The health insurance system of Korea was first launched in 1977 as a medical insurance program for urban workers at businesses of 500 or more employees. In 2000, the work health insurance program was integrated with the regional medical insurance program to build a single unified health insurance system.
     
      While the national health insurance program has expanded to include 97% of the national population, excluding people under the medical care assistance program, the health insurance allowance still insufficiently covers only 62% of medical expenses. This report evaluated the effectiveness, efficiency, fairness, and sustainability of the national health insurance program and suggested measures for its improvement.
     
      The assessment found that the national health insurance program is limited in expanding its coverage since the burden of self-insurance by the unemployed is continuously increasing and the Korean government is focusing on strengthening the coverage of the four major illnesses, including cancer. Due to such insufficient coverage of the national health insurance program, the burden of private medical insurance for the public is increasingly growing.
     
      The fee-for-service system triggers an oversupply of medical services. Plus, there are various inefficiencies due to the signing of the medical insurance contract through the Health Insurance Policy Deliberation Committee. Moreover, the system lacks horizontal and vertical equality, such as different insurance premium schemes for the employed and regional subscribers and the regressive premium burdens against income and assets. It has also been evaluated that a review should be performed on the estimation of the financing needed for the insurance coverage areas focused on by the Korean government and on the methods for securing the finances.
     
      Thus, the Korean government should establish plans to enforce stronger and more practical coverage by gradually introducing new insured items rather than focusing on the four major illnesses. Moreover, the program should revamp the insurance system to expand bundle payment services and raise efficiency by improving the insurance contract method. Furthermore, inequality between the insurance classes needs to be resolved with improved premium schemes that proportionately match the capabilities of the insured, and solid financing sources need to be secured to guarantee the sustainability of financing for the health insurance program.