Somebody call 1-1-9! How to Access Healthcare in South Korea

We are happy to report that thus far, we have not required any emergency services while living in Seoul. (Everybody knock on wood with us, please!) In an emergency here, you call 1-1-9 instead of 9-1-1. Easy enough for us to remember, though hopefully we never need it!

After six months of living in South Korea, all visitors not already registered by their employer are required to enroll in the National Health Insurance (NHI) Program. Our case was unique in that the chemist ended up on a student visa, so he is not covered under an employer and had to register with the NHI after eight months instead of six. I’m not employed here, so just prior to our six months of residence, I received a letter from the Korean government notifying me that I would be registered automatically with the NHI Program.

Given that we were paying into the system anyway, I decided to try using my insurance for some non-emergency care. I’m not an expert, but I will tell you about my handful of experiences using the healthcare system in South Korea, as well as some facts about the system I learned through my own research. Also, these are not ads or recommendations for any specific healthcare provider. I’m just telling you about the places I happened to choose.

Fast Facts about the NHI Program

For my fellow healthcare nerds, here are a few background points about how the NHI Program works:

• South Korea has universal healthcare, becoming a single-payer system in 2004. The legislation that created the current system sought to remedy inefficiencies resulting from over 350 different insurers operating in the country.
• The insurance system is funded by contributions, government subsidies (14%), and tobacco surcharges (6%).
• Employers pay about 5% of each employee’s salary as a contribution to the NHI, and the employee also pays a monthly premium, usually about $100 USD/month; self-employed persons contribute based on a sliding scale.
• The NHI reported in a 2017 survey that 86.9% of South Korean households had a supplemental private insurance, often provided by their employer (Organisation for Economic Co-operation and Development [OECD]).
• About 60% of an individual’s medical costs are covered under the national program, creating demand for supplemental private insurance to cover out-of-pocket costs (OECD).
• The total expenditure on health insurance as a percentage of South Korea’s GDP increased from 7.1% in 2014 to 8.1% in 2019, just below average among OECD countries. (The US, by comparison, spends 17%.) THE OECD attributes this rise in spending to South Korea’s rapidly growing wealth and greater attention to population health.

Visiting the Doctor’s Office

I have visited the same family physician (가정의학과 or ‘gah-jeong-eui-hak-gwa’) several times now. She is the sole practitioner at this office, and she is what I would think of as a ‘General Practitioner.’ I found her by Googling “English-speaking physicians in Seoul” and found an office that was conveniently located for me.

Finding businesses in Seoul has taken some getting used to. Space is at a premium, so lots of businesses are on upper floors of commercial buildings, even doctor’s offices. This office is on a second floor above a Baskin Robbins! I walked past it a bunch of times the first time I went before I finally found the entrance.

Although the practice is listed as an international clinic, as far as I can tell I’ve been the only non-Korean person in the waiting room each time I’ve visited. However, the physician and staff all speak excellent English, so perhaps when there are more foreigners around Seoul they have more international patients. The office is clean, modern, and comfortable, though small. When I visit, I check in by presenting my Alien Registration Card (ARC), which for foreign residents is also the ID card for the NHI Program. Although this office accepts walk-ins only, I’ve never waited more than about 15 minutes to see the doctor.

Lest you think I am making many visits to the doctor because I have many ailments, I will set your mind at ease. I take a prescription allergy medication, and in Korea doctors can give only one month’s worth of a prescription at a time. As long as I want to keep taking the medication, I have the visit the doctor once per month to get a new prescription. Each appointment costs me 3,500 KRW (about $3 USD), and the balance is covered by the NHI Program. I do wonder if Koreans have a more difficult time maintaining their prescription refill needs because of this requirement? South Korea appears to have one of the world’s lowest consumption rates of common prescription medications (OECD Health Statistics 2019), though I couldn’t say whether these factors are related.

Every person covered under the NHI Program is entitled to a free, comprehensive health screening every other year. In each odd year, those with odd-year birthdays have their screening, and in even years those with even birth years are screened. It’s fortunate that this opportunity is built into the system, because my observation is that preventive care is not a big part of a visit to a medical clinic. I’ve had no blood pressure or weight checks or any other screening as part of any doctor’s visit so far. While I can only speak to my own experience in this respect, the lack of emphasis on preventive care seems to be a known challenge of the Korean healthcare system.

Visiting the Dentist

My visit to the dentist was a snap. Google was my friend again in helping me find a nearby dental office with English speakers. The clinic was clean, modern, and efficient, and the dentist and staff all spoke excellent English. From the teeth cleaning to the dentist’s check-up, everything was exactly as I would have expected. I even got a nifty robe to wear over my clothes – much nicer than than paper bib I get at home!

The only significant difference I noticed was that instead of being placed in individual rooms, all patients were examined in one very large room with partitions between the exam spaces. The photo below is a little misleading since the exam spaces were much further apart than this when I was there, perhaps a change made in COVID times. There were also some curtains up for greater privacy.

I was very excited to get dental x-rays that did not involve putting giant plates in my mouth, which I appreciated. Moreover, my teeth got their big-screen debut as the dentist displayed photos for me on huge monitors in front of my seat. That must be a terrifying part of the visit for anyone with insecurities about their teeth!

My cleaning and check-up cost 20,000 KRW (about $17.75 USD), with the balance paid by NHI. My insurance at home would have provided this service for free, but overall not a bad price.

Visiting the Pharmacy

Pharmacies are important places to know in South Korea as very little medication is available over-the-counter (OTC). Just ten years ago, pharmacies here had the exclusive right to sell any kind of medicine. However, as of 2011 the government reclassified some medications to be sold OTC. Unsure what we would find available here, we brought with us most medication we thought we would need for the year. The prescription allergy medicine I take costs almost exactly the same here as what I pay in the US.

Pharmacies tend to be small shops in commercial areas and often have just a small counter with lots of products shelved on every available space. However, I occasionally have seen larger shops with more room to browse. A common Korean word for ‘pharmacy’ is 약국 (‘yak-kuk’), but if you’re looking for a sign while walking down the street it usually just says 약 (‘yak’).

As it turns out, most medications you would need are available here, although the name might be a little different. You do need a doctor’s prescription for many medicines, including for some we buy OTC in the US.

If you’re going to the doctor anyway, it can be good to ask for a prescription for some of these OTC medications as then the doctor will write down exactly what the pharmacist should give you. This has saved me some communication hassles at the pharmacy. However, using a translation app like Papago has also helped me communicate with pharmacists very effectively when we ran out of our mutual Korean and English.

A Brief Evaluation

Like every healthcare system, South Korea’s has pros and cons. On the plus side, the NHI Program provides a baseline of coverage for every person, including foreigners who have lived in the country for more than six months. On the minus side, most people still have to pay some out-of-pocket costs for care not covered by the national program. Those with employers who provide additional coverage, however, may get some supplemental insurance as a benefit.

The quality of healthcare overall is very good, though not as highly ranked as countries such as Sweden, Canada, and Japan. However, the average life expectancy in South Korea (82.7) is nearly as high as many of those countries with higher-rated healthcare systems and was significantly higher than the 2019 OECD average of 80.8. Korea also reports lower mortality for non-communicable diseases such as heart disease and dementia, although their cancer mortality is the same as the OECD average. Obesity rates are among the lowest in the world.

There are disparities present in the South Korean system. Nearly 90% of the country’s physicians are found in urban areas, as are the most respected hospitals and private healthcare institutions. Those who must travel from rural areas to see a specialist may experience long wait times for medical consultation, in addition to the expense of traveling for medical care. In addition, to visit a specialized general hospital (‘tertiary hospital’), often the most respected institutions, requires a referral letter from a primary doctor for those covered under NHI. Many private insurances do not have this requirement.

The South Korean system also tends to focus more on hospital-based care and treatment than on clinic care and prevention and consequently has been shown not to manage chronic diseases as effectively. Though everyone has access to care through hospitals and clinics through the NHI Program, the cost of this care may be more problematic as Korea’s population ages rapidly over the next few decades.

Korea also has some work to do in the area of mental healthcare. The rates of death by suicide are the highest in the world and have not improved substantially as has been reported in other countries over the past few decades. Though mood and anxiety disorders are as prevalent as in other developed countries, and in one survey more than a quarter of Koreans reported experiencing as least one DSM disorder in their lifetime, the rates of mental health treatment are far lower than those of other developed countries. The Korean government also expends fewer financial resources on treating mental health issues than do comparable nations.

My own limited experience with the Korean healthcare system and the NHI Program overall has been positive. I’ve been able to access the services I needed and have found resources in English. The South Korean government has proven past willingness to utilize resources to improve healthcare services and delivery. Hopefully, this trend will continue so that more citizens and visitors can enjoy equal access to a high-quality system.