The National Health Insurance Service recorded a 4.6 trillion won surplus in 2014, its largest ever. After four consecutive years of surplus, the accumulated figure now stands at more than 12.8 trillion won.

In announcing the figures, the Ministry of Health and Welfare said that the continued surplus shows that people are in better health. Indeed, the NHIS expenditure increased 5.7 percent over the previous year, continuing the significant slowdown in expenditure over the past few years. From 2012 to 2014 it rose at an average of 5.5 percent per year compared to the average annual rise of 12 percent between 2005 and 2011.

The Health Ministry attributed the slowdown in the growth of NHIS annual expenditure to healthier aging, a reduced cancer rate, and prevention and early detection of illnesses through regular medical checkups.

Civic groups, however, differ in their analysis of the NHIS figures. They attribute the slowdown in the growth of annual expenditure to people not seeking medical care due to costs. In fact, a closer look at the latest NHIS figures shows that the lower the income, the less frequent the visits to the doctor’s office.

A Korea Centers for Disease Control and Prevention survey also showed costs preventing low-income earners from seeking medical care. In the 2013 survey, 21.7 percent of patients who did not go to hospitals or clinics, although they wished to, cited financial reasons. This figure has been on the rise in the last few years ― recording 15.7 percent in 2010, 16.2 percent in 2011 and 19.7 percent in 2012.

A National Human Rights Commission of Korea survey on the human rights of those living below the poverty level but not receiving welfare payments released last November paints a similar picture. The survey showed that 36.8 percent of the nonwelfare recipients living below the poverty level were not able to go to hospitals or clinics in the past year because they did not have the money.

There is also the issue of families struck by catastrophic medical expenditure that sends them down the path of impoverishment. According to a recent research, medical costs account for more than 10 percent of total household expenditure in about 20.6 percent of households. In 4.7 percent of households, medical costs account for more than 40 percent of all household expenditure. The research also noted that the possibility of households spending more than 10 percent of all expenditure on medical bills falling into poverty stands at more than 18 percent.

How is it that the poor that need medical attention stay away from hospitals because of concerns about costs, and 1 out of 5 households are at risk of impoverishment because of health care costs while the NHIS boasts a record surplus?

The government which was due to announce a revamp of the NHI earlier this month abruptly postponed it under political pressure. With the NHI predicted to run into deficit starting 2016, access to medical care for the poor may become even more difficult without a major reform of the program soon.