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It was found that the so-called’Moon Jae-in Care’, which strengthens health insurance coverage, reduces the payment of ineligible medical insurance (indemnity insurance), that is, the reflected profit was 2.42%. This estimate is used for adjustment of real-life insurance premiums.
The Ministry of Health and Welfare and the Financial Services Commission held a video conference of the Public and Private Insurance Policy Council on the 24th and shared the results calculated by the Korea Development Institute (KDI).
The government previously calculated the return on indemnity insurance once again in 2018, resulting in a result that the payment reduction effect was 0.60%. I decided to recover property.
Accordingly, KDI re-derived the result of 2.42% by linking all the information on indemnity insurance subscribers and health insurance claim data, and comprehensively reflecting and analyzing the latest medical use status.
This is because the lower abdomen, urinary system, male genital ultrasound, cerebrovascular, head and neck MRI (Magnetic Resonance Imaging), and polysomnography are all covered by health insurance benefits due to the strengthening of health insurance coverage.
However, this study did not reflect changes in aspects such as the expansion of the use of non-paid medical services, pointed out by the so-called’balloon effect’.
In the report, KDI researchers said, “(The use of non-paid medical services) is confirmed only in individual cases, and it was difficult to quantify, so it was not reflected in numbers.”
The researchers also pointed out the limitations of this study, saying, “The rate of reduction in the size of the insurance amount compared to the total amount of insurance paid depends on the proportion of the total amount of insurance paid for indemnity insurance for the benefit item.
Applying a moving average of 34.67% of the proportion of health insurance payable medical expenses to the total billed medical expenses, the reduction rate of total insurance payments was 0.83%.
The meeting also discussed the progress of preparing the legal basis for linking construction insurance.
The Ministry of Health and Welfare and the Financial Services Commission plan to partially amend the Insurance Business Act and Health Insurance Act and enact joint enforcement decrees to lay the groundwork for linking construction insurance.
Specifically, the’Ministry of Welfare and Financial Services Commission’ will be established to provide recommendations and opinions on system improvement through a survey and committee deliberation.
After reviewing and reflecting various opinions, the two ministries plan to make a legislative notice of amendments to related laws within this year with the aim of passing the National Assembly next year.
In addition, the Financial Services Commission decided to promote the restructuring of insurance products in order to increase the equity burden of insurance premiums among subscribers of real-life insurance and to induce rational medical use. It plans to separate the non-payment special contracts and introduce a discount and premium system for real-life insurance premiums for non-payment medical use.
The ‘4th Generation Injury Medical Insurance’ reflecting this reorganization plan will be newly released on July 1 of next year after revising the relevant supervisory regulations and standard terms and conditions.
The Ministry of Health and Welfare also reported a plan to establish comprehensive measures to strengthen non-payment management at the meeting.
The comprehensive countermeasures will contain the contents of systematizing the classification of non-payments to grasp and analyze the status of non-payments, and establishing a management system such as an evaluation process after determining non-payments.
It also includes the expansion of medical institutions that are open to uncovered medical expenses from January next year from hospital level to clinic level. Non-invasive prenatal examinations and tartar removal are expected to be expanded from 564 items such as Da Vinci robot surgery, physical examination, and non-payment MRI to 615 items.
In addition, the’advance notification system’, which allows medical staff to explain the items and prices provided before non-indemnity treatment, will be implemented from January next year.
The Ministry of Health and Welfare plans to finalize and announce comprehensive measures within the year after collecting expert opinions.
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