Spectre of Ageing Population Worries Economists: Having Achieved So Much in Extending Health-Care Coverage over the Past 30 Years, the Republic of Korea Is Faced with Ballooning Costs from an Ageing Population
2010; World Health Organization; Volume: 88; Issue: 3 Linguagem: Inglês
ISSN
1564-0604
Autores Tópico(s)Global Health Care Issues
ResumoEighty-one-year-old Lee Yang-soon remembers how things were before the Korean War (1950-53). Many women died giving birth, she says, adding that, even after the war, health services were limited. Most pregnant women did not receive prenatal checkups and gave birth at home. Even when babies were born healthy, some of them died without the exact cause of death being verified, Lee says. Other health-care services were also poor then. was suffering from a skin disease. The medical costs were too expensive and the drug didn't work well. I used to apply a Japanese ointment that my friend who travelled to Japan frequently bought for me. It took another 20 years for the situation to begin to change. In 1976, the government introduced the National Health Insurance (NHI) scheme, obliging companies employing more than 500 people to offer the scheme. In the ensuing decade, this obligation was extended to smaller companies, then government and private school employees and finally the self-employed, who were brought under the umbrella of mandatory national health insurance in 1989. Running parallel to the NHI, the Medical Aid Program, a government-funded public assistance scheme, was established in 1977 to provide free medical insurance coverage to eligible low-income individuals, about 3% of the population in 2008. In the past 30 years, average life expectancy in the Republic of Korea increased from 64.8 to 78.5 years close to the average among member countries of the Organisation for Economic Co-operation and Development (OECD). Infant mortality also improved, from 27 deaths per 1000 live births in 1977 to 5.3 per 1000 in 2007, better than the OECD average of 6.1. Several factors may have contributed to the overall health improvement of people in the Republic of Korea, but the implementation of the health insurance system seems to be one of the most decisive factors, says Seo Namkyu, a research fellow at the Institute for National Health Insurance, an affiliate of the National Health Insurance Corporation. Lee Yang-soon's daughter-in-law, Lee In-sook, born in 1958, would be the first to agree. A cooking teacher at a local food institute in Seoul, Lee In-sook gave birth to her two daughters in 1983 and 1987 and the cost of prenatal care was never a concern. felt no financial burdens when I was pregnant, she says. visited hospital every month to have my baby checked. Her first daughter was born naturally but with her second she needed a Caesarean section, and for that she had to meet the entire cost of almost 1.2 million won (approximately US$ 1000). Two years later, when the mandatory national health insurance programme started, it covered 50% of the cost of Caesarean sections, and it now pays up to 80% of the total cost. Sharing the cost of care is a generally accepted fact of life in the Republic of Korea where, according to the OECD, the total proportion of household expenditure on health care, including payments into health insurance, stands at 10.5%--less than the OECD average of 12.9%. But it is a system with obvious limits. Cancer patients, whose treatment might involve multiple surgical interventions, chemotherapy and a prolonged period of hospitalization, may face huge bills as the NHI covers only 75% of the cost. Lee In-sook, who lost both her mother and a sister to cancer, considers additional private health insurance a necessity, even though it is expensive. Last year her mother-in-law had hip replacement surgery. While the NHI covered 50% of the cost, the family shouldered the remainder. [ILLUSTRATION OMITTED] The Republic of Korea has the highest out-of-pocket spending of any OECD country, with 36% of total health expenditure coming directly from patient payments at the point of service in 2007. Inevitably, this results in unaffordable bills for some: in 2007, an estimated 3% of all households in the country suffered catastrophic expenditure, defined by the World Health Organization as an obligatory disbursement greater than or equal to 40% of residual household income after basic needs have been met. …
Referência(s)