Foreign Residents Drive Record Surplus in Korea’s National Health Insurance, Reframing Longstanding Controversy (Image supported by ChatGPT)
SEOUL, June 19 (Korea Bizwire) — Contrary to persistent public concerns that foreign nationals are draining South Korea’s national health insurance system, new data reveal a dramatically different reality: foreign enrollees have delivered a growing budget surplus for eight consecutive years, reaching an all-time high in 2024.
According to figures released Wednesday by the National Health Insurance Service (NHIS), non-Korean citizens (excluding overseas Koreans) generated a surplus of ₩943.9 billion in 2024—marking the largest annual margin since the program began tracking foreign contributions. This means foreign residents paid significantly more in premiums than they received in medical reimbursements.
The surplus trend, which began in 2017, has accelerated in recent years. After logging a ₩225.5 billion surplus in 2018, the figure more than doubled by 2020 and surged again to ₩730.8 billion in 2023. The 2024 figure brings the total eight-year surplus to well over ₩4 trillion.
Notably, the once-controversial group of Chinese enrollees—long accused of “freeriding”—have now turned their fiscal balance positive. After generating deficits exceeding ₩1 trillion combined in 2018 and 2019, Chinese nationals narrowed their losses dramatically in 2023 and posted a ₩5.5 billion surplus in 2024.
Other nationalities, including those from Vietnam (₩120.3 billion surplus), Nepal (₩109.7 billion), the United States (₩82.1 billion), and Cambodia (₩74.2 billion), also contributed significantly to the program’s financial health.
The National Health Insurance Service (NHIS) (Image courtesy of Yonhap)
Policy Reforms Drive Fiscal Turnaround
The turnaround is largely credited to a series of policy reforms enacted over the past six years under successive administrations, now culminating under President Lee Jae-myung’s government. The Health Ministry has tightened eligibility rules for foreign enrollees, closed loopholes, and implemented stricter ID verification protocols.
Key reforms include a 2019 mandate requiring all foreign residents staying longer than six months to enroll in the national system. In April 2024, the government barred foreigners from registering as dependents of employed Koreans unless they had lived in Korea for at least six months—a move estimated to save ₩12.1 billion annually.
A separate measure introduced in May 2024 required medical institutions to verify patient identity at the point of care to prevent insurance fraud and misuse.
Debate over Reciprocity and Equity
A view of the National Health Insurance Service headquarters located in Wonju, Gangwon Province. (Image provided by NHIS)
Despite the improving fiscal outlook, debate persists in political and public spheres about whether South Korea should adopt a principle of “reciprocity”—offering foreign nationals health benefits proportional to those their home countries extend to Koreans.
The government remains cautious. Experts warn that applying differential benefits based on nationality could violate international trade norms and stoke diplomatic tensions, particularly given that many foreign residents in Korea hail from lower-income countries with limited public health coverage.
“There’s no precedent in developed countries for adjusting health insurance benefits based on nationality alone,” said a senior NHIS official. “Most countries base eligibility on length of stay or employment status—not national origin.”
Shifting the Narrative
The data-driven reversal challenges the long-held perception of foreign residents as a burden on the system. In reality, foreign enrollees have helped ease the financial load on Korean taxpayers and contributed to the system’s sustainability.
Experts now call for a deeper societal conversation on balancing national interest, humanitarian values, and the principle of non-discrimination.
“Rather than debating whether to restrict benefits, we should recognize the system’s success and focus on building an inclusive and fiscally responsible model,” said one health policy scholar. “The numbers speak for themselves—this is not a giveaway, it’s a policy win.”
M. H. Lee (mhlee@koreabizwire.com)
