National Assembly Research Service “Need to differentiate out-of-pocket expenses depending on income and medical need”
Photo = Yonhap News It has been pointed out that the current ‘elderly outpatient flat-rate system’ needs to be rationally improved in response to the expected increase in elderly medical expenses in the approaching super-aging society (more than 20% of the population over 65 years of age).
According to the National Assembly on the 17th, the National Assembly Research Service, a research and analysis agency specializing in legislation and policy, ordered in its recently published ‘2024 Government Audit Issue Analysis’ report that there is a need to initiate social discussions to reform the elderly outpatient outpatient flat-rate system in terms of financial sustainability of health insurance. did it
The senior outpatient outpatient flat-rate system is a system in which seniors aged 65 years or older need to pay only a flat fee of 1,500 won if the total treatment cost does not exceed 15,000 won when receiving outpatient treatment at a local medical institution (clinic, dental clinic, oriental medicine clinic, etc.). all.
It has been implemented since 1995 with the purpose of improving the medical welfare of the elderly.
However, after the system reform in 2018, a ‘stepped rate system’ that increases the out-of-pocket ratio for each section is being applied to outpatient treatment where the total medical cost exceeds 15,000 won.
In other words, the out-of-pocket cost must be paid differentially: 10% of the total medical cost if it exceeds 15,000 won but less than 20,000 won, 20% if it exceeds 20,000 won but less than 25,000 won, and 30% if it exceeds 25,000 won.
The problem is that, as a result of fee negotiations, the first consultation fee at clinic-level medical institutions increases every year, but the standard amount of the elderly outpatient flat-rate system (total treatment fee of 15,000 won) has not changed for 23 years since 2001 and has been frozen, thereby reducing the burden on elderly people to ‘relieve the burden of medical expenses for the elderly.’ The point is that it has reached a level where it is difficult to achieve the purpose of introducing the outpatient fixed-rate system.
In fact, the initial medical treatment fee in 2024 is 17,610 won, which far exceeds the standard amount for the elderly outpatient outpatient flat-rate system.
However, since it is not very effective in reducing health insurance expenditures, some are calling for a plan to quickly reform the outpatient outpatient system for the elderly.
The Legislative Research Service emphasized the need to begin reforming the elderly outpatient outpatient flat-rate system as soon as possible to rationalize the elderly’s out-of-pocket expenses and to ensure that health insurance, which is the national health safety net, is financially sustainable for the long term.
In order to achieve the goal of reducing medical expenses for the elderly, the Legislative Research Service will adjust the fixed-rate section and amount standard (total medical expenses of 15,000 won) for the outpatient outpatient plan for the elderly in line with the increase in number, but will also adjust the out-of-pocket burden by taking into account the income and medical needs of the elderly. He emphasized that detailed measures, such as differentiation, should be comprehensively reviewed.
In relation to this, the Ministry of Health and Welfare attempted to modify the outpatient outpatient flat-rate system for the elderly in order to reform the elderly medical care provision system when it released the first comprehensive national health insurance plan (2019-2023) in 2019, but was unable to implement it in detail.
At the time, the Ministry of Health and Welfare considered the fact that the healthy life expectancy of Koreans had already exceeded 70 years and the changes in the structure of diseases among the elderly, raising the applicable age for the elderly outpatient outpatient flat-rate system from ’65 or older to ’70 or older’ and adjusting the fixed-rate/fixed-rate section and amount standards. We reviewed plans to gradually reduce the flat-rate system.
Efficient management of elderly care costs, which increase every year due to the increase in the elderly population due to rapid aging, is a key task for health insurance sustainability.
According to the National Health Insurance Corporation, the number of people aged 65 or older covered by health insurance increased by an average of 5.2% per year from 6.81 million in 2017 to 8.75 million in 2022.
Health insurance medical expenses for people over 65 years old increased by an average of 8.6% per year from 27.7 trillion won in 2017 to 44.1 trillion won in 2022.
/Yonhap News
