3 Important Differences Between Primary Healthcare in South Korea and the U.S.

Disclaimer

Although we had survey respondents from all around the world, we chose to focus on the United States for this blog post because the U.S. healthcare system is dramatically different from South Korea’s. The main difference being that the U.S. doesn’t have universal healthcare like many other places such as Australia, Canada and the United Kingdom. However, if you are not from the U.S., don’t let this deter you from reading on. There will be some useful information on South Korea below that you can use to compare with your home country.

2021 SOS Public Health Survey on access to Primary Healthcare in South Korea

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Survey says…

We have been in the process of analyzing our 2021 SOS Public Health Survey responses. As we analyzed our survey results, we noticed an inconsistency among responses regarding individual understanding of primary health care. While some respondents referred to primary health care and health insurance synonymously, others believed primary health care to include specialized services and surgeries. As a result of this finding, we realized the importance of health literacy in regard to primary health care. Navigating a foreign health system can be extremely difficult if you aren’t familiar with how your home country’s health system works.

Therefore, understanding the differences in primary healthcare between the U.S. (or your home country) and South Korea gives you the upper hand to maneuvering your way through a healthcare system. This, in turn, allows you to advocate for your health and increase your access to healthcare services. Below are 3 important differences between primary healthcare in South Korea and the U.S.

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1. The Definition of Primary Healthcare

Both the U.S. and South Korea define primary healthcare, emphasis on “primary”, differently.

Primary Healthcare in the U.S.

The definition of primary healthcare has been redefined many times over the years. Several definitions have three main points in common: (1) primary healthcare is the first point of contact (gatekeepers) for a patient to a physician; (2) the focus of care is health promotion and disease prevention; and (3) the overarching goal is to increase accessibility of care to achieve the highest level of health in a population. In order to define primary healthcare as a whole, the the World Health Organization (WHO) and UNICEF formed the following definition:

“[Primary healthcare] is a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs and as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care, and as close as feasible to people’s everyday environment.”

World Health Organization. (2021, April 1). Primary health care. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/primary-health-care.

So, what types of medical services are provided under the primary healthcare umbrella? Primary healthcare medical services are services that can be provided by a general practitioner or family physician. These services include family medicine and internal medicine. Learn more about family and internal medicine here.

Any service that requires a specialist (i.e. cardiologist, dermatologist, etc.) is considered secondary healthcare. Any service that requires the use of highly specialized equipment (i.e. surgeries, transplants, etc.) would be considered tertiary care, and so on. In order to access these “higher” levels of healthcare services, in most cases, you must first receive a referral from your primary healthcare provider.

Primary Healthcare in South Korea

Similarly to the U.S., South Korea defines primary care as “the healthcare service first encountered by people (Cho et al., 2020).” However, two big differences delineate South Korean primary healthcare from U.S. primary healthcare.

First, rather than having a tiered system for medical services, South Korea has a tiered system for types of hospitals. IFEZ Global Center and Expat Guide Korea provide an excellent explanation of how this tiered system works (note: these articles label the tier system differently, I will be referencing the levels listed on the IFEZ site). Primary healthcare in Korea falls under the services of tier 1 hospitals/clinics. In addition to family and internal medicine-type services, tier 1 hospitals/clinics in South Korea may include some specialized services. See a list of specialized services that may fall under the tier 1 hospital domain here.

Second, Korea practices gatekeeping differently. In South Korea, there is little to no gatekeeping on specialized services. Many specialized services do not require a referral from a general practitioner as they do in the U.S. The gatekeeping in Korea occurs when a patient needs to visit a larger General Hospital (tier 3). In this case, a tier 1 or tier 2 hospital referral is needed before accessing tier 3 services. That said, you can still make an appointment at a tier 3 hospital without a referral; just keep in mind, that without a referral, your Korean National Health Insurance may not fully cover your treatment.

2. Primary Healthcare and Health Insurance

Health insurance also works differently in the U.S. and South Korea.

Health Insurance in the U.S.

Because the U.S. doesn’t have universal health care, access to primary care services based on insurance coverage differs greatly among individuals and families. In the U.S., not all health insurance is created equally. On average, individual spending on health insurance amounts to about $456 per month and $1,152 for a family per month (Poretta, 2020). If you don’t have some type of insurance, you may have limited access to primary healthcare services. With or without insurance, in the U.S., out-of-pocket costs remain high. You can increase your healthcare coverage by purchasing private or supplemental health insurance. However, purchasing private or supplemental insurance packages can get pricey. If you can afford these types of full coverage insurance packages, you can receive really great medical care. But, if you can’t afford insurance, visiting the hospital for minor ailments can seem daunting.

Health Insurance in South Korea

In South Korea, National Health Insurance (NHIS) is provided to all registered residents (though there are some cases when registered residents remain uninsured). All registered residents must pay into the insurance system in Korea. For international residents, automatic enrollment occurs after living in the country for six months. From this 6-month point, international residents must begin paying into the NHIS. If you don’t start payment, your bill will continue accruing costs until paid. I learned this the hard way. Just a few days ago, I received a hefty bill in the mail for the cost of about 5 months worth health insurance. Although I never registered myself for NHIS (because I had international student insurance), I was automatically enrolled once my 6-month mark hit. Expat Guide Korea has a great article that explains how NHIS works.

Although I have this large bill to pay, I am grateful to have access to the NHIS insurance. NHIS covers between 50-80% of an individuals medical cost depending on the service utilized. Fifty percent of coverage may seem low. However, the cost of medical services is overall much lower in Korea compared to the U.S. For those who need more specialized care services, the option to purchase private or international insurance is also available to help reduce cost of treatment.

NHIS is easy to use because it is tied to your Alien Registration Card (ARC) number. So, when hospitals look up your ARC number, insurance is automatically applied (no need for insurance cards or numbers). On average, NHIS costs about 120,000 won (roughly $120 USD) per person per month. Your salary determines the amount you will pay for health insurance. For those employed in Korea, depending on your job, your employer may cover up to 50% (or more in some cases) of your health insurance payment.

3. Primary Health Care and Copays

Last but not least, here are the differences in U.S. and South Korean copayment (copay) systems.

Copays in the U.S.

In the U.S., some insurances require a copay for services. Copays are fixed dollar amounts designated by the insurer. So, with a copay in the U.S. you always know how much you will pay when you seek medical services.

Copays in South Korea

In Korea, copays essentially function as deductibles would in the U.S. Korea calculates copays as a percentage of your medical care costs. According to Korea4Expats.com, for inpatient care, the patient covers 20% of the total medical bill as the copay. Copay percentages increase with the use of different tiered hospital systems: dental care (30%), outpatient care hospitals (40%), general hospitals (50%). You can reduce your copay amount by purchasing private insurance. Copays in Korea have a ceiling of 3 million won (roughly $3,000 USD) over a six month period.

Twenty percent of a medical bill can seem extremely terrifying when you think in terms of cost of medical care in the U.S., but fear not! In most cases, medical care tends to be relatively cheap which, in turn, makes copays (as low as 3,000 won [roughly $3 USD]) relatively cheap as well, depending on the type of medical care you receive. See below for the breakdown of outpatient copays based on area and hospital type.

Source: https://www.korea4expats.com/article-medical-expenses-korean-health-insurance.html

You have access. Don’t be afraid to use it.

With Korea’s universal healthcare system in place, just about anyone can access primary healthcare easily. Don’t let the copay percentages scare you. They seem high, but medical services in Korea are cheaper than you might expect. As a personal example, once upon a time in Korea, I was hospitalized overnight on an IV in the emergency room WITHOUT INSURANCE(this was before the automatic enrollment policy was in place). I was terrified of what I would have to pay when I left the hospital because I had friends in the U.S. who paid $10,000 out-of-pocket WITH INSURANCE for similar situations. I paid 60,000 won (roughly $60 USD).

Korean primary medical care is amazing. We can access so many different kinds of primary healthcare services here with little opposition. Most places allow walk-ins and the majority of basic care services are relatively affordable. Don’t be afraid to use these services. If you are unsure whether you are covered by NHIS, you can always call or stop in at a regional or local NHIS branch office to find out. Always do some research on cost and types of services available before visiting a hospital or clinic. This will take the stress out of being slapped with a big bill on the spot.

But don’t take my word for it. Here is what our U.S. survey respondents living in South Korea had to say about the accessibility and affordability of Korean healthcare.

In future blog posts, we will cover the importance of cultural competency in healthcare access, as well as, how to overcome language barriers. There is also a ton more survey data to share. So, stay tuned!

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