North Korea is preparing to transition from the free health care system it has nominally maintained over the years to a medical insurance model. This suggests the regime is determined not only to increase the number of hospitals and pharmacies but also to change the cost-sharing structure for medical care.
“Since the Central Committee’s plenary session this past December, the Cabinet’s Health Ministry and Workers’ Party departments have been assigned the technical task of rebuilding the health care system from the ground up. Right now, they’re preparing to formally announce the new health care system,” a source in North Korea told Daily NK recently.
According to the source, the regime is leaning toward making it mandatory for employees at various agencies and enterprises to enroll in medical insurance.
“Going forward, they plan to require company employees to enroll in medical insurance. One idea under discussion is to have the premiums deducted from people’s monthly wages,” the source said.
According to the source, officials are also considering the option of allowing North Koreans without an official workplace to still receive insurance benefits through working family members who are insured.
For example, young people with an official job could pay an extra premium so that their parents or other dependents could receive priority in receiving treatment or medication.
In addition, the regime is reportedly looking into including retired people who are no longer able to work in the medical insurance system.
Shift from “free care” to cost-sharing
“People enrolled in basic insurance could receive basic treatment at prices set by the state. But it’s likely that individuals’ or families’ out-of-pocket costs would go up in the event of hospitalization or specialized treatment,” the source said.
This appears to represent a shift from the state covering the entirety of medical expenses to a system in which costs are split with individuals.
“The current system is purportedly ‘free medical care’ but actually requires paying hospitals for care. Instead, the regime wants to provide institutional clarity about how much each individual is expected to pay for each kind of treatment,” the source said.
This institutional reform dovetails with the regime’s recent expansion of “model pharmacies” and construction of new hospitals at the municipal and provincial levels. The regime, having concluded that the new hospitals and pharmacies are not viable under the current system, has apparently decided to introduce medical health insurance as a way to stabilize medical expenses.
On a related topic, the introduction of medical insurance may be connected to the vision of a “public health revolution” that North Korean leader Kim Jong Un announced in early February 2025.
“The leadership is unhappy with the operational difficulties faced by the new hospitals. They’re making a concerted push to create institutional links between public health, medical care, and financial services,” the source said.
“The state may very well continue to use the phrase ‘free care.’ What we’ll probably see is that medical benefits at the operational level will depend on enrollment in medical insurance and the level of out-of-pocket expenditure,” the source said.
What this suggests is that North Korea will continue to espouse the socialist vision of free care even as, on a practical level, the country moves to a system of managed public health care based on medical insurance.
If North Korea does in fact adopt a medical insurance system, the key variables will be the level of insurance premiums and the level of out-of-pocket spending for treatment and medication.
“No concrete decisions have been made yet about how much premiums will cost or which regions the program will be rolled out in. Struggling households and households where nobody has an official job may well be skeptical about the introduction of medical insurance,” the source predicted.
Medical insurance cards to track treatment
As part of preparations for adopting medical insurance, the Health Ministry is reportedly getting ready to issue “social security medical insurance cards.” These cards would be used to manage individuals’ medical history and treatment records.
The adoption of these cards would make it possible to integrate medical records at all levels, from neighborhood clinics to top-tier hospitals managed by the Central Committee itself, the source explained.
“Treatment received at regional clinics, municipal hospitals, provincial hospitals, and Central Committee hospitals would all be linked to a single card. The goal is to give the medical authorities a top-down view of who has been treated, what treatment they’ve received, and where they got it.”
January 20, 2026 at 01:59AM
by DailyNK(North Korean Media)