Evaluation of the National Health Screening Program of Korea
Published on 6 October 2021
Published by Social Administrative Program Evaluation Division
The National Health Screening Program (NHSP) of Korea was launched in the 1950s and has long been supporting the nation’s health management efforts. The NHSP will continue to be expanded to help the public enjoy a healthy life. For the effective and efficient promotion of the program, a policy overview should be conducted to see whether there are any blindspots despite the expanded eligibility criteria, whether any inefficiency is found in the program, and so forth. In this report, a review was conducted on the NHSP program with a focus on the design of the examination package, management of eligible groups, management of the institutions providing the examination service, follow-up management and the program’s implementation structure; based on which the following improvement measures were drawn.
First, the examination categories were designed with little consideration as to whether an individual has an illness or not, exhibiting an inconsistency with the NHSP principles which require early detection, treatment and cost-effectiveness. Although the program distinguishes between in-office and non-office work positions and differentiates the associated examination term, it is difficult to determine a significant distinction in terms of prevalence rates and suspected rates of disease. While student health examinations and out-of-school youth health examinations are both provided to youths, it was found in the analysis that the two consisted of different categories. In this respect, the examination categories and term should be designed based on individual health conditions and medical feasibility.
Second, among those that were eligible to receive 5 examinations over the past 10 years, about 8.6% were found to have never taken the exam, while more than half of the nation’s local governments are not providing examinations for medical benefit recipients who are at least 65 years old. Also, it was found that runaway teens who suffer from unstable living conditions but are in need of effective health management have a low participation rate in out-of-school youth heath examinations. People such as 65+ medical benefit recipients and out-of-school youths are relatively likely to be in poor health and need society’s protection. Therefore, ways to improve their participation should be devised.
Third, due to a lack of private health examination data, the government is unable to determine whether NHSP providers observe the workforce standard (annual average of one physician per 25 patients on a daily basis); whereas households spend around 800 billion won each year on comprehensive health checkup services provided by the private sector. However, several studies point out that such services involve unnecessary tests or excessive radiation exposure. Therefore, in order to improve the NHSP’s quality and ensure safe examinations for the people, the government should identify the current state of private health examination services as well as provide information such as on the necessity or appropriateness of examination categories, thereby supporting the people in making rational decisions.
Fourth, given the low participation rate in confirmation tests and tricky interpretation of subsequent test results, follow-up management should be reinforced so that individuals may identify their own health risks and move on to seek treatment. Also, for the sake of providing individual health information, a system should be developed to enable access to not only an individual’s NHSP results but also the results of any private health examinations or additional tests that the individual chooses to undergo. Moving forward, the government should conduct panel and data analyses by utilizing data accumulated by institutions such as the National Health Insurance Service (NHIS) to continue to see if the nation’s health examination costs are appropriate, examine whether medical costs have been reduced and study the relevant management system, thereby aiming for higher efficiency in running the program.
Fifth, while the NHIS is responsible for NHSP for infants and toddlers, adults and seniors, only the health examinations for youths are operated under a separate system, creating inefficiency such as the maintenance of separate health data, limited choice of examination providers, and high administrative costs. Therefore, improvements should be made to the double-track examination system.