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From next year, all medical institutions, including clinic-level medical institutions, will disclose the cost of’non-payment’ to patients and explain to patients before treatment.
This is to reduce the burden of national medical expenses by reinforcing the management of non-indemnity sectors, which is increasing rapidly every year, and to select and use safe and reasonable medical services at an appropriate cost.
The Ministry of Health and Welfare announced on the 31st the’Comprehensive Measures for Strengthening Health Insurance Non-Payment Management’ containing these contents.
Non-payment refers to treatment in which the patient is not covered by health insurance, so the patient pays all the medical expenses.
Of the total medical expenses calculated last year, excluding beauty and plastic surgery, which are non-essential medical services, of 100.3 trillion won, non-payment amounted to 16 trillion won, accounting for 16.1% of the total. The average growth rate over the past three years has been around 7.6%.
There are positive aspects of non-payment, such as guaranteeing patient choices and promoting the introduction of new medical technologies, but it has been pointed out that the appropriate social control mechanism is insufficient, unlike pay with set prices and provision standards.
Most of all, service prices vary by medical institution, and according to 2019 data, the cost of manual treatment related to the musculoskeletal system varies greatly from a minimum of 5,000 won to a maximum of 240,000 won on a hospital-level basis.
Accordingly, the government has established comprehensive measures aimed at’innovating non-payment management and realizing people-centered medical security’, saying that it will minimize the increase in the burden of public medical expenses and create an environment where appropriate treatment is provided in the medical field.
First of all, from January next year, the government will disclose information on non-payment prices to more than 70,000 hospital-level medical institutions as well as clinic-level medical institutions, and will expand the disclosure items from 564 to 615.
In addition to the items subject to disclosure of medical expenses, a’non-payment pre-explained system’ is also implemented in which medical professionals or workers in medical institutions explain treatment items and prices before treatment for non-indemnity requested by patients.
There is also a plan to improve the form of receipts so that detailed contents related to the patient’s unpaid treatment can be confirmed.
Scale of health insurance non-payment The government is also working on preparations for the’non-paid treatment reporting system’, which is scheduled to be implemented on June 30 next year.
As the amendment to the Medical Law requires reporting items, standards, amounts, and details of treatment related to non-indemnity medical expenses to the Minister of Health and Welfare, a special task force (TF) will be established to prepare specific implementation plans.
The government is planning to establish a management system for both paid and unpaid treatment.
In particular, it is planned to first grasp the actual status of use, focusing on the area of’standard non-payment’, where salary and non-payment is applied after treatment.
In order to identify and analyze the exact status of non-payment, a plan to standardize non-payment names and disease codes is also prepared.
This is to improve the use of different names for different medical institutions because there is no separate name or code, unlike pay items.
Considering medical necessity, it will be reclassified into’medical non-payment’ and’selective non-payment’, and the effectiveness will be periodically evaluated.
The government plans to reinforce management in areas requiring policy intervention by calculating the coverage and non-payment rates for each type of medical institution, by major treatment subject, by target for vulnerable groups, and by major disease.
In addition, the related laws are revised to reduce the burden of national medical expenses for indemnity medical insurance, which many citizens have subscribed to, and plans to investigate the actual condition of the impacts between the KTO insurance system and improve the system by enacting an enforcement decree jointly governed by the Ministry of Health and Welfare and the Financial Services Commission. to be.
An official from the Ministry of Health and Welfare explained the significance of “this comprehensive measure is the first comprehensive non-payment management measure for the people to adequately bear medical expenses along with the measures to strengthen health insurance coverage announced in 2017.”
The Ministry of Health and Welfare is planning to implement the tasks to establish a foundation for non-payment management in stages from next year, and to include related contents in the ‘2nd Comprehensive Health Insurance Plan’ (2024-2028) to harmonize with each area of the health insurance system. .
Comprehensive plan for reinforcement of non-payment management, vision and implementation plan[연합뉴스]
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