National Health Insurance Corporation's mid- to long-term financial plan warns of operating deficit... This year's deficit is close to 2.8 trillion won.
Next year's insurance premium rate will be frozen and medical fees will be increased by 1.65%... Pressure to increase after 2028
(Seoul = Yonhap News) Reporter Seo Han-ki = A warning light has come on in health insurance finances. The National Health Insurance Corporation predicts that there will be an operating deficit of trillions of won every year for the next five years, and that the debt ratio of the health insurance business will exceed the management standard of 100% by 2030.
In addition, this year's balance of payments turned into a large deficit of 2.8 trillion won, and the variables of next year's health insurance premium rate freeze and medical fee increase overlapped, putting financial management in an emergency situation.
According to the '2026-2030 mid- to long-term financial management plan' submitted by the National Health Insurance Corporation to the office of Rep. Jeon Jin-sook of the National Assembly Health and Welfare Committee on the 13th, the total operating deficit will reach KRW 6.9161 trillion in 2026, then KRW 3.9714 trillion in 2027, KRW 4.2971 trillion in 2028, and KRW 4.2971 trillion in 2029. It is estimated to reach 3.4415 trillion won, reaching 3.2932 trillion won in 2030. The structure is such that deficits in the trillions of won range become chronic every year for five years.
In particular, if you look at the health insurance business sector separately, the trend of financial insolvency is clear. As financial assets decrease due to increased salary expenses, health insurance assets will decrease from KRW 44.234 trillion in 2026 to KRW 39.3503 trillion in 2030. On the other hand, as the liabilities to cover insurance benefits to be paid to hospitals and clinics increase, the debt increases from KRW 18.331 trillion to KRW 20.3753 trillion during the same period.
Accordingly, the health insurance business debt ratio, which represents the ratio of debt to capital, is expected to soar sharply from 71.2% in 2026 to 79.3% in 2027, 89.2% in 2028, and 98.7% in 2029, and then rise to 107.4% in 2030. This figure far exceeds the debt ratio of less than 100%, which is the management standard set by the National Health Insurance Corporation as a financial goal. The overall integrated debt ratio will also rise sharply by 30.9 percentage points (p) from 68.7% in 2026 to 99.6% in 2030, reaching below 100%.
◇ Shaking the premise of insurance premium increase… Income is tied up and spending increases
The problem is that even this mid- to long-term financial outlook was written on the premise that the insurance premium rate will steadily rise by 1.49% every year from 2027. Based on the 2nd National Health Insurance Comprehensive Plan (2024-2028), the National Health Insurance Corporation assumed that the insurance premium rate would increase by 1.48% in 2026 and then by 1.49% every year from 2027 to 2030, and that the government's treasury support rate (general accounting) would also increase from the current level of 12.0% to 14.0% in 2030.
However, actual policy decisions went in the exact opposite direction.
After a tug-of-war over four scenarios, including a freeze, a 0.5% increase, an increase of less than 1-2%, and an increase of more than 2%, the Ministry of Health and Welfare's Health Insurance Policy Deliberation Committee froze the 2027 health insurance premium rate at 7.19%, the same as this year. The amount per point of property insurance premiums for local subscribers was also tied to 211.5 won.
The Ministry of Health and Welfare cited the reduction of expenditures such as improving the drug price system (KRW 270 billion per year), adjusting sample and imaging fees (KRW 2.6 trillion per year), and management of unfair claims (KRW 800 billion per year) as the background for freezing additional insurance premium income (KRW 3.8 trillion) due to the boom in the semiconductor industry. However, as the increase in insurance premium rates, which should be a key pillar of increasing financial income, has stopped, disruption to the revenue path originally assumed by the National Health Insurance Corporation has become inevitable.
On the other hand, the burden of spending increased again. The 2027 nursing care benefit cost (medical fee), which is the compensation paid to medical institutions, has increased by an average of 1.65%, and an additional 1.2058 trillion won in health insurance finance has already been allocated. Following the increase of 1.2% for hospitals, 2.6% for dentists, 3.0% for oriental medicine clinics, and 3.7% for pharmacies, next year's rate of increase for clinic-level medical institutions, where negotiations had collapsed, was finally decided at 1.6% (conversion index 0.9%, relative value linkage 0.7%), putting a wedge in the spending increase. This is a structural mismatch that has become a reality, with income frozen but expenditures increasing due to increases in the number of all types of care institutions.
◇ This year’s deficit approaches 2.8 trillion won… Legal standards for government support still fall short
The party's financial situation has already entered a sharp deficit. As of the end of July 2026, the current health insurance balance recorded a deficit of 364.4 billion won, and it is expected that the deficit will increase to 2.8374 trillion won by the end of this year.
Accordingly, the cumulative balance in the form of emergency reserves is expected to shrink to 27.3844 trillion won, which is only about 3 months' worth of medical expenses paid to hospitals, clinics, pharmacies, etc. across the country. Medical expenses for seniors aged 65 or older amounted to KRW 52.1935 trillion in 2024, accounting for 44.9% of the total, and the health insurance finances invested in policy support such as the emergency treatment system (approximately KRW 3.7 trillion), restructuring of tertiary general hospitals (approximately KRW 2.1 trillion), and essential medical support (approximately KRW 2.7 trillion) alone exceeded KRW 8.6 trillion.
Government treasury support also falls far short of legal standards. The government set the government subsidy for health insurance in 2027 to 13.8 trillion won (11.8 trillion won for general account, 2 trillion won for National Health Promotion Fund), which is about 1.1 trillion won more than this year, but the national treasury support rate remained at 14.4% (12.3% for general account, 2.1% for health promotion fund). Ignoring the 20% standard of expected insurance premium income stipulated by the National Health Insurance Act, etc., the unpaid statutory support amount for 10 years from 2016 to 2025 amounts to a total of KRW 19.4531 trillion.
Inside and outside the National Health Insurance Corporation, the freeze on insurance premium rates in 2027 has reduced the short-term burden on households, but it is predicted that the burden of having to significantly increase insurance premiums by more than 2% every year from 2028 to 2030 will increase in order to maintain the legal emergency reserve (1.5 months) in 2030. Although the National Health Insurance Corporation announced that it would pursue self-rescue efforts worth 16.4565 trillion won over five years, it is pointed out that this is not enough to offset the rapid increase in benefit costs due to the super-aging population, the lack of actual government support, and the policy freeze in insurance premiums.
With the increase in fiscal deficit and debt threatening the sustainability of the system, it has emerged as an urgent task to prepare a reasonable expenditure efficiency plan along with complying with actual statutory national treasury support.
