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Corée, République de - P4H Network
Current Health Expenditure (CHE) as % Gross Domestic Product (GDP)8.4%CHE/GDP
Out-of-pocket (OOPS) spending as % of Current Health Expenditure (CHE)26.7%OOP/CHE
Domestic General Government Health Expenditure (GGHE-D) as % General Government Expenditure (GGE)13.6%GGHE-D/GGE
Gross Domestic Product (GDP), in constant (2020) US$ per capita1.7TGDP (USD)
Population in thousands (K), millions (M) or billions (B)51.8MPopulation
Incidence of Catastrophic Health Spending at 10% Threshold (SDG 3.8.2) Total12%Catastrophic Health Spending

La République de Corée a atteint ses objectifs de couverture sanitaire universelle en 1989, 12 ans seulement après l’introduction par le gouvernement de l’assurance maladie nationale obligatoire (NHI) en 1977[1].
[1]
. Au cours de cette période, l’affiliation à l’INSA a été progressivement étendue à l’ensemble de la population, en commençant par les entreprises de 500 salariés ou plus. En outre, le programme d’aide médicale (MAP), un programme d’assistance aux pauvres financé par l’impôt et créé en 1979, restera en place jusqu’en 2024. En 2000, les régimes d’assurance précédemment décentralisés ont été fusionnés en un système à payeur unique avec deux organisations quasi-publiques – le Service national d’assurance maladie, qui perçoit les primes et rembourse les prestataires, et le Service d’examen et d’évaluation de l’assurance maladie, qui examine les demandes de remboursement et fournit une assurance de qualité
[2]
. Bien que le système de santé obtienne des résultats supérieurs à la moyenne de l’Organisation de coopération et de développement économiques, le degré de protection financière reste préoccupant en raison du poids élevé des frais à la charge des patients en République de Corée. En 2019, le gouvernement du pays a mis en œuvre une réforme de l’assurance maladie nationale dans le cadre du Plan national global d’assurance maladie (2019-2023 ) afin d’étendre le taux de couverture de l’assurance maladie nationale à 70 % des dépenses médicales d’ici 2023.

Adoption proactive d'une assurance universelle pour les soins de longue durée

La République de Corée a la population qui vieillit le plus rapidement au monde. C’est pourquoi, en 2008, alors que les personnes âgées représentaient environ 7 % de la population de la République de Corée, le pays a mis en place un programme de formation à l’intention des personnes âgées. une assurance obligatoire pour les soins de longue durée (LTCI). L’assurance dépendance est une couverture universelle des soins de longue durée pour les personnes âgées. Ce régime contributif permet de faire face à la charge financière que représentent les soins de longue durée. Le taux de cotisation est un pourcentage fixe du taux de cotisation à l’INSA (12,83 % en 2023)..
[3]
,
[4]

Préparation à la protection sociale de la santé pendant la pandémie de COVID-19

Avant la pandémie de COVID-19, la République de Corée a connu une épidémie de syndrome respiratoire du Moyen-Orient. À la suite de cette épidémie, des réformes législatives et réglementaires ont renforcé les systèmes de préparation et de réaction aux urgences sanitaires du pays. Par conséquent, lorsque la pandémie de COVID-19 a frappé le pays, l’INSA a réagi rapidement. Le NHI a inclus les tests et les médicaments liés au COVID-19 dans l’ensemble des prestations et a adopté des mesures d’aide d’urgence. Ces mesures comprenaient une réduction de la contribution à la NHI pour les personnes fortement touchées par le COVID-19 et l’octroi de fonds de secours aux particuliers et aux entreprises. L’INSA a permis à la population d’accéder aux tests et aux traitements sans obstacle financier, conformément à la couverture sanitaire universelle de la République de Corée pour l’ensemble de sa population.[5]
Références

[1] Extension de la protection sociale en matière de santé : Accélérer les progrès vers la couverture sanitaire universelle en Asie et dans le Pacifique. Organisation internationale du travail, 2021

[2] Kwon, Soonman, et al. République de Corée : Examen du système de santé. 5:4Organisation mondiale de la santé, 2015

[3] Kim, Hongsoo, et Soonman Kwon. “A Decade of Public Long-Term Care Insurance in South Korea : Policy Lessons for Aging Countries“. Politique de santé, vol. 125, n° 1, janvier 2021, pp. 22-26. ScienceDirect

[4] Gouvernement de la Corée, communiqué de presse du ministère de la santé et de la protection sociale. 2023. Consulté le 8 avril 2024

[5] Kwon, Soonman, et al. “Republic of Korea’s COVID-19 Preparedness and Response”. Groupe de la Banque mondiale Bureau de Corée Série de notes sur l’innovation et la technologie, no. 3, 2020

Reform areas
 
 
 
 
 
2020

Telemedicine was temporarily permitted in response to the COVID-19 pandemic

2019

A two-year pilot programme for community care (for aging in place) began in 16 districts

2019

The First Comprehensive Plan of NHI (2019– 2023) was established

2018

Dementia patients at an early stage became eligible for LTC insurance

2018

Extra charge for treatments by highly experienced specialists was banned

2018

Compulsory enrolment in health insurance for all foreigners and immigrants staying in the Republic Korea for more than 6 months

2017

A five-year benefit expansion policy, called Moon Jae-In care or Moon Care, was announced

2015

NBLSS reforms expanded population coverage and personalized the benefits in four categories

2014

The levels of eligibility of LTCIs were expanded from three to four levels

2014

Economic evaluation exemption for anticancer and orphan drugs

2014

The copayment ceiling was further expanded from three to seven income levels

2013

A pilot programme for RSA was launched for orphan drugs and pharmaceuticals against cancer and rare diseases

2013

The DRG-based payment system for seven DRG was mandatorily implemented at general and tertiary hospitals

2013

A five-year benefit expansion policy (2014– 2018), the Benefit Expansion Policy for Four Major Severe Diseases, was announced

2012

The homeless became a Type 1 beneficiary of MA

2012

The DRG-based payment system for seven DRG was mandatorily implemented at clinics and hospitals

2011

Dementia Management Act was enacted

2011

Pay-for-performance scheme on a few services was implemented based on quality assessments

2010

Copayment reductions from 10% to 5% were applied for cancer and cardiovascular diseases

2009

The Price-Volume Agreement was implemented

2009

A new DRG-based payment, a combination of prospective payment and fee-for-service, was implemented as a pilot programme

2009

The cost of hospitalization for Type 2 MA beneficiaries was reduced from 15% to 10%

2009

Copayment reductions from 20% to 10% were applied for rare and incurable diseases

2009

A five-year benefit expansion policy (2009– 2013) was announced

2008

Conversion factor for fee scheduling was subdivided by the medical institution

2008

Economic evaluation was required for listed drugs

2008

Fixed rate per diem payment system for LTC hospitals was introduced

2008

LTCI was introduced, separate from the NHI, but managed by the NHIC

2007

LTCI Act was enacted

2007

The user fee for outpatient care was applied to MA beneficiaries: KRW 1000 for primary care and KRW 2000 for tertiary hospitals

2006

The positive list system was introduced

2006

Copayment reductions from 20% to 10% were applied for cancer and cardiovascular diseases

2005

A four-year benefit expansion policy (2005– 2008) was announced

2004

A copayment ceiling was introduced for cumulative OOP payments over six months

2004

The National Basic Living Security Act, enacted from Livelihood Protection Act

2003

Financial accounts of the NHI schemes were consolidated

2002

A HIPDC was introduced to decide the coverage of benefits package

2000

The NBLSS was launched

2000

The fee scheduling method changed to be based on a RBRV system

2000

Medicine prescribing and dispensing were separated between doctors and pharmacists

2000

All health insurance funds were merged into a single national health insurer (NHIS)

1999

Fee schedule began to be negotiated between the insurer and provider associations

1999

National Health Insurance Act enacted to succeed National Medical Insurance Act (enforced on 1 January 2000)

1998

The Fiscal Stabilization Fund was established to reallocate contribution revenues across insurance funds

1998

National Medical Insurance Act enacted succeeding Medical Insurance Act

1997

A DRG-based payment was launched as a pilot programme based on voluntary participation

1994

Long-term care hospitals were introduced for rehabilitation, mental health and postacute care

1989

The programme covered all self-employed in urban areas, and mandatory health insurance achieved the universal coverage of population

1989

Pharmaceuticals were covered by the NHI benefit package

1988

The pilot programme covered all selfemployed in rural areas

1983

Employees in companies with more than 16 workers were enrolled in NHI

1982

The pilot programme for the self-employed was implemented in five rural and one urban areas

1981

Welfare of Senior Citizens Act was enacted

1981

A pilot programme for the self-employed was implemented in three rural areas

1981

Employees in companies with more than 100 workers were enrolled in NHI

1979

Government employees, teachers and employees of companies with more than 300 workers were enrolled in NHI

1977

An MA programme for people living in poverty was initiated

1977

Employees of large companies with more than 500 workers were enrolled in NHI

1976

Medical Insurance Act was revised for compulsory enrolment as a legal foundation for SHP and UHC

1963

Medical Insurance Act was enacted for voluntary enrolment

1961

Livelihood Protection Act was enacted