South Korea's TB Safe Belt Struggles with Funding, Limited Hospital Participation
A patient in Seoul’s National Medical Center was diagnosed with tuberculosis after visiting for dizziness. The 69-year-old man, identified by a pseudonym Kim Joo-hyuk, stayed two weeks in a negative-pressure isolation ward. When he was discharged, a receipt for outpatient care showed a meal charge of 31,630 won, a cost he must bear even though TB treatment itself is free under a government exemption.
The hospital is linking such patients to the TB Safe Belt program, designed to ease the burden on vulnerable groups. An official said that even small outpatient copayments can deter patients from returning for care, noting that some have halted treatment because a 1,030-won outpatient fee was burdensome. The program aims to keep patients on TB treatment by helping with costs beyond the free medical services.
South Korea continues to face a relatively high TB burden among OECD members. In 2024 the TB incidence rate stood at 35 per 100,000 people, second only to Colombia within the OECD. More than half of TB patients were 65 or older (58.7%), and 11.3% were recipients of government medical aid; foreigners accounted for about 6% of cases. Among medical-aid recipients, TB incidence was markedly higher than among those with standard health insurance.
The TB Safe Belt program, begun in 2014, provides financial and caregiving support to disadvantaged TB patients, including medical-aid recipients, lower-income households, uninsured individuals, and those with income at or below 120% of the health-insurance threshold. The aim is to cover treatment costs and caregiving for those most at risk of dropping out of care.
According to the Korea Disease Control and Prevention Agency, last year the government supported 1,541 TB patients through the program (duplicates included). About 206 received treatment costs, 276 benefited from caregiving support, and 780 received nutritional snacks. The program also coordinates referrals to higher-tier hospitals when specialized procedures are necessary.
Challenges persist, in part because not all hospitals participate in the program. Only 20 hospitals are part of the TB Safe Belt network, and just three facilities outside the network cooperate to transfer patients. Doctors cited by the program say some patients with comorbid conditions, such as schizophrenia or bipolar disorder, may refuse treatment, and some psychiatrists are reluctant to treat patients in closed TB wards. The Disease Control Agency says it identifies participating hospitals to connect patients with available care, but capacity remains a bottleneck.
Funding for the program has been frozen for four years. This year’s budget stands at about 16.65 billion won, a level held since 2023. Officials say private-hospital participation is essential to close gaps, as some patients require advanced procedures or equipment not available at TB Safe Belt–affiliated centers. A senior pulmonologist at the National Medical Center warned that delaying TB treatment can threaten public health because TB remains contagious.
The KDCA director, Im Seung-kwan, noted that among an estimated 2,237 potential recipients, only 206 received treatment-cost support for TB through the program, or about 9.2%. He urged expanding the program so that at least 500 people could benefit. Officials describe the TB Safe Belt as a key tool for protecting public health by ensuring that vulnerable populations remain engaged in treatment and that transmission is kept in check.
Why this matters beyond Korea: the Korean case highlights how a high-incidence TB environment relies on targeted public funding to keep patients in care, prevent transmission, and reduce disparities. For the United States and other countries, the lesson is that treatment adherence among vulnerable groups hinges on affordable, easily navigable support—especially when care requires multiple visits to specialized facilities. It also underscores the ongoing challenge of coordinating public programs with private hospitals to reach patients who need complex care.