Calls grow for enhancing Assembly's control over state insurance amid low births, aging society

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The government-funded research institute raised the need to enhance the National Assembly's control over the finances of the national health insurance in preparation for a potential crisis that could be caused by the nation's low birth rates and aging society.

The Korea Institute for Health and Social Affairs said Monday that it recently submitted its research report to the Ministry of Health and Welfare to provide directions for the establishment of policies related to state insurance between 2024 and 2028.

In its report, the institute said there should be procedures obligating the ministry to report budget proposals for national health insurance to the Assembly to go through deliberation and approval.

Currently, the health ministry and its committee are involved in major decisions regarding the state insurance finances.

The institute said the Assembly's control could contribute to boosting financial transparency and stability of the state insurance, at a time when the population is shrinking due to the low birth rate and the worsening economy.

It added that the ministry should extend the scope of the related information to be released to the public, given that national health insurance is one of the most important social safety nets.

The Board of Audit and Inspection (BAI) expressed a similar position in its report announced in August last year.

After auditing the finances of the national health insurance at the time, the state auditor pointed out that the finances had been poorly managed, as they had not been under the control of external authorities such as the National Assembly.

“The state insurance should be led away from financial crisis to fulfill its role as a force for improving national health,” the BAI said in its report.

“In order for the sustainable operation of state insurance, the current decision-making process, which skips the National Assembly deliberation, should undergo improvements to raise financial transparency.”

All Korean nationals excluding recipients of certain livelihood programs and all foreign nationals residing in Korea for more than six months are obliged to to enroll in the national health insurance program, in accordance with the National Health Insurance Act.

The program requires monthly premiums to be paid based on one’s income and assets and offers about 70 percent of the coverage for most medical treatments, excluding non-essential services such as cosmetic procedures.

Equal medical coverage is given to anybody suffering from illnesses or injuries, regardless of how much one pays in monthly premiums. The laws allow coercive collection if one fails to pay the premiums for a certain period.

The state auditor pointed out that people deem these monthly premiums as tax, and this makes the Assembly’s deliberation of the state insurance finances indispensable.

Korea’s total fertility rate — the number of children, on average, that a woman aged 15-49 has during her lifetime — fell to 0.78 last year, the lowest level among the Organization for Economic Co-operation and Development (OECD) member countries.