The National Health Insurance Service said last year's health insurance finances posted a current balance surplus of 499.6 billion won on a cash flow basis. It was the fifth straight year of surplus, and accumulated reserves rose to 30.2217 trillion won.
On the surface, the finances may look stable, but a closer look at the detailed indicators shows the situation is not easy. The current balance surplus shrank from 1.7244 trillion won in 2024 to 499.6 billion won in one year, plunging about 88% over two years. With revenue growth slowing and medical expenditure rising quickly, warnings are growing about a "surplus illusion."
Total revenue last year was 102.8585 trillion won, up 3.7715 trillion won (3.8%) from the previous year. However, the growth rate has been declining each year, from 10.3% in 2022 to 6.9% in 2023, 4.4% in 2024, and 3.8% in 2025.
Insurance premium revenue was 87.2776 trillion won, up 3.3256 trillion won (4.0%) from a year earlier. Due to the slowing growth in the number of workplace subscribers and a freeze in the premium rate for two consecutive years, the growth rate of workplace premiums was only 3.5%, far lower than the 12.0% in 2022.
In contrast, regional premiums decreased through 2024 due to the overhaul of the contribution system and policies easing property and automobile premiums, then rebounded in 2025 with a 7.7% increase. As a result, the overall premium growth rate rose slightly.
Government subsidies totaled 12.5 trillion won, combining the general account and the Health Promotion Fund, up 325.5 billion won from the previous year. In addition, investment performance responding to financial market volatility delivered a return of 3.27%, exceeding the target return of 3.11%, and generated 708.8 billion won in cash revenue. Including valuation gains on assets not yet matured, gains reached 1.1376 trillion won, marking over 1 trillion won in annual investment income for three straight years.
The problem is the pace of expenditure growth. Total expenditure in 2025 was 102.3589 trillion won, up 4.9963 trillion won (5.1%) from the previous year, outpacing the revenue growth rate.
In particular, insurance benefit costs rose by 7.8965 trillion won in a year to reach 101.665 trillion won, driven by a fee schedule increase (1.96%), emergency care support, and the full-scale rollout of the program to transition tertiary general hospitals. The growth rate was 8.4%, the highest in recent years.
Although 1.4844 trillion won that had been prepaid in 2024 to training hospitals suffering management difficulties due to the exodus of residents was fully repaid in 2025, partially offsetting the increase in expenditure, it was not enough to reverse the structural rise in medical costs.
The service also acknowledged that financial conditions are getting tougher. It said the premium revenue base could weaken due to entrenched low growth and a decline in the working-age population. According to national statistics, the share of the working-age population is projected to fall from 69.5% in 2025 to 66.6% in 2030.
In addition, fiscal input is planned to expand essential medical care, advance medical reform, and carry out national agenda tasks. Policies such as applying health insurance to caregiving costs and institutionalizing sickness benefits will inevitably require considerable finances in the mid to long term.
Centering on the Committee for Appropriate Medical Practice (NHIS-CAMP), the service plans to strengthen its benefit analysis and expenditure management system and to push for the introduction of special judicial police powers to crack down on so-called "paper hospitals" and pharmacies renting out licenses. It also plans to tighten controls on excessive use, including raising the coinsurance rate to as high as 90% for outpatient visits exceeding 365 times per year.
National Health Insurance Service President Jeong Ki-seok said, "This year is expected to see a current balance deficit," adding, "As we need to push national agenda tasks in earnest, we will enhance fiscal soundness through meticulous expenditure management and the spread of a culture of sound medical use."