The realities of North Korea’s free universal healthcare system

Along with the country’s free education system, North Korea’s “Free Universal Health Care System” is touted as being the ideal “public health policy for the people” that provides medical services to the entire population on the state’s dime.
North Korea implemented its free universal healthcare system for laborers, farmers, office workers and their families from 1947 in accordance with the National Social Insurance Law. The country adopted a Cabinet decision entitled, “In Regards to the Implementation of the Free Universal Healthcare System” during the Korean War on November 13, 1952, and expanded those eligible under the system from workers and farmers to the entire population.
At the time, North Korea had established some hospitals and clinics with the support of the Soviet Union, China, and Eastern Bloc countries and was importing medical devices and medicines to supply these facilities. North Korea declared the full implementation of the “Free Universal Healthcare System” on January 1, 1953, despite a complete lack of medical personnel, including nurses, and an overall lack of infrastructure to support the system.
Following the end of the Korean War, North Korea committed national funds to implement the system, but the country’s resources were too meager for it to cover the expenses required for universal care. North Koreans have long lived without proper access to quality medical care while the state has claimed it provides “free medical care for all.” The country’s propaganda states that the free healthcare system guarantees the “superiority of the Korean Workers’ Party and Suryong’s (Supreme Leader’s) policies for the people.” The government proclaims that the free healthcare system has improved the health of the people and contributed to their financial welfare by enabling them to spend money on other important things. The reality is, however, that the system is nothing more than a failed attempt by the North Korean state to be viewed as succeeding in maintaining a social welfare state.
According to sources in South Pyongan Province, North Koreans are discontent with the rampant, potentially life-threatening and illegal production and sales of medical devices and pharmaceutical products in the country’s markets, due to the recent rapid rise in prices. In North and South Pyongan provinces, there are reportedly more and more pharmaceutical products being sold that are produced illegally by private citizens.
If a sick person asks a doctor for a night visit, they are expected to provide cigarettes, alcohol, or a meal, and must pay extra for the medicine they are prescribed. If a sick person appears wealthy, the doctor may put effort into diagnosing what is wrong, otherwise, they are seen as a waste of time.
Residents have been complaining about the rising costs involved in receiving a diagnosis from doctors affiliated with the country’s medical system.
The concept of “free healthcare” is barely recognizable in state-run medical facilities. A source in South Pyongan Province reported that one North Korean who went to a hospital for a sonogram had to pay an extra 30,000 KPW to the doctor administering the sonogram even after paying 20,000 KPW to the attending doctor. This person ended up paying around 190,000 KPW in total for the hospital trip: 40,000 KPW for travel, 50,000 KPW for meals and a room to sleep, and 50,000 KPW for the actual hospital costs.
They ended up being told that an appendectomy was required. After paying the fees for the diagnosis, he paid another 100,000 KPW in cash to the surgeon. He paid around 80,000 KPW for a seven-day stay in the hospital, and bought bandages, disinfectant, antibiotics, and nutrition supplements at the market with his own money.
While North Korea spreads propaganda about its “free healthcare system,” this North Korean citizen spent around 400,000 KPW for his diagnosis and surgery, with the price not even including his own purchases of medicine. A kilogram of rice sells for around 5,000 KPW in North Korea, so it was the equivalent of 80 kilograms of rice, which could feed an entire family for six months. The individual’s official monthly salary was only 3,500 KPW.
The country’s medical system is fully dependent on the market system, and those in need of medical care must pay all costs required for diagnosis, surgery and recovery if they want treatment.
The more dangerous the medical procedure, the more expensive the price. Female birth control surgery costs 3 million KPW, while surgery to remove uterine cysts costs 4 million KPW. One female farm worker in Paeksong-ri, Pyongsong, who knew she had uterine cancer, reportedly died because she didn’t have the money to pay for surgery and was left suffering at home.
For ailments that don’t require surgery, North Koreans will visit unlicensed doctors for acupuncture or buy medicine from the markets. The cost of staying in a hospital is too high for most to afford.
There are many cases in which abortions are performed in unsanitary conditions and patients sometimes get infected with other diseases or die due to uncontrolled blood hemorrhages. The death of a university student in Pyongsong during the process of receiving an illegal abortion in a private home reportedly caused a social uproar in the city.
North Koreans complain they are leading the lives of “bugs less important than savage animals” when it comes to receiving healthcare.
The poor state of North Korea’s healthcare system is too severe to simply place all the blame on the country’s economic difficulties and international sanctions. If they are paying for medical care anyway, North Koreans should be able to guarantee their “right to life” by choosing their own hospitals and the medical services they receive.
North Korea’s medical field has never really developed properly due to the country’s closed door policy to the outside world and its emphasis on “autonomous effort equals autonomous strength.”
North Korea’s free universal healthcare system is moribund. Healthcare should not be used as a propaganda tool for the “achievements” of the Party and Suryong. Practical measures must be put in place to guarantee the right of North Koreans to a healthy life and bodily well-being.
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