Building emergency-ready health systems that care for everyone

At its peak, the Covid-19 pandemic spread indiscriminately across borders. In East Asia and the Pacific, impacts varied widely by population, driven by a complex interplay of factors including government policies, public health responses and community engagement, and the preparedness of health systems. South Korea was one of the countries least affected by health care disruptions in the world. Hospitalization and death rates showed little change, and very vulnerable populations were able to access health care with minimal disruption.

South Korea’s commitment to Universal Health Coverage (UHC) and National Health Insurance (NHI) program have played a key role in effectively managing healthcare access and utilization during Covid-19. Our recent study, published in The Lancet, delves deeper into these aspects and offers insight into how strong health systems can improve the response to the pandemic. As nations plan for a more resilient and pandemic-ready future, three valuable lessons can be learned from South Korea’s experience.

1. Prioritize vulnerable groups

Since its inception, NHI has provided vulnerable groups with access to affordable and high-quality health care. The Medical Assistance Program, established in 1977, provides free or reduced-cost health care services to low-income households and people with disabilities. The NHI expanded its coverage in 1988 to cover the high percentage of people working in the informal sector at that time. Long-term care insurance for older people was introduced in 2008, initially targeting low-income older people, and then expanded to provide a comprehensive care package for all those in need. Generally, NHI premiums are proportional to income, and for low-income groups who are more likely to suffer from chronic diseases that require preventive care, premiums are covered by government subsidies.

2. Safe state budget for health insurance

South Korea’s National Health Insurance Law and the National Health Promotion Law require the government to allocate a certain portion of the national budget to the National Health Insurance Service. This safe budget allocation provides subsidies for low-income individuals and families and extends benefits to certain vulnerable groups, such as pregnant women, children and people with disabilities, enabling better 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. The WHO report noted that financial assistance programs helped reduce the financial burden of health care on vulnerable populations in Korea.

3. Real-time health data and analytics for policy

The NHIS has a platform that collects all health data in the country. The Health Insurance Review and Assessment Service enables the NHIS to inform government policy. During the Covid-19 pandemic, 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 make timely interventions such as providing vaccinations and testing for high-risk groups. It was used to help prioritize people who needed hospital care and underpinned policy to support vulnerable people who needed financial help and access to mental health services.

Valuable lessons across borders during a global crisis

Prevention, preparedness and response to health emergencies is a global challenge. At national, regional and global levels, we should continue to invest in stronger health systems that are increasingly able to deliver health care to all people. A key aspect here is to look at reforms that address inequalities and the disproportionate impact of health crises on marginalized and vulnerable groups in society. By removing financial barriers to care and treatment, using real-time data and prioritizing those most at risk, South Korea has helped set important steps that other countries 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 of South Korea for sharing their contributions and data.