Efforts by the Government to Lower Health Insurance Premiums and Manage Finances.

The South Korean government has decided to address the escalating issue of excessive medical expenses by restricting "combined treatments" for certain medical procedures. This mainly applies to procedures such as multifocal lens implantation surgery, cataract surgery, and bundled services like physical therapy and hydrotherapy, which will now be excluded from health insurance coverage.

 

The Ministry of Health and Welfare plans to designate specific items for the prohibition of combined treatments during the first half of the year through the newly established Presidential Special Committee for Medical Reform. This initiative targets high-cost and potentially overused medical services, aiming to efficiently manage the finances of health insurance.

 

These measures are understood as part of the government's efforts to efficiently manage health insurance finances and prevent patients from receiving unnecessary treatments.

 

According to the Ministry, non-reimbursable treatments require patients to bear the full cost, but there have been instances where hospitals induce patients receiving non-reimbursable treatments to undergo reimbursable treatments covered by health insurance. For example, the elderly may undergo cataract surgery as a prerequisite for multifocal lens implantation surgery, leading to unnecessary surgeries and an annual health insurance cost of approximately 160 billion won.

 

Moreover, there have been cases where health insurance covers physical therapy and follow-up examination fees under the guise of hydrotherapy during hydrotherapy sessions recommended by hospitals. The resulting health insurance costs are estimated to amount to 64 billion won annually.

 

The Ministry is also exploring ways to narrow down the scope of application for indemnity insurance. Excessive expansion of indemnity insurance coverage may encourage insurance companies to induce unnecessary treatments, leading to an increase in health insurance costs. Discussions with financial authorities aim to find solutions to prevent indemnity health insurance from becoming a cause of excessive non-reimbursable treatments.

 

These measures are understood as part of the government's efforts to efficiently manage health insurance finances and prevent patients from receiving unnecessary treatments. We anticipate continued efforts by the government for ongoing improvements in the healthcare system in the future.