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A Growing Elephant in The Room: Generational Equity Under Korean National Health Insurance

Korea is facing rapidly aging population, who take up bigger and bigger proportion of the expenditure of the Korean National Health Insurance (KNHI).  At the same time, Korea is saddled with sagging birth rate – which is among the lowest in the entire world.  The two factors combined do not bode well for the intergenerational equity under the KNHI.

Studies on the generational equity under the KNHI are hard to find.  But the few that did study the issue found that the young generation of today will very likely end up with large negative net benefit over their lifetime.  One study even concluded that the generational inequity is more pronounced under the KNHI than under the Korean National Pension System. I present two questions that follow from these circumstances, and offer my take on those questions.

First, how can the KNHI be skewed to the degree that it is?  The short answer is that the premium-setting and benefit-setting mechanisms under the KNHI are both actuarial and political processes, in which the latter component can easily trump the former component.

Second, why is the younger generation not revolting?  Part of the reason may be the lack of awareness.  But I also believe the paucity of research in this domain, in and of itself, is testament to another strong underlying reason.  Filial piety in the Confucian society just makes it very uneasy for Koreans to discuss an issue of this nature.

What is the takeaway from these?  A problem does not go away just because it is not being discussed.  Solving a problem starts with examining the extent of the problem and exploring the causes of the problem.  Korea should start acknowledging the elephant in the room sooner rather than later.


Won Bok Lee, MD, LLM, SJD
Won Bok Lee is a professor at Ewha Law School in Korea. Won Bok Lee has a unique background. After graduating from Seoul National University’s College of Medicine in 1995, Won Bok practiced medicine for the next four years. He then took a really unusual turn in one’s career path. Taking advantage of the open-eligibility policy of Korea that does not require a prior law degree, Won Bok passed the Korean Bar in 1998. Upon completion of the two-year statutory training with the Korean judiciary, he joined Kim & Chang in 2001, the most revered law firm in Korea. At Kim & Chang, Won Bok handled a number of significant cross-border and domestic transactions and litigations.
Since 2007, he has turned his attention to academia, earning master and doctoral law degree at Harvard Law School, before coming back to his home country to teach at Ewha.
At Ewha, he teaches patent law, drug regulations, health insurance law, and health policy. His main research interest lies at the cross-section of law and life science technology.
A father of two beautiful children, Won Bok also strives to serve his community.