Health Insurance System

Submitted by: BSN3-1 Group 2

1. Background history of the Healthcare System in South Korea Republic of Korea is a sovereign state in the southern part of the Korean Peninsula. The name "Korea" is derived from Goryeo, a dynasty which ruled in the middle Ages. The capital and largest city is Seoul. The efforts to introduce a social security system in Korea went back to the early 1960s with the legislation of various laws related to social security and protection. In 1977, the medical insurance program for employees of private companies was introduced. In 1979, another similar insurance program was implemented for public servants and private school employees. In 1988 medical insurance program was extended to all the self-employed in rural areas; 1989 the program for all the self-employed in urban areas was implemented. 2. Laws Governing South Korean Health Insurance In the present, health insurance is governed by the National Health Insurance Act. National Health Insurance Act which was promulgated on February 8, 1999. In this act, every Korean citizen living in Korea is automatically enrolled in the health insurance. 3. How the System Works South Korea has a National Health Insurance (NHI) system, which is compulsory and required by Korean law. Everyone resident in the country is eligible regardless of nationality or profession. The only exception is for those who receive medical protection, which means they are not required to pay a premium. This is reserved for the extremely poor, refugees, children of independence fighters and other significant contributors to Korea, such as possessors of important intangible cultural products (e.g. artisans of very rare traditional ceramics,) and so on. The National Health Insurance Corporation (NHIC) is the only public insurance institution operated by the Ministry of Health and Welfare in Korea. Its main function is to set the cost of every single medical procedure that the law covers.

The system is funded by compulsory contributions from all residents and government subsidies. Foreigners living in South Korea who are registered with the NHIC receive the same medical benefits and services as Korean nationals. The amount an individual pays in NHIC contributions depends on their income and economic power. People who are registered as disabled and those over the age of 65 pay less.

Everyone who is enrolled in the insurance must pay a premium. There are two avenues through which payments are made. The employed pay half of the premium, which is deducted out of their paycheck, and the employing company pays the other half. The unemployed pay their premium directly to the National Health Insurance Corporation. The amount of the premium is determined like tax -- the more you earn, the more you pay.

All companies in Korea with 5 or more employees are obliged by law to enroll their staff in the Workplace Medical Insurance program which also covers the workers spouse and children. All companies with 5 or more foreign employees must enroll their foreign staff in the National Medical Insurance Plan. 4. How to Avail Applying for either Workplace or Community Medical Insurance requires the following documents: 1. Alien registration certificate 2. Certificate of current employment or employment contract 3. For F-1 or F-3 visa holders, a certificate that establishes the family relationship

5. Benefits and Coverage The benefits of Health are available to the insured and their dependents, which include the insured's spouse, direct lineal ascendants (including those of the spouse), direct lineal descendants and their spouses, and brothers or sisters of the insured. They have to prove that they meet the qualification standards set by the Ministry of Health and Welfare. Those qualification standards are no income and actually depend on the insured. Benefits are granted both in cash and in kind. The insured people that are in the category of the self-employed have no concept of a dependent. All self-employed persons and their family members are considered to be the insured.

TYPES OF BENEFITS Benefits in kind - include Health care benefits, Health Examinations, and medical services for the childbirth. o Health care benefits - In the event of sickness or injury, the insured persons and their dependents are entitled to health care services from health care facilities. Health care benefits include in-patient and outpatient care, dental services, traditional oriental medicines, prescription drugs, essential preventive services, payment for diagnosis, hospitalization, and nursing. o Health Examinations - In order to prevent a disease by early detection, the insured and their dependents aged 40 years and above are entitled to health examinations every two years or every year for the blue collar workers. o o Medical services for the childbirth - are payable when an insured woman or a dependent woman gives birth at a medical care institution. Cancer Program - Cost: shared by NHIC (80%) and beneficiary (20%); Stomach, colon, breast, and liver cancer screening and pap-test: costfree Cash benefits - are reimbursements for health care expenses and delivery expenses paid by the insured or their dependents. It also includes some fixed amounts for funeral expenses. Health expense and delivery expense can be offered when the insured or their dependents have, in an emergency or for other unavoidable reasons, been treated or gave birth in an institution not authorized by the Ministry of Health and Welfare as a medical services provider.

COPAYMENT - In order to curtail the overuse of the medical care services, and the concentration of the services in large urban hospitals, the level of co-payment for outpatient services and in-patient services was set differently across medical care institutions. Classification Co-payment 10~20% of total treatment cost Inpatient (Co-payment for cancer treatment and rare disease: 10%) Tertiary care hospital General hospital Outpatient Hospital Clinic Pharmacy 60% of (treatment cost + Per-visit consultation fee) 50% of (treatment cost + Per-visit consultation fee) 40% of (treatment cost + Per-visit consultation fee) 30% of treatment cost 30% of total cost

EXCLUSIONS FROM BENEFITS Any medical services, drugs, or materials provided or used for diseases which do not cause serious problems in daily life or business Any medical services, drugs, or materials provided or used for care, which is not for the improvement of physically essential functions

RESTRICTIONS AND SUSPENSIONS FROM BENEFITS - For the purpose of maintaining financial stability and appropriate standardization of benefits, current health insurance program has some limiting conditions. Restrictions of Benefits o Excluded by Application of Health Care Standards: special or non-standard treatments not recognized by the medical professional o Impermissible Cases: slight fatigue or ennui, health checkups, inoculation, cosmetic surgery, skin ailments not affecting daily life, special consultations, room charges beyond the allowed amount. o Other Limitations: bodily harm suffered while committing criminal acts or from intentional accidents, expenses compensated by benefits or cash grants from other sources Suspension of Benefits o While in military service, during travel abroad, or when in the care of correctional institutions

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.

6. Comparison Between Health Insurance of South Korea & the Philippines South Korea Enrollment Eligible Members Automatically enrolled upon birth. All are eligible for Philippines Must enroll self upon legal age.

Health Only those who apply or are

Insurance as long as they are covered by parents are eligible Korean citizens. Foreigners may for Health Insurance. also be eligible if they are

working in Korea. Payment Compulsory residents in Funded Korea; by all Only those to who pay apply for are

payment obliged

Health

scheme made depends on the Insurance. employer Types of Benefits Has Health Care and Cash Has Health Care and Cash benefits February 14, 1995

benefits Date Established February 8, 1999

MEMBERS AND CONTRIBUTIONS Anciro, Kevhin Roy Host of creative presentation Buenaventura, Heide Lynne Researcher, Scriptwriter, Character in creative presentation De Guzman, Ameline Mhae Host of creative presentation, Designer of cover page Jao, Krizia Cassandra Researcher, Scriptwriter, Character in creative presentation Ontiveros, Glenerson Researcher, Voiceover in creative presentation Santos, Bianca Elisse Editor of written and creative output, Voiceover in creative presentation Tan, Holly Angelique Researcher, Character in creative presentation Torion, Gil Jeapril Researcher, Character in creative presentation

REFERENCES Medical Insurance - South-Korea - korea4expats. Retrieved September 20, 2012, from http://www.korea4expats.com/article-medical-insurance.html Philippine Health Insurance Corporation. Retrieved September 20, 2012, from http://www.philhealth.gov.ph/ United Nations Public Administration Network. Retrieved September 20, 2012, from http://unpan1.un.org/intradoc/groups/public/documents/APCITY/UNPAN009456.pdf NHIC - National Health Insurance Corporation. Retrieved September 20, 2012, from http://www.nhic.or.kr/portal/site/eng/