The National Health Insurance Service recorded a deficit of 3.8989 trillion won in the first quarter of this year. This puts the six-year surplus trend in jeopardy.

The National Health Insurance (NHI) fund recorded a deficit of nearly 4 trillion won in the first quarter of this year. The surplus trend that had continued since 2021 has been broken, increasing the likelihood of a return to a deficit six years later. Due to the structural impact of low growth and aging, there is a pressing need for measures such as fulfilling statutory government support for the NHI fund and strengthening preventive care.

On the 9th, Rep. Jeon Jin-sook of the Democratic Party of Korea, received data on the "NHI Financial Balance Status" from the National Health Insurance Service. According to the data, the NHI revenue in the first quarter of this year was 22.4416 trillion won, which was less than the expenditure (26.3405 trillion won), resulting in a deficit of 3.8989 trillion won.

The NHI fund had a deficit of 3.531 billion won in 2020, but then recorded surpluses of 2.8229 trillion won in 2021, 4.1276 trillion won in 2023, and 4.996 trillion won in 2025, maintaining a surplus for five consecutive years. However, the surplus has been decreasing over the past two years, and the fund turned into a deficit in the first quarter of this year.

The red flag for the NHI fund had already been predicted. When the "Second National Health Insurance Comprehensive Plan" (2024-2028) was established in 2024, it was forecasted that the NHI fund's current account balance would turn into a deficit this year.

Low growth, which has been in the 1-2% range annually, and low birth rates and aging are cited as factors that worsen the NHI fund's financial situation. The number of young people, who are the working-age population that pays insurance premiums, is decreasing, while the number of elderly people, who use a lot of medical services, is increasing, resulting in more expenditures than revenues.

It is projected that the proportion of medical expenses for people aged 65 and older will surge from 44.1% in 2023 to 53.1% in 2030 and 70.2% in 2050.

South Korea's health insurance coverage rate is 64.9%, which is significantly lower than the average of 80% for member countries of the Organization for Economic Cooperation and Development (OECD). Therefore, there is a need to expand NHI coverage in the future.

As it is not easy to respond with insurance premiums alone, there is a strong call for proper government support. According to the current National Health Insurance Act and National Health Promotion Act, the government is required to support the NHI fund with an amount equivalent to 20% of the expected annual NHI premium revenue (14% from the general account and 6% from the National Health Promotion Fund).

However, the government has never maintained the statutory ratio, with the government support rate ranging from 13-14% since the introduction of this system in 2007.

In a report released in June, the National Assembly Budget Office stated that "the government's statutory support level is not being fulfilled. It is necessary to strengthen the government's financial responsibility, such as by legislating the minimum support level and obligating the government to make up for any shortfalls."

Some experts also point out that there is a need to reform the medical system to strengthen prevention. Na Baek-ju, a professor of preventive medicine at Eulji University College of Medicine, emphasized, "Due to aging, medical demand continues to increase. We need to expand the preventive and management functions of primary care institutions, such as community health centers and clinics, so that residents can manage their health within their communities, which can help reduce medical expenses."

The government is considering a revision of the health insurance premium payment system, such as lowering the deductible for interest, dividends, and rental income for salaried employees from the current 20 million won to 10 million won, raising the upper limit of health insurance premiums for the ultra-high-income group, and gradually increasing the minimum insurance premium for low-income groups.