Growing up in the South of the United States was my first window into the complexities of healthcare where I gained exposure to the politicization of health and consequently, disparities, within the American healthcare system. Through my experiences shadowing physicians, I met patients who had traveled hours across state lines due to the lack of comprehensive care where they lived. Contrarily, there were those who lived nearby but faced matters of insurance coverage or finding a provider willing to perform a life-saving procedure banned in my state. So I asked myself, what determines who can obtain basic healthcare and how can we give it to them? Such a question propelled my interest in global healthcare systems, and as a Korean-American, I wondered, what does South Korea do differently?
This summer I had the incredible opportunity to participate in a dual study abroad-internship experience in my heritage country. From commuting to the Health Insurance Review & Assessment Service (HIRA) in Wonju to sitting down with a family medicine physician at the Seoul National University Hospital in Bundang, I learned the power of a centralized, universal healthcare system working across cities. My internship experience also allowed me the opportunity to see care being delivered upfront. From shadowing a fertility specialist to attending my own doctor’s visit, I also gained a more personal perspective on the standards of care in South Korea vs. the USA.
As a rising junior studying Health Policy and Law and minoring in Korean, I’ve always been fascinated by the cross-cultural delivery and inner-workings of healthcare. During my internship I learned some key similarities and differences between our two countries. First, unlike the coverage gap that exists in the USA, health insurance in South Korea is government-mandated and provided to all citizens by the Ministry of Health and Wellness. In other words, 100% of the population is guaranteed coverage. Second, both countries have a program dedicated towards insuring low-income populations. Beyond covering low-income individuals, Medicaid in the USA also insures pregnant women and people with disabilities while South Korea’s Medical Aid Program also insures those with chronic diseases. Third, a global trend seems to be an aging population with a need for comprehensive long-term care coverage. On the other side of the age spectrum, South Korea’s fertility rate hit a record low of 0.78 births per woman1) – the lowest in the world. I wonder, how will the government balance increased spending for an older population while bolstering the economy from a dwindling young workforce? Fourth, despite South Korea’s universal coverage system, there is a lack of an interoperable electronic health record system. Patients are usually the bearer of their own information which creates difficulties in switching hospitals and care coordination.
So what explains these differences? Why can’t we just copy and paste the strengths of South Korea’s healthcare system to the USA and vice versa? Aside from these comparisons, I learned that complex history, culture, and politics play a great deal into explaining current policies. One of the biggest cultural differences I experienced abroad is the extremely fast-paced environment of South Korea. Combined with
the collectivist culture of the nation, I saw this aspect to be a great strength. For example, South Korea’s recycling and transportation system are on a different standard of efficiency, and many Koreans are kept accountable in their waste disposal and public etiquette habits due to the collectivist mindset surrounding them. In Korean, ‘noonchi’ which means being sensitive/alert to your surroundings and ‘bae-ryuh’ which means being considerate of others can explain the cultural success of such systems. However, I noticed that overt ‘noonchi’ can sometimes have flaws. The healthcare system can be an example. Through my time touring hospitals, I noticed that many patients have limited time with their physicians. I recall a family medicine doctor telling me she only has 3 minutes to speak per patient due to the amount of patients booked for the day and that the system pushes for maximum quantity. She mentioned that patients themselves recognize this “rush” and feel as if they cannot ask extra questions out of consideration or ‘bae-ryuh’ for the next patient. Similarly at a fertility clinic I shadowed at, I noticed procedures being done at twice the speed than what I observed in the States. There was this constant “hurry hurry” mentality surrounding getting patients in and out, charting, consulting, etc. Even in my own experience at a dermatology clinic in Seoul, I felt discomfort in feeling rushed during my visit. Without realizing at the moment, I found myself restraining myself from asking follow-up questions and quickly collecting my things to ‘bae-ryuh’ the next patient. While the inherent cultural difference of South Korea’s push for efficiency can explain this unfamiliar experience, I couldn’t help but feel like a cog in a machine. Churning out as many patients in as little time as possible, the system seemed to favor quantity over quality. This is not to say the USA system doesn’t have its fair share of flaws, but direct patient care in the States felt more personable and decelerated (though at times I did have to wait over an hour at my appointment).
At the end of day, the South Korean vs USA healthcare systems contrast each other in many aspects, and there are many things that can be learned from each other. While one favors less waiting times and more volume, the other favors the opposite. While someone may receive high tech services at a more affordable price in South Korea, they may also experience a more personable service in the States. I learned that such differences cannot simply be judged black and white because they have been shaped by and are mediated through fundamental cultural differences. As a Korean-American, this summer taught me the value of immersing myself in a foreign community with the framework of these cultural and social contexts in mind. Nonetheless this experience not only gave me the opportunity to reconnect with my heritage ethnicity, but also see the beauty in how healing and medicine transpire beyond geographical borders.
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