The current programs to strengthen coverage for serious diseases are viewed positively because introducing selective benefits blocked the rapid growth of uninsured care at the source. With selective benefits, non-essential care such as cosmetic surgery was excluded while other medically recognized essential treatment was fully brought under insurance. The stagnation in health insurance coverage feared under earlier programs has largely eased, and because benefits were designed on a value basis, a new form of benefit has taken hold in which patients pay different shares depending on the care they receive.

Programs centered on the four major diseases have limits as a way to strengthen coverage disease by disease. The typical problem is fairness toward diseases left out of the four, which causes unmet medical need: cases where people have a medical need that goes unmet and do not receive proper care, including people whose illness could have been eased if proper treatment had come first. Identifying this precisely is not easy, and unmet need is felt very subjectively, so it is admittedly debated. Still, the very large gap in insurance coverage rates between ordinary illnesses and the four major diseases may mean that a high share of unmet need exists that we have not yet identified, so the current service system needs to be improved more effectively.

The first need is to expand benefits for low-income people who are excluded from medical aid. Because managing chronic illness is part of long-term planning for serious illness, I believe a broad survey and management are needed so that these patients face no barriers to care. People with chronic illness are likely to skip needed care because of heavy co-payments, or to fall into poverty because of continuing treatment. The coverage gap for them is far more serious than we expect, so measures should be prepared to ease medical costs for some share of people below the median income or to make sure they get needed care on time. And since chronic illness is more common among socially and economically vulnerable groups, detailed policies and support are needed so that they face no barriers in using medical services.

This paper examined the inherent limits of positive social welfare law and discussed the gaps in health coverage policy. Korea's welfare has developed a great deal compared with the past, but indifference to people falling through the gaps keeps causing social problems.

To add: the push to strengthen coverage for the four major diseases (cancer, heart disease, cerebrovascular disease and rare intractable diseases), which the paper analyzes, ran from 2013 to 2016, and from August 2017 it widened into a plan to bring uninsured care under insurance step by step, which abolished extra fees for designated doctors and covered upper-tier hospital rooms, MRI and ultrasound. The annual out-of-pocket ceiling that varies with income and the catastrophic medical expense support program are other safeguards against crushing medical bills. Under Article 28 of the Local Autonomy Act, an ordinance that limits residents' rights or imposes duties needs authorization from a statute.