President Lee Jae-myung called for a structural overhaul of the entire system, saying the National Pension Service and birth, youth, and emergency medical policies need to be "redesigned for fairness and effectiveness." From expanding pension credits to respond to low birthrates to supporting young people's enrollment in the national pension, tackling the problem of emergency room turnaways, and cracking down on overtreatment, concerns that the entire medical and welfare system needs to be reworked were raised intensively in the latter half of the briefing.
On the afternoon of the 16th, at the Health and Welfare Ministry's work briefing held at the Government Sejong Convention Center, Lee cited the National Pension Service's birth and military service credit system and stressed that "giving birth is now a public-interest activity that contributes to sustaining society." He added, "Support should be provided as much as possible."
Earlier, the government decided to revise the current system that recognizes birth credits from the second child, and starting next year, recognize 12 months of enrollment each for the first and second child, and 18 months for the third child. On this, Lee said, "We can consider whether there needs to be a distinction between the first and second child," suggesting the possibility of further improvements.
Regarding the background of the monthly increase in the number of newborns for more than a year, the Health and Welfare Ministry said structural factors in the population were significant. First Vice Minister Lee Seu-ran explained, "Marriages delayed after COVID-19 have resumed, and as children of the baby boom generation enter their childbearing years, the number of women of childbearing age has temporarily increased." Still, the ministry presented this year's forecast for the number of newborns at about 254,000, saying, "Structurally, it is difficult for the trend to continue." Lee said, "It is important to change the environment so that having and raising children becomes happiness, not suffering."
Fairness issues surrounding national pension policies for young people also came under scrutiny. Regarding the "support for young people's first national pension premium" policy, Lee said, "A structure where only a small number with information and resources benefit is not just," expressing concern. Lee said, "It is hard to call it policy when only those who know about retroactive contributions use them to extend their enrollment period," adding, "It would be fairer to give everyone the same opportunity, or, if the fiscal burden is the problem, to limit the period."
Lee cited an anecdote from his time as Seongnam mayor, when he learned the practical effect of retroactive national pension contributions, and noted, "Policy must not work only to the advantage of those who are fast and well informed." The government is preparing to introduce support for the first premium for young people in 2027, but Lee said, "This could also create another unfairness," ordering a reexamination of the overall system design.
On the problem of emergency room turnaways, Lee strongly rebuked, saying, "In theory we have built a plausible system, but in reality people are losing their lives in ambulances." Lee said, "The very structure in which 119 paramedics call around to find a hospital is the problem," adding, "We must change the reality where the system functions to refuse patients." In response, the ministry said it would strengthen the control tower function centered on regional situation rooms to quickly designate receiving hospitals for severe patients. Lee ordered that the measures on emergency room turnaways be reported separately to the Cabinet meeting.
Lee also ordered a crackdown on overtreatment and insurance fraud, which cause fiscal leaks. Lee emphasized, "Overtreatment and false claims drain resources for essential care," adding, "Reviews must be thorough." The ministry and the National Health Insurance Service are building a system to check in real time when the same patient uses multiple hospitals, and are also pushing to grant special judicial police powers to the insurance service. Lee said, "If necessary, deploy sufficient personnel to make sure you catch them."
Lee also raised the issue of managing private organizations that receive welfare budgets, saying, "There are repeated cases of some groups operating nontransparently and undemocratically." Lee ordered system improvements, saying, "Link the criteria for support to the actual number of members and operational transparency, and correct practices such as long-term rule by chairpersons."