Table of Contents
- 1 Non-benefit ratio of actual loss insurance is 61%… The proportion of injectable drugs increases by 24% per year on average.
- 2 What specific policy changes could be implemented by South Korean lawmakers to curb the rising trend of non-benefit medical expenses and its impact on actual loss insurance premiums?
Non-benefit ratio of actual loss insurance is 61%… The proportion of injectable drugs increases by 24% per year on average.
Reporter Baek Jong-hoon
Entered 2024-11-24 12:00:05
Of the 12.9 trillion won in medical coverage, 61% is non-covered… Physical therapy proportion: 18%
3rd and 4th generation actual losses, risk loss rate worsened by more than 50% points over the past 3 years
Insurance Research Institute.
It was found that the proportion of non-covered treatment among the individual expenses partially covered by actual cost medical insurance (hereinafter referred to as actual cost insurance) exceeds 60%. Injection drug prescriptions through non-reimbursed treatment have increased by more than 20% annually on average over the past three years.
According to the Insurance Research Institute on the 24th, actual cost insurance covered 12.9 trillion won, or 10.7% of total medical expenses, as of 2022 for individual expenses not covered by national health insurance. Personal expenses include both salary and non-benefit expenses.
As a result of the survey, non-benefit accounts for 61% of this 12.9 trillion won. Among non-covered treatments, physical therapy such as manual therapy, extracorporeal shock wave therapy, and proliferative therapy accounted for about 18% of insurance premiums paid. Non-reimbursed injection drugs increased by an average of 24% per year over the three years from 2020 to 2023.
Accordingly, the loss ratio of 3rd and 4th generation actual loss insurance is worsening. The risk loss ratio of 3rd generation actual loss insurance increased by 51.7 percentage points from 103.6% in 2020 to 155.3% in 2023. The 4th generation actual loss insurance worsened by 54.7 percentage points from 61.2% in 2021 to 115.9% in 2023.
For this reason, the share of self-pay for non-benefit management is increasing and premium discounts and surcharges are being strengthened, but concerns about the effectiveness of non-benefit management are growing.
The 3rd and 4th generation actual loss insurance sets limits on the annual coverage amount and number of visits for manual, extracorporeal shock wave, proliferative therapy, and non-reimbursed injections, but there is no daily limit. Therefore, there is an incentive to over-prescribe expensive non-covered items per day. In the case of 1st and 2nd generation actual loss insurance, manual therapy, extracorporeal shock wave, and proliferative treatment are not classified as special contracts.
In fact, among first-generation actual cost insurance patients who received treatment at the hospital, the proportion of patients in the top 25% of non-benefit ratios was 33%, and among fourth-generation actual loss insurance patients, the proportion of patients in the top 25% of non-benefit ratios was 38%. By region, the medical and non-covered medical expenses of 4th generation actual cost insurance patients were highest in the Seoul region based on the median value.
Accordingly, an official at the Korea Insurance Research Institute said, “There is a need to find ways to curb excessive medical incentives arising from non-compensated physical therapy and injection drugs,” and added, “We need to spread the increase in insurance premiums felt by actual loss insurance subscribers over several periods and manage loss ratios stably.” “To achieve this, it is necessary to consider a plan to allow rate adjustments within 5 years, provided that certain statistical requirements are met,” he emphasized.
He added, “In the mid- to long-term, there is a need to review the adequacy of medical expenses not covered by health insurance,” adding, “As medical expenses are increasing due to the aging population, ways to manage health insurance medical expenses should be more actively sought.”
For reference, actual cost insurance covers patients’ out-of-pocket medical expenses that are not covered by national health insurance. Rather than providing selective coverage for specific diseases and injuries, it is operated with a comprehensive structure that covers all items except for some.
The goal of national health insurance is to prevent high medical costs from becoming a burden on households. It is a social security system in which insured citizens pay premiums on a regular basis, and the insurer, the National Health Insurance Corporation, manages and operates them and provides insurance benefits when necessary, allowing citizens to share risks and receive necessary medical services.
[CEO스코어데일리 / 백종훈 기자 / [email protected]]
Unauthorized reproduction and redistribution prohibited> 2024-11-24 12:00:05 Sent
## World Today News – Actual Loss Insurance in Focus
**Introduction**
Welcome to today’s episode, where we delve into the topics of healthcare costs and insurance coverage in South Korea. We’re joined by two distinguished guests:
* **Dr. Lee Soo-jin,** Professor of Health Policy and Management at Seoul National University,
* **Mr. Kim Tae-woo,** CEO of MediCore, a leading healthcare consultancy firm.
Dr. Lee and Mr. Kim, thank you for joining us today.
**Section 1: The Rise of Non-Benefit Medical Costs**
* **Host:** The article highlights a concerning trend: non-benefit treatment accounts for a staggering 61% of actual cost insurance coverage. Dr. Lee, could you elaborated on the reasons behind this rapid increase in non-benefit medical expenses? What factors are driving this trend?
* **Host:** Mr. Kim, from a business perspective, how is this rise in non-benefit costs impacting actual cost insurance providers? What are the financial implications for both insurers and consumers?
**Section 2: The Impact of Injection Drugs**
* **Host:** The article also points out a significant surge in non-reimbursed injection drug prescriptions. Dr. Lee, are there any potential explanations for this trend? Are there inherent risks associated with the use of these injections?
* **Host:** Mr. Kim, what measures can both insurance companies and healthcare providers implement to ensure the safe and ethical use of these injections while managing costs?
**Section 3: Addressing the Loss Ratio Challenge**
* **Host:** The article mentions a worsening risk loss ratio for 3rd and 4th generation actual loss insurance. Dr. Lee, what are the long-term consequences of consistently high loss ratios for the insurance industry and the insured population?
* **Host:** Mr. Kim, are there any innovative solutions being explored to address this issue? Perhaps new insurance models or strategies for managing non-benefit expenses?
**Section 4: The Future of Actual Loss Insurance**
* **Host:** Looking towards the future, what changes do you foresee in the landscape of actual cost insurance in Korea?
* **Host:** Dr. Lee, what role should policymakers play in addressing the challenges presented by rising healthcare costs and ensuring affordable access to necessary medical treatment?
* **Host:** Mr. Kim, how can the healthcare industry innovate and adapt to better serve the needs of Korean patients while maintaining financial sustainability?
**Conclusion**
Thank you, Dr. Lee and Mr. Kim, for sharing your insightful perspectives on this critical topic. The discussion today has shed light on the complexities surrounding actual loss insurance in South Korea. As we continue to grapple with the challenges of rising healthcare costs and evolving treatment options, it’s crucial to have these conversations and seek solutions that promote both financial stability and patient well-being.
