Healthcare Utilization among North Korean Refugees: A Mixed-Method Study

Purpose: North Korean (NK) refugees are known to have poor physical and emotional health, yet the extent and pattern of their healthcare utilization have not been systematically investigated. The purposes of this study were three-fold: (1) to examine the extent and pattern of healthcare utilization among NK refugees before (in North Korea) and after they arrived in South Korea; (2) to assess their key health behaviors in terms of drinking, smoking, and medication taking; and (3) to explore key barriers and facilitators of their healthcare use. 

Methods: We surveyed NK refugees in South Korea.A total of 329 NK refugees (81% women, mean age=57 years) completed the survey. We also conducted individual in-depth interviews with a select group of participants (n=11). 

Results: About 40% of NK refugees indicated that they were in need of care while in North Korea but were not able to visit a healthcare facility. More than half (56%) reported receiving care from a clinic or local hospital; however, 52% of those reported no change or becoming worse as a result of treatment. Facilitators of healthcare utilization in North Korea included support from family and no concerns about healthcare costs (despite lack of resources). Barriers included hardships of life, lack of/limited medications; ineffective treatment, distance/lack of transportation, and criticism from the NK Labor Party. After arriving in South Korea, at least one out of five reported taking three or more prescribed medications; more than one third consumed alcohol at least 2-3 times a week, with about 12 visits to doctor’s office within the last 6 months. Key facilitators for NK refugees in South Korea included a culture of health promotion, supportive and convenient healthcare, affordable healthcare, and effective treatment. While some were unable to identify any barriers, others noted a lack of personal resources, feeling of illegitimacy to receive free healthcare, concern about healthcare costs, and the unfamiliar or inconvenient health system in South Korea. 

Conclusion: Upon arriving in South Korea, most NK refugees had no difficulty accessing healthcare; however, several barriers were identified. Future efforts should be directed towards promoting adequate utilization of healthcare among NK refugees by providing an enhanced support network and education about the South Korean healthcare system. While having access to care is consistently associated with better health outcomes, a more tailored approach needs to be taken to help NK refugees, particularly those with limited resources.