지수, the Korean would agree that choosing birth time is somewhat of a factor.

    Skeptico, the fact that WHO no longer publishes the report seems to the Korean an admission that their ranking is somewhat suspect. But you seem to be agreeing with the Korean on this point at any rate. The Korean also agrees that the prevalence of C-section in Korea is probably unhealthy.

    t-Hype, KyungHee U. traditional medicine is the best one in Korea, which means it does a lot of advanced things that NHIC does not cover. The Korean would not be surprised if your doctor included a lot of procedures and medicines that isn't NHIC-covered.

    question, that's a big question. Please see the questions policy on the right. And yes, medical tourism is definitely happening already.

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  37. just wanted to say thanks for such a detailed writeup and as always, your honesty and full disclosure make your blog one of the most informative and entertaining out there. Keep doing what you're doing!

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  38. Would you be so kind as to explain what if the healthcare covers services for the elderly? Such as nursing homes, treatment for alzheimers, arthritis, and other such things?

    Greatly apprectated!

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  39. Just came across this blog, and decided to leave few comments.

    As a Korean who lived in Korea for almost over half my life, I can safely say that I would prefer the Korean health care system over its American counterpart, ANY TIME OF THE WEEK. And that is even if I had a top-notch insurance plan(which I did until recently when I got bumped into my student health insurance plan).

    The reason is simple: In Korea, I'm not afraid to go see a doctor.
    Never in my life have I been scared to go to a doctor until I came to the U.S. My experience with the American system has been so consistently bad that I would probably prefer any thing over it. I had to wait longer to a GP and even longer for specialists, and even when I saw them they didn't seem to be able to figure out what to do. The only thing they did was tinker around my file and send me to get useless CAT scans and x-rays, and prescribe me pills that run over forty bucks a tiny bottle.

    And that's not even to mention my experience with the insurance company. Naive as I was I believed that the doctor or pharmacists will take care of my claims (which they would do had I still been in Korea). About three months after the visit, I got a 4-page claim form from the company, and then I waited for almost another three months just to get a rejection letter. I contacted my insurance agent, she told me to contact the company directly, whose headquarter was in New York (I live in CA). After I called them, they sent me a letter of appeal, and I went through the almost exactly same paper work again. And after almost a year and three months after my visit to the doctor, I finally got my reimbursement.

    Perhaps my experience is an extreme example of the dysfunction of the American health care system. But then why is it that almost the exact same thing happen every time I visit a doctor? My family had gone to different doctors and had several different insurance plans from several companies. And still the result is similar. Am I the only one going through this?

    My student health plan is pretty bad as well. It's like a love child between the American system and the Canadian system: all the flaws of both. But I would still prefer this over the private American health care line.

    This isn't to say that there aren't problems with the Korean system of health care, such as "5-minute diagnosis", doctors receiving kick-backs from big pharma, and long waits. Growing up in Seoul, I've gone through so many doctor visits. And yes, some of them were for nothing and due to my mom's hysteria.

    But there was one time when I thought I had the common cold, but then when I went to the doctor, it turned out to be pneumonia (or something like that, in any case it was something fatal had I left it undiagnosed). And this very often happens in Korea, and more in other countries with better systems, I would imagine. If I had gotten sick the same way in the states, I would probably in far worse condition or dead.

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  40. I have returned to share kind of an updated experience as a foreigner with the Korean healthcare system. Shortly after this post, I experienced a turn of events that greatly affected my healthcare budget (in a very good way).

    Originally, my family and I were seeing doctors at a large university hospital in Mok-dong, Seoul. The cost, we thought, was not so bad compared to America - visits ranged from 12,000~17,000 won, depending on whether or not the doctor was a resident, specialist, what have you. My son was perpetually sick last winter and spring, as he was only 1 year old, and just attending daycare for the first time in his life - he was still building up his immunities.

    Anyhow, after repeated illness, his daycare recommended a smaller private clinic near to our home, and because I was tired of dealing with hours-long waits and the expense of the hospital, I visited the clinic they suggested.

    When I went to the clinic, lo and behold, the visit cost a mere 1,900 won! The medications were also as cheap as the visit, if not cheaper. I was shocked.

    I asked one of my co-workers about this and they told me that the Korean government is trying to encourage people to use smaller clinics and so the cost of a visit at a smaller clinic is much less than the cost of a visit at a larger hospital. At this particular clinic I visited, both of the doctors (a husband-wife team) had graduated from Yonsei University and spoke excellent English. My whole family was seen there easily; we never had to wait more than 10 minutes to be seen, never had to make an appointment, there were lots of toys for my son to play with, my son's visits were always less than 2,000 won and visits for myself or my husband were always less than 4,000 won. We experienced good personal care and peace of mind regarding our health and finances after this switch.

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  41. So, the Korean's original post was correct - you CAN be seen at a clinic in Korea for less than $5, but you have to know where to go. Being American, I had assumed that a private clinic would be more expensive, since co-pays for a visit to a specialist's office in the U.S. was always more expensive for us than going to our neighborhood general clinic. It turns out that in Korea it works the other way around, and that has been very refreshing for us.

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  42. Healthcare in the U.S. is very good for diseases that one may need to visit a specialist for an operation or treatment. The cost is ridiculous and just goes to insurance companies, big pharma, and doctors. Money has ruined the system for the majority of the population. The upper middle and upper classes don't really want change b/c they are covered and don't pay that much money. Everyone is screwed though b/c if they get really sick or remotely injured they are going to be bankrupt or at the least use up their meager savings to be overpay for treatment. Just going to see a specialist in the U.S. is like $150 a visit, not an hour, a visit.
    Korea's system is definitely like a lot of other Korean products in the World marketplace, not the best, not luxury, but a good value for what you pay. See Hyundai Sonata or Samsung computers. I will say that Samsung has moved up the value chain in many of its products and while it is not a premium product, is not a cheap one in terms of quality and price either. I find that doctors here will not have the same advanced equipment as the average doctor in the states would have. The offices are little older, crappier looking, and one notices how the doc is trying to squeeze every little drop of profit out of the treatment. For example, there is a reputation for the dentists and sometimes doctors to be scheisters and recommend treatment that is not necessary. While that is not a rarity in the states, in my experience it has happened more to me here than back home. The dental work I received was not bad, but it was not up to the same quality as I received in the states. I think since there are more medical schools that are better academically in the States than here in Korea (Seoul National and Yonsei are the best here), the chances of getting a more qualified and better trained doctor in the U.S. are greater.
    That aside, I do prefer the Korean System more than the U.S. System.
    The design is better for the overall society. I think there should be a hybrid system setup in the U.S. It should be a baseline of quality of costs for everyone and then a premium market can be setup for the wealthy. The premium market would get ops done in a faster time period and other procedures would be done as well for an extra cost to the consumer. Whenever there is capitalism involved and even in communist government public services will never be equal for all as an entitlement. There will always be more and better services for the wealthy. Always....

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  43. Public, cheap, basic preventive care for all. And private, for-profit insurance for those who want and can afford. I don't know why it's so difficult for Americans to get it.

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    1. Good for the individual but not for the country itself... A public Health care system may put the country in a financial crisis. Plus like most people have stated, there is a reason why America has the best specialists because its not free. You don't want higher taxes but want to afford a higher health care system what does that give you... self imposed inflation and more foreign debt.

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    2. US has been supporting a public Health care system for decades, called MediCare.

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  44. I just stumbled on this post while googling about health care in Korea, and I must say it's quite excellent! So thanks a lot for putting in the effort to make such a well-researched post.

    I was wondering if you, the Korean, or perhaps some of the expats reading this blog have any tips about insurance for expats in Korea?

    I will be moving to Korea to study soon, and could either get a special insurance for people moving abroad at home (in Germany) or perhaps get insurance in Korea. How do expats go about getting insurance in Korea? Any insights are much appreciated.

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  45. Excellent article: gives a very complete picture of the Korean healthcare system.

    Since I'm commenting I'd also like to give a shout out to the Thai system. I fell off a motorbike while I was there and received treatment that was prompt, efficient and cheap.

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  46. It was so penetrating and informative.

    But, as a Korean, I want to point some things.

    I heard that there are 3 ways to cover health bills worldwide.One is through private insurance(U.S), the other is from tax(U.K.), the third one is from social insurance(Germany).

    Korea is adopting third one, so the premium is not tax but money charged by NHIC, a single public health insurance entity.

    So contray to the case of tax, you can check the amount your health care premium specifically in your salary bill.

    As a result, there are growing dissatisfactin among those who earns high levels of income. There is no limit to health care premium, just like the case of tax. So those who earn 30,000 USD a month has to pay, say, 1,200 USD a month. If earning 100,000 USD, premium 4,000USD a month. But what service they get from the hospital doesn't reach that amont of money.

    I earn 5,000 USD a month, but I pay about 130 USD for health premium, and my 2 childeren and my parents are all covered under my health care.(premium is decided by my income, but covering range is decided by who is supported financially and cared for by me.

    I think I am getting good benefit in spite of little money I am paying.
    The reason Korean system could be sustained in spite of little premium ordinary Koreans pay is that high-earning people are paying much sums of money even though they get the same level of medical treatment as I.

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  47. It's so penetraing and informative. Thank you.

    But, I just want to point 1 thing.
    I heard there are 3 ways to finance health care bill. One is through private insurance(U.S), the other is through tax(U.K.), the third one is thorough social insurance(Germany).

    The Korea is in 3rd category. Its health care bill is supported by NHIC, a single public insurance entity.

    The problem is that there are growing dissatisfaction about Korean health care system among the rich Koreans.

    Health care premium are decided on by the factor of income, and health care premium has no upper limit, so if your income becomes limitless, the premium also could be limitless.

    And if you have familly members who are depending on you(children, parents without income), they all are covered by your insurance, and the covering range doesn't have influence on your premium.

    For example, a Korean who earn a salary of 50,000 USD a month has to pay, say, 2,000 USD premium a month(of course his employer has to pay another 2,000 USD).

    I am earnig monthly salary of 5,000USD a month, and paying about 130 USD premium a month, and my 2 children and parents are all covered by my health care.

    But the benefits he gets from Korean medical system aren't different from mine.

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  48. Of course the rich Korean could pay big money to hospital for excellent services such as luxurious rooms, meals and special care. But I can also enjoy the same levels of services only if I pay the same deductibles to hospital as he. In conclusion, the fact that a rich Korean pays much more premiums for health insurance gives him no advantage during medical treatment.

    One major reason our system can be sustained is that rich Koreans are contributing to the system much more than their benefits.

    So our system would go down unless the rich people are included compulsorily in this public insurance system.

    And every hospital has legal duty to accept public health insurance and the price set by NHIC. Korean law is prohibiting some kinds of hospitals only for the rich which reject public health care and accept only some luxurious private health insurances.

    Every Korean's duty to eoroll in public health insurance, and every Korean hospital's duty to accept that health insurance, these two are the key elements for peserving current medical system in Korea.

    But these two key elements became very controversial nowadays, and being under attack from those who are advocating the competitiveness of medical industry in Korea.

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  49. Hi, I live in South Korea as well. I've noticed that some mothers say they pay 12,000 or more to see a ped. That is only because they are taking their child to a hospital rather than a clinic.

    The regular cost of a ped visit for my son is 2,000 and around 2,000 for his meds.

    Ask a Korean is correct when he stated that it costs around 5,000 to see a doctor.

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  50. As an American living in Korea I carried and gave birth to my 2nd child there. To be honest I was nervous before my initial appointment from horror stories I'd heard, however, it was the best experience I'd ever had childbirth wise. Now I will say I was asked at the first appointment when I wanted my csection to be and that through me off and they were just as shocked by my desire to do it natural but in the end they were awesome. My visits were about 20000 won a visit but each visits included an ultrasound with video and pictures ( and thanks to your article I now know why!). My total for labor, with an unexpected epidural and a three dy stay was $900.00 us dollars. To be honest I'd do it all again!
    I also didn't see in your article anywhere that it is not the norm to sue a doctor in Korea, and that is one do the many reasons here's in America we have such high expenses is that have to add in that liability insurance. I can remember several articles about young woman in Korea who had had botched plastic surgery that when they did try to sue the judge threw it out because they the patient should have done more research on the doctors abilities. Just had to throw that out there and say thanks for your insight.

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  51. If the drugs were developed by U.S. pharma companies, then the development costs were borne by us Americans.

    You're welcome.

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    1. And the profits were entirely inured to us Americans also. What's your point?

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    2. I think the point gnorm is clumsily trying to make is that one reason S. Korea (and other nations) are able to obtain drugs cheaply is that the U.S. effectively subsidizes the pharma manufacturers. Because pharma companies are able to make such big profits in the U.S. market, they can recover all R&D costs from that source and then give other countries the marginal rate.

      Call it the "Netflix effect." For a long time Netflix was an insanely good deal. Why? Because the content producers's main source of revenue was DVD sales, movie tickets, and TV fees, and Netflix was a minor side business. But as Netflix became more and more important, the content providers demanded higher and higher fees, until Netflix had to raise its prices.

      In other words, it's not necessarily correct to say that because drug X costs $20 in Canada and $100 in the U.S., the "real" price of the drug is $20. The price difference is because the Canadian customers have more bargaining clout (because of the single-payer system) than the U.S. customers (where Republican legislators have actually forbidden Medicare from negotiating with pharma companies). So if the U.S. ever got a single-payer healthcare system, either many drug manufacturers would go out of business, or Koreans would end up paying higher prices as the drug companies try to make up for the lost revenue.

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    3. Phil, I don't agree with you on that. The pharmaceutical companies can charge $100 because they have made sweetheart deals that allow them to do that. They get loads of R&D money from the US government and then pass on the cost to the consumers <-- irony-laden statement. Preventing the government from making these deals is part of their business model because it means less profit, not industry-killing drops in revenue.

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  52. Hey just a simple question and help from your hand...
    I am a freshly graduated university student here in Malaysia.. taking allied health sciences a s a radiographer.. wondering and planning to work in korea. I know university hospital in korea will be less chance for a foreign worker so i was thinking is there any x-ray clinic or centre or something not that big company as a yonsei Hospital or etc..for me to apply..help is much more pleased..thank you.

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    1. S Korea is not in need of skilled workers like you but rather unskilled, low wage workers I believe. But you can never say never I guess.

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  53. Honestly, I've been sick a lot in Korea, the first winter, when it was around -20 C with a lot of snow all the time, which is a mercilessly huge difference from my Mediterranean, 15 C during the day and -5 C in the night at the really cold days, winter where snow is a rarity. But I've never ever visited a doctor in Korea for now. While I used to visit the local doctors in my hometown (Umag, Croatia) for every regular cold and little injurries. Because, if you had a medical insurrance (and you do if you're under 18, a student or employed, maybe retired too), it was all free. And so many times I'd go to the hospital just so I could get some medicine for free. Sometimes I'd have to pay little money (was it around 2 Euro or less?) for blood anlyses, but that also depended on what you need to check out. And people had to pay expensive money for some serious diseases which require complex surgery and premium specialists. The whole system was kinda slow, though.... Now it might have changed, to worse, as the people complain due to some medical reforms. I remember doctors protested for the rights of the patients or something like that.

    So, the reason why I never visited a doctor in Korea is... I've heard it's expensive if you got no insurrance. I've heard forreigners can get an insurrance too, at least all of my Chinese and Japanese colleagues did. I plan on asking about it, but I really hate beaurocracy, it's too stressfull, and I always feel nervous when I have to deal with it, even the only thought makes me keep away from these things. So I keep delaying it. Not a good thing, heh.... Anyaway... Any disease I had, I could solve it at home, by myself, so let's say there was no real need for a hospital so far.

    I see here on the blog now, many people say how it is cheap to get cured and healed in Korea, so I'm a little bit encouraged, but just a little bit, because at my current economical situation, even 10 000 Won means a lot to me. (I'm a university student not receiving any scholarship or financial help, have to work my pocket money out, that I use for living costs, my parents can hardly afford me the tuitition fee, borrowing an insanely gigantic ammount of money from the bank, which is why they can't send me pocket money.) On the other hand, I've heard that the dentists are way too expensive, but everybody says plastic surgery and liposuction is fairly cheap and I hear only good things about that. Not planning a plastic surgery, though, it was just to mention.

    As for the medical products, I'm paying a little less than 10 000 Won monthly for contraception pills and sometimes I pay around 2 or 3 thousand Won for painkillers, if I need them. But I see on the news, they wanna change the policy on pharmaceutic products and that for contraception, I might be required to visit the doctor.... x_x

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    1. Dac, I urge you to get insurance while you're in Korea. I'm assuming you're on some sort of legal visa, and in fact you may be required to get insurance. Get it sooner rather than later, just in case you have something more serious happen to you than needing birth control pills. I had appendicitis, which was covered under the national health insurance so I only had to do the copay for the visits, surgery, etc. (about $500) plus the cost of opting for a private room.

      I agree, bureaucracy is no fun, but Korean bureaucracy is a breeze as far as bureaucracies go (meaning it's relatively better, and sometimes amazingly so, though you can run into a rough patch sometimes). Just yesterday I got my expired driver license renewed until 2022. Getting the photos done, the paperwork filed, and the payment made, took all of 20 minutes. Including the waiting.

      I think the NHIC office near Namyŏng Station (line #1, just south of Seoul Station) has people who speak English and can help out. Not sure if they speak Croatian, but your English seems fine.

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    2. It's okay, I know where I can get informations and support. My university is full of foreigners so they have a very nice service for foreign students like me (except if you run into a newbe working there who yet has to learn many things). I can speak both Korean and English, so there is no language problem for me.

      And yes, I do have a legal visa, a D-2 student visa, which I have to renew once a year, as I pay my scholarship (actually scholarship is payed two times a year, once per semester, but the visa lasts one year and not 6 months and is connected with paying my school).

      Well, thank you for your concern, I'd need it anyway. I mean, the sooner the better... I mean, it might sound paranoid, but with Fukushima in the neigbourhood, there might happen serious health problems without me even noticing and, well, women taking contraception pills should check on their health more often than those who don't.

      I know all of that and I dunno why my feelings, my psychological "I'll do it next time" problem keeps me away from doing it. It's not even like I'm afraid or something. And if it was merely just laziness, I had gotten over it a long time ago...

      Anyway, the 500$ that you mentioned, is already too expensive to me, I mean, it's like half of my mother or father's pay (they both receive the same amount of money, more or less, as they work at the same place). x_x And how much is the insurrance, btw? ^_^" Oh, guess I need to ask it at the Global Service Centre at my school. u_u

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  54. Need some help with a question. If a Korean (who is enrolled under the NHIP) travels abroad to do a pet ct scan (let's say in Singapore), is the costs covered (or reimbursed) by the National Health Insurance Program? Thanks.

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  55. If you are living in Korea, you do not have to wonder why this system works. All you have to do visit doctors whenever you are sick...without paying too much for it.

    But if you are living in US, you might have to ask why such a good (despite the drawbacks nicely described above) thing never happens in your country. I would if I were an American.

    In fact, I have been asking the question over and over for the past 20 years. And I think I have found a pretty good answer: The reason might be that US doctors can talk. They can talk, they can lobby, they can debate, they can reason with their society.... they can do whole lot of things we Korean doctors are not allowed to do.

    In other words, they have some kind of political rights that are not enjoyed by doctors in this country.

    My English is not good enough, and I cannot accurately describe what kind of rights I feel Korean doctors are deprived of. But I can say that they are of a political kind, and that they are rights universally given to all people.

    For example, when nurses or technicians are not happy about what they are paid, they can go on strike and nobody blames them for the inconveniences resulting from it. They can do that because they are a right to do so.

    Doctors? Well, they did strike once in this country. Not only that 2000 strike was illegal (illegal strikes are not so severely punished in this country, by the way), it won't happen again. We just know that we are not allowed to do that.

    Reading the books such as "The ascent of Money", I recognized that Jewish people were pretty much in our shoes when they were living in places like 1492 Spain or 16th century Italy. The book lacks details on what kind of like Jewish people lives, so my head could not get a nice picture of it. It was my heart that told me what it must have been like to be a "jew" in such a society, and I think it's because I am living such a life.

    In short, whether you like the medical system of Korea or not, you first need to ask yourself whether it is possible, in your society,to deprive one group of people of their political rights when they are constitutionally given to all the other people. You need to ask whether your Media can be as much biased against doctors as they are in this country. You need to ask whether your society can scare the doctors enough.

    Because, a Korea-style medical system won't work without that level of coercion.

    --Angry Radiologist in Seoul





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  56. Below are a few questions I have. I had to stay in a Korean hospital for two nights and three days. They run a system where if you can't pay at the time of discharge then there would be problem. Each time I asked someone, even at different hospitals, about payment, they exclaim you must pay the entire bill and there is no payment plan or system. What do they really do with people who have to be hospitalized long term/or need major services and cannot pay the entire bill? Do they actually have a billing system somewhere or do they really put people out if they can't pay?

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  57. I just came across this. Excellent information!
    If I understand the Korean's article above correctly, Korea's healthcare system adopts "Pay for Service" (PfS), where care providers get paid from NHIC for the services they provide to patients. This has also been the practice in the U.S. healthcare system until now, though the current administration has been trying to change it in the past a couple of years to "Pay for Performance" (PfP). The problem with PfS is, as what we've seen in South Korea (as written in the article above) as well as in the U.S., for in order to generate as much revenue as possible, the care providers naturally try to provide services as many as possible. This leads to unnecessary tests (duplication), unnecessary visits, unnecessary prescription, etc. Another factor that leads to expensive healthcare spending in the U.S. is the fact that people do live longer, but not necessarily with better quality of life. The higher rate of chronic disease in the U.S. is also not helping with keeping the healthcare costs low.
    I don't know for sure the chronic disease rate, life expectancy, and quality of life (in term of physical and mental health) in South Korea. But I am wondering how South Korea is still able to keep the healthcare costs low (as compared to U.S.) given unnecessary services rendered due to PfS. Would like to hear what other people think about this.

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    1. If you can make doctors go to bank, build a clinic, buy expensive devices.... and then set the medical fee low.... and then make the medical insurance mandatory... and then ban doctors from turning down insured patients..... then you can receive a medical system like that in Korea.

      Only if you can do those things...

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  58. So, so happy your blog exists and you do this service! I am a registered nurse with an associates, working on my bachelor's degree, and I am currently in my community nursing/public health class. I currently live in the Songtan area with my husband who is in the US Air Force, stationed at Osan AB. I am soaking up all the culture I can while I'm here. It's been a lot of fun learning about health promoting things in the community like the free exercise equipment at the parks that people actually use (the older Korean ladies here currently out twist me), the public transportation system (people can get where they need to go very cheap or for free), and the pharmacy setup (a pharmacist + medicine; no candy, film developing or toys), to name a few. My teacher wants me to find out more about the health delivery system here in S. Korea. I started with google.com and your site popped up second. I ran into your blog when I first got here in August, and haven't been back to it lately until now. Just wanted to share and say thank you!

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  59. As an expat in Korea who has visited several different hospitals and clinics since I've been here, I must say that I love the Korean system. The best part of it is the efficiency. I go in, show my ID, get treated, and leave. Very little waiting and no paperwork. There is no reason that a healthcare system needs to be more complex than this.

    However, I feel like the Korean system is a bit too cheap (maybe it's because I'm an American). I wouldn't mind paying a little more in office fees for a little more time with a physician. It does feel rushed. I read the average Korean doctor's salary is $91,000 and they see many more patients in a day. I imagine there is a high burnout rate, and I don't want an overworked physician diagnosing me.

    Also, Koreans go to the hospital for common colds, low fevers, muscle aches, and other ailments that can usually be treated at home with a couple Tylenol (which is usually what the doctor ends up prescribing). If the frivolous medical visits were done away with, physicians could spend more time treating patients who actually need to see a doctor.

    Still, I am very happy to be a part of this health system!

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  60. Can you tell me if there's any kind of waiting period or pre-existing condition exclusions for maternity coverage? We're coming (back) in a few weeks on an E-2 (teaching) and F-3 (dependent) visa, and hoping to start trying soon after. We won't get our ARCs and therefore enrolled in national healthcare till about a month later.

    Thanks!

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  61. Exceptional blog you guys have conserved there, I absolutely appraise your effort.

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  62. Hi Korean,

    I am Saneesh from Bangalore, India.
    I ve read your blog on Korean Healthcare. Thanks for providing insights into Healthcare in Korea.
    We are working for Kemedy - A healthcare portal in India concentrating on improving the Patient - Doctor relationship.

    During my search in Internet I did not find any online centralized health portal where you can view and book the appointments of Doctors in different Hospital.
    As we are building such a system in India, I would like to know about the advancements Korea has done in these areas.
    I would like to learn more about these from developed Nations in East (Korea, Japan, Malaysia) rather than from the West because the problems that we face in India are more similar in East

    Thanks and Expecting a response from you

    ReplyDelete

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