Believe it or not, South Korea’s national health insurance programme has been facing a peculiar problem from Chinese subscribers. According to the latest data of National Health Insurance Service, Chinese nationals have been making claims for total reimbursed medical expenses causing a huge deficit to the NHIS.
In South Korea, It is mandatory for all foreigners living for more than six months, to enroll in the National Health Insurance and pay monthly premiums commensurate with their income and assets. Some of them are insured by their employers or enjoy benefits as dependents.
South Korea’s ruling party wants to prevent Chinese nationals from abusing its medical insurance law. Kim Gi-hyeon, the chairman of President Yoon Suk-yeol’s conservative People Power Party (PPP) singled out the alleged abuse of South Korea’s public health insurance system by Chinese people stating that this is another key area that should be corrected under the principle of reciprocity.
“The health insurance fund created by the sweat and hard work of the people must not be abused for foreign medical shopping. We will stop health insurance frauds and freeriding on health insurance” by Chinese people, Kim recently said.
Health insurance coverage for foreigners who enrolled in domestic health insurance was smaller than the premiums they paid, resulting in a surplus of 1.7 trillion won (US$1.3 billion) from 2018 to 2021, according to the health ministry.
According to news reports,the National Health Insurance Service (NHIS) submitted data to Rep. Nam In-soon of the main opposition Democratic Party of Korea in stated that health insurance reached a deficit of 17.5 million US dollars for subscribers of Chinese nationality.
This contrasts with the overall surplus of 42,22,82,000 US dollar for foreign subscribers. Foreign nationals, including overseas Koreans, paid 1,31,35,89,000 US dollar in insurance premiums and received benefits totaling 93,36,93,000 US dollar.
According to koreatimes, the deficit’s scale is on a downward trend. The deficit in health insurance involving Chinese nationals peaked in 2018 at 11,45,48,190 US dollar, but it has been declining steadily to 7,49,33,040 US dollar in 2019,
23.9 billion won in 2020 and 82,77,460 US dollar in 2021. The rebound last year can be interpreted as a result of China reopening its borders.
In 2020, the reimbursement-to-premium ratio among Chinese subscribers stood at 121 percent, the highest among other foreign nationals. Chinese subscribers were top in the list and were followed by Vietnamese subscribers.
Expressing concern over the Chinese nationals making a dent in the National Minjoo Party lawmaker Nam In-soon has raised questions about Chinese expats making such lavish use of the medical insurance. Anecdotally there are many cases where foreign nationals register as dependent family members or distant relatives of insured people here, come here to get expensive treatment and disappear again.
The issue of Chinese subscribers making full claims for reimbursements from State health insurance coverage, became the point of contention in election as last year between the presidential candidates of the main opposition People Power Party (PPP) and the ruling Democratic Party of Korea (DPK).
PPP candidate Yoon Suk-yeol had stated that he would apply more stringent standards to screen foreigners living in Korea who are benefiting from the National Health Insurance Service (NHIS) coverage. Yoon promised to raise the bar for foreigners so that NHIS coverage would be more limited and less available to their family members or other dependents.
He had described foreigners as “putting their spoons on meal tables that have been prepared for Korean citizens through their hard efforts for the past 40 years”. Lee Jae-myung, the presidential hopeful of the ruling Democratic Party of Korea slammed his remarks, calling on Yoon to stop stoking xenophobia.
However, the NHIS has identified cases where some foreign nationals enroll their distant relatives as dependents and exploit the system ― entering Korea to receive treatment and then immediately departing. Health insurance
authorities thus plan to further refine the system for foreign dependents in the future.
The issue of Chinese exploiting the national health insurance service speaks volume about their intention. According to Insurance experts, It is possible that some Chinese nationals are intentionally engaging in fraudulent activities by submitting inflated or false claims to insurance providers. This behaviour may aim to exploit weaknesses in the insurance system, seeking financial gains without paying the appropriate premiums or meeting the required conditions.
Other experts said that if Chinese nationals have received medical treatments in South Korea with higher healthcare expenses than their home country, the amount they claim may surpass what they have paid locally. This could occur due to seeking advanced or specialized treatments abroad or receiving medical care in regions with higher healthcare costs.
However, it is worth considering that insurance fraud can occur in various forms, and it is possible that some individuals may engage in fraudulent activities to exploit the insurance system. This can include submitting false claims, inflating the costs of treatments, or misrepresenting medical conditions to receive higher payouts. Therefore, it is crucial to have robust mechanisms in place to detect and prevent fraudulent activities within the insurance industry.