This is because medical expenses are rising rapidly due to an aging population, while the working-age population—which pays the premiums—is shrinking. Consequently, all eyes are on the decision regarding the premium rate to be made by the Health Insurance Policy Deliberation Committee (HIPDC) this month.
According to the Ministry of Health and Welfare and the National Health Insurance Service on the 10th, based on cash flow figures for the first quarter of this year, National Health Insurance revenue totaled 22.4416 trillion won, while expenditures amounted to 26.3405 trillion won, resulting in a deficit of 3.8989 trillion won. The cumulative balance, which stood at 30.2217 trillion won at the end of last year, also decreased to 26.3228 trillion won. This means it has become increasingly likely that the “shift to a deficit in 2026”—as projected by the government in the Second Comprehensive National Health Insurance Plan for 2024—will become a reality.
The bigger problem lies ahead. The share of medical expenses accounted for by citizens aged 65 and older is projected to rise from 44.1% in 2023 to 53.1% in 2030 and 70.2% in 2050. Ultimately, the immediate challenge is how to replenish the National Health Insurance Fund.
To address this, the government is looking to revise the method of collecting insurance premiums.
The government is considering a “reform of the National Health Insurance assessment system” that includes lowering the deduction amounts applied to income such as interest, dividends, rental income, and business income—in addition to salaries—for employed subscribers, and raising the maximum premium cap for these subscribers. Through this reform, the government expects to secure approximately 1.3 trillion won in additional annual revenue.
However, some point out that even with these adjustments to the assessment system, there are limits to resolving the structural problems of the health insurance finances. Consequently, the focus of attention is on next year’s health insurance premium rate.
The health insurance premium rate was frozen for both 2024 and 2025, but rose by 1.48% this year to 7.19%. As the fiscal deficit became a reality starting in the first quarter of this year, whether to raise the premium rate again is expected to emerge as a key issue at this month’s Health Insurance Policy Deliberation Committee meeting.
Consequently, some are calling for the government to first increase its financial support from the national treasury before raising premiums further. While current law stipulates that the government must provide support equivalent to 20% of projected premium revenue, the actual support rate stands at around 13–14%. This represents a shortfall of more than 5 trillion won.
Along with expanding revenue, efforts to plug financial leaks—such as the introduction of Special Judicial Police (SJP) for the National Health Insurance Service—are expected to accelerate. The government plans to push for amendments to relevant laws within this year to introduce the SJP starting next year.
Despite these efforts, experts explain that an increase in health insurance premiums is inevitable.
A professor in the Department of Preventive Medicine at a university hospital stated, “Even if we refine the premium collection system, expand government subsidies, and strengthen measures to plug financial leaks, the structural pressures of an aging population and rising medical costs will persist.” He added, “Per capita current health care expenditure in Korea stands at $5,099 when converted using the purchasing power parity (PPP) exchange rate. "Considering that this falls short of the Organization for Economic Cooperation and Development (OECD) average of $6,097, we must also consider measures to adjust the health insurance premium structure—which is generally low—to bring it in line with levels seen in developed countries," he emphasized.
