J Prev Med Public Health.  2020 Jul;53(4):285-288. 10.3961/jpmph.20.074.

Dilemmas Within the Korean Health Insurance System

  • 1Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
  • 2Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea


The health insurance system in Korea is well-established and provides benefits for the entire national population. In Korea, when patients are treated at a hospital, the hospital receives a partial payment for the treatment from the patient, and the remaining amount is provided by the health insurance service. The Health Insurance Review and Assessment Service (HIRA) assesses whether the treatment was appropriate. If HIRA deems the treatment appropriate, the doctor can receive payment from the health insurance service. However, this system has several drawbacks. In this study, we aimed to provide examples of the problems that can occur in relation to HIRA assessments in Korea through actual clinical cases.


Health insurance system; Health Insurance Review and Assessment Service; Payment; Patient; Korea
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