Challenges in Strengthening National Health Insurance Coverage and the Necessity of Reforming Private Indemnity Health Insurance
10.21215/kjfp.2026.16.1.42
- Author:
Jong Myoung KIM
1
;
Hee Gyung KANG
;
Eun Jin HA
;
Sung-ju KIM
;
Junghee AHN
;
Mihwa YOO
;
Juhwan OH
Author Information
1. Department of Family Medicine, Pyeongchang County Health and Medical Center, Pyeongchang, Korea
- Publication Type:Review Article
- From:
Korean Journal of Family Practice
2026;16(1):42-47
- CountryRepublic of Korea
- Language:English
-
Abstract:
While South Korea’s National Health Insurance (NHI) was once disparaged as a rudimentary “discount program,” it has matured into the cornerstone of the nation’s medical safety net owing to sustained governmental initiatives. Nevertheless, the pursuit of expanded benefit coverage, exacerbated by demographic shifts toward low fertility and an aging society, has catalyzed a rapid escalation in aggregate national healthcare spending.Consequently, there is an urgent need for the NHI to implement benefit expansion policies that prioritize cost-efficiency and fiscal prudence. This perspective asserts that coverage enhancement should be strategically focused on high-cost catastrophic illnesses, specifically through the robust fortification of the annual out-of-pocket (OOP) maximum system. Furthermore, the reform of private health insurance is imperative, as its unbridled growth in non-reimbursable services has undermined the efficacy of public coverage efforts. This paper proposes concrete policy frameworks for both the enhancement of the OOP maximum system and the structural reform of private indemnity health insurance.
