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Healthcare System in Korea

Social Security System

The Ministry of Health and Welfare of Korea has implemented a variety of social security programs to ensure a basic standard of living and to raise the overall quality of life for all citizens. The Korean social security system provides social insurance, public assistance, and social welfare services.

Social Security System Social Security System

The health security system in Korea has two components: mandatory social health insurance and medical aid. The National Health Insurance (NHI) system provides healthcare coverage to all citizens. The major sources of NHI funding include contributions from those who are insured and government subsidies. The medical aid program is a form of public assistance that uses government subsidies to provide low-income groups with healthcare services.

Health Security System Health Security System

The Ministry of Health and Welfare (MoHW) oversees the National Health Insurance system and its two fundamental institutions: The National Health Insurance Service (NHIS) and the Health Insurance Review & Assessment Service (HIRA). The NHIS serves as the insurer and HIRA conducts claims reviews and quality assessment of health care services.

In Korea, fee-for-service (FFS) has been the standard payment model for outpatient care and the majority of inpatient care, leading to an increase in the volume of services that health care professionals can provide. In 2012, case-payment based on Diagnosis-related Groups (DRG) was introduced for 7 disease groups.

Healthcare providers submit claims to HIRA via the web-based Medical Claim Portal Service (MCPoS). HIRA first uses an IT system to automatically check for errors, omissions, or miscalculations. An electronic claim review is then conducted based on pre-determined criteria. Outliers are closely examined by HIRA staff, medical professionals, or by a committee of experts. After claims review is completed, HIRA submits the results to the NHIS where reimbursement for providers is processed.