Building emergency ready health systems that care for all

At its peak, COVID-19 moved indiscriminately across borders. In East Asia and the Pacific, the impact varied significantly among populations, influenced by a complex interplay of factors including governmental policies, public health responses, and community engagement, alongside the readiness of health systems. South Korea was one of the least affected countries in the world in terms of health service disruptions. Hospitalization and death rates showed little change, and highly vulnerable populations were able to access healthcare 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 recent study, published in The Lancet, delves into these aspects, offering insights into how robust health systems can enhance pandemic response. As nations plan a more resilient and pandemic prepared future, three valuable lessons can be learned from the South Korean experience.

1. Prioritizing vulnerable groups

Since its inception, the NHI has ensured that vulnerable groups have access to affordable and quality healthcare. The Medical Aid program, established in 1977, provides free or reduced-cost healthcare services to low-income households 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 the elderly was introduced in 2008, initially to target low-income elderly people, and expanded to provide a comprehensive package of care to all who need it. Generally, NHI contributions are proportional to income and, for low-income groups who suffer more from chronic diseases requiring preventive care, the 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 budgetary allocation subsidizes low-income individuals and families, and expands benefits to certain vulnerable groups, such as pregnant women, children, and people with disabilities, enabling improved healthcare access. 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 COVID-19 related expenses. A WHO report noted that the financial assistance programs have helped reduce the financial burden of healthcare on vulnerable groups in Korea.

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

The NHIS has a platform that brings together all health-related data in the country. The Health Insurance Review and Assessment service allows the NHIS to inform government policies. 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 underpinned policies that supported vulnerable people needing financial assistance 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 country, regional, and global levels, we should 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 inequities 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 map out important steps that other nations can build on.

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