Employment Permit System was 71.2% in 2015, but the subscription rates of industries other than the manufacturing industry was significantly lower with the construction industry at 54.9%, service industry at 44.5%, and agriculture and livestock industry at 16.1%. 48. The reason behind the low coverage rate in agriculture and livestock industry is either because the migrant worker and employer are not aware that they are mandated to join the health insurance, or they are reluctant to do so due to expenses. In addition, even when there exists a substantial employment relationship, if the workplace is not registered as business, the National Health Insurance Service do not recognize the workplace as place of business, thus do not grant the right for the employee insured subscription. 49. As for individual farms in agricultural and livestock industry, they are not required to submit a certificate of business registration, and as of April 2017, among 20,471 migrant workers in this field, 10,523 workers are working at places not registered as business and thus are not granted the right for the employee insured subscription. 50. Unlike the employee insured subscription, the self-employed insured subscription is allowed to those who stayed in Korea more than three months since they have entered the country. With increasing number of cases where people who already had developed disease came to Korea to treat the disease with health insurance program and then leave the country7, the amended National Health Insurance Act which was announced on 29 October prior to its legislation, extended the required period of stay in Korea from three to six months. 51. The fiscal deficit of the self-employed health insurance of foreigners stood at KRW 205.1 billion in 2017 and KRW 700 billion for the past five years. However, with the big volume of surplus in the employee insured insurance, the overall fiscal balance in 2017 of foreign subscribers of health insurance is KRW 249 billion surplus and KRW 1.1 trillion surplus for the past five years. 7 According to the analysis on top 100 foreign patients in terms of provision of medical expenses by the National Health Insurance Service, 31,983 aliens have received treatment and left the country, losing their eligibility for health insurance from 2015 to 2017. Patient’s sharing of the medical expenses were KRW 7.4 billion while the NHIS paid KRW 22.8 billion. For example, Mr. A, a Korean-Chinese received treatment for three years due to avascular anemia and the medical expenses for three years was KRW 61 million. He has paid KRW 61 million as a patient’s sharing but then he has received back KRW 45 million from the NHIS as the cost he has paid exceeded the ceiling of the patient’s sharing. So, he has paid only KRW 16 million 12

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