One of our writers for Clear Medical Solutions is currently residing in Seoul, South Korea and wanted to share her experiences with the health care system. Below is an interesting article on her experience and point of view of the South Korean health care system and how it differs from health care in the U.S.
I teach English in Korea and have lived here for little over a year. During my stay, I have had several encounters and experiences with the health care system. Korea has a National Health Insurance Corporation (NHIC), which guarantees health insurance for all Korean Citizens. Foreigners are also covered by the National Health Insurance (NHI) provided they meet the necessary requirements. My status as a registered, employed alien, with a proper visa (E2 for me) grants me access to the same NHI benefits as those for Korean nationals.
I am by no means an expert on the NHI; most of my knowledge about the NHI and health care in Korea comes from experience. However, I do know the basics of how it works, the benefits, and what is covered. Only properly documented and employed foreigners are eligible for NHI. A monthly contribution is deducted from each pay check. The contribution is determined by the monthly wage multiplied by the contribution rate (currently 5.08%). The employee pays half of the contribution and the employer is responsible for the other half.
The NHI has a co-pay system; patients pay 10- 20% of the total cost for inpatient care. Outpatient co-pay varies between 30- 50%. General hospitals require 50% co-pay, while hospitals require 40%. The co- pay for clinics and pharmacies is 30%. There is mandatory minimum payment of 3,000 Won for visits when the charges do not exceed 15,000W.
Currently 1 USD equals about 1,164W or .85 USD equals about 1,000W. It may be easier to think 1 USD equals 1,000W, since I will be quoting all prices in Won; just remember the actual cost in U.S. dollars will be slightly less.
In my experience, the quality of health care in Korea is equal to the U.S. The major difference is NHI makes the healthcare vastly more affordable and accessible. The costs for doctor visits and prescriptions are literally pocket change. Appointments are unnecessary for small clinics. Hospitals and dental offices usually require (or strongly recommend) making an appointment, but there is rarely more than a two day wait for an appointment.
Recently, I severely burned my feet in a few places. I tried treating them myself at first but was unsuccessful. On my way home one night, I sought the advice of a pharmacist. I showed the pharmacist my burned feet and he sold me a box of Band-Aids and a tube of Silmazin Cream (1% silver sulfadiazine cream; the Korean equivalent to Silvadene or Flamazine). The total cost of the cream and Band- Aids came out to be around 6,000W. The next morning I went downstairs to my regular pharmacist and bought gauze and medical tape; 3,000W. A few hours later, I noticed one of the burns was developing a red circle around it, was warm to the touch, and was increasingly uncomfortable. I headed back downstairs to the pharmacist hoping she could help me and she sent me to the doctor on the second floor. The doctor examined the burns, cleaned them, put an ointment on them, dressed them and wrote me a prescription for antibiotics; 4,000W. Back downstairs at the pharmacy, I filled the prescription, a 2-week course of antibiotics; 7,000W. The total expenditure for treating my 2nd degree burns was 20,000W; I did not have to make any appointments nor sit idly in the waiting room of a doctor’s office.
All foreign teachers must undergo a yearly physical. These are usually performed at bigger hospitals opposed to clinics. The physical includes but is not limited to a chest x-ray, vision and hearing test, urine test, CBC, and HIV/ AIDS STD test. You change into a hospital gown/top and you are pushed from one room to the next for each test to be performed. The most jarring aspect of the physical for me was the urine test. The nurse handed me a Dixie cup, which I thanked her for and used to get a cup of water before proceeding with the test. As I turned back from the water cooler and saw her face, I realized the Dixie cup was meant to collect my urine, not for me to drink out of. I do not think it matters how many times you do it, walking out of a bathroom holding a Dixie cup of your own urine and placing it on a tray next to other cups urine always feels wrong. Dixie cups aside, the physicals are easy to get and it usually does not take more than 30 min from when you walk in the door to when you walk out. I paid 60,000W for my physical this year, but the cost can vary from 55,000- 70,000W depending on where you go.
Dental work also costs much less in Korea than in the U.S. Friends of mine have had root canals, cavities filled, and crowns made (all things covered by NHI);they all rave about the price and how the quality of care was the same (some said better) as what they were used to back home. I have not had dental work of that nature done. However, I am currently undergoing Invisalign treatment for cosmetic purposes, which is not covered by NHI. Even without the benefit of NHI, I am saving a great deal of money by having it done here rather than in the U.S. Invisalign performed in the U.S. by an American doctor costs on average $5,000. My Korean dentist received her degree from Tufts University, is an ADA member and is licensed to practice in several East coast states. I am paying 3,500,000W for my treatment (note: at the time of payment the exchange rate was different so 3,500,000W was about $2,800USD). And my experience with Invisalign in Korea far surpasses the one I had with braces in the U.S.
The health care system in Korea also has some differences which are cultural. Confidentiality, which is paramount and a cornerstone in health care in the U.S. is pretty much non-existent here. I read warnings about this before I came here so I was prepared for it to be a little lax, but I was beyond shocked when my co-teacher showed the parking attendant the results of my physical in order to get her parking validated. When I recovered from my shock and asked her about it, she did not see anything wrong, strange, or inappropriate with sharing the test results with a stranger whose job it was to monitor a parking lot. As it turns out, it is not uncommon for doctors or nurses to discuss one patient in front of other patients or for the pharmacist to talk to other people about what medication you are taking.
Koreans typically do not play an active role in their health care. For the most part, they believe in their doctors, trust them completely and never question them. As a result they are often less informed about their treatment. Experience has taught me not to question a Korean on the specifics of any treatment they are receiving because the answers alternate between “Because the doctor told me to” or “I don’t know.”
I on the other hand like to know about my treatment. I want to know what’s wrong with me. I want to know what medication I am being given and why and I want to know the possible side-effects of this medication. All this proved to be too much for one doctor. My questioning of him during the examination and then disagreeing with his initial diagnosis that I had an STD (an unfortunate assumption sometimes made about foreigners, which is why a test is included in our physical) did not go over well. I think I pushed him too far when I asked him for a translated version of the prescription he was writing so I could know what I was taking (or could at least Google it). He was taken back by this request and stunned for a moment before he ordered one of his nurses to do it and shut the door on me. The other doctor I have seen did not have a problem with this request and in addition to writing the English name of the drug he also wrote its purpose.
The physical manner in which prescriptions are filled is another difference between health care in Korea and the U.S. Instead of the nice little orange bottles, clearly labeled with a patients name, drug dosage, and instructions; prescriptions in Korea come in rows of sealed little bags. Each bag represents one dose. When I filled my prescription for two weeks of antibiotics, the pharmacist handed me 14 little rows with three bags to each row (take 3 times a day for 2 weeks). My qualm with the bag system is the loss of control I feel by not being able to control my own medication and again not knowing what I am taking. However, I see how this system might have its merits for older patients taking multiple pills a day and how it could help prevent them from missing a dose or taking the wrong medication.
Korean pharmacies bare little resemblance to the big corporate owned pharmacies like Walgreens and CVS found the in the U.S. The wide florescent lit aisles with rows upon rows of cold, flu, headache, stomachache, heartburn, etc., medicine are replaced with surprisingly small shops, stocked floor to ceiling with foreign medication, most of it behind a counter and controlled by the pharmacist. When you have a cold (or any other ailment) in Korea you go talk to the pharmacist and s/he supplies you with the proper medication (in baggies) based on your symptoms; opposed to going to the drugstore in the U.S. and matching your symptoms to a box of cold medication. I prefer the U.S. system and so do most foreign teachers, which is why there is a cabinet stocked full of Advil, DayQuil, NyQuil, Imodium AD, etc., in most of our apartments. The benefit of the Korean system is that more drugs are available over the counter than in the U.S. The Silmazin I bought for my burns would have required a prescription in the U.S. More significantly, birth control does not require a doctor’s prescription and can be obtained from a pharmacist.
Health care in Korea has its pros and cons; it has been an adventure for me to experience and has given me numerous stories to tell. In the end, what has surprised me the most about health care in Korea is how even as a foreigner who does not speak the language; I have never had a problem accessing the health care. Come January 1, 2010 I will no longer be covered under my mother’s health insurance (which was very good insurance). With that date looming I have actually started to think about health insurance and health care for the first time in my life. I know the high quality health care the U.S. is capable of providing because I am used to receiving it; however, as of January 1st I am not sure how to access that care. I am dismayed by this fact; the fact that accessing healthcare in a foreign country where I am temporarily residing may be easier than accessing healthcare in my home county where I am a citizen.
Questions: Based on the above story, how do you feel about the health care system offered in South Korea? Patient confidentiality is a huge focus point for health care in the U.S.; would you be willing to give up patient confidentiality for more available and affordable health care?
About the Author: Erika Christenson is a Staff Writer with the Clear Medical Solutions Communication Team. Her work is regularly shared on the Clear Medical Agency newsletter and the ClearNursingMatters.com blog.
NHIC- National Health Insurance Corporation
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