Dilemmas Within the Korean Health Insurance System

• Published in: Journal of preventive medicine and public health Vol. 53; no. 4; pp. 285 - 288
• Main Authors: Park, Donghwi, Chang, Min Cheol
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society for Preventive Medicine 01.07.2020; 대한예방의학회
• Subjects: Attitude of Health Personnel; Fee-for-Service Plans - statistics & numerical data; health insurance review and assessment service; health insurance system; Humans; Insurance Claim Review - statistics & numerical data; Insurance, Health - statistics & numerical data; korea; National Health Programs - organization & administration; patient; payment; Physicians - economics; Physicians - psychology; Republic of Korea; 예방의학; Republic of Korea; Health Insurance Review and Assessment Service; Patient; Payment; Health insurance system; Korea
• ISSN: 1975-8375; 2233-4521; 2233-4521
• DOI: 10.3961/jpmph.20.074

The health insurance system in Korea is well-established and provides benefits for the entire national population. In Korea, when patients are treated at a hospital, the hospital receives a partial payment for the treatment from the patient, and the remaining amount is provided by the health insurance service. The Health Insurance Review and Assessment Service (HIRA) assesses whether the treatment was appropriate. If HIRA deems the treatment appropriate, the doctor can receive payment from the health insurance service. However, this system has several drawbacks. In this study, we aimed to provide examples of the problems that can occur in relation to HIRA assessments in Korea through actual clinical cases.