Health care systems in transition. II. Korea, Part I. An overview of health care systems in Korea.

Abstract

The republic of Korea occupies the southern half of the Korean peninsula. Japan lies to the south east across the Sea of Japan and in the north the peninsula shares borders with China and Russia. The country is characterized by abundant hills and mountain ranges, which take up about 70 per cent of the land surface. In 1995 Korea had a population of 44.6 million, with one of the highest population densities in the world, at 440 persons per square kilometre. Approximately 6 million Koreans reside in foreign countries and 500 000 foreigners live in Korea. Koreans form a single ethnic group with common language and culture. The main religions are Buddhism, Christianity, Confucianism and other traditional religions originally from Korea. Accelerating population growth was once a serious social and economic problem, but the rate of population growth dropped from 3.00 in 1960 to an average of 0.88 by 1996. Health policy and the health care system reflect changes in society and health conditions. Korea is one of the most rapidly industrialized economies in the world. It has experienced fast development with unprecedented social and cultural changes since the early 1960s, despite the fact that Korea was impoverished for at least a decade after the Korean war. Korea's per capita GNP in 1961 was one of the lowest even among less developed countries (Table I). Accordingly, health status was poor. During the immediate post-war period, the average life expectancy was 53.0 for males and 57.8 for females, and the infant mortality rate (IMR) was as high as 45.4 per 1000 births in I960. About 30 years of rapid economic progress, initiated and promoted by the Government's five-year economic development plans since 1962, have profoundly transformed the country from an agricultural to a highly urbanized and industrialized society. With the growth rate close to 10 per cent per year, the per capita GNP reached $10000 in 1995, more than 100 times the 1960s level. The accelerated rate of urbanization, which was due to economic growth, is also remarkable. The proportion of population residing in urban areas has risen from 43.7 per cent in 1961 to 88.4 per cent in 1995. The adult literacy rate is currently estimated to be around 97 per cent By 1993, the life expectancy had increased to 68.9 years for men and 76.8 years for women (Table 2), and the IMR in 1990 had come down to 12.8 per 1000 births. As a result of longer life expectancy, the proportion of the people aged more than 65 years increased to 5.5 per cent in 1990. A more distinct change can be found in the transition of mortality and morbidity patterns. Communicable diseases, which had been the main causes of death and illness until 1970, have mostly been replaced by chronic diseases as in other developed societies. A country with such rapid economic and social development masks wide health disparities between problems associated with poverty on the one hand and those of more affluent populations on the other. In this respect, Korea retains similarities with many other developing countries. For instance, the high prevalence of infectious diseases such as tuberculosis occurs concurrently with emerging problems such as cancer, ischaemic heart disease and other chronic illnesses.