Yoo Katelyn Jison, Lee Yoonkyoung, Park Sooyeol, Cha Yerin, Kim Junghoe, Lee Taejin, Patenaude Bryan, Bishai David
World Bank, South Korea.
Seoul National University, South Korea.
Lancet Reg Health West Pac. 2024 Dec 30;54:101269. doi: 10.1016/j.lanwpc.2024.101269. eCollection 2025 Jan.
South Korea has witnessed a rapid increase in health expenditure, reaching USD 135 billion in 2021 and accounting for 9.3% of its GDP, surpassing the OECD average. Despite achieving universal health coverage, significant gaps remain in service coverage, leading to high out-of-pocket (OOP) expenses that expose households to financial burdens.
This study examines healthcare spending in South Korea from 2011 to 2020 using national datasets, focusing on expenditures across two primary payer categories: public insurance and OOP payments. Data were stratified by health condition, age group, sex, type of care, and income level. A combination of the National Health Insurance (NHI) dataset and the Korea Health Panel Survey (KHPS) was used to estimate total health expenditures, with multiple imputation methods applied to address data gaps.
Healthcare expenditure in South Korea rose significantly from $45.6 billion in 2011 to $76.9 billion in 2020, placing an increasing economic burden on the system. Public health insurance spending grew at an annual rate of 5.1%, while OOP expenses rose by 5.0% for covered services and 6.7% for uncovered services. Despite a shift toward greater public funding-with public expenditure comprising 64.4% of total spending in 2020-OOP payments still accounted for 35.6%, remaining above the OECD average. Individuals aged 60 and above contributed to 51.3% of total expenditures. Gender disparities emerged, especially in high-cost areas like obstetrics and gynecology, where women incurred higher OOP costs. Additionally, uncovered services experienced significant spending growth across all income levels, with major cost contributors including musculoskeletal disorders, urinary tract disorders, and chronic diseases such as hypertension and diabetes.
This study highlights the need for targeted healthcare policies in South Korea to address rising costs and persistent inequalities. High OOP expenses disproportionately impact vulnerable groups, especially women and the elderly, while uncovered medical costs are growing across income levels, straining households. Conditions like musculoskeletal disorders, hypertension, and diabetes, along with gender-specific costs such as obstetric care, emphasize access inequities. Uncovered OOP expenses are rising faster than covered services, particularly among older adults. Addressing these issues requires policies to ease financial burdens and ensure equitable healthcare access.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
韩国的医疗支出迅速增加，2021年达到1350亿美元，占其国内生产总值的9.3%，超过了经合组织的平均水平。尽管实现了全民医保，但服务覆盖方面仍存在显著差距，导致高额的自付费用，使家庭承受经济负担。
本研究使用国家数据集考察了2011年至2020年韩国的医疗支出，重点关注两个主要支付方类别的支出：公共保险和自付费用。数据按健康状况、年龄组、性别、护理类型和收入水平进行分层。结合使用国家健康保险（NHI）数据集和韩国健康面板调查（KHPS）来估计总医疗支出，并应用多重插补方法来解决数据缺口。
韩国的医疗支出从2011年的456亿美元显著增加到2020年的769亿美元，给该系统带来了日益沉重的经济负担。公共医疗保险支出以每年5.1%的速度增长，而对于已覆盖服务，自付费用增长了5.0%，对于未覆盖服务则增长了6.7%。尽管公共资金的比例有所增加——2020年公共支出占总支出的64.4%——但自付费用仍占35.6%，高于经合组织平均水平。60岁及以上的个人占总支出的51.3%。出现了性别差异，尤其是在产科和妇科等高成本领域，女性的自付费用更高。此外，在所有收入水平上，未覆盖服务的支出都有显著增长，主要成本贡献因素包括肌肉骨骼疾病、泌尿系统疾病以及高血压和糖尿病等慢性病。
本研究强调韩国需要制定有针对性的医疗政策，以应对不断上升的成本和持续存在的不平等问题。高额的自付费用对弱势群体，尤其是妇女和老年人产生了不成比例的影响，而未覆盖的医疗费用在各收入水平上都在增加，给家庭带来了压力。肌肉骨骼疾病、高血压和糖尿病等病症，以及产科护理等特定性别的费用，凸显了医疗服务获取方面的不平等。未覆盖的自付费用增长速度快于已覆盖服务，尤其是在老年人中。解决这些问题需要政策来减轻经济负担并确保公平的医疗服务获取。
本研究未获得公共、商业或非营利部门的资助机构提供的任何特定资助。
