2.5.3. Medical Social Security System

The Korean medical social security system consists of the NHI and public assistance MA. NHI is a mandatory system of the social security network. Koreans enrolled in health insurance are required to pay premiums to the NHI Corporation according to their income and asset level. 97% of the people are obligated to join the National Health Insurance. Their copayments range from 20% up to 60% of the total cost for each medical service [23].

Meanwhile, MA supports the lowest income group or the persons with an incapacity for maintaining their life. They are covered by a tax-based MA system without paying obligatory NHI premiums. Their admission fees are either waived or significantly lower than NHI (0–10% of total cost), and OPD costs are also small (0.95–15% of total cost) [23]. In Korea, about only 3% of the people receive MA [12,13]. People with disabilities are more likely to fall into poverty because they are generally more vulnerable and need more health care [24,25]. People with disabilities receive a variety of social services from the government, but only about 30% of them receive MA. Therefore, it can be predicted that the economic hardship of the kidney disabled person, who is expected to have relatively catastrophic health expenditure, will be greater. In order for a person with kidney failure to be registered as kidney disabled, they must have been receiving dialysis treatment for at least three months immediately before the disability registration, and the doctor of the relevant medical institution must confirm this. In addition, in order for persons with disabilities to be enrolled in MA, they must be selected after reviewing household income, the ability of dependents, and working ability.