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 Offi ce 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 Offi ce for Europe Scherfi gsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Offi ce web site (http://www.euro.who.int/PubRequest) 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. 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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 fi gures ...............................................................................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 iii 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 specifi c 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 Benefi t expansion ...................................................................... 150 7.5 Ongoing debate on for-profi t 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 benefi ts across the population ....................................................156 8.3 Effi ciency of resource allocation in health care .........................158 8.4 Technical effi ciency 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 .................................................................