Participation of the Lay Public in Decision-Making for Benefit Coverage of National Health Insurance in South Korea

Although South Korea successfully established national health insurance (NHI) in 1977, and has maintained universal coverage since 1989, it has long been criticized for insufficient benefit coverage. Korea has been under public pressure to increase its NHI benefit coverage, while also facing controversies over the appropriateness of items that were newly added to the benefit package. Pressured by the controversies and difficulties regarding national policy decisions on the benefits package, the Korea National Health Insurance Services eventually decided to establish a lay citizen's council, named the Citizen Committee for Participation, to help incorporate social value judgments in benefit coverage priority setting in 2012. The experience of the citizen council in Korea shows that unlike common myth, people may be willing to increase their premium contribution to expand benefits once a deliberative, democratic decision-making process exists. The general public does not necessarily demand ever-increasing benefits; rather they wish to keep benefits at a reasonable level once they understand the nature of public funding, financial sustainability, and cost effectiveness. If these experiences are common among all people in the world, not only in the unique context of Korea, this public participation approach to deliberative democracy may help reduce policy failure in other cultural settings.