National Health Insurance: Tax Enforcement and Potential Withdrawal

Everyone has had the experience of visiting an otolaryngologist with cold symptoms and being recommended a nasopharyngoscopy.

This test, which observes the area between the nose and throat with an endoscope, should originally be performed only when complications are suspected, but it has been revealed that some hospitals are performing it ‘unconditionally’ on almost all patients. This is the background to the National Health Insurance Corporation taking out its own sword and cracking down on excessive medical treatment.

At a press conference on the 5th, Ki-seok Jeong, Chairman of the National Health Insurance Corporation, pointed out, “There are some otolaryngology and pediatric hospitals with a 90% nasopharyngoscopy performance rate,” adding, “Unless patients refuse, they do it unconditionally, which is abnormal.” This is a hard-line statement made at a time when financial pressure has reached its limit, with NHIS’ salary expenditure exceeding KRW 100 trillion for the first time since the launch of the health insurance system in 1997, exceeding KRW 101.7 trillion in 2024.

10% in tertiary hospitals vs. 90% in neighborhood clinics… a stark gap

According to an analysis by the National Health Insurance Corporation, the nasopharyngoscopy performance rate in all five tertiary general hospitals remained in the 10% range. 88 out of 101 general hospitals nationwide also conducted tests on only 1 in 10 patients. Since a cold is a naturally curable disease that takes a week to treat or 7 days to leave alone, the medical standard is to test only around 10% of cases.

On the other hand, more than 903 of the 1,926 clinic-level otolaryngology clinics, or nearly half, showed an implementation rate exceeding 10%. In some cases, the implementation rate is close to 90%, which means that unnecessary tests are recommended to most cold patients. As of December 2025, the National Health Insurance Corporation analyzed 74 cases and took follow-up measures on 46 cases through the ‘Appropriate Treatment Promotion Team’, which was launched in January last year. This is a system in which 22 departments within the corporation participate and conduct salary analysis and field surveys every month.

Hundreds of billions of billions in deficit by 2026… “The burden on the people is inevitable”

The reason why the National Health Insurance Corporation rolled up its sleeves is clear. This is because the current balance surplus plummeted from 2.8 trillion won in 2021 to 500 billion won in 2024, and a shift to a deficit in the hundreds of billions of won this year has become a fait accompli. The International Monetary Fund (IMF) warned that Korea’s aging rate is the highest in the world and that mandatory spending on health care and pensions will soar to 30-35% of GDP in 2050. This is a figure that will more than double over 25 years from 13.7% as of 2024.

Some in the medical community are concerned that the National Health Insurance Corporation’s crackdown on excessive treatment could put a burden on the management of medical institutions. However, Chairman Jeong emphasized, “The population is not increasing and the disease pattern is not significantly changing, but only expenditures for medical treatment are rapidly increasing,” adding, “We need to look more closely at the legitimacy and appropriateness.” There is an analysis that the deterioration of health insurance finances will ultimately lead to increases in insurance premiums or reductions in benefit items, which will inevitably result in a burden on the public.

Chairman Jeong predicted intensive follow-up measures, saying, “A concrete implementation plan will be released soon.” Attention is being paid to whether this measure by the National Health Insurance Corporation will change the practice of overtreatment, or whether it will only increase conflict with the medical community.