Health Insurance Posts 3.9 Trillion Won Deficit in Q1, Ending Six-Year Surplus Streak

South Korea's National Health Insurance fund plunged into a deficit of nearly 4 trillion won in the first quarter of 2026, signaling a potential end to a six-year period of surpluses. This sharp downturn raises concerns about the long-term financial stability of the nation's healthcare system.

The deficit, amounting to 3.8989 trillion won, resulted from expenditures of 26.3405 trillion won exceeding revenues of 22.4416 trillion won. While the fund had maintained a surplus since 2020, with a peak of 4.1276 trillion won in 2023, the surplus has been steadily shrinking, leading to the current deficit.

This financial strain is attributed to structural challenges, including persistent low economic growth and a rapidly aging population. The number of working-age individuals contributing to insurance premiums is decreasing, while the elderly population, which utilizes healthcare services more frequently, is growing. Projections indicate that individuals aged 65 and older will account for an increasing share of medical expenses, rising from 44.1% in 2023 to an estimated 70.2% by 2050.

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The government's legal support level has not been met. It is necessary to strengthen government financial responsibility by legally stipulating a floor and obligating the補填 of shortfalls.

Experts emphasize the need for immediate action. Calls are mounting for the government to fulfill its legal obligation to provide national co-funding, which has consistently fallen short of the mandated 20% of projected insurance revenue since the system's inception in 2007. Additionally, there is a push to strengthen preventative healthcare measures. Professor Na Baek-joo of Eulji University's College of Medicine suggests expanding the preventative and management functions of primary care institutions to reduce overall medical costs.

The government is reportedly considering reforms to the health insurance premium structure. These include lowering the deduction limit for income other than salary for corporate subscribers from 20 million won to 10 million won, increasing the upper limit for health insurance premiums for high-income earners, and gradually raising the minimum premium for low-income individuals.

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Medical demand is continuously increasing due to aging. We need to move towards reducing medical expenses by expanding the preventive and management functions of primary care institutions so that residents can receive health management at local health centers or clinics.