The health insurance coverage rate has slowed down for the first time in five years as non-payment treatments that are not covered by health insurance have expanded around local clinics.
Concerns are rising that the health insurance coverage rate will fall further at this rate as there are no clear measures to catch non-payment and the government is focusing on financial reduction, not strengthening health insurance coverage. The health insurance coverage rate is the ratio of health insurance to the total medical expenses, and if the coverage rate falls, the burden of medical expenses on households increases.
An official from the Ministry of Health and Welfare said on the 11th, "We are discussing with related agencies and external experts to come up with effective measures and include them in the 'second comprehensive measures to strengthen non-payment management'." "I think we can manage the increase in non-benefit to some extent if we properly implement existing non-benefit measures," he said, hinting that policy will be an important variable.
If non-payment increases at such a rapid rate, patients cannot feel the benefits even if the number of medical items covered by health insurance increases. For example, health insurance was applied to the eye ultrasound examination in 2020, reducing the cost from 2 million won to 500,000 won, but the burden on patients has not decreased since the medical institution raised the price of non-paid multifocal artificial lens for cataract surgery.
Non-payment has limitations in government management. Once health insurance is applied, it will be able to enter the control of health insurance and set prices, adequacy of service provision, and quality evaluation. However, the non-payment, which hospitals set prices on their own, has little social control.
In addition, there is no non-payment classification standard, name, and code commonly used by all medical institutions, so the basis for data collection is insufficient. The Ministry of Health and Welfare is currently conducting research on name and code standardization.
Some say that the 'mixed treatment prohibition system' should be introduced like Japan. Japan regulates that salary and non-payment procedures cannot be provided at the same time. However, in order to create a hospital without non-payment, health insurance must first be sufficiently applied to necessary medical practices. In Japan, most of the medical care items are paid. An official from the Ministry of Health and Welfare said, "There are definitely patients who need manual treatment or cataract surgery lenses, which are representative non-payment," adding, "We need to look more closely to see whether it is possible to ban mixed treatment with benefits."
Writer: Yeyoung Jeon
(Picture form Unsplash)
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