In 2011, 2,962,000 individuals from 1,163,000 households, with an average of 2.55 members per household, were involved in agriculture; of these, only 1.4% (40,017) were covered under IACI (Table 1) (1), while the remaining 98.6% (2,921,983) were ineligible (2). As mentioned above, IACI is not applicable to agricultural households (self-employed farmers).

Korea has three major insurance programs to cover farmers' injuries and diseases: IACI, Safety Aid System for Farmers (SASF), and National Health Insurance (NHI) Program. IACI is the only worker compensation system available to almost all citizens with the exception of special populations such as government officials, soldiers, educational staff members at private schools, self-employed individuals, and temporary contract workers. Insurance premiums are paid by the employers. This insurance program covers eight types of medical and indemnity costs for work-related injuries and illnesses sustained by workers, including wage replacement, nursing, disability, and funeral expenses. However, this insurance program is applicable only to large businesses or workplaces with five or more employees. As a result, self-employed Korean farmers are not eligible under IACI (Table 2).

SASF is a supplemental insurance system for farmers. The Korean national government subsidizes 50% of the insurance premium for this program and pays medical expenses for work-related injuries and illnesses. Despite government subsidy, the majority of farmers do not have this insurance due to economic privation or perceived lack of necessity. In 2011, approximately 816,000 farmers (27.5% of the agricultural population) joined this program. In comparison with IACI, however, SASF pays a lower amount or, in some cases, provides no insurance benefit for work-related injury and illness to farmers covered by the program. For instance, SASF pays four types of medical costs. The first type includes medical care costs due to occupational diseases (ODs). It only pays for expenses not exceeding KRW 1.5 million, and it deducts an amount of KRW 100,000. The second is hospitalization costs, wherein SASF pays KRW 20,000/day up to a maximum of 120 days. The third covers operation costs of up to KRW 300,000 per case for work-related musculoskeletal disorders only. The fourth covers costs of up to KRW 300,000 per case for the diagnosis of specific infectious diseases prevalent among farmers, such as the tsutsugamushi disease, leptospirosis, and hemorrhagic fever with renal syndrome. Furthermore, SASF pays KRW 50 million to designated beneficiaries in the case of a worker's untimely demise and up to a maximum of KRW 50 million as disability benefits. However, the level of coverage is relatively lower than that under IACI. Furthermore, SASF does not pay wage replacement benefits or benefits for expenses associated with nursing or rehabilitation, both of which are covered under IACI (Table 2).

Finally, the NHI program covers all Korean citizens, including farmers. This program pays approximately half of all medical expenses for any injury or illness to eligible program participants. Although this program plays an important role as a social safety net, many farmers suffering from injuries and illnesses are burdened by medical costs that exceed NHI's coverage limit.

Agriculture is considered as one of the most hazardous industries for workers all over the world. Farmers have a higher risk of work-related injury and illness than workers of most other occupations (3).

Currently, limited information is available on compensated work-related injuries and diseases among farmers in Korea. It seems clear that most Korean farmers have suffered or are suffering from a number of occupational health problems. In addition, many farmers in Korea are self-employed and are not eligible for coverage under ISH and IACI. This suggests that approximately 98% of Korean farmers do not benefit from a number of regulations concerning the management of the working environment, monitoring of occupational injury and disease, regular health examinations, and compensation for work-related accidents. Although a few farmers who joined SASF have been compensated for work-related accidents, their occupational safety and health service benefits are minimal compared with the benefits provided to workers covered by IACI.

There is an urgent need for an institutional strategy for improving farmer safety and health in Korea. First, the ISH Act needs to be extended to all farmers. Second, farmers suffering from work-related injury or disease must be compensated by workers' compensation insurance. This means that rather than being covered or compensated under pre-existing standards or acts such as the ISH and IACI, farmers should be covered by a new or modified compensation system that considers the unique characteristics of Korean farmers and their work. Third, a nationwide monitoring system with up-to-date reports of any major work-related injuries and diseases should be established.

Some important points to consider while developing a new compensation system for work-related injuries and diseases among Korean farmers are as follows: First, most farms in Korea are run by self-employed farmers or members of family farms. In other words, almost all Korean farmers are employers as well as self-employed employees. As a result, there are questions regarding the payer of insurance premiums and the beneficiary of compensation. This makes it difficult to directly apply the IACI compensation rule when creating a new insurance system for farmers. In the IACI program, employees suffering from a work-related injury or disease are compensated according to the principle of liability without fault, and the employers or the owners pay for all the insurance premiums.

Second, the agricultural industry in Korea is composed mainly of low-income individuals working on small-scale farms. Thus, some farmers cannot afford to pay insurance premiums for industrial accidents. Moreover, many farmers are not interested in getting insurance for industrial accidents. Therefore, it is important to consider issues such as eligibility of the person getting insurance (i.e., compulsory versus voluntary insurance) and affordable insurance premium. Considering that agriculture is one of the most hazardous occupations and that most Korean farmers are low-income workers vulnerable to work-related safety and health issues, the authors believe that compensation for work-related injuries and diseases should be viewed as social insurance with compulsory subscription and it should be subsidized financially by the government. In order to lessen the associated moral hazards, farmers should share a designated percentage of the insurance costs within reasonable and affordable limits.

Third, the scope and specific criteria for OD recognition among farmers may differ from those for OD recognition among workers of other occupations under IACI. The International Labor Organization (ILO) defines OD as a disease contracted because of exposure to risk factors arising from work activity. IACI defines the work capable of causing OD as any work under employer control, except for a few controversial cases (e.g., commuting accidents). When an employee sustains an injury or disease from an accident or mishap during the course of normal work duties or within the premises of a workplace, IACI readily approves it as an industrial accident caused by work performed under employer control. An OD in farmers can be defined as a disease that arises from or is aggravated by farm work. However, when determining whether a farmer's disease is work-related, the time and place in which the farmer performed the associated tasks should be given greater consideration. Farmhouses are very close to farms, and many farm activities such as maintenance and repair of farm machines and storage of agricultural products are performed in a backyard or warehouse adjacent to or within a farmhouse. Therefore, it is often difficult to define a farmer's working hours, unlike employees who are under the control of an employer.

Military personnel are employed in all occupations normally seen in the industrial setting but are also exposed to uniquely stressful situations, including increased workload and unusual work cycles. Because of this, many standard industrial hazards are combined with stressors that are unique to the military. These stressors may also contribute to increasing the severity of toxicants normally considered low risk (16). This unique work environment creates a need for a safety and health system specific to military personnel. As a rule, the IHS Act has been applied to civil servants and military personnel. However, depending on the type and size of the business and taking into account the level of risk, only some provisions are applicable. Recently, a military safety and health directive instructed the Ministry of National Defense to revise (17), which included changes to the working environment, medical examinations, and health education. The military safety and health system is still in the early stages, and an accurate evaluation is thus not possible.

The compensation of military personnel for work-related injuries and diseases is regulated by the Veterans' Pension (VP) Act. The VP Act is intended for voluntary officers ranking higher than a petty officer; soldiers and military cadets are excluded. The compensation includes disability benefits, survivor benefits, and expenses for medical care if wounded in the line of duty. The VP Act is similar to the IACI, except that the VP Act does not include vocational rehabilitation and nursing benefits.

The specific criteria for the recognition of injuries and diseases among soldiers on public duty are regulated by the Decree of VP Act, Article 4. Injuries and diseases are classified into one of the following eight categories: radiation exposure, burns, frostbite, exposure to noise, disease due to ingestion of toxic substances, disease caused by an accident, disease caused when on special duty, and previously existing diseases exacerbated by performance of duties. These criteria only include certain types of exposure encountered while on duty and do not consider various other types of exposure. It is also difficult to apply these criteria to the exacerbation of a previously existing disease due to the use of ambiguous terms such as special duty, consecutive night shift, and other official overtime work. In addition, there are no criteria for general diseases without any clear medical cause for pathogenesis, such as chronic diseases and malignant neoplasms. The decree states that detailed criteria will be set by the Ministry of National Defense, but there are no other ordinances (Table 5) (18).

The Council for VP Benefits decides whether an injury or disease occurred while on public duty. The Council consists of a maximum of seven members, all of whom are employees of the Ministry of National Defense and are appointed by the Secretary of Defense. External specialists were not appointed until 2011, despite regulations stating that the Minister can appoint external specialists from the medical or legal fields if necessary. However, external specialists were appointed starting from 2012, and the Council currently includes three external members. In the Workers' Compensation Insurance (WCI) system, ODs are approved through deliberation meetings of the Committee on Occupational Disease Judgment (CODJ), and with the exception of the Chairman, all members are external specialists. Thus, there is a clear difference between the Council for Veterans' Pension Benefits and CODJ.

During the last five years, approximately 20,000 soldiers have retired. The number of recipients of survivor benefits, those compensated when a retired beneficiary dies and those compensated when a beneficiary dies of accident or disease on public duty, is increasing, with 17,881 recipients in 2012. In addition, in 2012, there were 1,181 recipients of disability benefits, i.e., those compensated due to a disability resulting from injury or disease while on public duty. In 2012, the total pension entitlement was KRW 2.54 trillion, government subsidies were KRW 1.25 trillion, and the ratio of government subsidies to total pension entitlement was 49.1% (Table 6) (19).

The number of cases seeking compensation for injury or disease incurred during public duty peaked in 2010 with 661 cases. After 2010, this number declined to 397 cases in 2012. In 2012, there were 209 cases (52.7%) of compensation related to medical benefits, which was higher than compensation related to disability benefits or survivor benefits. The approval rate for all benefits peaked in 2010 at 96.1%, up from 90% in the previous years. However, this same rate then decreased dramatically to 76.0% in 2011 and 47.9% in 2012. This decrease in the overall approval rate was primarily due to a large decrease in the approval rate for medical benefits. Approval rates for survivor benefits and disability benefits decreased at a rate equal to each other, but at a less dramatic rate than the approval rate for medical benefits (Table 7) (19).

Regarding the approval rate for diseases, almost all diseases were compensated in 2010. In 2011, the approval rates were as follows: 25.0% for diabetes, 44.4% for liver diseases, 66.7% for non-traumatic intracranial hemorrhage, 69.6% for malignant neoplasm, 68.4% for gastrointestinal disease, and 77.8% for ischemic heart disease, indicating that the number of unapproved cases is increasing. As of the date of publication of this paper, the approval rates for 2012 are not available. However, because the overall approval rate decreased in 2012, it is likely that the approval rates of individual diseases also decreased (Table 8) (18).

Retirement pension beneficiaries comprise a large portion of the overall pension beneficiaries, but beneficiaries of survivor pensions and disability pensions are increasing as well, as is the total number of pension entitlements. This current rate of increase is expected to be higher than that in the past. In addition, the ratio of government subsidies to total pension entitlements has reached almost 50%, thus increasing the public burden.

The approval rate of compensation for injury and disease while on public duty was greater than 90% until 2010. This is likely because the standards cover all cases that occur while on public duty. Therefore, diseases that occurred while on public duty were approved without considering whether they were related to military service. In 2012, the approval rate of compensation for injury and disease while on public duty decreased to 47.9%. This type of decrease is typically due to changes in the criteria of recognition or changes in the deliberation system. The criteria of recognition have not changed recently, which suggests that the decreased rate of approval is probably because of the changes in the deliberation system due to the addition of external specialists. Although the participation of external specialists can have a positive impact, special circumstances such as the working conditions in military service and training must be considered during deliberation; this will only happen if it is specifically mandated in the detailed criteria. As with the IACI Act and other related laws, the VP Act should be amended and supplemented as follows: define official accidents of military officers; define the degree of work relatedness; clearly differentiate between accidents and diseases; add articles against intentional incidents, self-injury, and criminal acts; and provide specific criteria for diseases that may be contracted while on duty.