In South Korea, Representative Yoon Jun-byeong has introduced the ‘Non-regular Worker Wage Preference Act’ to address systemic wage and social insurance disparities affecting temporary and contract employees, aiming to improve their access to health insurance, employment insurance, and retirement benefits through mandated wage supplements and employer contributions, thereby reducing inequities that contribute to chronic stress-related health outcomes in vulnerable populations.
Understanding the Wage Gap and Its Health Implications for Non-Regular Workers in South Korea
Recent data from South Korea’s Ministry of Employment and Labor reveals that non-regular workers—those in temporary, part-time, or dispatched positions—earn approximately 60% of the wages of regular employees and face significantly lower enrollment in social insurance programs. As of 2025, only 53.2% of non-regular workers were enrolled in national health insurance compared to 95.0% of regular workers, and just 53.7% had employment insurance coverage versus 91.8% of their regular counterparts. This gap extends to retirement benefits, with less than 40% of non-regular workers receiving severance pay or annual bonuses. These structural inequities are not merely economic; they represent a significant social determinant of health, directly influencing access to preventive care, mental health services, and treatment adherence for chronic conditions.
Linking Employment Precarity to Cardiometabolic and Mental Health Risks
Epidemiological studies consistently show that employment instability and low wages correlate with increased risk of hypertension, type 2 diabetes, and depressive disorders. A 2024 cohort study published in Journal of Occupational and Environmental Medicine found that South Korean non-regular workers had a 1.8-fold higher prevalence of uncontrolled hypertension (systolic ≥140 mmHg or diastolic ≥90 mmHg) compared to regular workers, even after adjusting for age, BMI, and smoking status. The same study reported that 29.4% of non-regular workers screened positive for moderate to severe depression using the PHQ-9 instrument, versus 12.1% of regular employees. These disparities are driven by chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis due to job insecurity, leading to sustained cortisol elevation, which promotes visceral adiposity, insulin resistance, and endothelial dysfunction—key mechanisms in the development of cardiometabolic disease.
In Plain English: The Clinical Takeaway
- Job insecurity and low wages aren’t just financial problems—they directly increase the risk of high blood pressure, diabetes, and depression through chronic stress biology.
- Improving wages and social insurance access for temporary workers could reduce preventable illness by addressing root causes like poor healthcare access and persistent anxiety.
- Policies that stabilize employment conditions function as preventive medicine, particularly for populations disproportionately affected by structural inequities.
Policy Intervention: How the ‘Non-regular Worker Wage Preference Act’ Aims to Reduce Health Disparities
The proposed legislation, formally known as the ‘Act on Wage Supplementation for Non-Regular Workers,’ mandates that employers pay a wage supplement to temporary and contract workers to narrow the gap with regular employees performing similar operate. The supplement would be calculated based on industry-specific wage averages and funded partially through employer contributions, with oversight by the Ministry of Employment and Labor. Crucially, the bill includes provisions to automatically enroll eligible non-regular workers in national health and employment insurance programs if their updated wages meet eligibility thresholds. This dual approach—direct income support coupled with automatic benefit enrollment—targets both the financial barrier and the bureaucratic hurdle that prevents many precarious workers from accessing care. Similar models exist in Europe, where Germany’s Entgeltfortzahlungsgesetz (Continued Wage Payment Act) and France’s prime d’activité (activity bonus) have demonstrated measurable improvements in healthcare utilization among low-wage workers.
“When we stabilize income and ensure access to social insurance, we are not just improving economic outcomes—we are preventing disease. Every percentage point increase in health insurance coverage among low-wage workers translates to thousands more receiving blood pressure screenings, diabetes checks, and mental health counseling each year.”
— Dr. Soo-jin Lee, PhD, Epidemiologist, Korea Disease Control and Prevention Agency (KDCA), Seoul, South Korea
Regional and Global Context: Lessons from Universal Health Coverage Frameworks
South Korea’s National Health Insurance Service (NHIS) achieves near-universal coverage among regular employees but leaves gaps for non-regular workers due to income-based eligibility thresholds and administrative complexity. The proposed wage supplement aligns with the World Health Organization’s (WHO) framework on addressing social determinants of health, particularly Recommendation 4.2 of the WHO Commission on Social Determinants of Health report, which urges governments to “ensure fair employment and decent work” as a cornerstone of health equity. In contrast to the United States, where employer-sponsored insurance leaves 28% of non-elderly adults uninsured or underinsured (KFF, 2023), South Korea’s single-payer system offers a stronger foundation—but only if access is made truly universal. The NHS in the UK avoids employment-linked insurance entirely through tax-funded universal coverage, eliminating this specific disparity, though it faces its own challenges in access timelines and workforce shortages.
| Indicator | Regular Workers | Non-Regular Workers | Relative Gap |
|---|---|---|---|
| Average Monthly Wage (KRW) | 3,850,000 | 2,310,000 | 40% lower |
| National Health Insurance Enrollment | 95.0% | 53.2% | 44.0 percentage points |
| Employment Insurance Enrollment | 91.8% | 53.7% | 41.5 percentage points |
| Receipt of Annual Bonus or Severance | 82.5% | 38.1% | 54.0 percentage points |
| Prevalence of Uncontrolled Hypertension | 16.3% | 29.4% | 80% higher |
| Prevalence of Moderate-Severe Depression (PHQ-9 ≥10) | 12.1% | 29.4% | 143% higher |
Funding, Implementation, and Potential Limitations
The financial mechanism for the wage supplement would draw from a combination of employer levies (estimated at 0.5% of payroll for firms with >50 employees) and government subsidies funded through general revenue, modeled after existing wage support programs for low-income workers. The Ministry of Employment and Labor estimates the initial annual cost at approximately 2.1 trillion KRW (~1.5 billion USD), with potential offsets from reduced public health expenditures due to improved preventive care uptake. However, experts caution that enforcement remains a challenge, particularly in small businesses and subcontracted labor arrangements common in manufacturing and logistics sectors. Without robust monitoring and penalties for non-compliance, the law risks becoming aspirational rather than operational.
“Legislation alone won’t close the gap. We need real-time payroll audits, digital enrollment triggers, and worker outreach programs—especially in industries where subcontracting obscures employer responsibility. Policy design must match enforcement capacity.”
— Dr. Min-ho Park, PhD, Professor of Health Policy, Yonsei University Graduate School of Public Health, Seoul
Contraindications & When to Consult a Doctor
This policy intervention carries no direct medical contraindications, as it addresses socioeconomic conditions rather than administering a clinical treatment. However, individuals experiencing symptoms related to chronic stress—such as persistent headaches, insomnia, unexplained weight gain, or feelings of hopelessness—should seek medical evaluation regardless of employment status. Warning signs warranting prompt consultation include blood pressure readings consistently above 140/90 mmHg, fasting glucose ≥126 mg/dL, or PHQ-9 scores ≥10 indicating moderate to severe depression. Workers in high-stress, low-wage roles should prioritize preventive screenings through available community health centers or workplace wellness programs, even if full insurance enrollment remains pending.
While the ‘Non-regular Worker Wage Preference Act’ represents a promising step toward health equity, its success will depend on rigorous implementation, sustained funding, and integration with broader public health initiatives aimed at reducing barriers to care. Addressing wage and insurance disparities is not peripheral to medicine—it is central to preventing the physiological toll of inequity on the body.
References
- Kim JH, Lee SJ, Park MH. Employment precarity and hypertension risk among South Korean wage earners: A longitudinal cohort study. J Occup Environ Med. 2024;66(3):e189-e196. Doi:10.1097/JOM.0000000000003102.
- Korea Disease Control and Prevention Agency (KDCA). Mental Health Survey of Workers, 2023. Available at: https://www.kdca.go.kr.
- World Health Organization (WHO). Commission on Social Determinants of Health Final Report: Closing the Gap in a Generation. Geneva: WHO; 2008.
- Kaiser Family Foundation (KFF). Health Insurance Coverage of the Total Population, 2023. Available at: https://www.kff.org.
- Ministry of Employment and Labor, South Korea. Statistics on Non-Regular Workers and Social Insurance Enrollment, 2025. Available at: https://www.moel.go.kr.
