Mandatory health insurance subscription system for foreigners and overseas Koreans (PG) [장현경 제작] illustration
(Seoul = Yonhap News) Reporter Seo Han-ki = The financial balance of health insurance for all foreigners (including overseas Koreans) appears to be continuously improving, showing a continued surplus.
This is the result of the health insurance authorities steadily strengthening the standards for applying health insurance to foreigners.
However, Chinese health insurance finances are still in deficit.
Foreigners refer to people with foreign nationality, including Koreans, and overseas Koreans refer to Koreans who maintain their Korean nationality while living abroad.
According to the written response to the government audit submitted by the Ministry of Health and Welfare to the Health and Welfare Committee of the National Assembly on the 27th, the total foreign national health insurance budget balance is KRW 256.5 billion in 2017, KRW 232 billion in 2018, KRW 373.6 billion in 2019, and KRW 373.6 billion in 2020. KRW 587.5 billion in 2021, KRW 512.5 billion in 2021, It recorded a surplus every year, including 544.8 billion won in 2022 and 730.8 billion won in 2023.
The cumulative surplus over the past seven years from 2017 to 2023 reached 3.2377 trillion won.
This means that all foreign national health insurance subscribers used health care institutions such as hospitals, clinics, pharmacies, etc. with the health insurance premiums they had paid and received much less insurance benefits from health insurance.
This is the result of continuous efforts by health insurance authorities to prevent foreigners from illegally receiving health insurance benefits and to make eligibility for domestic health insurance benefits more stringent.
Since July 2019, health insurance authorities have strengthened the standards for foreigners’ subscription and premium imposition, including changing the voluntary subscription system for foreigners to a mandatory subscription system.
Accordingly, foreigners who enter Korea and reside for more than six months are required to subscribe to health insurance as a local subscriber and pay the full premium unless they are an employee or a dependent.
A dependent is a person whose livelihood mainly depends on their children or family members who are working, and receives insurance benefits even if they do not pay health insurance premiums.
Starting April 3 this year, health insurance authorities raised the threshold so that foreigners and overseas Koreans entering the country must reside there for more than six months to become dependents. This is to prevent cases where foreigners list themselves as dependents as soon as they enter the country, go straight to the hospital, enjoy health insurance benefits without paying health insurance fees, and then leave the country. Health insurance authorities predict that with the implementation of this system, the number of dependents will decrease by about 10,000 per year.
From May 20th of this year, the ‘mandatory system for verification of patient identity and qualifications of patients at medical institutions’ has been implemented, and medical institutions such as hospitals and clinics must verify the patient’s identity and eligibility for health insurance using an ID card before applying health insurance when a patient visits. I was told to check it. Anyone who violates this will be subject to a fine.
The purpose is to prevent leakage of health insurance funds by preventing cases of illegal receipt of medical treatment or prescriptions by foreigners illegally residing in the country by stealing or renting health insurance cards.
Despite these measures, the Chinese health insurance budget continued to show a deficit.
So far, Chinese health insurance finances have recorded deficits every year, including in 2019 (-98.7 billion won), 2020 (-23.9 billion won), 2021 (-10.9 billion won), 2022 (-22.9 billion won), and 2023 (-64 billion won). .
In relation to this, some in the political world have argued that reciprocity should be applied to health insurance as a measure to address the Chinese health insurance fiscal deficit, but health insurance authorities have shown reluctance.
The Ministry of Health and Welfare actually expressed its opposition, saying, “Applying reciprocity only to specific countries with fiscal deficits may lead to other side effects such as diplomatic friction, so a cautious approach is needed.”
Reciprocity refers to the principle of diplomacy and trade in which a country responds accordingly depending on how the other country treats its country.
Korea’s current National Health Insurance Act (Article 109) and the Foreign Employment Act (Article 14) provide, in principle, that foreigners who are eligible for insurance are covered by health insurance like domestic citizens without discrimination based on nationality. These laws take precedence over the principle of reciprocity.
If national reciprocity is to be applied to health insurance, related laws must be revised.
The majority of foreigners residing in Korea are from underdeveloped or developing countries with lower levels of health insurance coverage than our country. China’s medical insurance is still in its early stages of development, so regional differences are large and medical facilities are lacking, so it falls short of international standards.
There are concerns that applying reciprocity to foreign health insurance may ultimately mean that the health insurance benefits provided to foreign subscribers are reduced compared to domestic subscribers, which could end up justifying discrimination.
Looking at overseas cases, there are many countries that place general restrictions on foreigners’ eligibility for health insurance, such as employment and period of stay, but it is difficult to find cases where foreigners from countries with low levels of health insurance coverage are disadvantaged when applying for health insurance.
▶ Report via KakaoTalk okjebo
Considering the potential downsides and benefits discussed, what policy recommendations would you make regarding reciprocity in Korean health insurance for foreigners?
Here are some open-ended questions based on the article, divided into thematic sections to encourage discussion and explore different viewpoints:
**I. Foreigner Health Insurance Surpluses**
* What does the continuous surplus in the foreign national health insurance budget reveal about the initial concerns surrounding foreigner insurance coverage?
* How might the strengthening of eligibility requirements for health insurance impact the healthcare accessibility for legal foreign residents in Korea?
* Do you think the emphasis on preventing misuse of the system might overshadow the genuine healthcare needs of some foreign residents?
**II. Chinese Health Insurance Deficit and Reciprocity**
* The article mentions Korea’s financial deficit in its overall National Health Insurance system. How might this deficit factor into the debate about applying reciprocity to foreigners’ health insurance coverage?
* While the article highlights potential downsides, are there any potential benefits to applying reciprocity to health insurance? Could it incentivize other nations to invest more in their own healthcare systems?
* Given China’s developing healthcare system, could reciprocity lead to unintended consequences for Korean citizens who may need medical care while in China?
**III. Ethical Considerations**
* What are the ethical implications of distinguishing between degrees of healthcare coverage based on a person’s nationality?
* How does the principle of universality in healthcare intersect with the idea of national reciprocity?
* If reciprocity is not the answer, what other approaches could be considered to address the financial concerns regarding foreigner health insurance while upholding ethical standards?
**IV. Broader Context and Policy Implications**
* How does the article’s findings relate to larger discussions about immigration policies and the responsibilities of host countries towards foreign residents?
* What role should international cooperation and dialog play in finding sustainable solutions to cross-border healthcare issues?
* How might Korea’s approach to foreigner health insurance serve as a model, or a cautionary tale, for other countries facing similar challenges?
Remember that these are just starting points. Encourage participants to elaborate on their answers, share personal experiences if relevant, and respectfully consider different perspectives.
