Health resources and management in Korea: development in the past, current issues and perspectives
Song, K.Y.
In'gu Pogon Nonjip 8(1): 148-179
1988
PMID: 12281933 Document Number: 360376
Korea's health system has undergone major changes since the late 1970's due to massive economic growth developments. Compulsory health insurance was initiated for all wage earners in 1977 and was expanded to all rural and urban residents in 1980 and 1989. Health resources in the form of human and physical resources and health expenditures are very important to the success of any health insurance system. Korean economic growth in the past 40 years is staggering. It has gone from a per capita income of US $70 in the 50's to over US $2000 in the 80's. Korea is now an upper middle-income country. Population has more than doubled since 1949. Urbanization has increased from 28% in 1960 to 65% in 1985. Reduction of fertility through family planning practices is currently being promoted. Korea has developed 5 health care plans over a 25 year period -- from the 1954-60 allocation of funds for leprosy and tuberculosis control to the 1982-86 'health for all by 2000" policy. The National Health Insurance Program will be initiated in 1989. Communicable diseases were the major cause of death in the 60's, cardiovascular disease in the 70's, and chronic degenerative diseases in the 80's. Incidences of communicable diseases, tuberculosis and parasite infection have all decreased dramatically in the past few decades. Perceived unhealthiness has increased from 1981-87. The 1980's has ushered in a higher utilization of curative care, safe deliveries and immunizations. Inequalities in health care still exist and result from socioeconomic inequalities. Medical resources must be distributed adequately to alleviate inequality. Middle-level health personnel is lacking in Korea at this time, while upper-level personnel has increased. Physical resources tend to be wasted -- there is a high nonoccupancy rate of hospital beds. Other physical resource problems can be partially eliminated by a more equal distribution of health facilities relative to demand. Health insurance utilization has grown annually, however low income populations usually show a low usage rate. Payment-reimbursement methods include fee-for-service (FFS), capitation, salary, case payment, or a combination. In the future this payment system must be improved in order to achieve comprehensive care. Important policy issues are consensus on rising health expenditure; equity and efficiency of health services; role of the hospital and clinic; priority of primary care; rural health care delivery; rural hospitals; health care delivery system; payment-reimbursement scheme; governmental financial input; primary care reinforcement; and measures for the changes in disease patterns.