Republic of Korea - WHO/Europe

Health Systems in Transition

Vol. 11 No. 7 2009

Republic of Korea

Health system review

Chang Bae Chun ? Soon Yang Kim Jun Young Lee ? Sang Yi Lee

Health Systems in Transition

Chang Bae Chun, National Health Insurance Corporation Soon Yang Kim, Yeungnam University Jun Young Lee, University of Seoul Sang Yi Lee, Jeju National University

Republic of Korea:

Health System Review

2009

The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine.

Keywords: DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEM PLANS ? organization and administration REPUBLIC OF KOREA

? World Health Organization 2009 on behalf of the European Observatory on Health Systems and Policies All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full.

Please address requests about the publication to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen ?, Denmark

Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site () The views expressed by authors or editors do not necessarily represent the decisions or the stated policies of the European Observatory on Health Systems and Policies or any of its partners. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies or any of its partners concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation "country or area" appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The European Observatory on Health Systems and Policies does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use.

Printed and bound in the United Kingdom.

Suggested citation: Chun C-B, Kim S-Y, Lee J-Y, Lee S-Y. Republic of Korea: Health system review. Health Systems in Transition, 2009; 11(7):1?184.

ISSN 1817-6127 Vol. 11 No.7

Health systems in transition

Republic of Korea

Contents

Preface............................................................................................................ v Acknowledgements...................................................................................... vii List of abbreviations ..................................................................................... ix List of tables and figures ............................................................................... xi Abstract ........................................................................................................ xv Executive summary.................................................................................... xvii 1. Introduction................................................................................................ 1

1.1 Geography and sociodemography ................................................. 1 1.2 Economic context .......................................................................... 4 1.3 Political context ............................................................................. 7 1.4 Health status .................................................................................. 9 2. Organizational structure........................................................................... 17 2.1 Overview of the health care system............................................. 17 2.2 Historical background.................................................................. 18 2.3 Organizational overview.............................................................. 24 2.4 Decentralization and centralization ............................................. 33 2.5 Patient empowerment .................................................................. 34 3. Financing.................................................................................................. 43 3.1 Health expenditure....................................................................... 44 3.2 Population coverage and basis for entitlement ............................ 47 3.3 Revenue collection/sources of funds ........................................... 52 3.4 Pooling of funds........................................................................... 63 3.5 Purchasing and purchaser?provider relations.............................. 64 3.6 Payment mechanisms .................................................................. 66 4. Regulation and planning .......................................................................... 69 4.1 Regulation.................................................................................... 69 4.2 Planning and information system ................................................ 77 5. Physical and human resources ................................................................. 81 5.1 Physical resources........................................................................ 81 5.2 Human resources ......................................................................... 92

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Health systems in transition

Republic of Korea

6. Provision of services .............................................................................. 109 6.1 Public health .............................................................................. 109 6.2 Patient pathways .........................................................................113 6.3 Primary care................................................................................114 6.4 Secondary care............................................................................118 6.5 Emergency care ......................................................................... 120 6.6 Pharmaceutical care................................................................... 121 6.7 Rehabilitation services............................................................... 125 6.8 Long-term care .......................................................................... 126 6.9 Services for informal carers....................................................... 127 6.10 Palliative care .......................................................................... 128 6.11 Mental health care.................................................................... 130 6.12 Dental care............................................................................... 132 6.13 Complementary and alternative medicine ............................... 133 6.14 Health care for specific populations ........................................ 134

7. Principal health care reforms ................................................................. 135 7.1 The separation of drug prescribing and dispensing ................... 136 7.2 Merger of health insurance funds .............................................. 140 7.3 Implementation of the long-term care insurance scheme.......... 146 7.4 Benefit expansion ...................................................................... 150 7.5 Ongoing debate on for-profit hospitals ...................................... 153

8. Assessment of the health system............................................................ 155 8.1 The stated objectives of the health system ................................ 155 8.2 The distribution of the health system's costs and benefits across the population.................................................... 156 8.3 Efficiency of resource allocation in health care......................... 158 8.4 Technical efficiency in the production of health care ................ 159 8.5 Quality of care ........................................................................... 160 8.6 Contribution of the health system to health improvement ........ 161

9. Conclusions............................................................................................ 163 10. Appendices........................................................................................... 167

10.1 References ............................................................................... 167 10.2 Further reading ........................................................................ 176 10.3 Principal legislation ................................................................. 177 10.4 Useful web sites....................................................................... 178 10.5 HiT methodology and production process............................... 180 10.6 The review process .................................................................. 182 10.7 About the authors..................................................................... 182

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