While the increase rate of ineligible medical insurance (indemnity insurance) is expected to reach the 10% range, the return on the indemnity insurance from’Moon Jae-in Care’ was found to be 2.42%.
The estimated value of’Moon Jae-in Care’, which strengthens health insurance coverage, is used for premium adjustment, but is expected to have no real effect on the immediate increase rate. On the contrary, some point out that’Moon Jae-in Care’ increased the actual loss insurance premium.
On the 24th, the Ministry of Health and Welfare and the Financial Services Commission held a video conference for the’Public and Private Insurance Policy Council’ to discuss the effect of the policy to strengthen the coverage. At this meeting, the results of the reflective profit effect of real-life insurance, calculated by the Korea Development Institute (KDI), were disclosed.
In 2018, the government calculated the return on real-life insurance returns and found that the payment reduction effect was 0.60%. Accordingly, KDI announced a result of 2.42% by linking all the information on insured insurance subscribers and health insurance claim data and comprehensively reflecting the latest medical use status.
The results of this study show that hospital-level medical institutions are paid for two or three people, lower abdomen, urinary system, male genital ultrasound, cerebrovascular and head and neck MRI (magnetic resonance imaging), outpatient co-payment reduction under the age of 1, and polysomnography are all covered by health insurance. It reflected the fact that it was applied.
Although it differs by insurance company, it was also found that there was a 0.83% reduction in insurance payments in the entire insurance industry, including real-life insurance.
However, KDI explained, “The change in the use of additional non-payment medical services was difficult to quantify, so it was not reflected in the figures.” He also mentioned that there is a limit to deriving accurate research results, saying, “The rate of decrease in the size of insurance benefits compared to the total insurance payments varies depending on the proportion of the indemnity insurance payments to the total insurance payments.”
Among them, real-loss insurance premiums are expected to rise by about 10%. According to the insurance industry on the 24th, the risk loss rate for real-life insurance in the first half was 131.7%, an improvement of 6.6 percentage points from 138.3% in the second half of last year.
Industry analysts say that the loss ratio decline is due to the decrease in the size of claims for indemnity insurance, which is due to concerns over corona 19 infection that made mild patients reluctant to visit medical institutions. Therefore, the prevailing outlook is that if there is a reflective profit effect due to’Moon Jae-in Care’, it will not lead to a continuous loss ratio reduction.
‘Changes in the use of additional non-paid medical services’, which KDI said was not reflected in the figures, is also an enemy of the loss ratio reduction. According to the report on’Features and Tasks of Insolvent Medical Insurance Claims’ released by the Korea Insurance Research Institute on the 7th, the amount of non-indemnity insurance claims by hospitals in the first half of 2017 was 1,153 billion won, up 79.7% from the first half of 2017 (641.7 billion won). This is contrary to what was expected to expand the application of health insurance through’Moon Jae-in Care’ and reduce the expenditure of insurance premiums.
For this reason, the insurance industry has held the position that an increase in actual loss insurance premiums is inevitable, citing medical institution tricks such as creating new non-indemnity treatment items and moral hazards of insured persons as the cause of the deterioration of the loss ratio of real loss insurance. Voices that more fundamental measures are needed are also higher than ever.
However, the consultative body showed a position to lower the 20% increase rate claimed by the insurance industry. On this day, the council said, “In 2021, the insurance industry will calculate the insurance premium at a reasonable level, taking into account the public nature of the indemnity medical insurance, which has 38 million people, and the scale of reflected profit, so that the effect of the policy for strengthening coverage will be practically returned to the public. “I do,” he pressured to lower the increase rate.
The Financial Services Commission has also recently requested an insurance company to raise premiums for prerogative non-life insurance by 15-17%, standardized indemnity insurance by 10-12%, and to freeze the premiums for good insolvency.
However, at the meeting that day, the Financial Services Commission decided to promote a restructuring of insurance products in order to increase the equity burden of insurance premiums among real-life insurance subscribers and induce rational medical use. The plan is to separate the non-payment special contract and introduce a discount and premium system for real loss insurance premiums for the use of non-payment medical care.
The ‘4th Generation Ineligible Medical Insurance’ reflecting this reorganization plan is expected to be released on July 1 of next year after revising the relevant supervisory regulations and standard terms and conditions.