Why Americans Are Paying Cash for Medical Care in South Korea

How America’s insurance barriers are creating a new medical market in Seoul—and what happens after patients return home

On July 18, the Guardian reported that Black American women were travelling to South Korea for medical care they had struggled to obtain, trust or afford at home. The article’s central case involved Adzua Agyapon, a 36-year-old nonprofit worker from Washington, DC, whose examination at a Seoul medical centre revealed a uterine fibroid measuring about 10 centimetres. An ultrasound was followed within minutes by an MRI, and the full checkup cost less than $600, according to her account. Agyapon said she had undergone annual examinations in the United States without being told about the fibroid, leaving the Guardian with an arresting comparison between an American system she experienced as incomplete and a Korean centre able to move from screening to confirmation within a single visit.

The other women interviewed for the article had sought broader health assessments, dermatological procedures and treatment for alopecia. Price was part of their calculation, although their recollections returned just as often to the pace and tone of the appointments: clinicians appeared willing to listen, several tests could be completed in one place, and concerns about darker skin or hair loss were raised without the patient first having to explain why they mattered. The accounts correspond with a documented pattern in the United States, where Black women report unfair treatment in medical settings more frequently than White women and often describe preparing their words, appearance and behaviour before an appointment in the hope of being treated fairly.

Korean government figures establish that the number of American patients is rising, though they cannot establish the racial trend presented by the Guardian. Medical institutions recorded 173,363 patients from the United States in 2025, 70.4 per cent more than a year earlier and the largest American total since Korea began compiling foreign-patient statistics in 2009. The ministry sorts those patients by nationality, medical department, region and type of institution; it does not publish their race, American residence, insurance arrangements or principal reason for entering the country. A woman who chose Seoul after months of difficulty arranging diagnostic care can therefore appear in the same table as a tourist who booked a laser treatment after arriving.

The claim that Black women represent a rapidly expanding customer group comes instead from Himedi, the commercial facilitator through which several of the Guardian’s interviewees arranged services. William Ban, the company’s co-founder and chief operating officer, said inquiries had increased significantly, particularly for gynaecological, thyroid and cardiovascular screening. Neither the article nor Himedi’s public materials disclosed annual inquiry numbers, completed bookings or the share of American customers identified as Black women. Himedi’s privacy policy permits the collection of racial or ethnic origin alongside health and insurance information, giving the company the potential to observe shifts within its own clientele, but the method, denominator and historical series behind the claim remain private.

A more concrete description of the emerging business appears in Himedi’s terms of service. Its affiliated practices do not accept American commercial insurance, are outside commercial insurance networks and are not enrolled in Medicare or Medicaid. Customers explicitly choose to purchase the services on a cash-pay basis. The care described in the Guardian is consequently separate from Korea’s National Health Insurance Service and, in most cases, separate from the patient’s ordinary American provider network as well. The customer books a package, pays the Korean provider or facilitator and later determines whether any part of the bill can be submitted to an insurer or tax-advantaged medical account.

Seen from the payment desk, the journeys are connected by more than nationality or dissatisfaction. Korea is offering an appointment whose date, contents and initial price can be known before the patient leaves the United States, while many of the financial and administrative decisions that shape American care have already been removed from the transaction. The attraction does not prove that Korean clinicians provide superior outcomes for Black women, nor does it show that every test included in a private package is useful. It does show how gaps in American coverage, access and trust can be converted into demand for medical services sold on the other side of the Pacific.

Who Korea Counts

South Korea announced in April that 2.01 million foreign patients had used Korean medical institutions during 2025, nearly twice the 1.17 million reported a year earlier and more than three times the 606,000 counted in 2023. The ministry also recorded 2.72 million patient-visits, a higher figure that includes repeat appointments made by people already counted in the individual total. The scale of the rise has encouraged officials, hospitals and tourism agencies to describe Korea as a leading medical-tourism destination, yet the legal and statistical category is broader than the ordinary meaning of a tourist who entered the country primarily for treatment.

Korea’s foreign-patient framework generally covers foreign nationals who are outside the Korean health-insurance system, subject to rules concerning residence, registration and visa status. The category can include medical-visa holders and overseas patients recruited by registered institutions, but it is not confined to them; certain foreign residents, military personnel and family members, diplomats and overseas Koreans can also fall within the system. Korean authorities have previously clarified that eligibility as a foreign patient is determined by legal and insurance status rather than whether the person would describe herself as a tourist.

The treatment distribution shows why that distinction has become important. Dermatology accounted for 62.9 per cent of foreign patients in 2025, followed by plastic surgery at 11.2 per cent, integrated internal medicine at 9.2 per cent and health-screening centres at 3.1 per cent. Nearly nine in ten patients used clinics rather than general or tertiary hospitals, a pattern shaped by services that can be purchased and completed during a short visit: laser treatments, injections, consultations, non-surgical lifting procedures and packaged examinations. Reuters found the same commercial pattern in Seoul, where foreign visitors were combining sightseeing with several beauty treatments promoted through multilingual clinics and social media.

American patients used a wider range of departments than the national average, although dermatology still accounted for 44.3 per cent of their treatment. Integrated internal medicine represented 13.2 per cent and plastic surgery 9.3 per cent, while the ministry did not list dedicated screening centres among their three largest categories. The national total may therefore contain the beginnings of the diagnostic market described by the Guardian, alongside a substantially larger flow of outpatient skin and beauty services. Published tables do not identify which appointments had been planned before departure, whether the visit was prompted by unresolved symptoms or whether treatment was simply added to a journey already motivated by tourism, family or work.

Himedi’s reported increase in inquiries cannot supply what the national data omit. An inquiry may become a screening appointment, but it may also remain a request for prices from someone comparing Korea with Mexico, Turkey or a domestic provider. Airfare, accommodation, time away from work and uncertainty over follow-up can stop an interested customer from travelling, while another visitor may contact no facilitator at all and book directly with a clinic after arriving. A company can correctly observe that a particular group is becoming more visible in its sales pipeline without establishing that the same group is driving a national increase.

The Guardian’s article is strongest where national statistics are weakest: it documents why individual women found Korea appealing and how they interpreted the difference between their appointments in Seoul and the care they had received in the United States. Its evidence consists primarily of personal accounts and the observation of a facilitator rather than insurance records, comparative clinical outcomes or a census of completed journeys. The distinction does not invalidate the experiences. It determines which conclusions can be drawn from them.

The official figures support a narrower and still significant finding. American use of Korean medical services rose sharply in 2025, within a foreign-patient market dominated by clinics, dermatology and Seoul. Whether Black women account for a large portion of that increase cannot presently be measured from public data. The transaction itself is easier to examine because facilitators and hospitals explain how patients are expected to pay, what an insurer must authorise and what happens when no such agreement exists.

Outside the American Network

An American patient can reach Korea through several different payment routes, although only one is routinely available to a tourist buying a screening package online. Himedi’s route begins with direct payment: the client selects services outside commercial insurance, accepts responsibility for the charges and may pay through the company on behalf of the affiliated provider. The price may include a defined set of tests, consultations and logistical support, while examinations or treatments added after the appointment can be billed separately.

A customer with private insurance can still submit an overseas claim after returning home, but reimbursement depends on the specific contract rather than the logo on the insurance card. Plans that permit out-of-network treatment may require prior authorisation, proof of medical necessity, an itemised English bill, diagnosis codes, medical records and evidence that the patient paid the provider. Deductibles, coinsurance, exclusions and the insurer’s own allowed amount can leave much of the Korean bill with the patient even when the claim is accepted. Medicare generally excludes medical care obtained outside the United States, except in limited situations involving emergencies or unusual proximity to a foreign hospital, while some Medigap products cover emergencies during foreign travel rather than planned screening in Seoul.

Seoul’s largest hospitals operate a different corridor for holders of international insurance. Asan Medical Center lists direct-billing relationships with organisations including Cigna International, TRICARE Overseas and United Healthcare International, while Samsung Medical Center and Seoul National University Hospital publish similar arrangements for international or expatriate products, embassies and assistance companies. Patients are normally required to confirm eligibility and obtain a guarantee-of-payment letter; SNUH warns that the process can take five to ten days and directs patients without a contracted insurer or guarantee to pay first and claim reimbursement themselves.

Those agreements are important to Seoul’s international medical infrastructure, though they are easily misunderstood when described simply as acceptance of American insurance. International plans are commonly purchased for diplomats, military families, expatriates and employees working across borders, and their provider networks differ from the domestic HMO, EPO or marketplace coverage carried by most Americans. A person insured by a large company in the United States may have no contractual access to a Korean hospital even when the same corporate group sells an international product that the hospital bills directly.

For the ordinary cash-paying customer, the appeal lies partly in the visibility of the transaction. American insurance can make a preventive visit inexpensive when the patient uses an in-network provider and receives services recommended under federal guidelines, but later stages of investigation may require separate referrals, appointments, facility fees or prior authorisation. A Korean package places laboratory work, imaging and consultations within a schedule selected in advance. The patient sees the price of the package before the trip even when she cannot predict the cost of a comparable diagnostic sequence inside her American plan.

Pressure on people buying their own insurance increased in 2026 after the enhanced Affordable Care Act tax credits expired. KFF found that average monthly premium payments among returning marketplace enrollees rose by 58 per cent, while the average deductible increased by 37 per cent to $3,786 as more customers moved towards lower-premium bronze plans with greater cost sharing. Marketplace coverage represents only one segment of the insured population, but the changes show why a person with an active policy may still compare the price of overseas care with thousands of dollars in potential domestic spending.

Employer-sponsored and other private plans create a related problem when recommended care is denied. A 2026 Commonwealth Fund survey found that 21 per cent of working-age adults with private insurance had experienced a denial of doctor-recommended treatment for themselves or a family member during the previous year. Among those who encountered a prior-authorisation denial, 41 per cent reported a delay in care and 28 per cent said a health problem became worse. Appeals can overturn a denial, though they require time, documentation and participation from a clinician’s office, and many patients do not pursue them.

The group able to respond by travelling abroad is necessarily selective. Airfare, hotels, a passport and time away from employment put medical travel beyond many people facing the most severe barriers to care. The women interviewed by the Guardian included professionals, business owners and experienced travellers who could turn dissatisfaction into a purchase, sometimes by adding medical appointments to a trip they were already able to take. The market is therefore emerging less as an escape for Americans with no resources than as an alternative for people with enough money or credit to pay again after concluding that their existing coverage does not provide an acceptable path.

Black women may reach that decision with an additional history of distrust. KFF reported that 21 per cent of Black women said a healthcare provider or staff member had treated them unfairly because of race or ethnicity, and 61 per cent said they prepared for possible insults or were highly attentive to their appearance in medical settings. Most Black women also report positive experiences with providers, but the disparity is large enough to influence how a hurried consultation, refused test or unexplained delay is interpreted.

The consequences extend beyond satisfaction. The United States recorded a maternal mortality rate of 44.8 deaths per 100,000 live births among Black women in 2024, compared with 14.2 among White women, while fibroids and several other reproductive conditions impose a disproportionate burden on Black patients. Maternal mortality cannot be traced to a single encounter or reduced to insurance policy alone, and a positive checkup in Korea does not establish that Korean providers have solved those inequalities. The disparity nevertheless gives urgency to accounts from women who say that they have learned to push for further investigation because reassurance from the system no longer feels sufficient.

A private Korean clinic changes the setting in which that conversation occurs. The international customer arrives as a paying client whose itinerary has been organised around responsiveness, speed and hospitality; the clinic has a commercial reason to complete the promised examinations and maintain a positive experience. Such incentives can produce careful service without providing evidence that Korean practitioners deliver better long-term outcomes for Black women, darker skin or conditions that have been missed in the United States. They also shape the next medical decision, because the insurer’s refusal has been replaced by a catalogue in which additional access can be purchased.

The Price of More Testing

Health-screening packages marketed to overseas customers contain far more than the annual physical familiar to many insured Americans. Himedi advertises programmes ranging from a $299 baseline assessment to packages costing several thousand dollars, with higher tiers adding CT, brain MRI and MRA, echocardiography, ultrasounds, tumour markers, genetic risk tests and assessments marketed around longevity or biological age. Whole-body MRI is listed separately and can also be bundled with a broader checkup. The customer can compare programmes before travelling, using the number of tests and access to advanced equipment as visible markers of value.

Korea has the capacity to deliver this type of compressed examination. OECD data show 87 CT, MRI and PET units per million people, compared with an OECD average of 51, and the country records one of the highest combined rates of use for those technologies. Korea also has 12.6 hospital beds per 1,000 residents, three times the OECD average, although the abundance of equipment and beds coexists with continuing shortages and policy interventions in emergency care, obstetrics, paediatrics and regional essential services. The infrastructure is particularly well suited to organised checkup centres that can move a patient through imaging, endoscopy, laboratory testing and consultation during a single day.

The public programme available to eligible Korean residents operates on a different basis. National screening schedules use age, sex and risk criteria to determine access to general examinations and screening for specific cancers, while private programmes allow customers to add tests beyond those population guidelines. Korea is therefore exporting a commercial service built on the country’s medical infrastructure rather than extending the same insured public benefit received by residents.

A wider diagnostic search can be valuable when symptoms, age or family history justify it. Pelvic ultrasound and MRI may have been clinically appropriate for Agyapon, although the Guardian did not report enough about her symptoms, prior examinations or medical history to determine why imaging had not occurred earlier in the United States. The finding gave her information that could be taken into further gynaecological care; it did not by itself establish whether an American clinician had missed an indicated test or whether the Korean package had simply included imaging that is not routinely performed during an annual visit.

Broader screening also produces findings whose importance is uncertain. CT and MRI frequently reveal cysts, nodules, scars and other incidental abnormalities in people who have no related symptoms. Some lead to an early diagnosis that improves care, while others begin a series of repeat scans, biopsies and specialist visits for conditions that would never have affected the person’s health. The American College of Radiology has stated that the evidence is insufficient to recommend total-body MRI screening for people without symptoms, relevant risks or family history, in part because the technology can generate non-specific findings that require further investigation.

South Korea’s own history provides a prominent example of the same problem. The country’s thyroid-cancer diagnosis rate in 2011 was 15 times the 1993 rate after ultrasound screening became widespread, while mortality remained broadly stable. Researchers identified overdiagnosis as the principal explanation: screening had found many small cancers that would not have produced symptoms or death during the patient’s lifetime. Public concern and a campaign to discourage routine thyroid ultrasound were followed by a reduction in operations, illustrating how a medical system can become highly efficient at finding disease without producing a corresponding improvement in population outcomes.

The U.S. Preventive Services Task Force advises against thyroid-cancer screening in asymptomatic adults because the harms of overdiagnosis and treatment outweigh the expected benefit, while recognising that previous radiation exposure, a strong family history and certain genetic conditions alter an individual patient’s risk. Thyroid ultrasound included in a general foreign-patient package is consequently neither inherently inappropriate nor automatically valuable; its usefulness depends on information that cannot be conveyed by the label “premium” or the number of scans listed in a comparison table.

Tumour markers carry a related limitation. CA-125 and transvaginal ultrasound can assist clinicians who are investigating symptoms or caring for women at high inherited risk, but trials have not shown that routine screening of asymptomatic, average-risk women reduces ovarian-cancer mortality. False-positive results can lead to surgery in patients who do not have cancer, which is why the USPSTF concludes that the harms exceed the benefit for the general population. Several commercial packages nevertheless include CA-125 and other tumour markers as part of an extensive search for hidden disease.

The choice facing an American patient is therefore more complicated than restrictive care at home versus thorough care in Korea. An insurer may apply medical-necessity rules in a way that delays an appropriate examination, protects its own finances or forces a patient through months of appointments. A commercial screening centre receives more revenue when a customer purchases a larger programme and has an incentive to present additional tests as greater reassurance. Clinical judgement is present in both systems, as are financial interests, but the pressure moves in opposite directions.

Patients who have repeatedly felt dismissed may find the Korean offer especially persuasive because evidence-based restraint can sound indistinguishable from another refusal. A clinician may have good reasons to advise against whole-body MRI, routine thyroid ultrasound or a tumour marker, yet an explanation delivered after a rushed appointment or a denial from an insurer carries little authority for someone whose symptoms have previously been minimised. The Korean centre offers to investigate immediately, placing the burden of judging the package’s medical value on a consumer who may be buying precisely because she has lost confidence in gatekeepers.

A responsible international screening service would need to make the distinction visible before payment. The patient should know which tests are recommended for her age, symptoms and history; which have been added by preference; what false positives and incidental findings are likely to produce; and how an abnormality will be classified after the examination. Many Korean centres include physician consultations, yet their English marketing typically gives greater prominence to equipment, package size and the number of included tests than to the circumstances in which a test should be removed.

The immediate result can still be useful. The larger uncertainty appears when the result leaves Korea with the patient, because a diagnosis that cannot be interpreted, accepted or treated within her home system may begin another fragmented route rather than end the first one.

The Corridor Seoul Built

Seoul treated 87.2 per cent of Korea’s foreign patients in 2025. The concentration is often presented as the predictable advantage of a capital containing large hospitals and specialist clinics, but the city’s dominance extends across the commercial steps that precede and follow an appointment. English-language search results lead customers to Seoul providers; facilitators combine hospitals, dermatology, dental care and transport; major medical centres publish insurance and guarantee-of-payment procedures; and hotels, shopping districts and airports are already incorporated into the itinerary. Each completed visit generates reviews and social-media posts that direct the next customer towards the same neighbourhoods.

Seoul’s international hospitals have also spent years building administrative services that are less visible than a scanner or surgeon. SNUH, Asan and Samsung provide English-language billing guidance, medical-record requests and direct-billing information for contracted international plans. SNUH allows patients to request English medical certificates and copies of image data, while its insurance pages distinguish customers with a guarantee of payment from those required to settle the bill themselves. The services do not make every international episode seamless, but they give a patient abroad a clearer account of how appointments, payment and records will be handled.

Commercial facilitators extend the same pathway beyond hospital walls. Himedi describes a concierge service that can include transportation, accommodation and appointments across health screening, dermatology, dental care, vision correction, hair treatment and other elective services. The company says it does not charge a separate inquiry fee to the customer, though its public materials do not disclose the commercial terms governing relationships with partner providers. The product is broader than medical navigation: it converts Korean care into an itinerary that can be compared, purchased and completed by someone unfamiliar with the country.

Busan’s 2025 record reflects a different stage of market development. The city counted 75,879 foreign patients, an increase of 151.5 per cent that placed it second nationally, yet the growth was concentrated in dermatology and among nearby Asian markets. Taiwan supplied 37.4 per cent of patients, Japan 22.2 per cent and China 15 per cent; Americans represented 3.7 per cent. Busan reported dermatology at 67 per cent of the total, followed by plastic surgery, integrated internal-medicine screening centres and dentistry.

A Breeze in Busan analysis comparing the city’s 2024 and 2025 figures found that dermatology contributed about 86.7 per cent of the net annual increase. The result does not diminish the commercial success of Busan’s clinics, which have attracted a substantial short-haul market and moved the city beyond its pre-pandemic foreign-patient totals. It does mean that Busan’s national ranking cannot yet be read as evidence that the city has become a broad alternative to Seoul for American screening, complex treatment or extended international care.

Busan possesses tertiary hospitals, international centres and specialist capacity. Pusan National University Hospital describes a one-stop service covering appointments, treatment, payment, testing and interpretation, while Kosin University Gospel Hospital operates a foreign-patient centre and publishes basic payment guidance. Online information viewed for this investigation was less likely to provide the detailed insurer lists, guarantee-of-payment procedures and English documentation workflows displayed by the large Seoul hospitals. The comparison concerns public accessibility rather than proof that Busan institutions have no such contracts; a patient making a decision overseas can only evaluate arrangements that are visible before the trip.

Busan’s next medical-tourism strategy therefore depends on the type of patient it intends to attract. Continued growth in dermatology may be achieved through airline access, multilingual marketing and links with tourism from Taiwan, Japan and China. An American woman travelling for gynaecological assessment or a complex screening package requires a longer chain: records reviewed before departure, a physician-led test plan, transparent base and additional charges, image files and English reports prepared for her home doctor, and a contact able to respond after she leaves Korea. Ocean views, hotels and wellness programmes can support the stay, but they do not perform those clinical and administrative functions.

The same requirement applies in Seoul, despite the city’s more mature corridor. The Centers for Disease Control and Prevention advises medical travellers to obtain complete records in English, provide them to clinicians responsible for follow-up and seek care promptly if complications occur after returning home. The CDC also warns that follow-up care can be expensive and may not be covered by the patient’s insurance. Those cautions are most often associated with surgery, though continuity matters just as much when a screening centre identifies an unexpected lesion that needs further imaging, biopsy or monitoring.

An American physician reviewing a Korean result may need the original DICOM images, the radiologist’s full report, laboratory units, reference ranges and details of how the examination was performed. The insurer may accept the Korean evidence, require a domestic consultation before authorising treatment or insist that the imaging be repeated. A patient who paid cash to avoid prior authorisation in Seoul can find the same insurer controlling the next step once she asks it to fund a biopsy, operation or long-term follow-up in the United States.

Medical responsibility becomes still less clear when the interpretation changes or a complication emerges. The Korean provider completed the original examination; the American clinician inherits a result produced by another institution under different reporting and legal systems; the facilitator that organised the trip may define itself as an administrative service rather than a healthcare provider. Korea offers dispute mediation to foreign patients, but language, documentation and distance make any cross-border claim more difficult after the patient has returned home.

The Guardian did not report what happened after Agyapon’s fibroid was identified. The article does not say whether the MRI was reviewed by an American gynaecologist, whether her insurer funded subsequent treatment, whether another examination was required or whether the fibroid needed intervention. Those omissions are understandable in a feature centred on the experience of discovery, yet they mark the point at which the value of medical travel can no longer be judged by price, speed or hospitality alone.

A 10-centimetre fibroid found during a Seoul checkup may represent exactly the kind of diagnosis that makes the trip worthwhile. The same industry can sell tests with a limited evidentiary basis, generate findings whose significance remains unclear and return patients to an insurance system they had temporarily avoided. Korea’s foreign-patient count records the appointment. It does not record whether the result improved the patient’s health.

Seoul has built an efficient route from online interest to a Korean clinic, and American dissatisfaction is supplying new customers for it. Busan has captured a fast-growing but narrower version of the market through dermatology and short-haul tourism. Both cities will eventually be judged by a part of the journey that appears only faintly in annual statistics and promotional packages: whether the records, responsibility and medical reasoning remain intact when the patient enters her next consulting room at home.