Medical reform special committee discusses measures… Medical community is concerned about decline in patient treatment options
input 2024.11.08 10:00
input 2024.11.08 10:00correction 2024.11.07 20:34
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Actual loss insurance quick claim kiosk. [사진=한림대학교춘천성심병원·한림대학교강남성심병원]As the government accelerates medical reform, it is reported that a ban on so-called ‘parallel treatment (mixed treatment)’, which involves receiving both health insurance-covered treatment and non-covered treatment, is being discussed, and opposition from the medical community is expected to be strong.
The government plans to come up with a plan by the first half of next year, and will only address non-benefit items that are at risk of being excessive. Manual therapy, cataract surgery (including non-covered multifocal lenses), and nasal valve reconstruction in the plastic surgery field, which are at the top of the list of actual cost insurance expenses, are expected to be strong candidates.
The ‘Non-reimbursement and actual cost insurance subcommittee under the Special Committee on Essential Medical Care and Fair Compensation’ of the President’s Medical Reform Special Committee, which started its first meeting last July, holds meetings every other week and discusses issues such as the ban on concurrent treatment, focusing on non-reimbursed items of concern about excessive treatment.
Parallel treatment, also called mixed treatment, means providing covered medical treatment with non-covered treatment or treatment materials. For example, in neurosurgery or orthopedics, both health insurance-reimbursed treatment and non-reimbursed manual therapy are received together, but the ban on concurrent treatment (reimbursement for concurrent treatment) means that not only non-reimbursed treatment but also health insurance-reimbursed treatment received at the same time must be paid entirely by the patient. This is the way to do it.
When the government announced the first plan for medical reform on August 30, it announced that it would prepare specific measures to ban parallel treatment for non-coverage cases (restricting health insurance benefits) due to excessive concerns by the first half of next year. In addition, example cases being reviewed by the Special Committee on Parliamentary Affairs were also disclosed.
In the case of non-covered manual therapy, if it is repeated more than a certain number of times beyond medical necessity, ▲ outpatient re-visit examination fee ▲ covered physical therapy fee ▲ health insurance coverage of covered treatment performed with manual therapy is limited, except for some areas that are more effective than existing techniques. It’s a method.
In addition, when nasal valve reconstruction, which is not covered by insurance, is performed together with septum correction, which is covered by health insurance, for cosmetic purposes, the health insurance coverage of septum correction is limited. It was also mentioned that health insurance coverage of the cataract surgery fee is excluded if there is no evaluation of the opacity of the lens when performing cataract surgery with a multifocal lens (non-coverage).
Japan is one country that bans public insurance treatment and uninsured treatment in parallel. The medical systems of Korea and Japan have many similarities, as they both have a public health insurance system for the entire population and a private-centered medical provision system. According to the Medical Policy Research Institute of the Korean Medical Association, insurance benefits cannot be received not only for free treatment that is not covered by insurance in Korea, but also for treatment that is covered by health insurance. This is also similar to the government’s current policy of restricting concurrent treatment.
Currently, the medical community appears to be protesting, led by private practice doctors’ associations. Jeong Hye-wook, president of the Korean Ophthalmological Association, said, “It is very unreasonable to place surgeries that most people do once in a lifetime in the same category as procedures that are performed repeatedly, such as manual therapy.” He added, “The issue of excessive surgery has emerged, but insurance companies and brokers are not to blame.” “Most of what was there,” he explained. They also argued that if the government intervenes in privately contracted, non-reimbursed treatment, patient treatment options could be severely limited.
Kim Wan-ho, president of the Korean Orthopedic Association, said, “Manual therapy is a treatment with sufficient academic value. “Of course, we are aware of cases where it is excessive, such as combining cosmetic and manual therapy,” he said. “It is impossible to take away all patients’ options for treatment with an academic basis because of some immoral cases like this.” .
The academic world is emphasizing the medical community’s efforts to correct the controversy over overtreatment. An official from the Korean Academy of Ophthalmology said, “We have been making efforts to address the cataract surgery problem at some medical institutions.” Moreover, he added, “Overtreatment has been partially suppressed as the Supreme Court recently ruled that cataract insurance should be paid within the outpatient coverage limit when inpatient treatment is unnecessary.”
The Korean Vein Society also said that it has been making efforts to improve varicose vein surgery and is working to create correct treatment guidelines. Varicose vein surgery is also often pointed out as an excessive non-reimbursement item. An official from the Vein Association said, “We announced varicose vein disease and related examination and diagnosis guidelines last year. “We even announced a code of ethics a few years ago,” he said. “This year, we plan to announce treatment guidelines for chronic lower extremity venous dysfunction, which is included as varicose veins.”
An official from the hospital industry said, “Japan does not ban all parallel treatment,” and added, “As an advanced medical system, it guarantees parallel treatment of new medical technologies that have been reported, and also partially lifts (allows) various parallel treatments.” said.
However, despite these appeals from the medical community, it is known that the Special Committee on Medical Reform is actively discussing actual cost insurance. This is because combining actual cost insurance and non-covered medical care leads to overtreatment and causes leakage of actual cost insurance benefits, putting a burden on subscribers.
The issue here is the restructuring of the three-party contract. In the first plan for medical reform, an example was given of setting non-reimbursement standards and prices through consultation between insurance companies and medical institutions and creating a practical review plan to encourage appropriate treatment. It was also proposed to change the current contract structure of ‘patient-private insurance company’ to a three-party structure of ‘patient-insurance company-medical institution’. The idea is for insurance companies to monitor non-covered treatment at medical institutions based on reviews by organizations such as the Health Insurance Review and Assessment Service. Therefore, excluding the limitation of concurrent treatment benefits not only from health insurance but also from actual cost insurance is emerging as an issue that can be fully discussed.
Regarding actual cost insurance reform last month, President Yoon Seok-yeol asked, “I hope that the Chairman of the Financial Services Commission and the Minister of Health and Welfare will prepare a plan to improve actual cost insurance within the year to lead the normalization of the medical system and establish a system of coexistence.”
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