Building emergency-ready health systems that care for everyone

At its peak, COVID-19 moved indiscriminately across borders. In East Asia and the Pacific, the impact varied significantly between populations, influenced by a complex interplay of factors including government policies, public health responses and community engagement, alongside health systems readiness. South Korea was one of the least affected countries in the world in terms of disruptions to health services. Hospitalization and death rates showed little change, and highly vulnerable populations were able to access health care with minimal disruption.

South Korea’s commitment to Universal Health Coverage (UHC) and their National Health Insurance (NHI) scheme played a crucial role in successfully managing healthcare access and utilization during COVID-19. Our latest study, published in The Lancet, delves into these aspects, providing insights into how robust health systems can improve pandemic response. As nations plan for a more resilient and pandemic-prepared future, three valuable lessons can be learned from South Korea’s experience.

1. Priority of vulnerable groups

Since its inception, NHI has ensured that vulnerable groups have access to affordable and quality healthcare. The Medical Assistance Program, established in 1977, provides free or reduced-cost health care services to low-income families and people with disabilities. The NHI expanded its coverage in 1988 to cover the high proportion of people working in the informal sector at that time. Long-term care insurance for seniors was introduced in 2008, initially to target low-income seniors, and expanded to provide a comprehensive package of care for all who need it. In general, NHI contributions are proportional to income and, for low-income groups that suffer more from chronic diseases requiring preventive care, contributions are covered by government subsidies.

2. A secure national health insurance budget

South Korea’s National Health Insurance Act and National Health Promotion Act require the government to allocate a certain percentage of the national budget to the National Health Insurance Service. This secure budget allocation subsidizes low-income individuals and families and extends benefits to certain vulnerable groups, such as pregnant women, children and people with disabilities, enabling improved access to health care. Even during the pandemic, subsidized testing and treatment, expanded benefits, and telemedicine services continued for the entire population. In early 2020, the government approved four supplementary budgets to provide stimulus funds to citizens, stabilize the economy, and cover the costs of testing, treatment, and other expenses related to COVID-19. A WHO report noted that financial assistance programs have helped reduce the financial burden of health care for vulnerable groups in Korea.

3. Real-time health data and analytics to inform policy

NHIS has a platform that brings together all health related data in the country. The Health Insurance Review and Evaluation Service allows the NHIS to inform government policy. During COVID-19, this helped the government assess how the pandemic was affecting different populations. For example, it was used to track the spread of the virus and initiate timely interventions, such as providing vaccinations and testing for high-risk groups. It was used to help prioritize who would need hospital care and supported policies that supported vulnerable people who needed financial help and access to mental health services.

Valuable lessons across borders during a global crisis

Health emergency prevention, preparedness and response is a global challenge. At the country, regional and global levels, we must continue to invest in stronger health systems that are increasingly able to provide health care for all people. A critical aspect of this is to look at reforms that address disparities and the disproportionate impact of health crises on marginalized and vulnerable populations. By removing financial barriers to care and treatment, embracing real-time data and prioritizing those most at risk, South Korea has helped chart important steps that other nations can build on.

Acknowledgments: We would like to express our sincere gratitude to David Bishai from the University of Hong Kong and Soonae Shin from the National Health Insurance Service in South Korea for sharing their data and information.