HCS 400 final paper

Running Head: NORTH KOREAN HEALTHCARE SYSTEM 1
North Korean Healthcare System
HCS 400 Systems and Policy
Megan Serafin

NORTH KOREAN HEALTHCARE SYSTEM 2
The North Korean health care system has been under a great amount of stress ever since
the economic recession in the mid 1990’s. This was majorly due to the lack of resources the
country has access to. Compared to the United States health care system, North Korea’s or the
Democratic People’s Republic of Korea is far behind what it should be. The current status of the
system is destitute, their coping mechanisms are only minimal, and their system’s weaknesses
greatly trump its strengths.
Soon after World War II in 1945, the North Korean health care system was established
when the Korean peninsula was freed from colonial rule in Japan. It was modeled after the
Soviet healthcare system which has been greatly focusing on reform and expansion of the health
care economy. As part of the socialist medicine in the Democratic People’s Republic of Korea,
the foundation is of preventative medicine. Due to this type of medicine, most of their hospitals
are, in fact, called preventative centers, not hospitals. This type of system relies on the care from
a more natural approach from herbs and acupuncture. Over the past 60 years, their hospital, also
known as preventative centers, has greatly increased from 285 centers to over 2,400, and their
health clinics increased from just over 1,200 to over 6,000 clinics. As poor a system as North
Korea has, one major benefit they strive from is the amount of health care workers they have in
their system. North Korea has ten provinces, all having its own medical university. This provides
a stable contribution of workers into the system. In the system, there are household doctors, also
called section doctors. There is one doctor per 130-150 households and one hospital bed per
every 350 patients. There are 1,000 hospitals and 6,500 clinics working at the Ri and Dong
levels. A Ri is the administrative unit beneath a county in a rural area and a Dong is the same but
in an urban area.

The United States health care system is very different from North Korea’s health care
system. The cost, coverage, access, life expectancy, and the general health status of individuals
are vastly different in both countries. Throughout the United States, in different states, some of
the statistics may vary. Although the government plays a large role in our health care system,
each state has the rights to fund different parts of the system, with different amounts of money.
In the late 1800s, a campaign took place to gain some form of governmental-funded health care.
Over nearly a century, the evolution of these efforts failed at times. However, the development of
a health insurance system came about by the early 1930s followed by Medicare and Medicaid, by
the late 1960s. Now with the Affordable Care Act, reforms have been made and slight changes
are still in progress.
”Insured individuals tend to enter the health-care system through a primary care provider,
though with some kinds of insurance (e.g. PPO) individuals may go directly to a
specialist. Uninsured individuals often do not have a regular primary care provider, but
instead visit community health centres (which provide primary care for low-income,
uninsured and minority populations) and hospital emergency rooms for their health care,
which hinders continuity of care” (Barnes, Rice, Rosenau, Unruh, 2013, pp.224).
According to the World Health Organization (WHO), North Korea “had achieved an
efficient and effective free universal health care system accompanied by impressive health
indicators” before the 1990’s. North Korea’s health care has a national medical service and
health insurance system. The state claims it to be free and guaranteed for all individuals. By the
1990’s, the economy of North Korea plummeted into a near collapse. The GDP per capita
decreased by half, all within a few years. This dropped the USD from 991 to USD 457 in 1998
(UNICEF, 2003). The loss of trade relationships with the former Soviet Union and China was the

single largest contributing factor to this loss of economy. Because of this recession, the health
care system has been under significant stress and will most likely remain in this state of
vulnerability due to a heavy reliance on international assistance.
Unlike North Korea, the United States pays over $6,000 per capita public and private
health expenditures combined. This is over double the second highest paying country, Norway.
“Public sources constitute 48% of health-care expenditures in the United States, private third
party payer sources 40%, with the remaining 12% being paid by individuals out of pocket. Even
though the proportion of public and private spending on health care is roughly comparable, only
a minority (30%) of the United States population is covered by the public financing system –
mainly” (Barnes, Rice, Rosenau, Unruh, 2013, pp.92). Because coverage and health costs are so
expensive, it leaves one out of every six Americans uninsured. There are many different factors
that play into an individual’s payment plan: the type of health care provider and the service they
are administering, available services, and the company who is funding the service. Medicare and
Medicaid are two types of these health- related services that are government funded and support
a specific population.
“Medicare is a social insurance program that serves more than 44 million enrollees (as of
2008). The program costs about $432 billion, or 3.2% of GDP, in 2007. Medicaid is a
social welfare (or social protection) program that serves about 40 million people (as of
2007) and costs about $330 billion, or 2.4% of GDP, in 2007. Together, Medicare and
Medicaid represent 21% of the FY 2007 U.S. federal government” (Medical News
Today, 2003).

As seen with these high statistics, it costs an extremely high amount of money to fund
health care in the United States.
After the Korean War in the early 1950’s, the Democratic People’s republic of Korea was
able to reform and industrialize its economy rather quickly. The industry was made stronger and
more resilient. However, in the early 1980’s the economy took a turn for the worst because it had
a hard time adapting to the Soviet model that was used for development. This lead to a lack of
resources, many natural disasters happened; there were food and energy shortages and copious
amounts of economic problems. The current status of North Korea’s population is much worse
than it had been in the past before the recession. “The economic downturn had a significant
impact on healthcare, and throughout the 1990s key health indicators such as the maternal,
infant, and child mortality rates worsened as a result” (WHO, 2003). Life expectancy is only
64.13 years. A large contributing factor to this is that their health status is impoverished. They
significantly suffer from malnutrition, tuberculosis, H1N1, and drug abuse. Tuberculosis is
heavily prevalent among children and is still an ongoing issue. Although the United States has to
pay a considerably large amount for decent health care, it is much better than North Korea’s care.
In the United States the average life expectancy is 78.24 years. Most people in America do have
the means for health care even if it is through Medicare or Medicaid. This allows people to get
the care that they need even if their income cannot afford to pay for private insurance. The
general health status in the United States is overall pretty good. However, the majority of the
population suffer from heart disease, obesity, cancer, and drug abuse. Since the health care that is
administered is one of the best in the world, most people do not worry about not receiving the
quality care that is needed to combat these diseases.

Although the amount of health care workers is numerous and continue to exist vastly,
countless numbers of problems and stressors continue to impact the system’s ability to carry out
even the most basic operations. These problems and stressors are the majority of the system’s
weaknesses. These problems include a lack of financial resources, shortages of medicines and
vaccines, power and heat, clean water and food.
“More often than not, efforts to bring about a unified coordination effort fail, owing to
competing, fragmentary interests, insufficient early attention to the health priority, and
lack of sustained high-level political will. Since the mid- 1900s, that has frequently been
the pattern with respect to North Korea: coordination among donors in the international
response to famine and chronic food insecurity has been very problematic” (Morrison,
2010, pp. 5).
The shortage of electric power is said to be greatly responsible for the fall of
pharmaceutical companies, which forces North Korea to have to import much of its medicine.
Imports of medicines have been a necessity for their system to survive. Weakness in health
finance is the number one reason for the decline in many other aspects of the system. When there
is a decrease in finances for health, it majorly affects all other aspects of the system. This cause
all other resources to be constantly in short supply. Without sufficient funding, it is very difficult
for the system to return to normal function. Shortages in medicines and vaccines cause a major
problem because there aren’t even enough supplies for emergencies. Without energy and clean
water, the hospitals are unable to keep a clean and hygienic environment increasing the amount
of infection among the patients and workers as well. There is also a shortage in proper
equipment. When the equipment supply is low, workers are forced to use worn out equipments
and reuse products that are designed to be disposable. Sterilization equipment is also in short

supply. Another major weakness of the system is in human resource development. Most health
practices are outdated as well as their ability to effectively manage and supervise the system.
Although it may not seem like it would be a problem affecting the health care system,
transportation is also a major weakness. North Korea has a shortage of vehicles and extremely
poor road conditions. This prohibits health care workers, vaccines, and necessary supplies to be
transported to the appropriate places.
Despite all of its weaknesses, North Korea’s system does have minimal strengths. With
the small amount of resources they have the system does pretty well. When the resources are
available, the health care workers perform high and adequately. These workers are habituated to
getting by with minimal resources. Another vital strength for North Korea’s health care system is
the cost. It is the lowest costing health care system in the world. It is less than one dollar per
capita public and private health expenditures combined. In 2001, GDP for health expenditures
was 2.5%. The state claimed it to be 100% free and guaranteed for all medical care. (Survival
Politics, 2011). This raises the question, is it actually free? The government “claims they have
excellent universal healthcare, free for everybody. However, Amnesty International learnt from
many witnesses that this is not true- people in North Korea have had to pay for all the services
since the 1990s. For a basic consultation, a North Korean doctor is usually paid by barter with
alcohol, food or tobacco; for tests and surgery, though, they appear to prefer cash” (Nordqvist,
2010, pp. 2). Many patients have to bribe doctors for certain procedures and medications. Often,
medicines are not even available at the local hospitals or clinics. “A significant number of North
Koreans go straight to the markets to get their medications and do not bother going to the doctor.
They self-medicate according to what they and their friends know, plus feedback from market
vendors” (Nordqvist, 2010, pp. 2). It is clear that the cost of health care system is not what the

state claims it to be and the access is obviously not easy either. Like the North Korean health
care system, the United States system does not grant easy access to all individuals and it is not
guaranteed for everyone. This is a major weakness of our system. However, the major benefit of
having good, quality health care to some extent outweighs this weakness. The quality of our
health care is one of the best in the world. High performance rates and more than adequate
supplies and equipment put our health care system way above North Korea’s system. Another
strength would be that most people can afford some form of medical health insurance. Although
it isn’t as easy as it should be to access it is available to most of the population of the country.
Our government has provided a website, healthcare.gov, to allow uninsured people or anyone
who would like to change insurance plans, to shop around and see what the best insurance plan
would be for them.
For individuals to cope with these problematic circumstances, they often seek treatment
in China or borrow money from or ask for help from overseas family. Different coping
mechanisms for health care workers include growing their own herbal medicine. Since North
Korea’s system focuses on the Soviet model and uses preventative medicine this strategy
generally helps them. It allows doctors to prescribe traditional medicines, and can, therefore,
charge for their services. (North Korea Public Health, 2012) “Private practices provide
resources, expertise, and convenience (accessibility) the state health care system cannot provide.
Patients provide trust, reputation and demands” (Survival Politics, 2012).
Governmental influence has a lot to do with the structure of the health care economy.
They refuse to pay the right amount of income to the doctors and any health care worker. Politics
in North Korea have been the main source of decline. They control the price of food and
medications. In December of 2009, the North Korean government raised the value or currency.

For something as small as a bag of rice, people could not afford to pay for it because the prices
nearly doubled which lead to an immense amount of people to starve to death. Severe
malnutrition, such as this, has caused a major increase in the tuberculosis cases.
The only way this problem could even be somewhat resolved would be for an influx of
international support. Countries that support North Korea and bring in food and resources would
have to make a donation continuously. Food shortages will most likely remain the same unless
these countries make a change as well. Without international help, North Korea will not be able
to return to its normal functioning system. According to J. Morrison, Senior Vice President for
Center for Strategic and International Studies, there is another way to help North Korea.
“Realistically, the South Korean government is the only entity capable of leading a health
reconstruction effort, assuming it is the political and financial fulcrum of unification” (Morrison,
2010, pp.5).
The United States health care system has implemented a new reform in 2010, the Patient
Protection and the Affordable Care Act. Since Medicare, the Affordable Care Act has been the
most significant change in our health care system. The ACA is aimed at improving coverage for
all people and making it mandatory all throughout the country. It even targets a population who
are underinsured so they can receive the quality care they need and deserve. Due to the fact that
insurance is now required by the new reform under the Affordable Care Act, a penalty is given to
those who do not sign up with some insurance plan. This is a major drawback and a problem for
a myriad of people going through the process of deciding if they want to sign up for an insurance
plan or pay the penalty charge. This reformation has been an ongoing process since 2010 and
will not be fully implemented until the year 2019. The government is working on working out
some of the flaws by making some of the different mandates easier for the general population.

This should allow for major improvement to the Unites States health care system and should
improve the lives of a greater amount.
“The ACA also addresses underinsurance, providing greater protection for insured
persons from their insurance being too limited in scope, inadequate in coverage or even
being cancelled once they become ill. There are also increased funds for primary care to
improve access. Public health is also strengthened, with increased funding for public
health programs, and requirements for chain restaurants and vending machines to display
calories for food products” (Barnes, Rice, Rosenau, Unruh, 2013, pp. 300).
North Korea and the United State’s health care systems bring very different elements to
the table. North Korea’s system has major drawbacks and has numerous things that need to be
fixed in order to have a better flowing system for its population to function as it once did.
Because of the lack of resources North Korea has, these changes may not ever happen. Until the
state comes up with an action plan for their return to a better functioning country, they will
remain in a state of complete vulnerability. This opens a new door for more disease and a higher
mortality rate. On the other side of the spectrum, the United States health care is of overall good
quality. Although the cost of expenditures and the GDP are the highest in the world, the quality
of care is what separates it from other countries like North Korea.
The model that I chose that most closely related to this was the Model Policy of Analysis.
This policy is called Stone’s Policy Paradox Approach. The key elements to this policy are the
goals, problems, and solutions. Goals of this approach include equity, efficiency, security, and
liberty. North Korea’s goals from these four structures are seen through the distribution of
services to the general population of the country. This focuses on how these services are received

and provided. The efficiency of this model focuses on how to measure the costs of the services,
the constituency and its imports and exports. It is clearly seen that the efficiency of North
Korea’s health care system is not good. It is very hard for individuals to obtain services and
receive the proper amount of imports the hospitals and clinics need to survive. The security in
North Korea’s system is poor as well. The minimums needed to meet the security needs are not
met and can only be met through the imports from other countries. Liberty addresses the concern
for a lack of interference and the degree of individual choices and actions.
In the second portion of this model, it addresses the problems, which North Korea has an
abundance of them. Symbols, numbers, causes, interests and decisions are all factors of this part
of the model which North Korea also faces a lack in.
The last part of this model is solutions. Solutions to these problems were also addressed
in this paper. Inducements such as rewards, punishments and incentive did not seem to hold any
major contributing factors to North Korea’s health care system. As for rules and rights from this
model, North Korea allows all people the right to health care, even though it is not always easily
accessed. The government’s power had a lot to do with this because they did not supply proper
incomes to the doctors who were servicing the patients that came into the hospitals and
preventative center. The political power has not been restricted, although it definitely should be.
North Korea must undergo major changes to regain its normalcy it had before the recession in
the early 1990s.
North Korea and the United States are very different health care systems. They both have
very different policies that their general population must follow.

References
Amnesty International. (2010) The crumbling state of health care in north korea. Retrieved from:
http://www.amnesty.org/en/library/asset/ASA24/001/2010/en/13a097fc-4bda-4119-aae5-
73e0dd446193/asa240012010en.pdf%20
Barnes, A., Rice, T., Rosenau, P., & Unruh, L. (2013) United states of America. Health System
Review. Health Systems in Transition. Vol. 15 No. 3 Retrieved from:
http://www.euro.who.int/__data/assets/pdf_file/0019/215155/HiT-United-States-of-
America.pdf
Medical News Today. (2010). North Korean health care system is a shocking state. Retrieved
from: http://www.medicalnewstoday.com/articles/195051.php
Medical News Today. (2003). What is Medicare/Medicaid? Retrieved from:
http://www.medicalnewstoday.com/info/medicare-medicaid/
Morrison, J., (2010) Health reconstruction in north korea; The Korea Project: Planning for the
Long Term. Center for Strategic and International Studies
North Korea Public Health, (2012) Country studies. Retrieved from: http://country-
studies.com/north-korea/public-health.html
Survival Politics, (2011) Health Care in North Korea, Emergence and Evolution of Informal
Health Care Institution in North Korea. Retrieved from:
http://survivalpolitics.wordpress.com/case-study/china/health-care-in-north-korea/
WHO. (2008) World Health Statistics. Retrieved from:
http://who.int/whosis/whostat/EN_WHS08_Table1_Mort.pdf

HCS 400 final paper

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Empfohlen

Empfohlen (20)

HCS 400 final paper