Global Health Project: South Korea by Gilbert Bundalian, Johanna Hudson, & Gurneek Sandhu

(World Health Organization, 2017)

Life Expectancy & Morbidity/Mortality in 2015

South Korea

Life Expectancy:

  • Males: 79
  • Females: 86

Morbidity/Mortality:

  1. Cerebrovascular Disease
  2. Ischemic Heart Disease
  3. Lung Cancer
  4. Alzheimer Disease
  5. Self-Harm

United States

Life Expectancy:

  • Males: 77
  • Females: 82

Morbidity/Mortality:

  1. Ischemic Heart Disease
  2. Alzheimer Disease
  3. Lung Cancer
  4. Cerebrovascular Disease
  5. COPD

(World Health Organization, 2017)

South Korea, 2015 [Figure 1} and United States, 2015 [Figure 2]

(Institute for Health Metrics and Evaluation, 2015)

Comparing the progress of the United Nations Sustainable Development Goals (SDGs) in 1990 to 2015 in South Korea and United States as shown in Figures 2 and 3:

Similarities

The following are at an index value of 100.00: war (decrease in mortality rate due to collective violence and legal intervention), stunting (no prevalence of stunting among children under 5), wasting (no prevalence of childhood wasting among children under 5), skilled birth attendance (100% coverage of skilled birth attendance), water (0% risk-weighted prevalence of populations using unsafe water or unimproved water sources), sanitation (0% risk-weighted prevalence of populations using unsafe or improved sanitation), and household air pollution (0% risk-weighted prevalence of household air pollution). This indicates that both countries have reached their SDG by 2015 (Institute for Health Metrics and Evaluation, 2015).

Differences

Tuberculosis is a major health issue in South Korea, compared to the United States. It is an infectious disease that affects the lungs. According to the World Health Organization (WHO), tuberculosis is one of the top 10 causes of death worldwide. In fact, the WHO states that in 2015 the total number of cases notified in South Korea was 40,847, compared to the United States with 9,551 cases (World Health Organization, 2017).

Suicide is a mental health issue that is more prevalent in South Korea than in the United States. According to the Organization for Economic Cooperation and Development, in 2013 alone the suicide rate in South Korea was 28.7 per 100,000 persons, compared to the United States, which was 13.1 per 100,000 persons (Organization for Economic Cooperation and Development, 2013).

Smoking is a health risk that knows no gender or age. It is a health-harming problem that can lead to disease such as cardiovascular disease, stroke, and cancer. According to The Tobacco Atlas, in 2013, 42.2% of adult men smoke and 5.9% of females smoke in South Korea, whereas in the United States 17.2% of adult men smoke and 14.2% of adult women. In regards to children smoking, in South Korea 9.8% of boys smoke and 4.3% of girls smoke. Compared to the United States, 2.1% of boys smoke and 1.6% of girls smoke (Eriksen, 2010).

Obesity is a health issue that is prevalent worldwide. It is a common morbidity that many Americans face. According to The World Factbook, in 2014 the United States ranked #18 in adult prevalence of obesity worldwide with 35% of the population being obese. Compared to South Korea, it is ranked #139 worldwide with only 6.3% of the population being obese (The World Factbook, 2017).

Alcohol consumption is a common practice in various cultures for many years. It is often used in social settings or in times of celebration. However, inappropriate alcohol consumption can also place a person at risk for diseases both physically and mentally, such as liver disease, cirrhosis, cancer, and injury from violence and motor vehicle accidents. According to the World Health Organization, in 2010 the total alcohol per capita consumption in those ages 15 and older was 27.5 liters of pure alcohol in South Korea, while in the United States it was 13.3 liters of pure alcohol (World Health Organization, 2017).

The Three Arms of Healthcare Security: National Health Insurance Program, Medical Aid Program, and Long-Term Care Insurance Program

History of the National Health Insurance Program: Universal Coverage for all Citizens

The first health insurance law in South Korea, the Medical Insurance Act, came into force in December 1963. From July 1977, all companies with more than 500 employees were required to provide a health insurance program, and separate health insurance societies were established (Song, 2009).

In January 1979, the insurance coverage requirement was expanded to companies with more than 300 employees, public servants, and private school employees. The year 1989 is the most important year in the history of South Korean National Health Insurance Program. In July of that year, the health insurance program for urban areas was expanded to include the self-employed (Song, 2009).

It took 12 years from the establishment of the Medical Insurance Act to achieve universal health insurance coverage for all citizens. In 2000, all health insurance societies were integrated into a single insurer, the National Health Insurance Program (Song, 2009).

Structure and Operation of The National Health Insurance Program

The National Health Insurance Program is broadly divided into four parts.

First, the Ministry of Health, Welfare, and Family Affairs (MIHWAF) is in charge of supervision and policy decisions. It supervises the operation of the National Health Insurance Program through the formulation and implementation of policies (Kwon, 2015).

Second, the National Health Insurance Corporation (NHIC) is in charge of managing the National Health Insurance Program, namely the enrollment of insured people and their dependents, collection of contributions, and setting of medical fee schedules (Kwon, 2015).

Third, the Health Insurance Review Agency (HIRA) is in charge of reviewing medical fees and health care evaluation. After receiving medical care, the patient can submit a claim to HIRA requesting a review of his/her medical fees, and the NHIC may reimburse the claim.

Fourth, medical care institutions provide healthcare services. They are directed and supervised by the MIHWAF (Kwon, 2015).

Population Coverage and Payment of Contribution

It is mandatory by law for everyone in South Korea to obtain health insurance. All employed people in South Korea are eligible for coverage under the National Health Insurance Program. In 2006, the total number of covered people was over 47 million, or over 96.3% of the total population. The remaining 3.7% are supported by the Medical Aid Program (Song, 2009).

The National Health Insurance Program is divided into two groups:

1. Employee insured - includes the insured person’s spouse, descendants, brothers or sisters, and direct lineal ascendants.

  • 28,445,033 (57.7%) people are insured by their employee (Song, 2009).
  • Insured employees pay 5.08% of their average salary in contribution payments (Song, 2009).
  • Contribution rates change every year

2. Self-employed insured - includes people excluded from the category of insured employee

  • 18,964,567 (38.6%) people have self-employed insurance (Song, 2009).
  • Their contribution amount is set taking into account their income, property, living standard, and rate of participation in economic activities.

Co-Payments - The insured individual is required to pay a certain portion of the health care costs. The co-payments differ according to the level and type of medical care institution. When an insured individual pays more than the co-payment ceiling threshold within a period of six consecutive months, he or she is exempted from any further co-payments incurred (Song, 2009).

Funding Sources of The National Health Insurance Program

The National Health Insurance Program has three sources of funding: contributions, government subsidies, and tobacco surcharges (Kwon, 2015).

The first source of funding is the payments (contributions) made by the insured.

  • Employee insured individuals are required to contribute 5.08% of their salary. The employer and employee each pay 50% of this amount (Kwon, 2015).
  • The contributions of self-employed insured individuals are based on their level of income. To calculate the income, the insured person’s property, income, motor vehicles, age, and gender are taken into consideration.

For the insured living on islands or remote rural areas, there is a system of reduced contributions.

The second source of funding is through the government. The government of South Korea provides 14% of the total annual projected revenue (Kwon, 2015).

The third source of funding is the surcharge on tobacco. This provides 6% of the total annual projected revenue (Kwon, 2015).

The Medical Aid Program

Around 3.7% of the total population is covered under the Medical Aid Program. As of 2006, the number of people enrolled under the Medical Aid Program is 1,828,627 out of the total national population of 49,238,227 (Song, 2009).

The Medical Aid Program was established in 1979 for low-income households. Under this program, the government pays all medical expenses for patients who are unable to pay for health care. After 2004, the Medical Aid Program was expanded to cover patients with rare, intractable, and chronic diseases as well as children under the age of 18 (Song, 2009).

The Medical Aid Program is jointly funded by the central and local governments. The Ministry of Health, Welfare, and Family Affairs sets the criteria for those who will receive funding through this program (Song, 2009).

Recently the government has faced financial difficulty in providing the needed medical services for low-income people, and changed the system so that the National Health Insurance Program provides partial funding for the Medical Aid Program (Song, 2009).

Long Term Insurance Program

Recently, life expectancy in South Korea has increased sharply, rising more than eight years over the past 20 years. Traditionally, taking care of elderly people had been a major family burden in South Korea. To solve this problem, the government introduced a Long-term Care Insurance Program in July 2008 in several locations around the country as a pilot implementation study (Song, 2009).

It is a social insurance system and currently covers 3.8% of elderly Koreans (Song, 2009).

Elderly people with serious limitations in performing activities of daily living (ADLs) are qualified to apply for the program. For example, those aged 65 years or older, or those aged less than 65 years old but suffer from an age-related disabling condition such as Alzheimer’s disease, Parkinson’s disease, or paralysis due to stroke, can apply for the program. If they are qualified as a beneficiary, they receive medical treatment services including baths, laundry, and nursing care (Song, 2009).

Long-term Care Insurance Program is funded by long-term care insurance contributions paid by the insured, government subsidies, and co-payments by beneficiaries. The government finances 20% of total long-term care insurance, which is based on a co-payment system. Users of the services pay 15% (in-home services)–20% (institution services) of the expenses for care services (Song, 2009).

The national government hopes to expand the program to include coverage of elderly people with less serious limitations in performing ADLs (Song, 2009).

Comparing the healthcare of South Korea to the healthcare of the United States

South Korea and the United States have similar healthcare practices. Both countries have private and government funded insurance programs. In South Korea, it is mandatory for both visitors and residents to obtain health insurance. Compared to the United States, with the Affordable Care Act, only residents are required to obtain health insurance (Kwon, 2015).

Many families both in the United States and South Korea possess two insurances. In the United States, residents are able to have two private insurances. For example, a husband and wife can both have their own private insurance through their employer in which they can use to cover each other's medical expenses as a secondary insurance. Compared to South Korea, many people have one government funded insurance as well as a private insurance. This is due to the fact that the government funded insurance only covers basic medical needs. Therefore, many citizens obtain a private insurance to cover the remaining medical expenses (Kwon, 2015).

“What can we learn from them?” and “What is their biggest health-related asset and threat?”

Asset:

One of the biggest things we can learn from South Korea is a method that discourages patients from going directly to expensive medical facilities. For example, if a patient has a cold, they must see their primary care provider first before going to a hospital. Patients must first visit a primary care doctor upon which they can be referred to a general or university hospital (Kwon, 2015). This would be great in the U.S., as it will help reduce numbers of patients seen in hospital emergency room and help increase primary care visits.

Another big health asset is that fees and operating budgets are set by the government in coordination with providers, consumers and corporations (Kwon, 2015). If the U.S. adopts this system, it would not just change the health insurance of America but also make it more affordable.

The recognition of both traditional Korean medicine and Western trained physicians by the Korean government and health care industry allows for Western-trained doctors to also recommend massages, dieting, therapeutic baths, and stretching and breathing exercises to maintain good health. This practice makes Korea unique from other health care systems in most Western countries (Kwon, 2015). If the U.S. was to implement having both western and traditional medicine instead of just western, patients would trust doctors more and be healthier. This is because many patients believe that doctors recommend expensive treatments and medication that they do not really need.

Threat:

In South Korea, it is mandatory for everyone to have health insurance. Anyone who does not have health insurance will not be considered for treatment in the hospital setting. Basic health care practices will not be given until adequate proof of health insurance is provided. This places extreme constraints not only on the hospital setting, but also on emergency medical services throughout the country. Thus, it becomes a health disparity issue due to residents not being given the proper medical treatment necessary (Kwon, 2015).

Target Vulnerable Population: Teenagers in South Korea

Teenagers in South Korea face a far more stressful experience preparing for college admission than young people in the United States.

Student suicides tend to increase around November, when high school students take college entrance exams. For example, the College Scholastic Ability Test is a life-determining exam that affects their future career and also their future prospects for marriage (Costa, 2015).

The maximum amount of sleep kids get is 5 hours of sleep everyday.

Drinking among teenagers and young adults is also growing. Despite a legal minimum age being 19, the youth grasp every opportunity to have a good time. Many students drink 5 nights a week (Hong, 2011).

(Public Broadcasting Service, n.d)

Health Harming Problem: Suicide

The primary causes of adolescent suicides are school-related problems such as stress from overwhelming academic responsibilities, mental health problems, lack of social support, and other socioeconomic issues (Beak, 2015).

South Korea’s suicide rate has remained the highest among Organization for Economic Cooperation and Development (OECD) nations for 10 consecutive years, with 29.1 people out of every 100,000 having committed suicide (Beak, 2015).

It is not easy to get therapy for depression in South Korea, where there is still strong societal resistance to psychological treatment (Kim, 2014).

One out of three depression patients stops mid-treatment. One of the biggest issues is that many patients think they can overcome depression on their own through a religious life or through exercise (Kim, 2014).

When viewing the video, please use closed caption. (Youtube, 2015)

What Is Being Done In The Country To Address This Health Problem?

On the national level, the government is starting to address the problem of suicide among teenagers, but the effort is still too weak. The annual budget of Massachusetts, U.S for mental health was 651.06 million USD in 2012. On the other hand, the annual budget of Seoul, Korea for mental health services was 32,735,000,000 won (about 31.46 million USD) (Beak, 2015).

The South Korean government also adopted the “Act for the Prevention of Suicide and the Creation of Culture of Respect for Life” in 2011. The Seoul suicide prevention program also tries to increase the awareness of suicide. However, it puts more emphasis on a culture in which respect for life is considered important (Umeda, 2016).

The background picture is of the Mapo Bridge across the Han River, where many suicides occur. In order to combat this health harming issue, Samsung created the "Bridge of Life". It is an interactive bridge that has sensors on the guardrails, which light up when people walk by, offering up messages of comfort (“The Best is Yet to Come,” or “Tomorrow’s sun will rise”), kind words and even jokes, created by psychologists (Kim, 2014).

Additional Solutions to Help Combat Suicide Among Teenagers In South Korea

  • Educate parents and school staff on the signs and symptoms of suicide risks and behaviors
  • Educate students on stress relieving techniques, such as breathing exercise, sports, yoga, pet therapy, meditation, and listening to music
  • Teach students how to develop positive self-talk
  • Provide students with more mental health counselors, such as a school psychologists
  • Hold support groups at school and in the community
  • Healthcare providers should screen for mental health aside from physical health

Thought-Provoking Question

In 2015, South Korea was known as the number one educational system in the world. The culture of South Korea places high expectations on their students to excel in their education. However, research has shown that South Korea has had one of the highest suicide rates consecutively for the past 10 years, education as one of the biggest factors. Do you feel that South Korean parents and educators should sacrifice their culture of high educational expectations to maintain positive mental health?

Credits:

Created with images by lperron - "gyeongbokgung palace south" • Leon_Ting - "south korea temple lake" • tiseb - "South Korea: Gyeongbokgung Palace" • Free Grunge Textures - www.freestock.ca - "South Korea Grunge Flag" • tragrpx - "namdaemun market myeongdong" • w00kie - "ceiling of a Korean palace" • tautaytb - "the village neck the world gi" • tampigns - "buddha statue asia" • strogoscope - "City hall area" • ATMAN - "republic of korea jeollanam-do suncheon"

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