Total medical expenses for Korea's national health insurance patients rose 4.2% last year to approach 140 trillion won, while the coverage rate remained unchanged at 64.9%, according to a government survey released Monday.
The National Health Insurance Service (NHIS) announced the results of its "2024 Survey on Medical Expenses of Health Insurance Patients," showing total medical expenses including non-covered treatments reached approximately 138.6 trillion won ($102 billion).
Of the total, insurer-covered expenses accounted for 90 trillion won, statutory copayments for 26.8 trillion won, and non-covered treatment costs for an estimated 21.8 trillion won. Total medical expenses rose 4.2% from 133 trillion won the previous year and increased 65.6% compared to 83.7 trillion won in 2017.
The health insurance coverage rate remained at 64.9%, unchanged from the previous year. The statutory copayment rate decreased by 0.6 percentage points from 19.9% to 19.3%, while the non-covered treatment burden rate rose by 0.6 percentage points from 15.2% to 15.8%.
Excluding administrative costs such as certificate issuance fees and items with low necessity for coverage—including nutritional injections, manual therapy, and premium private room charges—the coverage rate stood at 66.6%.
The health insurance coverage rate represents the proportion of total medical expenses, excluding over-the-counter drugs, cosmetic prosthetics, and health-promoting herbal medicines, that is covered by the NHIS. If a health insurance patient incurs 1 million won in medical expenses, 649,000 won is covered by health insurance while the patient pays 351,000 won out of pocket. Of the 351,000 won, 193,000 won represents the legally mandated copayment, and 158,000 won covers non-covered treatments.
By medical institution type, coverage rates at tertiary hospitals, general hospitals, hospitals, and clinics increased, while nursing hospitals saw a decline.
Tertiary hospitals recorded the highest year-on-year increase of 1.4 percentage points, reaching a coverage rate of 72.2%. General hospitals rose 0.6 percentage points to 66.7%. Hospitals saw coverage rates climb 0.9 percentage points to 51.1%, influenced by policy fees for obstetrics and gynecology, including 116.2 billion won in insurance payments for childbirth-related services last year. Non-covered copayment rates at these facilities also declined due to reduced non-covered examination fees.
Nursing hospitals (67.3%) and pharmacies (69.1%) saw coverage rates decrease by 1.5 percentage points and 0.3 percentage points respectively, as non-covered treatment costs increased primarily for cancer-related conditions.
Coverage rates for severe and high-cost medical conditions declined slightly from the previous year. The top 30 severe and high-cost conditions by per-capita expenses—including leukemia, pancreatic cancer, and lymphoma—had a coverage rate of 80.2%, while the top 50 conditions, including laryngeal and bladder cancer, showed a rate of 78.5%. These represented decreases of 0.7 percentage points and 0.5 percentage points respectively.
Coverage for the four major severe diseases fell 0.8 percentage points to 81.0%, with cancer coverage dropping 1.3 percentage points to 75.0%.
By demographic characteristics, coverage for children aged 0-5 rose 3.0 percentage points to 70.4%, driven by pediatric rehabilitation medical institution programs and new policy fees for children's medical services. Coverage for those 65 and older edged down 0.1 percentage points to 69.8%, as increased use of non-covered medical supplies for cataracts and musculoskeletal treatments raised out-of-pocket burdens.
By income level, lower-income groups showed higher coverage rates and greater benefits from the copayment ceiling system.
