International students pay health insurance premiums, but less than one in seven are satisfied with Korea’s health insurance system due to financial burdens, according to a study.

They also called for the health authorities to reconsider calculating insurance premiums for foreigners.

A team of researchers from Soonchunhyang University College of Medicine published a study, "Analysis of International Students' Perceptions of the National Health Insurance System and Utilization of Medical Services," in the latest issue of the Korean Society for Health Promotion and Disease Prevention.

As the number of international students in Korea continues to increase, the government reorganized the foreign health insurance system in July 2019 to rationally manage foreign health insurance, making it mandatory for international students staying in Korea for more than six months to enroll in health insurance. That has increased the benefits available to students, but some have pointed out that it has also increased the financial burden due to insurance premiums.

Against this background, the research team analyzed international students' perceptions and health insurance usage and compared them to Koreans.

The team surveyed 364 international students studying at universities in South Chungcheong Province from May to June 2022 and compared the results to a survey of 2,000 Koreans conducted in 2019.

The results revealed differences in perceptions of the health insurance system between international students and Koreans.

By nationality, Vietnamese students accounted for the largest share, with 45.3 percent, followed by those from Mongol (21.1 percent), Uzbekistan (19.2 percent), China (10.7 percent), Russia (1.65 percent), Kyrgyzstan (1.1 percent), and Cambodia (0.8 percent).

International students were younger, with an average age of 23, and were less likely to visit hospitals. Nearly 58 percent had never used a healthcare facility, such as a hospital or pharmacy, while 42 percent had. Of the international students who used a healthcare facility at least once, 37.8 percent used a pharmacy, 26.6 percent received health checkups, 20.0 percent used outpatient care, 6.9 percent were hospitalized, and 4.3 percent visited them for emergency medical services.

Of them, 15.7 percent needed medical treatment or check-ups but could not access them. As the reason, 45.5 percent cited the financial burden of medical expenses, followed by "no time due to studying or working part-time" (17.0 percent) and fear of communicating in Korean at the hospital (17.9 percent).

Asked about their perceptions of health insurance coverage, only 16.0 percent made positive responses, 38.0 percent were negative, and 46.2 percent were neutral. Of those with negative perceptions, 91.2 percent were dissatisfied with higher insurance premiums than private insurance.

On the other hand, 83.9 percent of Koreans have used a medical institution in the past year, far higher than the 42.4 percent of international students. Like international students, the most common healthcare services used were pharmacies, outpatient clinics, and other services related to mild illnesses.

Besides, only 3.9 percent of Koreans had unmet healthcare needs, meaning they did not receive medical treatment or checkups when needed. Almost 58 percent said they did not have time to go to a medical institution, followed by 31.6 percent who did not want to wait and 29.4 percent who could not afford when asked to cite multiple reasons.

International students also differed in their perceptions of the health insurance system. Only 16.0 percent of international students were positive, compared to 75.6 percent of Koreans.

One of the reasons for the difference in perception is how insurance premiums are determined between international students and Koreans.

"For Koreans, insurance premiums are based on income level, property, and occupational characteristics. However, international students are charged the same premium regardless of their nationality, age, income, and wealth, based on the average of the premiums of all local subscribers in the previous year."

Most international students are younger and healthier, with a lower prevalence of chronic diseases, lower awareness of using hospital services, and lower utilization of national health checkups, it noted. Therefore, the current practice of charging a uniform premium is likely to result in resistance to paying the premium, the team added.

"It is necessary to study and review the health insurance application to foreigners and calculate premiums. The government must set up a customized insurance policy to help foreign students settle as members of our society and retain talented foreigners," it said.