NATIONAL MEDICAL INSURANCE IN KOREA
How did Korea succeed in providing health insurance to the whole nation within 12 years? Before 1977, Korea had only voluntary health insurance. In 1977, President Park Chung-Hee and the legislature passed a law that mandated medical insurance for employees and their dependents in large firms with more than 500 employees (Table 1). Gradually health insurance coverage was expanded to different groups in the society: in 1979 to government employees, private school teachers, and industrial workplaces with more than 300 employees, and in 1981 to industrial workplaces with more than 100 employees. In the late 1980s, health insurance expansion became regionally based, first to rural residents in 1988 and then to urban residents in 1989. Each of these expansions was mandated by government.
Clearly, South Korea had adopted Japan's health insurance system as a model. Given the overall impact of the Japanese model of industrialization on the socioeconomic development of Korea, it is not surprising that the Japanese health insurance system became a prototype for Korean NHI. This in spite of the fact that American medicine had a dominant influence on the development of Korean medicine after 1945. However, the American model was not an ideal model for the Korean health insurance system because the United States had failed to achieve compulsory, universal health insurance.
The Japanese model's influence in shaping Korean health insurance was most notable in 3 areas: (1) the administrative structure of the system, (2) the choice about who would be covered, and (3) the policy for mobilizing financial resources for the system. While Japanese health insurance was a dual system in the 1970s, consisting of employer-- and employee-financed health insurance and government sponsored NHI, at the outset Korea adopted only the former scheme of employer-employee health insurance in firms with more than 500 employees. According to the legislation, as in the Japanese model, the employer and the employee each paid half the premium. There was some government subsidy, not for the beneficiary but for the operating budgets of "medical insurance societies." Premiums were determined by multiplying the standard monthly salary by the health insurance contribution rate, which ranged from 3% to 8% of wages.
NATIONAL MEDICAL INSURANCE IN KOREAHow did Korea succeed in providing health insurance to the whole nation within 12 years? Before 1977, Korea had only voluntary health insurance. In 1977, President Park Chung-Hee and the legislature passed a law that mandated medical insurance for employees and their dependents in large firms with more than 500 employees (Table 1). Gradually health insurance coverage was expanded to different groups in the society: in 1979 to government employees, private school teachers, and industrial workplaces with more than 300 employees, and in 1981 to industrial workplaces with more than 100 employees. In the late 1980s, health insurance expansion became regionally based, first to rural residents in 1988 and then to urban residents in 1989. Each of these expansions was mandated by government.Clearly, South Korea had adopted Japan's health insurance system as a model. Given the overall impact of the Japanese model of industrialization on the socioeconomic development of Korea, it is not surprising that the Japanese health insurance system became a prototype for Korean NHI. This in spite of the fact that American medicine had a dominant influence on the development of Korean medicine after 1945. However, the American model was not an ideal model for the Korean health insurance system because the United States had failed to achieve compulsory, universal health insurance.The Japanese model's influence in shaping Korean health insurance was most notable in 3 areas: (1) the administrative structure of the system, (2) the choice about who would be covered, and (3) the policy for mobilizing financial resources for the system. While Japanese health insurance was a dual system in the 1970s, consisting of employer-- and employee-financed health insurance and government sponsored NHI, at the outset Korea adopted only the former scheme of employer-employee health insurance in firms with more than 500 employees. According to the legislation, as in the Japanese model, the employer and the employee each paid half the premium. There was some government subsidy, not for the beneficiary but for the operating budgets of "medical insurance societies." Premiums were determined by multiplying the standard monthly salary by the health insurance contribution rate, which ranged from 3% to 8% of wages.
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