5 Surprising Truths About Foreigner Healthcare Costs in South Korea

The debate over healthcare access and costs for non-citizens is a global one, sparking conversations about fairness, financial sustainability, and national responsibility. Recently, this discussion has intensified in South Korea, with headlines focusing on a rapid surge in medical expenses for foreign nationals covered by the National Health Insurance Service (NHIS).

While the numbers appear dramatic, the full story is far more complex than a simple narrative of runaway spending. The data reveals a series of surprising truths that challenge common assumptions, pointing to a critical policy crossroads between fiscal prudence and healthcare accessibility. Here are five key facts that unpack the real story behind the headlines.

1. The Growth Rate Isn't Just High—It's Double That of Locals

The most striking figure driving the current debate is the growth rate of medical spending. According to data from the Ministry of Health and Welfare, medical expenses for foreign nationals covered by the NHIS jumped 68 percent over the past five years, rising from 948 billion won in 2019 to 1.6 trillion won in 2024.

In contrast, medical expenses for Korean nationals increased by 36 percent during the 2019-2023 period, rising from 66.97 trillion won to 90.92 trillion won. While the total amount spent on healthcare for Koreans is vastly larger, the rate of increase for foreigners is nearly double. This velocity of growth, more than the absolute cost, presents a significant challenge for long-term fiscal planning and policy stability.

2. It's Not Just Major Surgeries; Local Clinic Costs Are Skyrocketing

One might assume that high-cost procedures at major hospitals are the primary driver of rising expenses. However, the data reveals a different and more systemic trend. While costs for foreigners at large hospitals did rise significantly by 53.9 percent, from 615 billion won to 946 billion won, expenses covered at smaller, local clinics surged by a much more dramatic 94.1 percent, from 333 billion won to 646 billion won.

The top treatment types by cost provide further context, led by internal medicine (298 billion won), surgeries (143 billion won), and orthopedics (99.6 billion won). This pattern suggests that rising costs are not driven by a few catastrophic cases but by a fundamental shift in routine healthcare utilization, a trend that is often harder to manage through targeted policy interventions.

3. Politicians Allege "Medical Shopping" and Unfair Burdens

The surge in costs has not gone unnoticed by lawmakers, who have raised concerns about the system's fairness and potential for abuse. Rep. Kim Mi-ae of the People Power Party has called for greater transparency and institutional measures to manage medical expenses for Koreans and foreigners separately. Highlighting specific instances, Rep. Kim noted a case where 111 foreign patients left the country after receiving medical treatments worth over 10 million won each, leaving behind combined bills of 1.8 billion won covered by the NHIS.

The political rhetoric escalated when Rep. Lee Gae-ho of the Democratic Party alleged "medical shopping" by some foreign nationals, particularly from China. His frustration was captured in a direct and impactful statement made during a government audit.

“Koreans pay for the insurance, and foreigners take the benefits.”

4. The Counter-Intuitive Reality: The System Is Still in Surplus

Contrary to the alarming growth figures, the government's data reveals a counter-intuitive reality: the system is not actually losing money. Health Minister Jeong Eun-kyeong provided a direct rebuttal to the allegations during a National Assembly audit, stating that the overall health insurance balance for all foreign nationals is currently in surplus.

“The overall health insurance balance for all foreign nationals is currently in surplus. While China once recorded a slight deficit, it has recently shifted to a surplus.”

This single fact dramatically complicates the debate. Despite the rapid growth in expenses and specific instances of high-cost treatments, the system as a whole is taking in more in contributions from foreign nationals than it is paying out in benefits. This surplus shifts the focus from an immediate financial crisis to a question of long-term sustainability and equitable contribution.

5. In Response to Concerns, Eligibility Rules Have Already Been Tightened

The government has not been idle while this debate has unfolded. Acknowledging the potential for system abuse and the need to ensure fairness, policymakers have already taken concrete steps to strengthen the integrity of the NHIS for foreign residents.

According to the Health Minister, the required residence period for a foreign national to become eligible for health insurance has been extended from three months to six months. This policy adjustment is a direct administrative response to the "medical shopping" allegations raised by lawmakers, aiming to curb potential abuse by short-term residents and ensure contributors have an established presence in the country before accessing benefits.

Conclusion: A Complex Balance

The data on foreigner healthcare costs in South Korea presents a complex picture. On one hand, the rate of spending growth is alarmingly high, and legitimate concerns about fairness and potential abuse have been raised by lawmakers. These concerns are supported by data showing a disproportionate spike in spending at local clinics and specific cases of high-cost care.

On the other hand, the system covering all foreign nationals is not actually losing money; it is operating in a surplus. Furthermore, the government has already moved to tighten eligibility rules to safeguard the system's integrity. This reveals a fundamental tension between a financially stable present and a potentially unsustainable future trajectory. As costs continue to climb, how can South Korea maintain a fair and inclusive healthcare system without creating an unsustainable financial burden for the future?