Overview
In South Korea, the National Health Insurance System (NHIS) is provided to residents. It is run by the Ministry of Health and Welfare and is free to all citizens at the point of delivery. The system is funded by a compulsory National Health Insurance Scheme that covers 97% of the population. Foreign nationals living in South Korea enjoy the same access to universal health care as the local people. For working people, the employer pays half of the NHIS contribution as part of the deductions.

There is a set limit as to how much doctors can charge, and other treatments such as physiotherapy may only be funded up to a certain amount of visits per year. The amount of the co-pay varies depending on the level of hospital visited – a high-level hospital may have a 50%-60% co-pay, whereas a smaller clinic may only have a 30% co-pay. There are special rates for cancer patients or people with rare/incurable diseases.

Other benefits include free health checkups, usually provided biannually. There are also cash refunds if a co-payment level is reached. For type 1 diabetes, the NHIS covers 90% of the costs of consumables such as test strips, needles, lancets, syringes, insulin pump supplies and infusion sets, up to a maximum amount 2500 won a day (about 2 dollars) for each consumable category. The prescription will confirm how many days can be claimed for and a refund can be applied for. Refunds require a bit of paperwork but are actioned very quickly. Private health insurance is also available and helps to cover costs for areas NHIS doesn’t provide.

What happens if you need to see a doctor?
Anyone can go to any hospital or clinic, and there are usually several to choose from in each area. Larger hospitals require a referral and appointments need to be booked in advance, whereas smaller clinics often have walk-in times. People with type 1 diabetes usually go for 3-monthly checkups at hospitals, but also have the option to attend smaller endocrinology clinics. Doctors are becoming more familiar with using CGM data to discuss further treatment.

In terms of language, large hospitals usually have an international department available with doctors who are fluent enough in English. Smaller clinics are a bit hit and miss as to who is happy to discuss treatment via a translator.

Who decides what medicines a doctor can prescribe?
The Ministry of Food and Drug Safety conducts drug licensing reviews in South Korea. Most insulin released on the global market is also available in Korea with the approval of the Ministry of Food and Drug Safety. Doctors select which medicine to prescribe. These days, doctors actively accept patients' demands or preferences for certain types of insulin. The Ministry of Food and Drug Safety quickly approved the CGMs. Dexcom, Medtronic and Libre got approval from the Ministry of Food and Drug Safety.

Practically, what is it like to live with type 1 diabetes in South Korea?
During the regular checkups, blood and urine tests are carried out and HbA1C is checked. Doctors review blood glucose data and discuss any concerns. They also hand out prescriptions for the required amount of insulin, as well as for consumables such as test strips, needles and CGMs. With the prescription, insulin can be bought at the pharmacy. As consumables are refunded after, they can be bought at the pharmacy or online, where it is often cheaper, as long as the seller is registered with the NHIS as a supplier.

Yearly checkups for eyes and other complications are recommended and bigger hospitals also have diabetes nurses and nutritionists available to discuss a healthy diet for a diabetic. The calorie counting method is widely used and exercise is encouraged.

Financially, it can be a bit expensive, and a lot of people opt out of using CGMs due to cost. Up until recently, CGMs were not allowed to be bought from abroad, as importing medical equipment was illegal. Anyone attempting to do so faced arrest. The Korean Society of Type 1 Diabetes worked hard to collect signatures and spoke to decision makers, including the president of South Korea. By showing them the need for CGMs, especially for children, they succeeded in having CGMs approved and partly funded by the insurers.

These days, Dexcom, Medtronic and Libre can be bought within Korea, with the first 2 being funded up to a threshold amount by the NHIS, with Libre hopefully being added later. The NHIS covers up to 70% of the threshold amount, which is slightly lower than the actual CGMs cost, so the total coverage works out at about 50-55% of the total cost of the CGMs supplies.

Socially, type 1 diabetes still has a big stigma in South Korea, as most people are not aware of the differences between type 1 and type 2 diabetes and think it is all diet related. People with type 1 diabetes often avoid talking about it at work or with friends and many feel the need to hide to take injections and check blood sugar levels.

The atmosphere is slowly changing however, with several people using Instagram and YouTube as a way to inform people and show their lives as people with type 1 diabetes openly. Events and camps are being held for everyone to attend and people can find a lot of support on social media. For foreigners moving to South Korea, diabetes information is becoming a lot more accessible too. There is a small expat community of people with type 1 diabetes who share information via social media.

What about getting admitted to the hospital?
Most people with type 1 diabetes stay in a hospital for about 10 days at diagnosis for the initial treatments, exams, and diabetes education. The medical costs are covered by the insurance. The National Health Insurance covers basic medication, medical bills, room charges, and patient meals, however, it only covers shared hospital rooms, not private rooms. As there are times when certain drugs or treatments are not covered by National Health Insurance, most citizens buy private medical insurance separately. Private medical insurance covers areas that the National Health Insurance does not cover.

How does diabetes care vary throughout South Korea?
The standard of health care is high in all of Korea. Even if you live in rural areas or a small island, you can receive good quality care and the access to insulin is not a problem. Various kinds of insulin are also available in rural private hospitals. Continuous blood glucose meters have been approved and devices such as Dexcom and Libre can be prescribed at any hospital. They are usually received within two days of ordering.

Thank you to Jennifer Lienig and Yuna Oh for this information.