Is free medical care possible?

ABSTRACT

Free medical care is currently a highly debated issue in Korea. However, from a practical point of view, 'completely free' medical care is impossible. Last year the National Health Insurance Corporation (NHIC) reported a huge deficit of up to 1.3 trillion in Korean won, which is the largest deficit in the past 10 years. NHIC expenditures are skyrocketing for many reasons: drug overuse, very expensive new drugs or devices increasing geriatric population and survivors of cancer or chronic illnesses, expanding insurance coverage for new diagnostic tests, drugs, neonates, rare diseases, disabilities, and cancer, occurrence of new diseases, increasing number of doctors, moral hazard, and wasting of resources due to the duplication and counteraction between modern medicine and Oriental medicine. What, then, should we do to provide partially free medical care? We need to reduce expenditures for drugs and increase health insurance premiums. Korean health insurance premium currently low compared to that of other countries in Organization for Economic Co-operation and Development. It is also necessary to introduce the concept of a health tax, in which healthy individuals with a high income pay higher premiums while sick or low-income individuals pay lower premiums. Expanding public health coverage such as vaccinations, regular health surveillance programs, and education on health promotion should be implemented. Private health care insurance can be introduced carefully with close monitoring. The last and most important recommendation is that society must become more ethical and transparent. Korea is entering a new era as a developed country and as a result a welfare system, including medical care is notoptional but is mandatory in some part. However, even a partially free medical care is going to be possible only if the entire health care system is operated in an ethical and efficient way for maximal utilization of limited resources while avoiding moral hazard and waste.