Unpaid health insurance premiums by foreign residents in South Korea have already exceeded last year’s total, even though the year is not yet halfway through. As of May 25, 2024, foreign enrollees owed a total of 35.7 billion Korean won in unpaid premiums, according to data from the Health Insurance Service submitted to Rep. Kim Mi-ae and reviewed by the National Assembly’s Health and Welfare Committee. This amount is higher than the entire annual arrears of 30.8 billion won recorded for 2023, raising concerns about the effectiveness of the current management system for foreign participants in the national health insurance program.
The data also reveals that more than half of these unpaid premiums come from just three countries. Chinese nationals are responsible for the largest share, owing 10.9 billion won. Vietnamese residents follow with 4.5 billion won, and Uzbekistani nationals with 4 billion won. Other countries with significant arrears include Indonesia (1.9 billion won), the United States and Japan (1.5 billion each), and Mongolia and Russia (1.1 billion each).
While China’s total arrears are the highest, its proportion of delinquent households is relatively low at 3.7%. This means that although many Chinese nationals are enrolled in the health insurance program, only a small percentage are behind on payments. In contrast, Indonesia has the highest rate of delinquent households at 15.4%, followed by Uzbekistan (14.6%), Japan (11.9%), and Mongolia (10.2%).
Rising Medical Expenses Add to Financial Strain
A more urgent issue is that medical expenses covered by health insurance for foreigners are increasing even faster than the rate of unpaid premiums. In 2023, health insurance expenditures for foreigners reached a record 1.3925 trillion Korean won—a sharp increase of 51.6% from 2020’s figure of 918.6 billion won. For comparison, medical expenses for domestic residents rose by 34% over the same period.
Outpatient care is driving most of this spending among foreign residents, accounting for 44% of all health insurance payouts—more than inpatient care (37%) or pharmacy costs (18.9%). This suggests that foreigners are visiting medical institutions frequently for outpatient treatments rather than being hospitalized or buying medication. The trend toward higher outpatient costs among foreigners has grown every year and differs from domestic residents, whose inpatient and outpatient expenses are more evenly balanced.
Rep. Kim Mi-ae expressed concern about these developments, noting that repeated outpatient visits by foreign enrollees are a major factor behind the rising medical expenses. She also pointed out that current efforts to manage unpaid premiums are not sufficient to address the problem.
To protect the financial stability of South Korea’s health insurance system, Rep. Kim stressed the need for stronger measures to manage arrears and to expand audits targeting unfair claims by foreign enrollees. These steps are considered essential to ensure that both foreign and domestic participants benefit from a sustainable national health insurance program.
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