The National Health Insurance (NHI) finances have returned to a deficit for the first time in five years. The surplus trend that continued since 2021 was broken entering the first quarter of this year.

According to data obtained by the office of Representative Jeon Jin-sook of the Democratic Party of Korea, a member of the National Assembly Health and Welfare Committee, from the National Health Insurance Service (NHIS), NHI revenue for the first quarter of 2026 was recorded at 22.4416 trillion won, while expenditure was tallied at 26.3405 trillion won. With expenditure increasing faster than revenue, the first-quarter current balance recorded a deficit of 3.8989 trillion won. As a result, the cumulative balance, which was 30.2217 trillion won last year, decreased to 26.3228 trillion won in the first quarter of this year.

Shift to Deficit After Continued Surplus Reduction The health insurance program recorded current balance deficits for three consecutive years from 2018 to 2020. It then turned to a surplus of 2.8229 trillion won in 2021, with the surplus expanding to 3.6291 trillion won in 2022 and 4.1276 trillion won in 2023. However, the surplus size shrank to 1.7244 trillion won in 2024 and 499.6 billion won in 2025, before returning to a deficit in the first quarter of this year.

This shift to a deficit is consistent with forecasts from the government and related agencies. In the "Second Comprehensive Plan for National Health Insurance" announced in February 2024, the Ministry of Health and Welfare predicted that the NHI current balance would turn to a deficit this year. Additionally, in the meeting materials of the NHIS Financial Management Committee in September 2025, the shift to a current balance deficit this year and the possibility of continued deficits thereafter were also mentioned.

Diversification of Factors Influencing Financial Operations It has been pointed out that volatility in the economic environment is increasingly becoming a factor influencing NHI financial operations. Recently, policy changes such as measures to strengthen regional and essential public healthcare and plans to improve health insurance premium assessment standards have also been under discussion.

The NHIS stated that it plans to assess the financial impact on revenue and expenditure and conduct fiscal projections based on performance monitoring.