Healthcare Insurance System

HOME > Biopharmaceutical Policy & Regulation > Pricing System Overview > Healthcare Insurance System

Healthcare Insurance System

Sources  [ HIRA & NHIS homepagewww.hira.or.krNational Health Insurance System of Korea, 2015 (NHIS)  ]

South Korea’s Health Insurance system is a public and single payer system. In 2000, National Health Insurance Act was enacted and all insurers were integrated into a single insurer. The NHI covers 97% of the population, which the remaining 3% are covered by the Medical Aid program. It is financed by compulsory contributions from the insured and their employers, government subsidies and tobacco surcharges.

The healthcare system is run by three bodies, namely the Ministry of Health and Welfare (MOHW), the National Health Insurances Services (NHIS), and the Health Insurance Review and Assessment Service (HIRA).

The MoHW legislates related laws and overseas the national health insurance system. The NHIS serves as the single insurer. The HIRA reviews medical fee claims, assess the quality of care provided, and evaluated the adequacy of healthcare services by providers. Also, the HIRA is responsible for the assessment on the appropriateness of reimbursement.