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Korea carries out new plan to end 'healthcare dine and dash' by foreigners
  • By Lee Han-soo
  • Published 2019.08.09 17:27
  • Updated 2019.08.09 17:46
  • comments 0

In May 2015, a Mongolian came to Korea and gained access to health insurance after paying a monthly premium of about 100,000 won ($89) for three months. From August, the Mongolian began to receive cancer treatment worth 84.6 million won for 241 days and went back to his country as soon as finishing the treatment.

The new health insurance plan for foreigners, which calls for all expats who stay in Korea for six months or longer to sign up for the country's health insurance program, is receiving a welcome from Korean subscribers but some complaints from non-Koreans.

Also, a Korean-American with arthritis got various treatments after finding out that foreigners can enjoy the same health insurance benefits as Koreans if she paid a specific health insurance fee upfront. She benefited off 5.8 million won before going back to the U.S.

These are just a few of numerous cases that have forced the Ministry of Health and Welfare to toughen the nation's health insurance system faced with a growing number "healthcare dine and dash" by foreigners – which happens when foreigners pay low insurance premiums and receive reimbursements for expensive treatment, including cancer, and leave the country upon completion.

Under the new rule, foreign nationals residing in South Korea for six months or longer are obligated to enroll in the country's health insurance program.

Foreigners who have newly signed up for the local health insurance plan now have to pay more than 110,000 won per month. The figure rises to 113,500 won when premiums for long-term care for the elderly are included. If they do not pay the premiums, they are liable to receive some disadvantages. Those disadvantages include not obtaining health insurance benefits when using hospitals and clinics and a possible restriction when applying for a visa extension.

Since the National Health Insurance Service (NHIS) announced the newly revised law, the number of foreigners enrolled in Korea's health insurance plan has reached 1.2 million, as of July 28. Considering that the number of foreigners subscribed to the national healthcare plan had stood at 980,000, the boost in the figure came in a mere few weeks after the ministry unveiled its new regulation on July 12.

The ministry views the new policy as quite fair because it is similar to foreigner health insurance policies in other countries, and will not be a disadvantage to foreigners or expats. These countries are also amending their health regulations to plug loopholes slipped through by foreigners exploiting their health insurance system.

For example, the Japanese government has revised its health insurance system, applying stricter rules for its coverage to prevent abuses by foreigners. The new law provides insurance benefits only to foreign workers and their dependents residing in Japan. Tokyo revised its law after witnessing more cases of nonpayment by foreign travelers who fall ill but lack insurance coverage.

The revision came after a survey by Japan's Ministry of Health, Labour and Welfare, in which about 80 percent of 1,710 responding medical institutions said they provided outpatient treatment for foreigners, and about 60 percent offered in-hospital care. Among those, 35 percent said they had nonpayment issues over the previous year.

Thailand is also planning to receive a mandatory health insurance fee from all foreign visitors. If the revised law comes into effect, a foreigner will have to pay about 100 Thai Baht ($3) in its visa fees as health insurance fee.

European countries such as the U.K. and Germany also have health insurance regulations that aim to keep foreigners from abusing their healthcare system.

In fact, the Korean government had been tightening insurance laws for foreigners but seen little, if any, effects as the health insurance benefits claimed by foreigners increased annually. According to the NHIS, 228,491 foreigners received a total of 41.9 billion won in health insurance benefits from 2016 to 2018.

The total health benefits cannot be chucked up to foreigners and expats abusing the system, considering that the foreigner health insurance benefit was 3.1 billion won when the abusing problem began in 2007. However, the steep rise in insurance payouts has raised some eyebrows among Koreans.

"It is alarming that my tax money is going to treat foreigners, who seem to be exploiting the system that is meant first to benefit Koreans," an office worker said, asking to remain anonymous. "Such benefits toward foreigners seem to be reverse discrimination against Koreans, who are paying the money to keep the national health insurance system running."

As of now, the new plan seems to be working out as the number of foreigners joining the national health insurance plan is increasing. The NHIS expects that about 400,000 foreigners will join the system as additional subscribers to the national health insurance plan and provide additional revenue of more than 300 billion won annually.

Considering that the foreigner insurance payouts were 41.9 billion won from 2016 to 2018, the recent increase in premium receipts will likely subdue the ongoing controversy regarding the “healthcare dine and dash” by expats and foreigners.

Some industry watchers here still raise a question, however: Will Korea's new regulation finally be able to provide equal medical treatment for foreigners while sorting out only those that abuse the system?

Foreigners also say that the new regulation is discrimination against non-Koreans. The new rule has already drawn backlashes from migrant workers and international students.

The Joint Committee with Migrants in Korea (JCMK) released a statement last month, saying, "Before the revision of insurance plans for foreigners, JCMK and other immigrant organizations had expressed objections several times through statements and ministerial inquiries."

The group noted that the U.N. Committee on the Elimination of Racial Discrimination (CERD) has also recommended Korea to improve its health insurance system, as it racially discriminates foreigners by making them pay a higher premium than Koreans. "There is a problem with the proposed conditions for the mandatory health insurance subscription by foreigners," JCMK said.

"For instance, the amended law allows Korean employees to be covered by their work health insurance plan and to change to regional insurance system from the very next day of their job termination," it said. "For foreigners to join the regional health insurance system, however, they have to live in Korea for at least six months and register as a foreigner with the authorities concerned."

The group added that migrant workers in rural areas are having problems going to the hospital due to fear of losing their jobs or repercussion from their employer. “If the government fails to address such problems for migrant workers, we might be left with paying a hefty bill for insurance without receiving additional medical care,” the group said.

Also, international students studying in Korea are expressing concerns about the financial burden and negative impact it might have on their stay in Korea.

"Not all students who come to Korea to receive an education are financially supported," Tsz Chiu Guan, a Chinese student who is studying in Korea, told Korea Biomedical Review. “It is also not easy to find additional revenue sources such as getting a job since most international students don't speak Korean when they first arrive in Korea.”

To resolve some of the issues, the NHIS said it would run more foreigner support centers to prepare for a mandatory subscription of the national health insurance program for expatriates who stay for six months or longer in Korea.

The Ministry of Health and Welfare has also exempted expat students from the mandatory registration in the state health insurance program until February 2021.

However, the ministry is adamant in enforcing the regulation and believes the new health insurance system will benefit both Koreans and foreigners.

"The new amendment is expected to plug loopholes in foreigners' and overseas Koreans' health insurance management, and enhance equity between Koreans and foreigners," said an official at the ministry's Division of Health Insurance Policy, wanting to remain anonymous.

The ministry also noted that they are aware of public concerns and are closely observing the progress of the new insurance plan.

"The new regulation has just been implemented," the official said. "Therefore, we will have to watch for some time if the new regulation will resolve all the problems."

Although too early to say, the ministry may extend the period again if the regulation does not make a significant difference, she added.

The industry experts note, however, there are still some underlying problems that lie ahead, such as the improvement of workplace quality for migrant workers and that international students will still have to deal with the same financial problems in 2021 when they are no longer exempted from the mandatory insurance plans.

While the ministry says it would carefully observe the situation, it needs to come up with a solution that addresses the problems and shows that they made health insurance mandatory for foreigners because they care about the health of foreigners and not just as a policy to raise money and fill in the NHIS deficit, the experts said.


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