INTRODUCTION
North Korea has free healthcare, along with free public education which has been extremely important for their communism. It was introduced for all workers and their families by the Social Insurance Law of 1947. During the post-war period, the healthcare for workers was given importance for restoring the country in the state’s efforts to rebuild and expand the medical and children care provision. An inclusive and complete free health care system was aimed to be established by 1960.
South Korea’s healthcare system is efficient and modern as the country is more advanced and open to change. Medical practitioners and medicines are available from both, eastern and western parts of the world and the National Health Insurance (NHI) covers them both. General healthcare products, pharmaceutical drugs, dentists, doctors, dermatologists and other specialists are all readily available and affordable.
Health Issues in Korea
The prevalence of common diseases in North Korea stems due to poverty. The government focuses its monetary funds and services to the military rather than paying equal attention to the health and well-being of its people. Patients of non-communicable diseases such as cardiovascular diseases, respiratory diseases and cancer have the highest mortality rates.
Insufficient nutrition reduces the immunity strength which makes the body extremely fragile and becomes an easy host for microbes. One-third of the children in North Korea show signs of stunted growth which also leads to early deaths.
Another issue is that there is absolutely no guarantee of health care. Article 56 in the North Korean constitution declares that “The State protects the people's lives and improves the working people's health by consolidating and developing the system of universal free medical service and improving the district doctor system and the system of preventive medicine.” But according to the patients, this is not being followed. It has been informed that if a patient does not pay or offer presents to the doctor, the illness is left untreated.
According to Dr. Eric Goemaere, director of ‘Doctors Without Borders’, North Korea may have buildings as hospitals and doctors to treat, but there is lack of basic medications such as aspirin; no anesthetics or even simple hygienic soaps, thus, there is also a lack of patients. The health system in North Korea collapsed, leaving almost the entire population with no care and facilities except for traditional ‘Korio’ herbal medicine. This deficiency of resources has been occurring from almost 4 years.
In South Korea, the health issues aren’t as defined as in the North. Suicide is a major problem in Korea especially in the elderly and the poor, given the large amount of population being mature. Smoking was also very common and eventually the government banned smoking in places such as bars, restaurants and cafes.
Air pollution is also another issue in South Korea and according to the Environmental Performance Index 2016, more than 50% of the population in South Korea are exposed to dangerous levels of fine dust.
Insurance
South Koreans have the right to universal healthcare, ranking first in the OECD (Organization for Economic Co-operation and Development) for healthcare access . Satisfaction of the healthcare being provided has also been consistently among the highest in the world with South Korea being rated as the most efficient healthcare system by Bloomberg.
Social health insurance was introduced under the National Health Insurance Act, providing industrial workers with health insurance. The program was later expanded to include government employees and teachers. Universal coverage was achieved in 1989 when the program was rolled out to the general public.
The South Korean healthcare system was initially dependent on not-for-profit insurance societies to manage and provide the health insurance coverage for its citizens. Currently the insurance system is funded by contributions from individuals and corporations, government subsidies and tobacco surcharges. Employed contributors are expected to pay 5.08% of their income to the fund while self-employed individual’s contributions are based on their income and property. The national government provides about 14% of the total amount of funding and the tobacco surcharges account for about 6% of the funding.
The South Korean healthcare has been ranked among the world's best. It has the OECD's highest colorectal cancer survival rate at 72.8%, cervical cancer survival rate at 76.8% (OECD Indicators, 2011) Hemorrhagic stroke 30 day in-hospital mortality per 100 hospital discharges is the OECD's third lowest at 13.7 deaths. For ischemic stroke, it ranked second at 3.4 deaths. South Korean hospitals ranked 4th for MRI units per capita and 6th for CT scanners per capita in the OECD. It also has the OECD's second largest number of hospital beds per 1000 people at 9.56 beds.
The Korea International Medical Association was formed to encourage medical tourism. With 400,000 medical tourists visiting South Korea in 2013 alone. The number of potential medical tourists is expected to rise to 1 million by 2020. Compared to procedures done in the US, patients can save between 30% to 85% of the costs if they have the same treatment done in South Korea.
In comparison, North Korea has a life expectancy of 71.69 years as per reports published in 2016. Even though North Korea is classified as a low-income country, the major causes of deaths are non-communicable diseases such as cardiovascular disease unlike that of other low-income countries.
The North Korean government provides universal health care to all citizens with all health services being offered for free. With North Korea spending 3% of its gross domestic product on health care as per 2001 reports.
South Korea provided free education and healthcare in 1960s. However, in the late 1980s the government was unable to supply basic medicines and medical equipment, leading to the collapse of the free health care system. In the 1990s, the scarcity of medicine and widespread death due to famine, incapacitated the health care workers even further. The virtual collapse of the free socialist health care system led to the formation of several helpful but illegal informal institutions. Most hospitals that exist today were built in the 1960s and 1970s.
In 2010, the World Health Organization described the healthcare system as 'the envy of the developing world' while recognizing that 'challenges remained, including poor infrastructure, a lack of equipment, malnutrition and a shortage of medicines.' (WHO, 2010). The WHO criticized an earlier Amnesty International report that described 'barely functioning hospitals' as outdated and factually inaccurate (Amnesty International, 2010).
A 2013 study stated that the largest obstacle for understanding the accurate health status of North Korea is the lack of the validity and reliability of its health data.
All numbers per hundred thousand people
The most common communicable illnesses found in North and South Korea are tuberculosis and malaria. 20 deaths per hundred thousand (in North Korea) and 71 .1 per hundred thousand (in South Korea).
The occurrence of diabetes in South Korea is about 9% times higher than in North Korea.
Liver cancer is 100% more likely to occur in North Korea than in South Korea. There’s a 37% higher chance of lung cancer in North Korea than in South Korea. There’s a 70% higher chance of stomach cancer in North Korea than in South Korea. There’s a 376% higher chance of heart diseases in North Korea than in South Korea.
Vaccination in Korea
Immunization is a measure taken to prevent the onset of an infectious disease.
The most commonly used vaccine is for influenza, and its supply has almost doubled from 1 million doses to 2 million doses in approximately 10 years. The number of recipients of the influenza vaccine has tripled in 20 years. Currently, the domestic production for the influenza vaccine stands at 70% of the total required.
The government purchases vaccines via procurement contracts for adults ≥65 years, which are then supplied to public health centers and private clinics.
The following is a list of initiatives taken by the government of Korea with regards to the healthcare system:
- 2004: The government initiated the management of Internet-based monitoring of the vaccine supply status at public health units.
- 2007: Influenza immunization field education started at the city/district/county level.
- 2009: In response to the 2009 H1N1 influenza pandemic, the government initiated the Influenza Immunization Professional Education Program that operates at the city/district/county level.
- July 2009: The H1N1 Influenza Immunization Planning Committee was established.
- 2012 and 2015: The government implemented real-time services and developed vaccine supply systems for clinics and hospitals participating in the National Immunization Program (NIP) hence allowing immediate response and management when vaccine shortage or supply problem occurs.
- July 2012: Vaccination registration systems combined its forces with the Integrated System for Disease Control/Public Health to allow physicians to report directly through this integrated system.
- 2013: A structured online educational program has been operating since via the KCDC (Korean Center for Disease Control and Prevention) training system.
Conclusion
Overall, South Korea has achieved remarkable economic growth under democracy and a market economy system since being liberated from Japanese ruling in 1945. Cosmetic care like Plastic Surgery and Implants of Southern Korea have become famous worldwide in the recent generations especially after societies have become more accepting of change and individual growth aside from the norms. This splurge of foreign tourists has made the economy much stronger. It has also made South Korean hospitals and clinics English-friendlier, however, there are still certain districts that will require a Korean translator. On the other hand, North Korea has maintained a socialistic system. North Korea has suffered from extreme economic crisis since the 1990s and due to this, there is a major difference in health level between the two Koreas. Economic status not only directly influences health level but also indirectly affects it through influences on nutrition, hygiene, health resources, and other intervening factors. The South Korean government has concentrated its limited resources on public health activities such as tuberculosis control, family planning (FP), and maternal and child health (MCH) programs whereas the private sector has taken charge of constructing the health delivery system including health facilities and human resources. This enforcement of the NHI and regulation policies since the 1960’s has allowed South Korea to develop its medical services for the better, unlike North Korea, which still has a long way to improvement.
