Increase in actual loss insurance premiums paid for <a href="http://www.world-today-news.com/85-million-won-per-year-for-manual-therapy-and-extracorporeal-shock-waves-non-covered-physical-therapy-actual-loss-insurance-premium-1-6-trillion-won-this-year-alone/" title="85 million won per year for manual therapy and extracorporeal shock waves? Non-covered physical therapy actual loss insurance premium: 1.6 trillion won this year alone”>non-covered physical therapy
Over the past four years, manual therapy was the highest at KRW 4.4809 trillion.
President Yoon Seok-yeol watching thermoelectric and manual therapy. [사진 연합뉴스]
[이코노미스트 이지완 기자] #Mr. A, a man in his 40s, received inpatient and outpatient treatment at eight medical institutions for about 11 months, and received a total of 342 sessions of non-covered physical therapy. Afterwards, Mr. A filed an actual loss insurance claim of approximately 85 million won.
#Mr. B, a man in his 40s, was hospitalized for about 6 months, alternating between 2 medical institutions over the course of a year. During his hospitalization, Mr. B received a total of 694 sessions of non-covered physical therapy, including 149 sessions of manual therapy, 191 sessions of extracorporeal shock wave treatment, and 354 sessions of other treatments. Afterwards, Mr. B filed a claim for actual loss insurance of approximately 65 million won.
There are strong voices calling for improvement of the actual loss insurance system, including strengthening the management of non-benefit items. This is because the actual loss insurance money paid for non-covered physical therapy this year exceeded 1.5 trillion won. If this trend continues, it is predicted that it will exceed 2 trillion won by the end of the year.
According to data submitted by the Non-Life Insurance Association to Rep. Kang Min-guk (People Power Party), a member of the National Assembly’s Political Affairs Committee, on the 31st, the total actual loss insurance premiums paid for non-covered physical therapy such as manual therapy, extracorporeal shock wave therapy, and proliferative therapy from January to August of this year was 1. It was found that the number of payments amounted to 562 billion won and the number of payments amounted to 7.84 million.
The actual loss insurance payment status by year is ▲ KRW 1.8468 trillion (9.362 million cases) in 2021 ▲ KRW 1.8692 billion (9.86 million cases) in 2022 ▲ KRW 2.127 trillion (11.52 million cases) in 2023. The amount of actual loss insurance payments is increasing every year.
During the period, manual therapy, a type of non-covered physical therapy, accounted for the largest amount at KRW 4.4809 trillion (23.344 million cases). This was followed by ▲extracorporeal shock wave therapy at KRW 1.6521 trillion (8.607 million cases), ▲proliferation therapy at KRW 83.5 billion (4.352 million cases), and ▲others at KRW 436.9 billion (2.276 million cases).
Non-covered physical therapy is a major cause of insurance payment disputes. This is because the scope of the doctor who prescribes and administers the drug is not set, and treatment costs vary depending on the medical institution.
This problem can be seen by looking at past precedents. In June 2022, the Supreme Court ruled that hospitalization for cataract surgery cannot be collectively recognized. It is difficult to say that there is a reason for a patient to be hospitalized for cataract surgery, which takes about 2 hours from the preparation stage to the completion stage.
The government also feels that the current actual cost insurance system needs to be improved. President Yoon Seok-yeol recently ordered, “Prepare a plan to improve actual loss insurance within the year.”
ⓒThe Economist (Unauthorized reproduction and redistribution of ‘The Economist’s economic news for tomorrow’ is prohibited.
